title: Predictors of waterpipe smoking progression among youth in Irbid, Jordan: A longitudinal study (2008-2011).
abstract: BACKGROUND
  The predictors of waterpipe smoking progression are yet to be examined using a longitudinal study that is guided by a theoretical model of behavioral change. This study identifies the gender-specific predictors of waterpipe smoking progression among adolescents in Irbid, Jordan.
  
  
  METHODS
  This study uses data from a school longitudinal study of smoking behavior in Irbid, Jordan. A random sample of 19 schools was selected by probability proportionate to size. A total of 1781 seventh graders were enrolled at baseline, and completed a questionnaire annually from 2008 through 2011. Students who reported ever smoking waterpipe (N=864) at any time point were assessed for progression (escalation in the frequency of waterpipe smoking) in the subsequent follow-up. Grouped-time survival analysis was used to identify the risk of progression.
  
  
  RESULTS
  During the three years of follow-up, 29.6% of students progressed in waterpipe smoking. Predictors of waterpipe smoking progression were higher mother's education, enrollment in public school, frequent physical activity, and low refusal self-efficacy among boys, having ever smoked cigarettes, and having friends and siblings who smoke waterpipe among girls. Awareness of harms of waterpipe was protective among boys and seeing warning labels on the tobacco packs was protective among girls.
  
  
  CONCLUSIONS
  Even at this early stage, about a third of waterpipe smokers progressed in their habit during the 3 year follow up. Factors predicting progression of use differed by gender, which calls for gender-specific approaches to waterpipe interventions among Jordanian youth.
authors.affiliation: Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, 33199 FL, United States. Electronic address: rjabe001@fiu.edu.
authors.forename: Rana
authors.initials: R
authors.lastname: Jaber
authors.affiliation: Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, 33199 FL, United States. Electronic address: pmadhiva@fiu.edu.
authors.forename: Purnima
authors.initials: P
authors.lastname: Madhivanan
authors.affiliation: Department of Community Medicine, Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan. Electronic address: yskhader@just.edu.jo.
authors.forename: Yousef
authors.initials: Y
authors.lastname: Khader
authors.affiliation: Syrian Center for Tobacco Studies, Aleppo, Syria; Department of Epidemiology and Biostatistics, University of Memphis, Memphis, TN, United States. Electronic address: fmzayek@memphis.edu.
authors.forename: Fawaz
authors.initials: F
authors.lastname: Mzayek
authors.affiliation: Syrian Center for Tobacco Studies, Aleppo, Syria; Department of Epidemiology and Biostatistics, University of Memphis, Memphis, TN, United States. Electronic address: kdward@memphis.edu.
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Ward
authors.affiliation: Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, 33199 FL, United States; Syrian Center for Tobacco Studies, Aleppo, Syria. Electronic address: wmaziak@fiu.edu.
authors.forename: Wasim
authors.initials: W
authors.lastname: Maziak
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D002648:Child; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007597:Jordan / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D012907:Smoking / Q000639:trends*; D013334:Students / Q000523:psychology / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires
keywords: Adolescents; Jordan; Longitudinal; Predictors; Progression; Waterpipe