title: Better view on attitudes and perceived parental reactions behind waterpipe smoking among Iranian students.
abstract: BACKGROUND
  Because of the increasing usage of waterpipe globally, we need to know more about the different factors related to waterpipe and cigarette smoking. Therefore, the present study aims at gaining more insight on waterpipe and cigarette smoking based on perceived parental reaction and appeal and repellent of smoking among adolescents.
  
  
  METHODS
  A cross-sectional survey entitled "Isfahan Tobacco Use Prevention Program" (ITUPP) was conducted among 5,500 adolescents in Isfahan Province, Iran in 2010 using a self-administered anonymous questionnaire. Demographic factors, cigarette and waterpipe smoking status, appeal and repellent of smoking, perceived parental reactions, and the main reasons behind the increase in waterpipe smoking were measured. Chi-square, univariate logistic regression, and multiple logistic regression were used. For all analyses, we defined statistical significance a priori with a two-tailed alpha of 0.05. Statistical analyses were conducted using the Statistical Package for the Social Sciences (SPSS) version 15.
  
  
  RESULTS
  50% of the sample was female and 89% lived in urban areas. The average age of the respondents was 14.37 ± 1. 70 years. While a majority of cigarette smokers (70.9%) were waterpipe smokers, only 35.7% of waterpipe smokers smoked cigarettes. The incidence of smoking was high in those who expected less extensive parental reaction with odds ratio (OR) = 1.89 [95% confidence interval (CI): 1.35-2.63] (P < 0.001) among cigarette smokers and OR = 2.75 (95% CI: 2.16-3.50) (P < 0.001) among waterpipe smokers. "Taste" was rated the most attractive feature by waterpipe and cigarette smokers 2.83-fold (95% CI: 2.06, 3.90) (P < 0.001). Most waterpipe smokers compared to nonsmokers believed that the main reason behind waterpipe popularity was habit.
  
  
  CONCLUSIONS
  The factors related to waterpipe smoking were different from those in cigarette smoking; so we need to implement different interventions to overcome the surging usage of tobacco use.
authors.affiliation: Tobacco Control Unit, Isfahan Cardiovascular Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Hamidreza
authors.initials: H
authors.lastname: Roohafza
authors.affiliation: Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Zahra
authors.initials: Z
authors.lastname: Kasaei
authors.affiliation: Isfahan Province Health Center, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Kamal
authors.initials: K
authors.lastname: Heidari
authors.affiliation: Isfahan Province Health Center, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Razieh
authors.initials: R
authors.lastname: Omidi
authors.affiliation: Department of Epidemiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Tahereh
authors.initials: T
authors.lastname: Alinia
authors.affiliation: Expert Prevention of Isfahan Welfare Organization, Isfahan, Iran.
authors.forename: Mojtaba
authors.initials: M
authors.lastname: Naji
authors.affiliation: Isfahan Province Health Center, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Morid
authors.initials: M
authors.lastname: Jaberifar
authors.affiliation: Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Masoumeh
authors.initials: M
authors.lastname: Sadeghi
keywords: Adolescents; Eastern Mediterranean Region (EMR); attitude; hookah; parent reaction; parents; perception; smoking; students; waterpipe