title: Determinants of Tobacco and Hookah Smoking in a Nationally Representative Sample of Iranian Children and Adolescents: The CASPIAN-IV Study.
abstract: BACKGROUND
  The consumption of tobacco through a hookah is growing in popularity, especially among children and adolescents, but little is known about the determinants of hookah smoking.
  
  
  OBJECTIVE
  The current study aimed to assess the determinants of tobacco smoking and hookah smoking in a nationally representative sample of Iranian children and adolescents.
  
  
  METHODS
  This study was conducted as part of the fourth cross-sectional survey of a national school-based program. Using a cluster random sampling method, a validated questionnaire was completed anonymously by 14,880 students who were aged 6 - 18 years and living in urban and rural areas of 30 provinces in Iran.
  
  
  RESULTS
  The final study group consisted of 13,486 children and adolescents (participation rate of 90.6%), of whom 49.2% were girls and 75.6% were urban residents. The mean age was 12.47 ± 3.36 years. According to the self-reports of the students, 2.6% (3.5% of boys and 1.7% of girls) were current tobacco smokers, 5.9% (7.5% of boys and 4.2% of girls) were ever tobacco smokers, and 1.8% (2.49% of boys and 1.14% of girls) were current hookah smokers. Based on a multiple logistic regression (MLR) model, the following factors increased the risk of current smoking: age, number of days spent with friends per week, hookah smoking or cigarette smoking by the father, hookah smoking by siblings, hookah smoking by other members of the family, and screen time. The age, number of days spent with friends, hookah or cigarette smoking by the father, hookah smoking by siblings, and screen time increased the risk of hookah smoking. Female gender and living in rural areas decreased the risk of current tobacco and hookah smoking.
  
  
  CONCLUSIONS
  Preventive measures against tobacco use should be underscored for Iranian families. The preparation of strategies on the promotion of a healthy lifestyle should be considered a health priority.
authors: Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Diseases, Isfahan University of Medical Sciences, Isfahan, IR Iran.
authors: Roya
authors: R
authors: Kelishadi
authors: Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, IR Iran.
authors: Ramin
authors: R
authors: Heshmat
authors: Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Diseases, Isfahan University of Medical Sciences, Isfahan, IR Iran; Department of Community Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, IR Iran.
authors: Armindokht
authors: A
authors: Shahsanai
authors: Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, IR Iran; Development of Research and Technology Center, Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, IR Iran.
authors: Shirin
authors: S
authors: Djalalinia
authors: Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran.
authors: Mohammad Esmaeil
authors: ME
authors: Motlagh
authors: Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Diseases, Isfahan University of Medical Sciences, Isfahan, IR Iran.
authors: Mojtaba
authors: M
authors: Keikha
authors: Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Diseases, Isfahan University of Medical Sciences, Isfahan, IR Iran.
authors: Gelayol
authors: G
authors: Ardalan
authors: Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, IR Iran.
authors: Fereshteh
authors: F
authors: Najafi
authors: Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, IR Iran.
authors: Maliheh
authors: M
authors: Khoramdad
authors: Department of Medical Emergency, Qom University of Medical Sciences, Qom, IR Iran.
authors: Hamid
authors: H
authors: Asayesh
authors: Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, IR Iran; Dietary Supplements and Probiotics Research Center, Alborz University of Medical Sciences, Karaj, IR Iran.
authors: Mostafa
authors: M
authors: Qorbani
keywords: Adolescents; Children; Hookah; Iran; Smoking