title: Association of passive and active smoking with self-rated health and life satisfaction in Iranian children and adolescents: the CASPIAN IV study.
abstract: To assess the joint association of passive and active smoking with self-rated health and life satisfaction among Iranian children and adolescents.
  
  
  
  Using a multistage random cluster sampling method, a representative sample of 14 880 school students were selected from urban and rural areas of 30 provinces of Iran. Data were gathered using a questionnaire, a weight scale and metre. Participants were classified into four groups based on their smoking patterns: 'non-smoker', 'only active smoker', 'only passive smoker' and 'active and passive smoker'. Life satisfaction (LS) and self-rated health (SRH) were assessed by self-administered validated questionnaires based on the WHO-Global School-based student Health Survey (WHO-GSHS). Data were analysed using a t-test, χ2test and multiple logistic regression.
  
  
  
  A total of 13 486 individuals (6640 girls and 6846 boys) out of 14 880 invited participated in the study (response rate 90.6%). LS and good SRH showed linearly negative associations with smoking status in both sexes. The proportions of LS and SRH categories were significantly different among all subsets of smoking status. Those classified as 'non-smokers' had the highest proportions of LS and good SRH, followed by 'only passive smokers' and 'only active smokers', while those with 'active and passive smoking' had the lowest proportions of LS and good SRH. In a multivariate model, students in the 'active and passive smoking' group had lower odds of LS (OR 0.43; 95% CI 0.32 to 0.57) and good SRH (OR 0.51; 95% CI 0.38 to 0.68) than those in the 'non-smoker' group. Students in the 'only passive smoker' group also had lower odds of LS (OR 0.75; 95% CI 0.67 to 0.83) and good SRH (OR 0.72; 95% CI 0.66 to 0.80) compared with the 'non-smoker' group.
  
  
  
  Adolescents with different smoking habits and exposure patterns have poorer SRH and LS than non-smokers. Both active and passive smoking status could affect LS and SRH in adolescents. Therefore, smoking prevention strategies should be considered as a health priority in school health services for promoting psychological well-being in children and adolescents.
authors.affiliation: Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Ramin
authors.initials: R
authors.lastname: Heshmat
authors.affiliation: Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran.|Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Mostafa
authors.initials: M
authors.lastname: Qorbani
authors.affiliation: Managerial Epidemiology Research Center, Department of Public Health, School of Nursing and Midwifery, Maragheh University of Medical Sciences, Maragheh, Iran.
authors.forename: Saeid
authors.initials: S
authors.lastname: Safiri
authors.affiliation: Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Amir
authors.initials: A
authors.lastname: Eslami-Shahr Babaki
authors.affiliation: Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Nassim
authors.initials: N
authors.lastname: Matin
authors.affiliation: Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Nazgol
authors.initials: N
authors.lastname: Motamed-Gorji
authors.affiliation: Department of Pediatrics, Ahvaz Jundishapour University of Medical Sciences, Ahvaz, Iran.
authors.forename: Mohammad-Esmaeil
authors.initials: ME
authors.lastname: Motlagh
authors.affiliation: Development of Research and Technology Center, Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran.
authors.forename: Shirin
authors.initials: S
authors.lastname: Djalalinia
authors.affiliation: Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Gelayol
authors.initials: G
authors.lastname: Ardalan
authors.affiliation: Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Morteza
authors.initials: M
authors.lastname: Mansourian
authors.affiliation: Department of Medical Emergencies, Qom University of Medical Sciences, Qom, Iran.
authors.forename: Hamid
authors.initials: H
authors.lastname: Asayesh
authors.affiliation: Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Roya
authors.initials: R
authors.lastname: Kelishadi
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D007492:Iran / Q000453:epidemiology; D008297:Male; D010549:Personal Satisfaction; D011788:Quality of Life; D057566:Self Report; D012907:Smoking / Q000453:epidemiology*; D014028:Tobacco Smoke Pollution / Q000706:statistics & numerical data*
chemical_list: D014028:Tobacco Smoke Pollution
keywords: STATISTICS & RESEARCH METHODS