Smoking motivators are different among cigarette and waterpipe smokers: The results of ITUPP

The present study explores different drivers of cigarette and water pipe smoking among middle and high school students in Isfahan province. A questionnaire-based cross-sectional study was conducted. Trained staff collected questionnaires and saliva samples for response accuracy evaluation. Prevalence by demographic, parental and educational factors was calculated. Logistic regression was applied to compare behavior drivers of those who purely smoked cigarettes or a waterpipe. Waterpipe smokers were considered as the reference category. This study reported ORs along 95% confidence intervals; 5408 questionnaires were returned. The sample age was 15.37 ± 01.70 on average. The self-reported prevalence of cigarette and waterpipe experimentation was 11.60% (n = 624) and 20.70% (n = 1,109), respectively; and 5.08% (n = 311), 11.06% (n = 619) for smokers, and 13.30% (n = 711) for the whole sample. Psychological factors were the most important driver for cigarette smoking; bad event happening with odds of 2.38 (95% CI: 1.29–4.39); angriness 2.58 times (95% CI: 1.51–4.43); and distress by 2.49 times (95% CI: 1.42–4.40). Habitual situations were strong predictors of cigarette smoking, but not a predictor of waterpipe smoking, such as smoking after a meal (OR = 3.11, 95% CI: 1.67–5.77); and smoking after waking up (OR = 2.56, 95% CI: 1.42–4.40). Comprehensive and multifaceted preventive programs must tailor identified factors and increase family’s awareness.