Using Prototype Willingness Model to PredictWaterpipe Smoking among High School Adolescents in Birjand, Iran

Background: While waterpipe tobacco smoking is associated with several health-related risks, its prevalence is on the rise among young age individuals, including high school adolescents. Social aspects related to waterpipe smoking comprise a major reason for the initial orientation to its consumption. Objectives: This study aimed to investigate the application of prototype Willingness Model to predict waterpipe smoking among high school adolescents in Birjand, eastern Iran. Methods: This cross-sectional study was undertaken on 432 high school students (239 boys and 193 girls) in Birjand, eastern Iran, in 2016 via multi-stage sampling. Inclusion criteria included residence in Birjand, being a high school student, and willingness to participate in the study. The data were collected by a researcher-made questionnaire and analyzed by SPSS (version 18) using descriptive statistical tests, Pearson correlation test, and linear and logistic regression analyses. Results: The results showed that 17.4% of the students had a history of tobacco use. Subjective norms were the main predictors of intention (B = 0.17, P < 0.001), and attitude was the strongest predictor of behavioral willingness (B = 0.43, P < 0.001). Logistic regression results showed that both behavioral willingness (OR = 1.22, 95% CI: 1.14, 1.30) and behavioral intention (OR = 1.28, 95% CI: 1.15, 1.43) were significantly effective in waterpipe smoking among students. Conclusions: The prototype willingness model is an appropriate theoretical framework for predicting waterpipe smoking among adolescents in Birjand, Iran. Since both behavioral willingness and the intention are contributory to waterpipe smoking among high school students, it would be necessary to adopt health promotion strategies in order to improve these constructs in preventive interventions.