Using Social Cognitive Theory to Investigate the Risk Factors of Waterpipe Smoking among Southeastern Iranian Adolescents

Background: Explaining the risk factors of waterpipe smoking (WS) is very necessary in prevention programs. The aim of this study was determining the risk factors and the prevalence of WS in adolescents based on the social cognitive theory (SCT). Materials and Methods: This cross-sectional study was conducted among urban adolescents in two provinces located in the South East of Iran. We recruited 1,218 adolescents (girls=595 and boys=623) through multistage sampling during the period October 2017 to February 2018. The data collection tool was a self-administered standardized questionnaire that included basic baseline characteristics, SCT constructs items and questions about WS behavior in the participants. The data were analysed using SPSS software version 22.0. Results The ever use prevalence of WS in boys was 43.8% (n= 264), and in girls 27% (n=160). WS in family member (OR=1.87, CI: 1.32-2.63; p<0.001) and intimate friends (OR=2.34, CI: 1.70- 2.26; p<0.001) were the most important risk factors for adolescents. In the relation of WS with constructs of SCT: outcome expectations (OR=0.64, 95% CI: 0.50-0.84; p<0.001), outcome expectancy, (OR=0.65, 95% CI: 0.55-0.85; p=0.002) self-efficacy, (OR=0.30, 95% CI: 0.23- 0.41; p<0.001), and situational perception (OR=0.63, 95% CI: 0.47- 0.84: p=0.002) were the most important and related factors of WS. Boys were 1.92 times (OR: 1.06 – 2.43; p<0.001) more exposed to water-pipe smoking than girls. Conclusion The prevalence of WS was notable in students especially in boys. Peer group and family are important risk factors for tendency toward WS in adolescence. Also, lower score in SCT constructs such as knowledge, self-efficacy and situational perception in adolescents are important risk factors for WS in participants.