Age at Smoking Onset and Risk of Heavy Cigarette Smoking Among Iranian Adult Male: An Application of Generalized Additive Model

Abstract

Background: Because the age at which a person first starts smoking has such a strong correlation with future smoking behaviours, it's crucial to examine its relationship with smoking intensity. However, it is still challenging to accurately identify this relationship due to limitations in the methodology of the performed studies .Therefore the main purpose of this study is to evaluate this relationship and also to identify the other risk factors affecting smoking intensity using an appropriate model.Methods: Data from 913 Iranian male current smokers over the age of 18 was evaluated from a national cross-sectional survey of non-communicable disease (NCD) risk factors in 2016. Individuals were classified into: light, moderate, and heavy smokers. A generalized additive model (GAM) was used to assess the relationship.Results: 246 (26.9%) subjects were light smokers, 190 (20.8%) subjects were moderate smokers and 477 (52.2%) subjects were heavy smokers. According to the GAM results, the relationship was nonlinear and smokers who started smoking at a younger age were more likely to become heavy smokers. The factors of unemployment (OR = 1.364), retirement (OR = 1.217), and exposure to secondhand smoke at home (OR = 1.364) increased the risk of heavy smoking. but, smokers with high-income (OR = 0.742) had a low tendency to heavy smoking. Conclusions: GAM identified the nonlinear relationship between the age of onset of smoking and smoking intensity. Tobacco control programs should be focused on young and adolescent groups and poorer socio-economic communities.