Objective
Guided by the Attitude-Social influence-self Efficacy (ASE) theory, this study identified predictors of waterpipe (WP) smoking initiation in a WP naïve cohort of Jordanian schoolchildren.
Methods
A school-based cohort of all 7th grade students (N=1,781) in 19 of 60 schools in Irbid, Jordan, was followed from 2008 to 2011. Generalized linear mixed modeling was used to examine predictors of WP initiation among WP-naïve students (N=1,243).
Results
During the 3-year study, WP initiation was documented in 39% of boys and 28% of girls. Prior cigarette smoking (boys: Odds Ratio 7.41; 95% Confidence Interval 4.05–12.92 and girls: 8.48; 4.34–16.56) and low WP refusal self-efficacy (boys: 26.67; 13.80–51.53 and girls: 11.49; 6.42–20.55) were strongly predictive of initiating WP. Boys were also more likely to initiate WP smoking if they had siblings (2.30; 1.14- 4.64) or teachers (2.07; 1.12–3.84) who smoked and girls if they had friends (2.96; 1.59–5.54) who smoked.
Conclusion
There is a sizeable incidence of WP initiation among students of both sexes. These findings will help in designing culturally responsive prevention interventions against WP smoking. Gender-specific factors, refusal skills, and cigarette smoking need to be important components of such initiatives.