The influence of social environment on smoking behavior among adolescents in Iran

 Abstract Background: Research suggests that factors in the environment are major determinants of health behavior for populations. This cross-sectional study used a combination of quantitative and qualitative data collection methods to determine the prevalence of smoking and identify the possible associations between smoking and environmental variables among school pupils in Iran. Methods: A self-reported questionnaire was administrated and collected data from 2200, students15-18 from 100 high schools who agreed to take part in the research. The sample was selected from the Iranian Education System Database using a two-stage cluster sample based on a random sample of schools and pupils as a representative sample of this population. Almost 90% of respondents had completed the questionnaires. Examination of the test-retest answers over all questions among 70 students in two weeks interval revealed reliability coefficient ranges 0.72 to 0.98. The Adjusted Enter Logistic Regression Models were applied to significant variables identified through Chi square tests. In addition, 40 of the sample took part in focus groups exploring the facilitators and barriers to smoking behavior. Content analysis was also used to extract themes from the focus group discussions. Results: The effects of social environment variables including peers', mothers', and sisters' smoking on cigarette consumption among young people were explored in this study. Levels of cigarette availability and exposure, effects of parents' attitudes and supervision, legislation on tobacco control, expanding life opportunities and more options for leisure activities perceived as influencing factors on adolescent smoking were all highlighted in the focus group discussions. Conclusion: The qualitative and quantitative findings revealed the impact of social environment on smoking behavior among young people. This study provides strong evidence to support environmentally oriented smoking prevention programs targeting young people.