Determinants of waterpipe smoking initiation among school children in Irbid, Jordan: A 4-year longitudinal analysis

Karma McKelvey, Jennifer Attonito, Purnima Madhivanan, Rana Jaber, Qilong Yi, Fawaz Mzayek, Wasim Maziak

Research output: Contribution to journalArticlepeer-review

22 Scopus citations


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 school children. Methods: A school-based cohort of all 7th grade students (N= 1781) 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= 1243). 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.

Original languageEnglish (US)
Pages (from-to)307-313
Number of pages7
JournalDrug and Alcohol Dependence
StatePublished - Sep 1 2014
Externally publishedYes


  • Cohort
  • Gender
  • Initiation
  • Jordan
  • School children
  • Waterpipe smoking

ASJC Scopus subject areas

  • Toxicology
  • Pharmacology
  • Psychiatry and Mental health
  • Pharmacology (medical)


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