Predictors of Transition in Smoking Stages in Iranian Adolescents: A Probabilistic Discrete Event System Model

Background: Cigarette smoking is one of the most important public health problems. Objectives: This study determined the personal and environmental predictors of transition across smoking stages using cross sectional data. Methods: In this cross sectional study, 4 853 students (14 to 19 years) completed a self-administered multiple-choice anonymous questionnaire. We used a probabilistic discrete event system (PDES) for estimating the transitional probabilities in smoking stages in terms of sex, peer and family smoking, attitude towards smoking, general risk taking behavior, and the socio-economic status. Results: The results showed factors such as being a boy (OR = 8.9 (7.9 - 10.0)), having a positive attitude towards smoking (OR = 8.2 (6.5 - 10.5)), and having a smoker friend (OR = 5.2 (3.6 - 7.6)) were highly associated with the initiation of smoking. In contrast, having a smoker friend is the most important factor that prevents one from quitting smoking (OR = 0.08 (0.07 - 0.09)). Also, this factor is important in the adolescents’ relapse from being an ex-smoker to a current smoker. Conclusions: Prevention efforts will need to be mentioned for reducing the smoking initiation risk factors and the quitting of smoking. The programs aimed at smoking prevention and intervention should focus on the protective factors to reduce the probability of smoking initiation and relapsing.