Assessing Risk Factors for Hookah Smoking in Adolescent Girls: An Application of the Prototype Willingness Model (PWM)

Abstract

Background: Despite the importance of hookah smoking (HS), comprehensive and in-depth studies that examine the reasons and motivations for this behavior among teenage girls are limited in Iran. Objectives: The aim of this study was to determine the predictors of HS among girl students based on the prototype willingness model (PWM). Materials and Methods: This cross-sectional study was carried out in 2021 on a randomly selected sample of 407 female high school students in grades 10 to 12. Students from six schools in one district of Kermanshah, Iran, were selected, and a validated questionnaire based on the constructs of the PWM was administered and evaluated. Data entry was performed using SPSS 22, and both descriptive and inferential statistics, such as Pearson's correlation test and linear regression, were utilized for analysis. Results: Of all the students, 10.56% of them had smoked hookah in their lifetime, and 5.6% had smoked hookah in the past year. Among the 407 participants in the study, 23 individuals had smoked hookah in the past year. Participants, who had tried hookah before, showed a significantly greater intention to continue smoking hookah compared to those who had never tried it (P < 0.01). Both intention (P < 0.001) and willingness (P < 0.02) were related to hookah use behavior. Results also demonstrate that both attitude and subjective norms were significantly associated with intention. Attitude, subjective norms, and prototype perceptions were all significantly related to willingness. Among these three factors, subjective norms had the strongest relationship, as shown by its higher standardized beta value compared to the other two variables (B = 0.172). Conclusions: It can be concluded that attitude, subjective norms, and prototype perceptions are associated with hookah consumption behavior among adolescent girls by affecting their intention and willingness.