Smoking Behavior Among Students: Using Health Belief Model and Zero-Inflated Ordered Probit Model

Abstract

Background: Smoking is increasing among adolescents and young adults. Adolescents’ smoking can predict frequent smoking in early adulthood. This study aimed to explore the predictors of smoking among high school students using health belief model (HBM). Materials and Methods: In this cross-sectional study conducted in 2019 in Bandar-Abbas city, South of Iran, 444 male high-school students aged 15-19 years (mean age: 16.7±0.85) were explored. Data were collected using a researcher-made questionnaire consisted of two main sections: sociodemographic characteristics and HBM constructs. The zero-inflated ordered probit (ZIOP) model was adopted for investigating the association between HBM constructs and smoking behavior. Results: Results indicated that 82% of the participants never smoked cigarette. The results of ZIOP model showed that the knowledge (P=0.026), susceptibility (P<0.001), severity (P=0.035), benefits (P=0.004), and cues to action (P=0.019) had significant effects on smoking cigarette after being adjusted for other covariates (i.e., age, parents’ education, losing one of the parents). Moreover, having a smoker friend was found to be an inflation factor (P<0.001). Adolescents with smoking friends were 44% less likely to avoid smoking. Conclusion: It was concluded that having a smoker friend, knowledge, susceptibility, severity, benefits, and cues to action had considerable predictive capacity for predicting smoking attitude. Therefore, it was recommended that these factors should be seriously considered when designing educational programs with the aim of reducing adolescent smoking.