@2024 Afarand., IRAN

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ISSN: 2383-2150    Journal of Education and Community Health 2015;2(1):10-18

Background
Smoking is fourth risk factor for the global burden of diseases [1] and the main risk factor for many health [2] and its socio-economic [3] problems.
Previous Studies
… [4]. Previous studies have shown that factors such as knowledge, peer pressure, attitudes, subjective norms, intention and behavioral control are predictors of smoking in young people [5]. … [6-17].The ultimate goal of the planned behavior theory isto predict behavior, and it is assumed that behavior is a direct determinant of behavioral intention and behavioral control and attitudes, subjective norms, behavioral control and demographic factors indirectly affect behavior[5, 7, 18, 19].
Aim(s)
This study aimed to determine predictors of smoking in medical students using the theory of planned behavior.
Research type
The current research is a sectional descriptive-analytic study.
Research society, place and time
In the spring of 2014, this study was done on a sample of students in Ahwaz Jondi-Shapour University of Medical Sciences.
Sampling method and number
The sample size in this study with regard to the accuracy of 5% and confidence coefficient of 95%,the prevalence of 9%of using cigarette in Iranian male adolescents [19] and the taking into account loss was calculated 170 persons.
Used devices&materials
After studying literature and consultation with internal and external experts in the world on the subject of and advice from the Ajzen website (Producer theory of planned behavior), it was decided to design and make a questionnaire. Initially several question were asked again. Then outstanding views, advantages, perceived disadvantages and influential reference groups in this population were identified. In the next stage, research group, according to analysis of the responses and the comments of expert, designed a 5 Likert scale questionnaire consists of 39 questions. To determine the content validity of the designed questionnaire, both qualitative and quantitative methods were used.In qualitative method, the prepared from was given to12 people who were expert in the field of health education.At this point, they were asked to complete a questionnaire based on the use of appropriate keywords, placement of items in the right place, observing the proper grammar, appropriate scoring and providing feedback. To review the content validity in quantitative method two indicators, content validity ratio (CVR) and content validity index were calculated. To determine the content validity ratio regarding of necessity and non-necessity of each item, experts were consulted and CVR values higher than0.56 were accepted according to Lawshe table.Then, to determine the content validity index, measures of relevance, clarity and simplicity of each item, were reviewed and higher levels of 0.79 were adopted [5]. In the next step to clarify items, groups of students were given a questionnaire to study and respond to the items and ask any ambiguity or questions about things.Based on comments and suggestions received from the people, the necessary changes to items clearly took place.Also, at this stage to reduce and remove inappropriate items and determine the importance of each item, the item, the quantitative impact factor was also used.Impact rating higher than 1.5was considered acceptable (20).Also, the reliability of the questionnaire's internal consistency coefficient calculated on a group of 30 students. The rate of Cronbach's alpha, for the questions of attitude, subjective norms, perceived behavioral control, and behavioral factors was 0.71, 0.73 0.70, and 0.84 respectively. After psychometric procedures, the final questionnaire was consisted of two part: first part was consist of demographic characteristics (such as age, gender,number of friends who smoke, smokers in family members, etc.) and using tobacco that was investigating the consumption of hookah and cigarette,with questions such as "Have you ever tried cigarette smoking, even one or two puff?" Or "Are you smoking now?" that were set as yes or no responses. Second part of questionnaire was consisted of 38 questions about theory of planned behavior. 14 questions for attitude evaluation was about relation between using tobaccos with questions such as "I think most people who start smoking become addicted to drugs", that their answer in method of Likert scale from totally agree(5) to strongly disagree(1) was set . In this sector, earning higher scores was indicating more negative attitude to use tobaccos.Attitude scores range was between 14 and 54.Perceived behavioral control was consisted of 7 questions with questions such as "I am sure that even if my friends offer using tobacco (cigarette and hookah), I can persist it", that their answer in method of Likert from most likely (5) to less likely (1) was set.In this sector, earning higher scores was indicating greater perceived control compared to non-smoking.The score range in this section was between 7 and 35.subjective norms were five questions such as "my religious beliefs, with using tobacco" that their answer in method of Likert from totally agree (1) to strongly disagree (5) was set.This score ranges was between 5 and 25.Intention of using tobacco included 7 questions such as "If I have problems in my life?" or" in the next three month" with answer I surely will smoke (1) to I surely will not smoke (5) was set. The score range of intentional behavior was between 7 and 35. Statistical analysis After encoding, the data entered for analysis in SPSS 18. To identify the factors related to tobacco use, multiple logistic regression analysis was used. In the next stage, only independent variables in the univariate analysis that were significant entered into the multiple regression model. The level of significance in all tests was considered less than 0.05.
Findings by Text
Of total of 170 students participated in this study, 56 participants (32.9%) were male and 114 (67.1%) were female. The mean age of boys was 22.7 with standard deviation of 3.2 and the mean age of girls was 20.5 with a standard deviation of 2.4. 30% of the samples were freshman, 38%were in the second year; 18% were in the third year; and 8 and 6% were in the fourth and fifth year and higher respectively. 58% were undergraduate, 5%were master, 2%had Ph.D. and 35% had medical doctorate. According to the results, 61.4% of male students had smoking experience, 65%had the experience of Hookah consumption; and 36% were current tobacco consumer. These numbers in the girls were 14, 18.4 and 3.5% respectively. A total of 14.1% of the samples were current tobacco users. The least age of smoking onset was in 15 years and the highest in 22 years. Among male current tobacco users, 69%had their first experience with friends and in the consumer females, 58% had their first smoking experience in isolation. By using multivariate logistic regression it was found that the group of smokers compared to non-smokers, had friends, parents and brother who smoke cigarettes and among mentioned variables friend-smoker (odds ratio 5.6), parental smoking (odds ratio 5.3), brother-smoker (odds ratio 4.9) and being boy (with an odds ratio of 4.8), were significant predictors factors of using tobacco among students, and having more than 2 smoker friends(odds ratio 6.8) was the most important predictor of using tobacco(Table 1). As Table 2 shows, for every one unit increase in the mean score of behavioral intention, chance of using tobacco increases by 1.44. In addition, among theconstructs of planned behavior theory, the construct of subjective norm thatencourages consumption (with an odds ratio0.88) was the most important predictor of using tobacco.
Main comparison to the similar studies
[21-28]-In the most areas of behavior, the strong relationship between intention and behavior has been confirmed by various studies such as the study of Cooke et al. [29] and Van de Ven et al. [30]. However, in the domain of behavior of smoking and drug misuse, the contrary results have been obtained. Some studies such as the study of Wilkinsonand Abraham [31], and Lettow et al. [32] found a strong relationship between intention and behavior whereas in the studyby Higgins and Conner [33] in contrast to other model constructs, a strong relationship between intention and behavior of tobacco use wasnot observed[34-38].
Suggestions
The theory of planned behavior is recommended for designing series of plans to prevent using tobacco among students.
Limitations
Of limitations of this of study, using the self-report of smoking behavior scan be mentioned although the validity of this method in other studies (8) using biochemical method simultaneously has been approved.
Conclusions
The results of this study shows that having a friend who smoke; especially having more than two smoking friends is the most important reason of smoking. Also, the results of the study support deployment of the constructs of theory of planned behavior in predicting tobacco use among students, especially the construct of subjective norm at the universities where young people away from parental supervision and family.
Acknowledgments
The authors are grateful to all the students who participated in this study as well as officials from the Ahwaz Medical University who patiently cooperate in this study.
Conflict of interest
Non-declared
Ethical Permissions
After completion, data and questionnaires were answered as anonymous person, kept in safe box and were not opened until the completion by samples.
Funding Sources
Non-declared

TABLES and CHARTS

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