@2024 Afarand., IRAN
ISSN: 2383-2150 Journal of Education and Community Health 2020;7(2):73-80
ISSN: 2383-2150 Journal of Education and Community Health 2020;7(2):73-80
Effects of an Educational Intervention on Male Students’ Intention to Quit Water Pipe Smoking: an Application of the Theory of Planned Behavior (TPB) and Health Action Process Approach (HAPA)
ARTICLE INFO
Article Type
Original ResearchAuthors
Joveini H. (1)Dehdari T. (2)
Hashemian M. (1)
Maheri M. (3)
Shahrabadi R. (1)
Rohban A. (4)
Mehri A. (1)
Eftekhar Ardebili H. (*5)
(*5) Health Education & Promotion Department, School of Health, Tehran University of Medical Sciences, Tehran, Iran
(1) Health Education & Promotion Department, School of Health, Sabzevar University of Medical Sciences, Sabzevar , Iran
(2) Health Education & Promotion Department, School of Health, Iran University of Medical Sciences, Tehran, Iran
(3) Health Education & Promotion Department, School of Health, Urmia University of Medical Sciences, Urmia, Iran
(4) Rehabilitation Management Department, School of Rehabilitation, Iran University of Medical Sciences, Tehran, Iran
Correspondence
Article History
Received: January 21, 2020Accepted: March 18, 2020
ePublished: June 20, 2020
ABSTRACT
Aims
Water pipe smoking has become very popular among young people. Regarding to the increasing prevalence of water pipe smoking among students, the aim of this study was to determine the effects of an educational intervention based on Theory of Planned Behavior (TPB) and Health Action Process Approach (HAPA) on male students’ intention to quit water pipe smoking.
Materials & Methods This semi-experimental study was conducted on 150 male students of the Islamic Azad University of Sabzevar-Iran, in 2017 who were selected by simple random sampling method and allocated to two control and intervention groups (75 people in each group). Data collection tool included a demographic information questionnaire and a researcher-made questionnaire based on motivational phase constructs of health action process approach and theory of planned behavior. Intervention group participants received six sessions of education (45 minutes per session). Both groups completed questionnaires in baseline and one month after the intervention. Data were analyzed in SPSS 23 software using statistical tests.
Findings Before the intervention, there was no significant difference in the mean scores of the constructs of risk perception, outcome expectancy, action self-efficacy, attitude, subjective norms, perceived behavioral control, and behavioral intention to quit water pipe smoking between the two groups (p>0.05). However, after the intervention, these differences were significant except attitude (p<0.05). Also, after the intervention, intention to quit water pipe smoking in the students of intervention group had significant difference compared to the control group (p=0.004).
Conclusion The educational intervention based on Theory of Planned Behavior (TPB) and Health Action Process Approach (HAPA) is effective in creating the intention to quit water pipe smoking among students.
Materials & Methods This semi-experimental study was conducted on 150 male students of the Islamic Azad University of Sabzevar-Iran, in 2017 who were selected by simple random sampling method and allocated to two control and intervention groups (75 people in each group). Data collection tool included a demographic information questionnaire and a researcher-made questionnaire based on motivational phase constructs of health action process approach and theory of planned behavior. Intervention group participants received six sessions of education (45 minutes per session). Both groups completed questionnaires in baseline and one month after the intervention. Data were analyzed in SPSS 23 software using statistical tests.
Findings Before the intervention, there was no significant difference in the mean scores of the constructs of risk perception, outcome expectancy, action self-efficacy, attitude, subjective norms, perceived behavioral control, and behavioral intention to quit water pipe smoking between the two groups (p>0.05). However, after the intervention, these differences were significant except attitude (p<0.05). Also, after the intervention, intention to quit water pipe smoking in the students of intervention group had significant difference compared to the control group (p=0.004).
Conclusion The educational intervention based on Theory of Planned Behavior (TPB) and Health Action Process Approach (HAPA) is effective in creating the intention to quit water pipe smoking among students.
CITATION LINKS
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[14]Bashirian S, Barati M, Sharma M, Abasi H, Karami M. Water pipe smoking reduction in the male adolescent students: An educational intervention using multi-theory model. J Res Health Sci. 2019;19(1):e00438.
[15]Joveini H, Dehdari T, Ardebili HE, Mahmoudi M, Firouzian AA, Rohban A. Factors associated with hookah smoking among university students. Electron physician. 2016;8(12):3403-8.
[16]Tamim H, Terro A, Kassem H, Ghazi A, Khamis TA, Hay MM, et al. Tobacco use by university students, Lebanon, 2001. Addiction. 2003;98(7):933-9.
[17]Maziak W, Fouad FM, Asfar T, Hammal F, Bachir EM, Rastam S, et al. Prevalence and characteristics of narghile smoking among university students in Syria. Int J Tuberc Lung Dis. 2004;8(7):882-9.
[18]Mohaddes Hakkak HR, Taghdisi MH, Shojaezadeh D, Nedjat S, Peyman N, Taghipour A. Clarifying the Role of Schools in Tendency or Lack of Tendency Toward Smoking among Teenage Boys (11-14) in Mashhad, Iran. Iran Red Crescent Med J. 2014;16(1):e12848.
[19]Yousefinejad V, Mansouri B, Ramezani Z, Mohammadzadeh N, Akhlaghi M. Evaluation of heavy metals in tobacco and hookah water used in coffee houses in Sanandaj city in 2017. Sci J Kurdistan Univ Med Sci. 2018;22(6):96-106. [Persian]
[20]IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Personal habits and indoor combustions. Volume 100 E. A review of human carcinogens. IARC Monogr Eval Carcinog Risks Hum. 2012;100(Pt E):1-538.
[21]El-Zaatari ZM, Chami HA, Zaatari GS. Health effects associated with waterpipe smoking. Tob Control. 2015;24 Suppl 1:i31-43.
[22]Fathi Y, Moeini B, Bazvand A, Barati M, Roshanaei G. The effectiveness of educational program based on theory of planned behavior on preventing and decreasing tobacco smoking among post-secondary students. J Educ Community Health. 2016;3(2):54-61. [Persian]
[23]Yaghobi Z, Mohaddes Hakkak H, Tavakoli Ghoochani H, Joveini H, Maheri M, Taherpour M, et al. Factors affecting the intention to choose the natural vaginal delivery based on the theory of planned behavior among primigravidae. J Educ Community Health. 2019;6(3):169-76. [Persian]
[24]Yaghobi Z, Mohaddes Hakkak H, Tavakoli Ghoochani H, Joveini H, Maheri M, Taherpour M, et al. Factors affecting the intention to choose the natural vaginal delivery based on the theory of planned behavior among primigravidae. J Educ Community Health. 2019;6(3):169-76. [Persian]
[25]Ghodsi M, Maheri M, Joveini H, Rakhshani MH, Mehri A. Designing and evaluating educational intervention to improve preventive behavior against Cutaneous Leishmaniasis in endemic areas in Iran. Osong Public Health Res Perspec. 2019;10(4):253-62.
[26]Malaijerdi Z, Joveini H, Hashemian M, Borghabani R, Maheri M, Rohban A. Effects of an empowerment program for promoting physical activity in middle-aged women: an application of the health action process approach. Sport Sci Health. 2019;15(3):595-603.
[27]Hakkak HM, Joveini H, Rajabzadeh R, Robatsarpooshi D, Tori Na, Haresabadi M, et al. Health literacy level and related factors among pregnant women referring to Bojnord Health Centers in 2017. Int J Pharm Res. 2019;11(1);152-8.
[28]Shojaezadeh D, Peyman N, Shakeri MT, Nedjat S, Mohaddes Hakkak A, Taghdisi MH, et al. Pictorial health warning labels on cigarette packages: an investigation on opinions of male smokers. Iran Red Crescent Med J. 2014;16(3):e14879.
[29]Maheri A, Tol A, Sadeghi R. Assessing the effect of an educational intervention program based on Health Belief Model on preventive behaviors of internet addiction. J Educ Health Promot. 2017;6:63.
[30]Joveini H, Rohban A, Eftekhar Ardebili H, Dehdari T, Maheri M, Hashemian M. The effects of an education program on hookah smoking cessation in university students: an application of the Health Action Process Approach (HAPA). J Subst Use. 2020;25(1):62-9.
[31]Maheri M, Rohban A, Sadeghi R, Joveini H. Predictors of quality of life in transfusion-dependent thalassemia patients based on the PRECEDE model: a structural equation modeling approach. J Epidemiol Global Health. 2019.
[32]Joveyni H, Dehdari T, Gohari Mr, Gharibnavaz H. The survey of attitudes, subjective norms and perceived behavioral control of college students about hookah smoking cessation. Health Syst Res. 2012;8(7):1311-21. [Persian]
[33]Dehdari T, Joveyni H, Gohari M. Waterpipe smoking in the male college students: an education intervention using theory of planned behavior. J Res Health. 2013;3(4):497-503.
[34]Schwarzer R, Sniehotta FF, Lippke S, Luszczynska A, Scholz U, Schüz B, et al. On the assessment and analysis of variables in the health action process approach conducting an investigation. Berlin: Freie Universität Berlin; 2003:1-18.
[35]Chow S, Mullan B. Predicting food hygiene. An investigation of social factors and past behaviour in an extended model of the Health Action Process Approach. Appetite. 2010;54(1):126-33.
[36]Karimy M, Niknami S, Heidarnia A, Hajizadeh I. Assessment of knowledge, health belief and patterns of cigarette smoking among adolescents. J Fasa Univ Med Sci. 2011;1(3):142-8. [Persian]
[37]Haug S, Meyer C, Dymalski A, Lippke S, John U. Efficacy of a text messaging (SMS) based smoking cessation intervention for adolescents and young adults: Study protocol of a cluster randomised controlled trial. BMC Public Health. 2012;12(1):51.
[38]Payaprom Y, Bennett P, Alabaster E, Tantipong H. Using the health action process approach and implementation intentions to increase flu vaccine uptake in high risk Thai individuals: a controlled before-after trial. Health Psychol. 2011;30(4):492-500.
[39]Tidey JW, Rohsenow DJ. Smoking expectancies and intention to quit in smokers with schizophrenia, schizoaffective disorder and non-psychiatric controls. Schizophr Res. 2009;115(2-3):310-6.
[40]Setoudeh A, Tahmasebi R, Noroozi A. Effect of education by health volunteers on reducing water-pipe use among women in Bushehr: an application of health belief model. Hayat. 2016;22(1):50-64. [Persian]
[41]Moeini B, Hazavehei SMM, Shahrabadi R, Faradmal J, Ahmadpanah M, Dashti S, et al. The effectiveness of cognitive–behavioral stress-management training on the readiness for substance use treatment in Iran. J Subst Use. 2018;23(4):371-6.
[42]Momenabadi V, Kaveh MH, Hashemi SY. Effect of educational intervention on intention of university students’ disuse of hookah smoking: BASNEF model. J Subst Use. 2018;23(3):262-7.
[43]Korkmaz Aslan G, Kartal A, Özen Çınar İ, Koştu N. The relationship between attitudes toward aging and health‐promoting behaviours in older adults. Int J Nurs Pract. 2017;23(6):e12594.
[44]Botvin GJ, Griffin KW, Diaz T, Scheier LM, Williams C, Epstein JA. Preventing illicit drug use in adolescents: Long-term follow-up data from a randomized control trial of a school population. Addict Behav. 2000;25(5):769-74.
[45]Bashirian S, Heidarnia A, Allahverdipour H, Hajizadeh E. Application of theory of planned behavior in predicting factors of substance abuse in adolescents. J Fasa Univ Med Sci. 2012;2(3):156-62. [Persian]
[46]Barati M, Allahverdipour H, Moinei B, Farhadinasab A, Mahjub H, Jalilian F. Application of the theory of reason action for preventing of ecstasy abuse among college students. J Res Addict. 2009;3(10):77-96.
[2]Khodadost M, Maajani K, Abbasi-Ghahramanloo A, Naserbakht M, Ghodusi E, Sarvi FS, et al. Prevalence of hookah smoking among university students in Iran: a meta-analysis of observational studies. Iran J Public Health. 2020;49(1):1-13.
[3]Salloum RG, Lee J, Mostafa A, Abu-Rmeileh NME, Hamadeh RR, Darawad MW, et al. Waterpipe tobacco smoking among university students in three eastern Mediterranean countries: patterns, place, and price. Subst Use Misuse. 2019;54(14):2275-83.
[4]El-Awa F, Warren CW, Jones NR. Changes in tobacco use among 13-15-year-olds between 1999 and 2007: findings from the Eastern Mediterranean Region. East Mediterr Health J. 2010;16(3):266-73.
[5]Ben Taleb Z, Breland A, Bahelah R, Kalan ME, Vargas-Rivera M, Jaber R, et al. Flavored versus nonflavored waterpipe tobacco: a comparison of toxicant exposure, puff topography, subjective experiences, and harm perceptions. Nicotine Tob Res. 2019;21(9):1213-1219.
[6]Akl EA, Gunukula SK, Aleem S, Obeid R, Jaoude PA, Honeine R, et al. The prevalence of waterpipe tobacco smoking among the general and specific populations: a systematic review. BMC Public Health. 2011;11(1):244.
[7]Bashirian S, Barati M, Mohammadi Y, Mostafaei H. Factors associated with hookah use among male high school students: The role of demographic characteristics and hookah user and non-user prototypes. J Res Health Sci. 2016;16(4):217-23.
[8]Dehdari T, Jafari A, Joveyni H. Students’ perspectives in Tehran University of Medical Sciences about factors affecting smoking hookah. Razi J Med Sci. 2012;19(95):17-24. [Persian]
[9]Bahelah R, Ward KD, Taleb ZB, DiFranza JR, Eissenberg T, Jaber R, et al. Determinants of progression of nicotine dependence symptoms in adolescent waterpipe smokers. Tobacco control. 2019;28(3):254-60.
[10]Knishkowy B, Amitai Y. Water-pipe (narghile) smoking: an emerging health risk behavior. Pediatrics. 2005;116(1):e113-9.
[11]Maziak W, Nakkash R, Bahelah R, Husseini A, Fanous N, Eissenberg T. Tobacco in the Arab world: old and new epidemics amidst policy paralysis. Health policy plann. 2014;29(6):784-94.
[12]Rice VH, Weglicki LS, Templin T, Hammad A, Jamil H, Kulwicki A. Predictors of Arab American adolescent tobacco use. Merrill Palmer Q (Wayne State Univ Press). 2006;52(2):327-42.
[13]Weglicki LS, Templin T, Hammad A, Jamil H, Abou-Mediene S, Farroukh M, et al. Health issues in the Arab American community. Tobacco use patterns among high school students: do Arab American youth differ? Ethn Dis. 2007;17(2 Suppl 3):S3-22-4.
[14]Bashirian S, Barati M, Sharma M, Abasi H, Karami M. Water pipe smoking reduction in the male adolescent students: An educational intervention using multi-theory model. J Res Health Sci. 2019;19(1):e00438.
[15]Joveini H, Dehdari T, Ardebili HE, Mahmoudi M, Firouzian AA, Rohban A. Factors associated with hookah smoking among university students. Electron physician. 2016;8(12):3403-8.
[16]Tamim H, Terro A, Kassem H, Ghazi A, Khamis TA, Hay MM, et al. Tobacco use by university students, Lebanon, 2001. Addiction. 2003;98(7):933-9.
[17]Maziak W, Fouad FM, Asfar T, Hammal F, Bachir EM, Rastam S, et al. Prevalence and characteristics of narghile smoking among university students in Syria. Int J Tuberc Lung Dis. 2004;8(7):882-9.
[18]Mohaddes Hakkak HR, Taghdisi MH, Shojaezadeh D, Nedjat S, Peyman N, Taghipour A. Clarifying the Role of Schools in Tendency or Lack of Tendency Toward Smoking among Teenage Boys (11-14) in Mashhad, Iran. Iran Red Crescent Med J. 2014;16(1):e12848.
[19]Yousefinejad V, Mansouri B, Ramezani Z, Mohammadzadeh N, Akhlaghi M. Evaluation of heavy metals in tobacco and hookah water used in coffee houses in Sanandaj city in 2017. Sci J Kurdistan Univ Med Sci. 2018;22(6):96-106. [Persian]
[20]IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Personal habits and indoor combustions. Volume 100 E. A review of human carcinogens. IARC Monogr Eval Carcinog Risks Hum. 2012;100(Pt E):1-538.
[21]El-Zaatari ZM, Chami HA, Zaatari GS. Health effects associated with waterpipe smoking. Tob Control. 2015;24 Suppl 1:i31-43.
[22]Fathi Y, Moeini B, Bazvand A, Barati M, Roshanaei G. The effectiveness of educational program based on theory of planned behavior on preventing and decreasing tobacco smoking among post-secondary students. J Educ Community Health. 2016;3(2):54-61. [Persian]
[23]Yaghobi Z, Mohaddes Hakkak H, Tavakoli Ghoochani H, Joveini H, Maheri M, Taherpour M, et al. Factors affecting the intention to choose the natural vaginal delivery based on the theory of planned behavior among primigravidae. J Educ Community Health. 2019;6(3):169-76. [Persian]
[24]Yaghobi Z, Mohaddes Hakkak H, Tavakoli Ghoochani H, Joveini H, Maheri M, Taherpour M, et al. Factors affecting the intention to choose the natural vaginal delivery based on the theory of planned behavior among primigravidae. J Educ Community Health. 2019;6(3):169-76. [Persian]
[25]Ghodsi M, Maheri M, Joveini H, Rakhshani MH, Mehri A. Designing and evaluating educational intervention to improve preventive behavior against Cutaneous Leishmaniasis in endemic areas in Iran. Osong Public Health Res Perspec. 2019;10(4):253-62.
[26]Malaijerdi Z, Joveini H, Hashemian M, Borghabani R, Maheri M, Rohban A. Effects of an empowerment program for promoting physical activity in middle-aged women: an application of the health action process approach. Sport Sci Health. 2019;15(3):595-603.
[27]Hakkak HM, Joveini H, Rajabzadeh R, Robatsarpooshi D, Tori Na, Haresabadi M, et al. Health literacy level and related factors among pregnant women referring to Bojnord Health Centers in 2017. Int J Pharm Res. 2019;11(1);152-8.
[28]Shojaezadeh D, Peyman N, Shakeri MT, Nedjat S, Mohaddes Hakkak A, Taghdisi MH, et al. Pictorial health warning labels on cigarette packages: an investigation on opinions of male smokers. Iran Red Crescent Med J. 2014;16(3):e14879.
[29]Maheri A, Tol A, Sadeghi R. Assessing the effect of an educational intervention program based on Health Belief Model on preventive behaviors of internet addiction. J Educ Health Promot. 2017;6:63.
[30]Joveini H, Rohban A, Eftekhar Ardebili H, Dehdari T, Maheri M, Hashemian M. The effects of an education program on hookah smoking cessation in university students: an application of the Health Action Process Approach (HAPA). J Subst Use. 2020;25(1):62-9.
[31]Maheri M, Rohban A, Sadeghi R, Joveini H. Predictors of quality of life in transfusion-dependent thalassemia patients based on the PRECEDE model: a structural equation modeling approach. J Epidemiol Global Health. 2019.
[32]Joveyni H, Dehdari T, Gohari Mr, Gharibnavaz H. The survey of attitudes, subjective norms and perceived behavioral control of college students about hookah smoking cessation. Health Syst Res. 2012;8(7):1311-21. [Persian]
[33]Dehdari T, Joveyni H, Gohari M. Waterpipe smoking in the male college students: an education intervention using theory of planned behavior. J Res Health. 2013;3(4):497-503.
[34]Schwarzer R, Sniehotta FF, Lippke S, Luszczynska A, Scholz U, Schüz B, et al. On the assessment and analysis of variables in the health action process approach conducting an investigation. Berlin: Freie Universität Berlin; 2003:1-18.
[35]Chow S, Mullan B. Predicting food hygiene. An investigation of social factors and past behaviour in an extended model of the Health Action Process Approach. Appetite. 2010;54(1):126-33.
[36]Karimy M, Niknami S, Heidarnia A, Hajizadeh I. Assessment of knowledge, health belief and patterns of cigarette smoking among adolescents. J Fasa Univ Med Sci. 2011;1(3):142-8. [Persian]
[37]Haug S, Meyer C, Dymalski A, Lippke S, John U. Efficacy of a text messaging (SMS) based smoking cessation intervention for adolescents and young adults: Study protocol of a cluster randomised controlled trial. BMC Public Health. 2012;12(1):51.
[38]Payaprom Y, Bennett P, Alabaster E, Tantipong H. Using the health action process approach and implementation intentions to increase flu vaccine uptake in high risk Thai individuals: a controlled before-after trial. Health Psychol. 2011;30(4):492-500.
[39]Tidey JW, Rohsenow DJ. Smoking expectancies and intention to quit in smokers with schizophrenia, schizoaffective disorder and non-psychiatric controls. Schizophr Res. 2009;115(2-3):310-6.
[40]Setoudeh A, Tahmasebi R, Noroozi A. Effect of education by health volunteers on reducing water-pipe use among women in Bushehr: an application of health belief model. Hayat. 2016;22(1):50-64. [Persian]
[41]Moeini B, Hazavehei SMM, Shahrabadi R, Faradmal J, Ahmadpanah M, Dashti S, et al. The effectiveness of cognitive–behavioral stress-management training on the readiness for substance use treatment in Iran. J Subst Use. 2018;23(4):371-6.
[42]Momenabadi V, Kaveh MH, Hashemi SY. Effect of educational intervention on intention of university students’ disuse of hookah smoking: BASNEF model. J Subst Use. 2018;23(3):262-7.
[43]Korkmaz Aslan G, Kartal A, Özen Çınar İ, Koştu N. The relationship between attitudes toward aging and health‐promoting behaviours in older adults. Int J Nurs Pract. 2017;23(6):e12594.
[44]Botvin GJ, Griffin KW, Diaz T, Scheier LM, Williams C, Epstein JA. Preventing illicit drug use in adolescents: Long-term follow-up data from a randomized control trial of a school population. Addict Behav. 2000;25(5):769-74.
[45]Bashirian S, Heidarnia A, Allahverdipour H, Hajizadeh E. Application of theory of planned behavior in predicting factors of substance abuse in adolescents. J Fasa Univ Med Sci. 2012;2(3):156-62. [Persian]
[46]Barati M, Allahverdipour H, Moinei B, Farhadinasab A, Mahjub H, Jalilian F. Application of the theory of reason action for preventing of ecstasy abuse among college students. J Res Addict. 2009;3(10):77-96.