Perceived factors related to cigarette and waterpipe (ghelyan) initiation and maintenance in university students of Iran

To investigate the perceived factors leading to cigarette and waterpipe (ghelyan) smoking initiation and maintenance in Iranian university students. A cross-sectional study was conducted on 233 students aged 20-25 enrolled in Isfahan University and Kashan University in 2007. Demographic factors as well as cigarette and ghelyan status, and perceived factors related to cigarette or ghelyan smoking initiation and maintenance were recorded. Principal component analysis was carried out to cluster perceived smoking initiation and maintenance factors. In a multiple logistic regression model, perceived psychological factors were more significant to cigarette smoking initiation and maintenance than ghelyan smoking among girls (odds ratio, OR = 1.90; P < 0.04) although perceived psychological factors (OR = 2.20; P < 0.001) and social factors (OR = 2.42; P < 0.001) were more significant in cigarette smoking initiation than ghelyan smoking initiation among boys (OR = 2.42; P < 0.001). Moreover, study appears that in boys, perceived entertainment factors could play more significant role in ghelyan smoking initiation compared with cigarette smoking initiation (OR = 0.42; P < 0.001). Whereas the factors related to smoking initiation and maintenance are different in both genders and in both tobacco products, identification of cigarette and ghelyan smoking may guide policy makers to develop comprehensive interventions.