A teenager is more likely to display a behavior in a facilitative situation without any prior planning or intention (for example, at a party with friends where alcoholic beverages and shisha are available). Willingness is more easily ‘moved’ by situational influences 16. This path is less intentional, and the decision-making process is often unintended, with behavioral willingness playing a role in performing high-risk behaviors 13. The ‘social reaction’ pathway comprises two factors: the prototype or the mental images of people involved in the high-risk behavior, and the willingness to do it in certain situations. According to this path, the youth who have a positive attitude towards smoking and their perceived subjective norms will predict their smoking behavior including the strong determination to start smoking and most likely initiation of use of tobacco products 15. This path includes the two variables of ‘attitude’ and ‘subjective norms’, which predict the behavioral intention as outlined in the Theory of Reasoned Action (TRA) and the Theory of Planned Behavior (TPB). A decision then must be made whether or not to do it 14. Most behavioral models are based on the premise that the intention for a behavior is the result of deep thought, which needs to be scrutinized. The former (reason path) shows that young people, with previous will and plan, decide to engage in risky behaviors 13. This model has the ‘reason’ and ‘social reaction’ paths. Predictors of high-risk behaviors in adolescents can be determined through the Prototype-Willingness Model (PWM). social norms and specific beliefs) of adolescents’ inclination to engage in this risky behavior 12. It is important to understand the determinants (e.g. 11 showed that identifying predictors of SS among women is essential for planning future interventions to control SS among them and the community at large. In their study in the Eastern Mediterranean region, Afifi et al. Besides, complications such as changes in menstrual function, lower bone density and estrogen-deficiency disorders are the adverse effects of SS in women that require more dedicated attention 10. The prevalence of respiratory diseases in female smokers of shisha is higher than in male smokers 8, 9. In Middle East countries, people have not acquired negative attitudes toward SS, and it is much more acceptable in society than other types of tobacco. The World Health Organization (WHO) has attributed the increased tendency to shisha smoking in adolescents to misunderstandings about its harmlessness compared to other tobacco products 7. The results of the latest national survey of risk factors of non-communicable disease (SuRFNCD-2007) in Iran showed that more than half of female tobacco users are shisha consumers 6. The lower age of SS and the popularity of shisha in adolescence, especially in females, have become major concerns 4 as young females view SS as a hobby 5. Recent studies show that the prevalence of shisha smoking (SS) among Middle Eastern adolescents ranges from 6% to 34%, and among American adolescents 5–17% 3. Shisha smoking (SS) in the Middle East is known as a traditional way of consuming tobacco, and its consumption has increased significantly in recent years 2. According to the WHO report, deaths caused by smoking will rise to 8 million by 2030, which will be worse in developing countries 1. Structures in designing educational strategies for the prevention of adolescent Shisha smoking (SS) in adolescent females, it is necessary to consider these Conclusions: Given the efficient role of behavioral willingness and intention for Were significant predicting factors for shisha smoking among adolescent females. PWM constructs (behavioral intention OR=1.37 behavioral willingness OR=1.32) Obtained from the logistic regression analysis revealed that both pathways of Were the most important predictors for behavioral willingness. Of behavioral intentions, whereas subjective norms, attitudes, and prototypes Attitude andīehavioral willingness and subjective norms were the most important predictors Results: The prevalence of current consumers of shisha was 20.4%. Statistical tests included descriptive statistics, PearsonĬorrelation test, and linear and logistic regression analyses. Prototype-Willingness Model structure-based questions. Data were collected using a questionnaireĬonsisting of sociodemographic questions, history of shisha smoking, and Methods: This cross-sectional study was conducted on 1302 adolescent females in This study aimed to determine predictors of shisha smoking amongĪdolescent females in Western Iran based on the Prototype-Willingness Model Introduction: Given the increasing prevalence of shisha smoking (SS) in adolescentįemales, it is necessary to determine the factors influencing adolescent’s choice
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