Peyman Habibi
1 
, Asghar Mohammadpoor-Asl
2 , Farhad Shekari
3* 1 Healthy Ageing Research Center, Neyshabur University of Medical Sciences, Neyshabur, Iran
2 Health & Environment Research Center (HERC), Tabriz University of Medical Sciences, Tabriz, Iran
3 Department of Epidemiology and Biostatistics, School of Public Health, Tabriz University of Medical Sciences, Tabriz, Iran
Abstract
Background. Smoking at a younger age puts people at greater risk for health damage. This study aimed to investigate the relationship between the age of smoking onset and high-risk behaviors such as smoking, alcohol consumption, substance abuse, and high-risk sexual behavior among university students in Tabriz, Iran.
Methods. This web-based, cross-sectional study was conducted in Tabriz, Iran, in 2019. A total of 3,649 students were included in the study according to the proportion of students in each university. The required information was collected through an online questionnaire. Logistic regression analysis was used to assess the relationship between the age of smoking onset and high-risk behaviors.
Results. The mean (standard deviation) age of the participants in the study was 22.85 (3.66) years old, and 55.7% were boys. The findings of the study indicate that students who initiated smoking at the age of 16 or younger exhibited higher likelihoods of alcohol consumption over the previous 30 days (OR= 1.77, CI 95%: 1.20 - 2.62) and participation in unsafe sexual practices (OR= 1.54, CI 95%: 1.06 - 2.26) compared to their non-smoking counterparts.
Conclusion. Early smoking onset is associated with high-risk behaviors. The age of onset of smoking should be considered as one of the factors associated with high-risk behaviors, and smoking prevention programs should be started from adolescence.
Extended Abstract
Background
Risky behaviors are one of the most severe threats to adolescents and young people's physical and mental health. Smoking, alcohol consumption, unprotected sexual behavior, and drug abuse are high-risk behaviors that increase the possibility of harmful physical, psychological, and social consequences for a person. Studies showed that starting smoking earlier during a vulnerable developmental period, such as adolescence, can have more severe health effects than starting smoking later. Starting smoking (not regular consumption) at a young age is one of the potential factors that may influence risky behaviors. The initiation of smoking in adolescence affects smoking behaviors in adulthood and other risky behaviors and adverse health/social outcomes such as alcohol use, illicit drug use, academic problems, mental health problems, violence, risky sexual behaviors, and suicide. The relationship between the age of smoking initiation and high-risk behaviors in Iran has not been investigated. The current study aims to investigate the relationship between the age of smoking initiation and high-risk behaviors among students in Tabriz.
Methods
This web-based cross-sectional study was conducted in Tabriz, Iran, between May and June 2018. Sampling was done from all the universities in Tabriz (9 universities) proportionally according to the number of students in each university. This study used a questionnaire to evaluate high-risk behaviors among students. After confirming the validity and reliability, the final questionnaire was designed using Google Forms. All students were invited to participate in the study and provided a shortened link to answer the questionnaire online. Students participated in the study through social apps, including Telegram and Instagram. High-risk behaviors in this study were current smoking, alcohol consumption in the past 30 days, substance abuse, and risky sexual behavior.
Results
The current study included 3,649 students, with 23.5% (855 people) current smokers, and 21.2% (772 people) ex-smokers. Also, 13.0% (444 people) reported substance abuse, 11.3% (412 people) consumed alcohol during the last 30 days, and 16.1% (576 people) had high-risk sexual behaviors. The average (± standard deviation) age of smoking initiation in our study was 17.64 ± 3.26 (age range: 7-35). Individuals who started smoking at 16 or younger made up 74% of the participants (P<0.001). Also, 37% of the students who started smoking at the age of 16 or younger had drug abuse experience (P=0.017). Almost 40% of participants who started smoking at 16 or younger reported alcohol consumption in the past 30 days (P<0.001). Also, about 35% of students who started smoking at 16 or younger had high-risk sexual behavior (P=0.001). Students who started smoking at 16 or younger compared to those who initiated at age 18 or older were 77 and 54% more likely to engage in risky sexual behavior and alcohol use, respectively. This relationship was not observed in our study for other high-risk behaviors (P> 0.05).
Conclusion
Early initiation of smoking is associated with risky behaviors. Adolescent years should be the starting point for programs aimed at preventing young people from developing the habit of smoking, as this is one of the risk factors connected with smoking.