Prevalence and Psychosocial Correlates of Traditional and Electronic Cigarette Use among Iraqi Secondary School Students
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Objective: Tobacco use in adolescence increases the risk of lifelong nicotine dependence and chronic disease. This study aimed to estimate the prevalence of traditional and electronic cigarette use among Iraqi secondary school students and to identify key psychosocial and social correlates of smoking behavior.
Methods and Materials: A descriptive cross-sectional survey was conducted in Babylon province using stratified random sampling. Data were collected from 1005 students aged 12–19 years in six public and three private secondary schools between December 2023 and January 2024 (response rate: 89.6%). A structured, self-administered questionnaire assessed sociodemographic characteristics, smoking status, type of tobacco product used, and social and cultural reasons for smoking. Data were analyzed in SPSS version 26, using descriptive statistics and logistic regression to examine associations between potential psychosocial factors and current smoking.
Findings: The mean age of participants was 16.5 years; 19.7% were current smokers. Among smokers, 56.6% used traditional cigarettes only, 23.2% used e-cigarettes only, and 20.2% reported mixed use. The mean age at smoking initiation was 14.2 years, and the average daily consumption was 13 cigarettes. Significant correlates of current smoking included peer influence, using smoking for stress relief, self-image–related beliefs, and parental smoking. In multivariable analysis, peer influence (OR=1.8, p<0.01), stress relief (OR=1.5, p<0.05), and parental smoking (OR=2.1, p<0.001) remained significant predictors.
Conclusion: Nearly one in five Iraqi secondary school students reports current use of traditional cigarettes and/or e-cigarettes. Peer and parental smoking, along with psychological stress, play central roles in adolescent smoking behavior. School-based prevention programs, family-focused interventions, and stricter control of flavored e-cigarettes and tobacco advertising are recommended to reduce smoking initiation in this age group.
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