Prevalence and Correlates of Health Risk Behaviors among High School Adolescents in Iran : With focus on Water-pipe Smoking, Suicide Ideation, Physical Activity and Nutrition

Background: Adolescence is a transitional stage from childhood into adulthood and many habits, with long-term implications for health, from this period of life can continue into adulthood. Identifying risk factors related to health risk behaviors is therefore an important part of health promotion. The main aim of this thesis was to analyze the prevalence and correlates of health risk behaviors among 15-17 year old high school adolescents in Iran. The risk behaviors explored in Papers I–IV include waterpipe smoking, suicide ideation, physical inactivity and sedentary behavior, and nutritional habits. Methods: Two-stage cluster sampling was used to select representative high schools and classes in the Iranian city of Tabriz. At the first stage, high schools were selected with a probability proportional to the enrollment size. At the second stage, classes were randomly selected, and all students in these selected classes were eligible to participate in the study. Overall, thirty high schools, including sixteen girls’ and fourteen boys’ high schools, ninety classes (grades 9 to 11) and 1,517 students, including 727 boys (47.9%) and 790 (52.1 %) girls participated in the study. The participants’ (students’) response rate was 84.27 %. A reliable, valid and anonymous self-administered Persian Version of the Global School-Based Student Health Survey (GSHS) questionnaire was used for data collection. Statistical methods used were Chi- square test, Fisher exact and multivariate logistic regression analyses. Results: Water pipe smoking: Overall, 21.6 % of students were classified as ever WP smokers and 9.7% as current smokers. Ten percent of students had started WP smoking when younger than 12. Ninety-one percent of current WP smokers smoked one session per day, 49% smoked at a café (Ghahvekhaneh). Ninety- five percent of students reported that their age did not prevent them from being served a WP. Ninety-one students out of 147 reported that they did not notice any health warning on the WP tobacco packages. Seven percent of students out of 1,517 participants reported that they would accept a WP if offered by their friends. Being in the third grade of high school, having experienced cigarette smoking, even one or two puffs, and accepting a WP offered by close friends showed significant odds ratios for ‘ever WP smokers’. Accepting a WP offered by close friends and gender (female) showed significant odds ratios for current WP smokers. Suicide ideation: Four percent of students had seriously considered attempting suicide in the past 12 months. Thirteen point two percent of students reported that they wanted to use alcohol or other drugs when they were worried. The results also revealed that 8.8% of students had been sexually abused. Also, 20.6% declared that they had been bullied in the past 30 days. Being worried, being a current cigarette smoker, consuming alcohol or other drugs and being sexually abused were significantly associated with suicide ideation. Physical activity/inactivity and sedentary behavior: The prevalence of physical inactivity (<5 days/Weeks) was 72.2% and sedentary behavior (sitting ≥3 h or more) 71.4%. Being female, having a higher BMI (being overweight or obese), walking/cycling to or from school on 1-4 days, sedentary behavior, low vegetable intake, being the victim of bullying, lack of parental support, peer support, and parental connectivity (protective factors) were directly associated with physical inactivity. Walking/cycling to or from school on 5-7 days was negatively associated with physical inactivity. Walking/cycling to or from school on 1-4 days, being physically inactive, inadequate fruit intake, and being bullied were positively associated with sedentary behavior. Fruit and vegetable intake: The prevalence of fruit intake was 76.1% (≥ 2 times/daily) and vegetable intake 23% (≥ 3 times /d). Low fruit consumption was associated with being an 11th grade student, sedentary behavior (sitting ≥3h/d), low intake of vegetables (intake < 3 daily), low or lack of parental support, low or lack of peer support, and the lack of enough food (hunger) at home. Low vegetable consumption was associated with higher BMI (overweight or obese), low consumption of fruit (< 2 daily), lack of peer support, and physical inactivity. Conclusion: Identified correlated factors (risk factors) should be taken into consideration by public health authorities in the development and implementation of interventions aimed at promoting health among students in the related areas.Vid tidpunkten för disputationen var följande delarbeten opublicerade: delarbete 3 (accepterat), delarbete 4 (manuskript).At the time of the doctoral defence the following papers were unpublished: paper 3 (accepted), paper 4 (manuscript).Global School Based Student Health Surve