Prevalence and Predictors of Cigarette Smoking Stages among Male High School Students in Shahroud, Iran: A Latent Class Analysis

The aim of this study was to determine the prevalence of cigarette smoking stages and their predictors among male students using the Latent Class Analysis (LCA).

In this cross-sectional study, a questionnaire was administered to 1,100 adolescent male high school students in Shahroud, northeastern Iran. This study assessed their smoking behavior, attitudes, normative beliefs, and socio-demographic data. Smoking stages were classified based on a validated adolescent smoking behavior algorithm encompassing four smoking behavior indicators, and LCA was then used to identify distinct smoking behavior classes.

The three-class model was the one with the best fit (AIC3 = 1511.53). This model indicated an adequate fit and provided the most parsimonious and interpretable classification of smoking behaviors. The classes were named: non-smokers (prevalence: 75.4%, 95% CI: 72.7 –77.9%), experimental smokers (18.0%, 95% CI: 15.8-20.4%), and regular smokers (6.6%, 95% CI: 5.2-8.3%). These classes reflect a behavioral continuum ranging from no smoking experience to experimentation and regular cigarette use. A lower grade point average (GPA) was associated with higher odds of being an experimental smoker (adjusted OR = 0.78, 95% CI: 0.65–0.94). More positive attitudes toward smoking (adjusted OR = 1.90, 95% CI: 1.63–2.22), (Adjusted OR=1.68, 95% CI:1.46-1.94) and more permissive norms regarding cigarette use (adjusted OR = 1.48, 95% CI: 1.10–1.98), (adjusted OR = 1.46, 95% CI: 1.11–1.92) were associated with increased odds of membership in higher-risk smoking classes (exprimental and regular smoker, respectively). Living with parents was also associated with smoking class membership.

The LCA distinguished three different classes regarding the smoking behavior of males during adolescence. Regular smoking was less common than the figures mentioned for some adolescent populations around the world. Attitudinal and normative aspects were the main determinants of the classification into smoking classes.

The study highlights that smoking-related attitudes and norms should be addressed in adolescent smoking prevention programs for male students, especially for students with lower academic performance or non-traditional living arrangements.