Predictors of shisha smoking among adolescent females in Western Iran in 2019: Using the Prototype-Willingness Model

INTRODUCTION: Given the increasing prevalence of shisha smoking (SS) in adolescent females, it is necessary to determine the factors influencing adolescent’s choice of shisha. This study aimed to determine predictors of shisha smoking among adolescent females in Western Iran based on the Prototype-Willingness Model (PWM). METHODS: This cross-sectional study was conducted on 1302 adolescent females in Kermanshah city, western Iran, in 2019. The method was multi-stage sampling with a systematic random approach. Data were collected using a questionnaire consisting of sociodemographic questions, history of shisha smoking, and Prototype-Willingness Model structure-based questions. Data were analyzed using SPSS 22 software. Statistical tests included descriptive statistics, Pearson correlation test, and linear and logistic regression analyses. RESULTS: The prevalence of current consumers of shisha was 20.4%. Attitude and behavioral willingness and subjective norms were the most important predictors of behavioral intentions, whereas subjective norms, attitudes, and prototypes were the most important predictors for behavioral willingness. The results obtained from the logistic regression analysis revealed that both pathways of PWM constructs (behavioral intention OR=1.37; behavioral willingness OR=1.32) were significant predicting factors for shisha smoking among adolescent females. CONCLUSIONS: Given the efficient role of behavioral willingness and intention for shisha smoking (SS) in adolescent females, it is necessary to consider these structures in designing educational strategies for the prevention of adolescent smoking.