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Joint Association of Active and Passive Smoking with Psychiatric Distress and Violence Behaviors in a Representative Sample of Iranian Children and Adolescents: the CASPIAN-IV Study

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Abstract

Background

Mental health and smoking have been receiving increasing attention in adolescents all over the world. Although some studies have assessed the independent association of active/passive smoking with mental health, joint association of active and passive smoking with mental health remains unclear.

Purpose

This study was designed to evaluate the joint association of smoking status (active and passive smoking) with psychiatric distress and violent behaviors in Iranian children and adolescents.

Method

In this national survey, 13,486 students, aged 6–18 years, living in rural and urban areas of 30 provinces of Iran were selected via multistage, cluster sampling method. Psychiatric distress (including worthless, angriness, worrying, insomnia, confusion, depression, and anxiety), violence behaviors (including bullying, victim, and physical fight), and smoking status (nonsmoker, only passive smoker, only active smoker, and active and passive smoker) were assessed. The questionnaire was prepared based on the World Health Organization Global School-based Student Health Survey (WHO-GSHS). Data were analyzed by the Stata package.

Results

Psychiatric distress and violent behaviors had linearly positive association with smoking status (p trend < 0.001). Compared to “nonsmoker” group, participants who were exposed to passive smoking besides active tobacco use were at increased risk of having angriness (odds ratio (OR) 2.55, 95 % confidence interval (CI) 1.86–3.48), worrying (OR 1.66, 95 % CI 1.24–2.20), and anxiety (OR 1.99, 95 % CI 1.52–2.61) and victim (OR 1.77, 95 % CI 1.34–2.33) and bully behaviors (OR 3.08, 95 % CI 2.33–4.07).

Conclusion

The current findings suggest that active and passive tobacco smoking has synergistic effect on psychiatric distress. Since majority of smokers with psychiatric distress do not receive mental health services or counseling on smoking, strategies to address mental health problems and smoking prevention should be included as a part of school health services.

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Acknowledgments

This study was performed by contribution of the Ministry of Health and Medical Education, Ministry of Education and Training, universities of medical sciences nationwide, and students and their parents and school staff. The authors would like to forward sincere thanks to all organizations and the large team collaborating with this project.

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    Authors and Affiliations

    1. Pediatrics Department, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran

      Roya Kelishadi & Gelayol Ardalan

    2. Research Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran

      Amir Eslami Shahr Babaki

    3. Department of Community Medicine, Alborz University of Medical Sciences, Karaj, Iran

      Mostafa Qorbani

    4. Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran

      Mostafa Qorbani, Zeinab Ahadi, Ramin Heshmat & Asal Ataie-Jafari

    5. Pediatrics Department, Ahvaz University of Medical Sciences, Ahvaz, Iran

      Mohammad Esmaeil Motlagh

    6. Department of Medical Emergencies, Qom University of Medical Sciences, Qom, Iran

      Hamid Asayesh

    7. Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran

      Rasool Mohammadi

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    1. Roya Kelishadi
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    Correspondence to Mostafa Qorbani or Ramin Heshmat.

    Additional information

    Mostafa Qorbani and Ramin Heshmat contributed equally to this work.

    Appendix

    Appendix

    Table 5 List of questions for psychiatric distress and violent behaviors according to the Global School-based student Health Survey (GSHS) questionnaire
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    Kelishadi, R., Babaki, A.E.S., Qorbani, M. et al. Joint Association of Active and Passive Smoking with Psychiatric Distress and Violence Behaviors in a Representative Sample of Iranian Children and Adolescents: the CASPIAN-IV Study. Int.J. Behav. Med. 22, 652–661 (2015). https://doi.org/10.1007/s12529-015-9462-6

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