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Decomposition of passive smoking inequality in Iranian children and adolescents: the CASPIAN-V Study

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Abstract

To investigate the socioeconomic inequality in passive smoking in Iranian children and adolescents. Through a multistage random cluster sampling method, a representative sample of 14,400 school students, aged 6–18 years, were enrolled from urban and rural areas of 30 provinces of Iran. Using a non-linear principal component analysis (NLPCA), the correlated variables were summarized as socioeconomic status (SES). Normalized concentration index (NCI) was used to measure inequality in passive smoking at national and regional SES levels. We decomposed total socioeconomic inequality in passive smoking into explanatory variables to identify the main contributors of inequality in passive smoking in the population studied. Data of 12,327 students and parents were complete for the current study. The response rate was 85.6% (50.9% boys, 71.2% urban residents). About 44% of Iranian students were exposed to passive smoking. The NCI for passive smoking at a national level was − 0.043 (95% confidence interval − 0.035, − 0.012), indicating that passive smoking was more concentrated among poorer children and adolescents. This inequality was statistically significant at a national level and in all regions except for regions with lower middle- and lowest SES levels. Considering the decomposition analysis, the household SES (63%), mothers’ educational level (37%), fathers’ educational level (29%), and school type (18%) made the largest positive contribution to inequality in passive smoking of children and adolescents. Passive smoking was distributed unequally among Iranian children and adolescents; it was more concentrated among socioeconomically disadvantaged families. Public health policies attentions should be given to reduce passive smoking among low SES children and adolescents living with illiterate or low-educated parents.

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Acknowledgement

The authors are thankful of the large team working on this study and all participants in different provinces.

Source of funding

This study was conducted by using the data of a national school-based surveillance program.

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Author notes

  1. Mostafa Qorbani and Roya Kelishadi equally contributed as to this study.

Authors and Affiliations

  1. Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

    Mostafa Amini Rarani

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

    Ramin Heshmat, Armita Mahdavi-Gorabi & Zeinab Ahadi

  3. Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran

    Ramin Heshmat

  4. Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran

    Shirin Djalalinia

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

    Mohammad Esmaeil Motlagh

  6. Health Psychology Research Center, Education Ministry, Tehran, Iran

    Hasan Ziaodini

  7. Office of Adolescents and School Health, Ministry of Health and Medical Education, Tehran, Iran

    Majzoubeh Taheri

  8. Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran

    Mostafa Qorbani

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

    Mostafa Qorbani

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

    Roya Kelishadi

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  1. Mostafa Amini Rarani
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Correspondence to Mostafa Qorbani or Roya Kelishadi.

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Rarani, M.A., Heshmat, R., Djalalinia, S. et al. Decomposition of passive smoking inequality in Iranian children and adolescents: the CASPIAN-V Study. Environ Sci Pollut Res 26, 18921–18929 (2019). https://doi.org/10.1007/s11356-019-05146-6

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