Passive smoking and cardiometabolic risk factors in Iranian children and adolescents: CASPIAN-V study

  • Mehdi Ebrahimi
  • Mohammadreza Hashemi Aghdam
  • Mostafa Qorbani
  • Faeze Abbaspour Kaboodan
  • Gita Shafiee
  • Fatemeh Khatami
  • Zeinab Ahadi
  • Mohammad Esmaeil Motlagh
  • Hasan Ziaodini
  • Majzoubeh Taheri
  • Roya KelishadiEmail author
  • Ramin HeshmatEmail author
Research article



Smoking behavior as a harmful trend among adolescents and young adults has increased over last two decades. Many children and adolescents are at the risk of “second-hand” smoking at home due to their exposure to parents’ or siblings’ smoking. These second hand smokers are called “passive smokers” and are at risk of several health complications like cardiometabolic risk factors.


The present study aims to evaluate the association between passive smoking and increase of cardiometabolic risk factors in a sample of Iranian’s children and adolescents, aged 7–18 years.


This multicenter cross-sectional study was carried out over 14,400 students (aged 7–18 years). Blood sampling were randomly collected from a sub-sample of 4200 selected pupils. According to their degree of exposure to smoke for both cigarette and hookah, water pipes that are used to smoke specially made tobacco that comes in different flavors, all participants were divided to the two separate groups of positive and negative exposure. Metabolic syndrome (MetS) is defined as a constellation of at least three out of five cardiometabolic risk factors, including abdominal obesity, elevated blood pressure, elevated fasting plasma glucose concentration, high serum levels of triglycerides (TG), and depressed high-density cholesterol (HDL-C) levels.


The mean and standard deviation (SD) age of participants was 12.3 ± 2.24 years. 49.4% were girls and 71.4% of them were urban residents. The mean SD for BMI of participants was 18.5 (4.7) Kg/m2. The mean TG levels were considerably higher among passive smoker children and adolescents. MetS and being overweight were found to have a major association with passive smoking (OR 1.63 CI 95% 1.17–2.29 P Value 0.004 and OR 1.21 95% CI 1.06–1.37 P Value 0.004, respectively).


This study confirms that passive smoking or second-hand smoking is linked with the increased prevalence of cardiometabolic risk factors and places children and adolescents at a higher risk of being overweight. Preventive strategies could be incorporated against passive smoking to recognize it as a health priority among children and adolescents.


Passive smoking Cardiometabolic factors Children and adolescents 



Special thanks to the Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences and Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences.


Mehdi Ebrahimi, Ramin Heshmat, and Roya Klishadi are main investigator of this study. Mohammadreza Hashemi Aghdam, and Faeze Abbaspour Kaboodan wrote the manuscript. Mostafa Qorbani analyses the data, Fatemeh Khatami edited the manuscript after reviewer comments, Gita Shafiee, Zeinab Ahadi, Mohammad Esmaeil Motlagh, Hasan Ziaodini, Majzoubeh Taheri were taking part in questionnaire completing.


There was no founding for this study and it was defined as part of a larger study.

Compliance with ethical standards

Conflict of interest

All authors declare that there is not any kind of conflict of interests.

Ethics approval

Participation in the survey was voluntary. The participants entered the survey after explaining the study objectives and protocols and obtaining oral assent from students and written consent from their parents. The research ethics committee of the Endocrine and Metabolism Research Center (EMRC) from Tehran University of Medical Sciences and ethics boards of Isfahan University of Medical Sciences approved the study protocol. All questionnaires and checklists were completed anonymously.


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Mehdi Ebrahimi
    • 1
    • 2
  • Mohammadreza Hashemi Aghdam
    • 1
  • Mostafa Qorbani
    • 3
    • 4
  • Faeze Abbaspour Kaboodan
    • 1
  • Gita Shafiee
    • 1
  • Fatemeh Khatami
    • 1
  • Zeinab Ahadi
    • 1
  • Mohammad Esmaeil Motlagh
    • 5
  • Hasan Ziaodini
    • 6
  • Majzoubeh Taheri
    • 7
  • Roya Kelishadi
    • 8
    Email author
  • Ramin Heshmat
    • 1
    Email author
  1. 1.Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences InstituteTehran University of Medical SciencesTehranIran
  2. 2.Department of Internal Medicine, Sina HospitalTehran University of Medical SciencesTehranIran
  3. 3.Non-communicable Diseases Research CenterAlborz University of Medical SciencesKarajIran
  4. 4.Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences InstituteTehran University of Medical SciencesTehranIran
  5. 5.Department of PediatricsAhvaz Jundishapur University of Medical SciencesAhvazIran
  6. 6.Health Psychology Research CenterEducation MinistryTehranIran
  7. 7.Office of Adolescents and School HealthMinistry of Health and Medical EducationTehranIran
  8. 8.Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable DiseaseIsfahan University of Medical SciencesIsfahanIran

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