Application of Social Cognitive Theory to Prevent Waterpipe Use in Male High‑school Students in Kerman, Iran

Mohammadreza Rajabalipour, Hamid Sharifi, Nouzar Nakhaee, Abedin Iranpour


Background: The growing supply and prevalence of waterpipe (WP) smoking among Iranian
adolescents have become a concern for both families and policymakers. The aim of this study was
to determine the factors underlying WP use and also to design an intervention program based on
social cognitive theory (SCT) aimed to reduce the demand for WP smoking among male adolescents.

Methods: This quasi‑experimental study involved 189 high‑school students in Kerman, Iran, who
were split into two groups, an intervention group and a control group. A validated questionnaire
based on SCT constructs was used to collect data. The intervention was performed over four
sessions with a focus on preventing WP smoking.

Results: Before intervention, the lifetime and
current‑use prevalence of WP smoking across both groups was 48.5% and 20.2%, respectively.
In the intervention group, the most change was related to knowledge score from 10.70 ± 4.38 to
16.52 ± 3.89 (P < 0.0001) and outcome values score from 12.40 ± 3.81 to 13.53 ± 4.23 (P = 0.007);
however, in the control group, no significant changes were seen in posttest scores. The scores for
self‑efficacy (P = 0.21), outcome expectations (P = 0.09), and environment constructs (P = 0.06)
did not show any statistically significant changes after the intervention in both groups. Overall, there
was no significant difference in the rate of WP smoking after the intervention.

Conclusions: Based
on the results of this study, although some construct scores showed significant differences after
the intervention, there was no significant change in the prevalence of WP smoking. More effective
educational interventions based on this theory but with a greater focus on self‑efficacy and
environmental influences may be warranted.

Keywords: Adolescent, social cognitive theory, student, waterpipe smoking

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