Smoking is one of the world's leading health problems these days, and may lead to a higher death rate than AIDS ⁽¹⁾. Unfortunately the prevalence of smoking among the people of developing countries is increasing. Cigarettes are addictive ⁽²⁾. Withdrawal from cigarette smoking is very difficult and that is the reason for preventing and reducing this worldwide problem. An overview of previous studies shows that most cigarette-smokers started smoking under the age of 18 and in the teenage period ⁽³⁾. This shows the necessity of providing programs and taking preventive measures on this problem in the mentioned age groups.

The prevalence of smoking is different in different parts of the world but the age of first smoking is somehow the same. Some examples can be shown in the following studies:

In a study done by Ford and his colleagues on 3,432 New Zealand young adults (14 and 15 years old) showed that one third of them were smokers.

In the year 1994, in Düsseldorf of Germany, a study showed that most of the fellows among 12-16 years old smoke at least one or two cigarettes among their friends and beyond the eyes of spectators mostly for satisfying their curiosity ⁽⁵⁾.

Bank and his co-workers during a study on 6330 students between 11-16 years old found out that 6% of males and 2.5% of females smoke more than a cigarette during a week ⁽⁶⁾.

Barruelo and his colleagues in the year 1999 during a study on high school students found out that 68% of males and 50.7% of females smoke and also the age of first smoking among males is much lower than females ⁽⁷⁾.

Widespread studies focusing on the prevalence and the pattern of smoking among young adults have not been conducted in Iran. But some scattered studies were done in different parts of Iran:

In a study done in the year 1367-68 (1988-89) in Esfahan in the 3rd stage of high school students showed that 22.5% of them were smokers and the first smoking age was among 10-13 years old ⁽⁸⁾.

In the year 1363 (1984) in Kerman, Jamalian and his colleagues during a study using a questionnaire on 387 males and 324 females of the last stage of high school students and 83 male-scholars in arts studying in the last stage of industrial school, got these results: 40.54% of boys, 13.81% of girls and 45.22% of male-scholars were smoking at least a cigarette every week during a 3 month period ⁽⁹⁾.

Based on the study done in the year 1372 (1993) by Dr.Mohammad and his colleagues with the aim of determining the pattern of smoking in the country, 66.3% of smokers (70.6% males and 34.4% females) stated that the age of first smoking was between 15-24 years old, i.e. during the age of their high school, serving in the army and university period. Their conclusion was the necessity for programming on the mentioned periods ⁽¹⁰⁾.

In a wide study done by Dr.Mohammad and Noorbala in the framework of Health and Disease Project working on these two items in the year 1378 (1999) including the pattern of smoking, paid attention to the first smoking age among smokers of Tehran province which is said to be 20 years old ⁽¹¹⁾.

In this cross-sectional study 4023 pre-university students including 2018 females and 2005 males were studied, using a questionnaire. School and classes were selected by systematic cluster method. Co-workers had the psychiatric license and had participated in special courses. In each class at first they insisted on the privacy of the information gathered from students and the importance of their true answers. They explained the aim and the pattern of the study. Also they explained how the students must fill in the questionnaire. The questionnaires were handed out among the students and they were asked not to write their names on it.

The questionnaire was self-made and its validity and reliability was searched. It contained 58 questions, designed for studying the prevalence of first smoking age, and related factors to smoking, among students.

So the prevalence of smoking and the age of first smoking were determined.

In this survey the individuals were put into 3 categories based on their experience of smoking:

1. Smoker: an individual who smokes at least a cigarette once a week.
   
2. Experienced smoker: an individual who has smoked cigarettes at least once until now, and is not included in the upper category.
   
3. Non-smoker: an individual who didn't smoke a cigarette even once.
   
   

These results were obtained after analyzing the data:

35% of boys and 26.9% of girls in this study had an experience in smoking cigarettes and 7.2% of males and 1% of females were smokers.

Among the individuals who had experience in smoking before entering the pre-university period, the possibility of becoming smoker was 20% for boys and 3% for girls. This shows a significant difference between males and females (P<0.0001).

The mean age of starting smoking in female-smokers was 14.3 while it was 14 for females who had experience in smoking.

9% of the females who were smokers or had experience in smoking had their first experience before 6 (before schooling age)

The mean age of starting smoking in males was 14.4 while this was 13.7 in males who had experience in smoking. 4.5% of these two groups had their first experience before schooling age (i.e. before 6 years old).

The time pattern of having experience in smoking, separating the sexes is shown in Figure (1).

Click here to view Table 1

According to information released by C.D.C., most of the adult smokers started smoking less than 18 years old and in adolescence ⁽³⁾. In comparison with a study done by Ford and his colleagues in the year 1997 in New Zealand ⁽⁴⁾, which indicates that 1/3 of adolescents of 14-15 years old are smokers in New Zealand, the prevalence of new smokers in our study group is less than that in New Zealand. In this research the prevalence of being smokers is 1% among females and 7.2% among males.

In this study it can be understood that there are two peaks, for the first experience of smoking cigarette in the ages of 9 and 13 years old. Fig and Table 1 show that the experience of smoking is increased about 13 years old. Because this study is focused mostly on 17 year olds, nothing can be said about their future smoking trends. In different studies this figure is drawn for only smokers. According to the Table 1 if Fig.1 is drawn only for smokers, the mentioned frequency is decreased. This information is gathered according to the proportion of smokers, to all of the experienced smokers, which is about 1/5 in boys and approximately 1/20 in girls. The pattern of smoking in this study is similar to the one done in Düsseldorf in the year 1994 ⁽⁵⁾. In Düsseldorf's study, the first experience of smoking cigarette is mentioned to be between 12-16 years old. Bank and his colleagues in England in the year 1978 studied a population of more than 6000 students which showed 6% tendency in boys and 2.5% in girls for smoking more than a cigarette during a week ⁽⁶⁾. This finding is similar to our pattern of smoking more than a cigarette during a week which is 7.2% among the studied males, while it is 2.5 times less than the other study which was only 1% in females. In comparison to the other study done in the year 1995 by Barruelo and his colleagues in Spain on high school students ⁽⁷⁾, the rate of smoking among boys and girls was much higher than our results. Also the age of first smoking in boys was much lower than girls, which is different from our results.

A specific study focusing on the prevalence and pattern of smoking among young adults is not done in Iran but the results obtained from a few other studies were beneficial, including a study done in the year 1367-68 (1988-89) in Esfahan ⁽⁸⁾ 22% of studied male students were smokers, which is higher than our results but the age of the first experience in these two studies is the same.

In the study done by Jamalian and his co-workers in the year 1363 (1984) in Kerman ⁽⁹⁾ on last year high school students, the prevalence in two sexes is much higher than ours. Dr.Mohammad and his colleagues ⁽¹⁰⁾ studied the trend of varying prevalence of smoking between the years 1370 (1991) and 1378 (1999) but the number of 15-19 years old cases was very few and also the information on this age range was not released separately, so it cannot be a basis for comparison to our study.

In a report by Noorbala and Mohammad ⁽¹¹⁾, the percentage of smokers in the 3 main districts of Tehran, which are under the supervision of Iran, Shahid Beheshti and Tehran University of Medical Sciences, in the year 1378 (1999) were 13.2%,13.3%, and 12.8%, respectively. In this report there was no categorisation according to age and sex but on the whole, the percentage given was more than 1% in girls and 7.2% in boys who were under study. Regarding the differences in the age groups of these two studies the mean age was 17.8 in our study but in Noorbala's was 15 and more). It can be understood that the trend of becoming a smoker is considerable in the ages above the pre-university ages.

The age median of starting smoking in smokers in the mentioned districts of Tehran was reported to be 20 years old ⁽¹¹⁾. This means that at most, half of the smokers after 20 started smoking, but this is not the age median of smoking in the whole society, because a number of the smokers may start smoking in the ages more than the mentioned one. Also Dr.Mohammad and his colleagues in another study showed that in the range of 40-69 years old, 18% of females and 35.5% of males, and in the range of 25-39 years old, 37.3% of females and 45.5% of males started smoking at the ages lower than 20 ⁽¹²⁾. On the basis of different studies done in Iran, the age median of starting smoking is 20 ^{(11, 12)} and becoming smoker in the adolescence period and above 20 is very important, for instance the following can be mentioned:

Becoming a smoker is more dangerous due to its cumulative effect of smoking during a long period and can make the user more susceptible to different diseases.

Becoming addicted to cigarettes in these ages can pave the way for addiction to other drugs.

A smoker can make his or her friends become smokers in future.

According to all of the information gathered from different studies and comparing them with each other, this can be concluded that males are more susceptible for becoming smokers than females due to the fact that the ………… (O.R) of becoming smoker and experiencing cigarette among males is much higher than females. Thus this shows the necessity to pay more attention to the danger of first experience in smoking and becoming smokers among males.

It can be seen that there are two jumps in the rate of first experience in smoking according to the age domain (the first one in 9 and the other one which is more obvious is about 13). These two periods can be made clear according to the known facts of these two ages (before and during the attaining puberty) in the life of children and adolescents ^{(13, 14)}.

Children after passing a period of stillness and tranquility, which is between the years of late 6 to about 10 - Froyd names it the period of incubation- show the primary signs of puberty in the form of changing in moods and primary attempts for obtaining experiences like adults. The readiness for experiencing the cigarette and obtaining the experiences similar to adults can be interpreted to the basis of playing a role or imitating adults.

The early period of attaining puberty - about 13- shows great sensitivity of their life due to known factors resulting from physical, emotional, mental, and social changes.

The confusion of their behaviors, are known as the results of the four mentioned factors in this period (15). Considering the Crisis hypothesis or not, it is obvious that adolescents are more susceptible in this period (14). Becoming smokers in this phase, due to its age characteristics and susceptibilities resulted from special attention to giving information, strengthening and mental health is needed (Polygern) ⁽¹⁵⁾.

Also it is worthy of attention that the age of beginning the use of cigarettes among smokers (males and females) is a little bit higher in comparison to the others who just experienced it and did not become smokers. This pattern needs more studies in future.

It can be definitely said that more attention and programming is needed for these two age ranges which are 9 and 13 and taking preventive measures should be considered. The reader should pay attention to this fact that the studied population was only pre-university students who were studying in this stage. Thus the students who did not study in this stage due to any reasons such as being married, working or other limitations are not concluded in this population. This group could have a specific pattern and trend of smoking which may be similar to or different from the studied population and needs its own studying. It seems that the high risk ages of our adolescents needs its own information, preparation for encountering with their problems such as smoking. The youth need to be well-prepared with knowledge and information about their high risk behavior so it can protect them initially against threats and dangers.

Figure 1

Figure (1): Cumulative Frequency of Experience of Smoking based on Timing and Separating the Sexes, in all of the Experienced Individuals (Smokers and Experienced Smokers)

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Table 1. Shows the Age Distribution of First Smoking among Smoker and Experienced Smoker Students Separating their Sexes

· 1996 out of 2013 female students, who were studied, answered the question
· 1969 out of 2005 male students answered the mentioned question

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