Document Type : Original Article

Authors

1 Department of Public Health,

2 Department of Public Health

3 Department of Public Health, School of Health, Shiraz University of Medical Sciences, Shiraz

4 Department of Biostatistics, School of Health, Hamadan University of Medical Sciences, Hamadan,

5 Department of Public Health, School of Health, Shahid Beheshti University of Medical Sciences, Tehran

6 Department of Public Health, School of Health, Bushehr University of Medical Sciences, Bush

Abstract

The most important preventive measure is technique to resist against peer pressure. Any
educational program should design with an emphasis upon theories of behavioral change and
based on effective educational program. To investigate the interventions through educational
program in prevention of cigarette smoking, this paper has used the Extended Parallel
Process Model (EPPM). Materials and Methods: This study is a quasi‑experimental study.
Two middle schools were randomly selected from male students in Shiraz. Therefore, we
randomly selected 120 students for the experimental group and 120 students for the control
group. After diagnostic evaluation, educational interventions on the consequences of smoking
and preventive skills were applied. Results: Our results indicated that there was a significant
difference between students in the control and experimental groups in the means of perceived
susceptibility (P < 0.000, t = 6.84), perceived severity (P < 0.000, t = −11.46), perceived
response efficacy (P < 0.000, t = −7.07), perceived self‑efficacy (P < 0.000, t = −11.64),
and preventive behavior (P < 0.000, t = −24.36). Conclusions: EPPM along with educating
skills necessary to resist against peer pressure had significant level of efficiency in improving
preventive behavior of cigarette smoking among adolescents. However, this study recommends
further studies on ways of increasing perceived susceptibility in cigarette smoking among
adolescents.

Keywords

1. Christophi CA, Savvides EC, Warren CW, Demokritou P,
Connolly GN. Main determinants of cigarette smoking in youth
based on the Cyprus GYTS. Prev Med 2009;48:232‑6.
2. Bawazeer AA, Hattab A, Morales E. First cigarette smoking
experience among secondary school students in Aden, Republic
of Yemen. East Mediterr Health J 1999;5:440‑9.
3. Gu D, Wu X, Reynolds K, Duan X, Xin X, Reynolds RF. Cigarette
Smoking and Exposure to Environmental Tobacco Smoke in China:
The International Collaborative Study of Cardiovascular Disease in
Asia. Am J Public Health 2004;94:1972‑6.
4. World Health Organization (WHO). Tobacco: WHO region. Available
from: http://www.who.int/healthinfo/WHS2012_CORRIGENDUM.
pdf [Last accessed on 2012 Dec 18].
5. World Health Organization (WHO). Tobacco: WHO Report on
the Global Tobacco Epidemic, 2011. Available from: http://www.
who.int/tobacco/surveillance/policy/country_profile/irn.pdf[Last
accessed on 2012 Dec 25].
6. Mannino DM, Moorman JE, Kingsley B, Rose D, Repace J. Health
effects related to environmental tobacco smoke exposure in
children in the United States: Data from the Third National Health
and Nutrition Examination Survey. Arch Pediatr Adolesc Med
2001;155:36‑41.
7. Rauh VA, Whyatt RM, Garfinkel R, Andrews H, Hoepner L, Reyes A,
et al. Developmental effects of exposure to environmental
tobacco smoke and material hardship among inner‑city children.
Neurotoxicol Teratol 2004;26:373‑85.
8. Jamrozik K. Estimate of death attributable to passive smoking among
UK adults: Database analysis. BMJ 2005;330:812‑5.
9. Dowdell EB, Santucci ME. Health risk beahavior assessment:
Nutrition, Weight and tobacco use in on urban seventh‑grade class.
Public Health Nurs 2004;21:128‑35.
10. Jones S, Sharp D, Husten C, Crossett L. Cigarette acquisition and
proof of age among US high school students who smoke. Tob
Control 2002;11:20‑5.
11. Dalton MA, Beach ML, Ada‑Mejia AM, Longacre MR, Matzkin AL,
Sargent JD, et al. Early exposure to movie smoking predicts
established smoking by older teens and young adults. Pediatrics
2009;123:551‑8.
12. Husten CG. Smoking cessation in young adults. Am J Public Health
2007;97:1354‑6.
13. Chang HY, Wu WC, Wu CC, Cheng JY, Hurng BS, Yen LL. The
incidence of experimental smoking in school children: An 8‑year
follow‑up of the child and adolescent behaviors in long‑term
evolution (CABLE) study. BMC Public Health 2011;11:844.
14. Conley Thomson C, Siegel M, Winickoff J, Biener L, Rigotti NA.
Household smoking bans and adolescents’ perceived prevalence of
smoking and social acceptability of smoking. Prev Med 2005;41:349‑56.
15. Fakhfakh R, Hsairi M, Belaaj R, Romdhane H, Achour N.
Epidemiology and prevention of smoking in Tunisia. current
situation and perspectives. Arch Inst Pasture Tunis 2001;78:59‑67.
16. Ramlau R, Ditdkowska J, Wojciechowska U, Tarkowski W.
Tobacco smoking in Wielkopolska towards the end of 20th century.
Pneumonal Alergol Pol 2005;73:128‑34.
17. Mohtasham Amiri Z, Cirus Bakht S, NikRavesh Rad R. Cigarette
smoking among male high school students in Rasht. J Guilan Univ
Med Sci 2008;17:100‑7.
18. Lloyd‑Richardson EE, Papandonatos G, Kazura A, Stanton C,
Niaura R. Differentiating stages of smoking severity among
adolescents: Stage‑specific psychological and social influences.
J Consult Clin Psychol 2002;70:998‑1009.
19. Ayatollahi SA, Mohammadpoor asl A, Rajaeefard AR. Predicting
the stages of smoking acquisition in the male students of Shiraz’s
high schools, 2003. Nicotine Tob Res J 2005;7:845‑51.
20. Alexander C, Piazza M, Mekos D, Valente T. Peer, schools, and
adolescent cigarette smoking. J Adolesc Health 2001;29:22‑30.
21. Mercken L, Candel M, van Osch L, de Vries H. No smoke without
fire: The impact of future friends on adolescent smoking behavior.
Br J Health Psychol 2011;16:170‑88.
22. Golbasi Z, Kaya D, Cetindag A, Capik E, Aydogan S. Smoking
prevalence and associated attitudes among high school students
in Turkey. Asian Pac J Cancer Prev 2011;12:1313‑6.
23. Gasparotti C, Limina RM, Donato F, Comincini F, Facchi G, Festa A,
et al. A survey to assess consumption, attitudes and knowledge
regarding tobacco smoke amongst secondary school students in
Brescia (Italy). Ig Sanita Pubbl 2010;66:623‑35.
24. Maatoug J, Harrabi I, Gaha R, Bouyahia O, Gaha M, Kebaili R, et al.
Intervention on smoking in adolescents in Sousse, Tunisia. Rev
Pneumol Clin 2010;66:179‑86.
25. Witte K. Fear as motivator, fear as inhibitor: Using the extended
parallel process model to explain fear appeal successes and
failures, In: Andersen PA, Guerrero LK, editors. The Handbook of
Communication and Emotion: Research, Theory, Applications, and
Contexts. San Diego: Academic Press; 1998. p. 423‑50.
26. Witte K, Cameron KA, McKeon JK, Berkowitz JM. Predicting risk
behaviors: Development and validation of a diagnostic scale.
J Health Commun 1996;1:317‑41.
27. Wong NC, Cappella JN. Antismoking Threat and Efficacy Appeals:
Effects on Smoking Cessation Intentions for Smokers with Low and
High Readiness to Quit. J Appl Commun Res 2009;37:1‑20.
28. Witte K, McKeon JK, Cameron KA, Berkovitz JM. The risk behavior
scale: A health educator’s tool. Michigan State University. 1995.
Available from: https://www.msu.edu/~wittek/rbd.htm [last
accessed on 2009 June 15].
29. Gharlipour Gharghani Z, Seyyed Hazavehei MM, Sharifi MH,
Nazari M. Study of cigarette smoking status using extended parallel
process model (EPPM) among secondary school male students in
Shiraz city. Jundishapur J Health Sci 2010;2:26‑36.
30. Witte K, Allen MA. Meta‑analysis of fear appeals: Implications
for effective public health campaigns. Health Educ Behav
2000;27:591‑615.
31. Hong H. An extension of the extended parallel process model (EPPM)
in television health news: The influence of health consciousness on
individual message processing and acceptance. Health Commun
2011;26:343‑53.
32. Pechmann C, Zhao GZ, Goldberg ME, Reibling ET. What to convey in
antismoking advertisements for adolescents: The use of protection
motivation theory to identify effective message themes. J Mark
2003;67:1‑18.
33. Sharot T, Korn CW, Dolan RJ. How unrealistic optimism is
maintained in the face of reality. Nat Neurosci 2011;14:1475‑9.
34. Harris AJ, Hahn U. Unrealistic optimism about future life events:
A cautionary note. Psychol Rev 2011;118:135‑54.
35. Allahverdi Pour H, Heidar Nia AR, Kazem Nezhad A, Witte K,
Shafiei F, Azad Fallah P. Applying fear appeals theory for preventing
drug abuse among male high school students in Tehran. Scientific
J Hamadan Univ Med Sci 2006;13:43‑50.
36. Arnett JJ. Optimistic bias in adolescent and adult smokers and
nonsmokers. Addict Behav 2000;25:625‑32.
37. Ziaadini H, Kheradmand A, Nakhaee N, Taherzadeh H. Prevalence
of cigarette smoking and relevant factors among school students
in south of Iran. J Fundamentals Ment Health 2008;10:239‑45.38. Sharifi‑rad GH, Hazavei MM, Hasan‑zadeh A, Danesh‑amouz A.
The effect of health education based on health belief model on
preventive actions of smoking in grade one, middle school students.
Arak Med Univ J 2007;10:79‑86.
39. Rahnavard Z, Mohammadi M, Rajabi F, Zolfaghari M. An educational
intervention using health belief model on smoking preventive
behavior among female teenagers. J Fac Nurs Midwifery Tehran
Univ Med Sci 2011;17:15‑26.
40. Rogers RW. A protection motivation theory of fear appeals and
attitude change. J Psych 1975;91:93‑114.
41. Maddux JE, Rogers RW. Protection motivation and self‑efficacy:
A revised theory of fear appeals and attitude change. J Exp Soc
Psychol 1983;19:469‑79.
42. Witte K. Putting the Fear Back into Fear Appeals: The extended
parallel process model. Commun Monogr 1992;59:329‑49.
43. Cho H, Witte K. Managing fear in public health campaigns:
A theory‑based formative evaluation process. Health Promot Pract
2005;6:482‑90.
44. Lorenzo‑BlancoEI, BaresC, Delva J. Correlates of Children adolescents’
negative attitudes toward cigarettes: The role of gender, peer, parental,
and environmental factors. Nicotine Tob Res 2012;14:142‑52.
45. Schuck K, Otten R, Engels RC, Barker ED, Kleinjan M. Bidirectional
influences between parents and children in smoking behavior:
A longitudinal full‑family model. Nicotine Tob Res 2013;15:44‑51.
46. Rafiee A, Haghighizadeh MH, Pouryazdan M. Prevalence rate
and individual, familial and social characteristics associated.
Jundishapur J Health Sci 2010;1:16‑21.
47. Fujimoto K, Valente TW. Decomposing the components of friendship
and friends’ influence on adolescent drinking and smoking.
J Adolesc Health 2012;51:136‑43.
48. Zadeh S, Sadeghi A. Epidemiological study of cigarette smoking
in Urmia high school boys. Med J Tabriz Univ Med Sci Health Serv
2001;34:27‑32.
49. Leatherdale ST, Cameron R, Brown KS, McDonald PW. Senior
student smoking at school, student characteristics, and smoking
onset among junior students: A multilevel analysis. Prev Med
2005;40:853‑9.
50. Botvin GT, Griffin KW, Diaz T, Scheier LM, Williams C, Epstein JA.
Preventing illicit drugs use in adolescents: Long‑term follow‑up
data from a randomized control trial of a school population. Addict
Behav 2000;25:769‑74.
51. Lintonen TP, Konu AI, Rimpela M. Identifying potential heavy
smokers in early adolescence. Health Educ 2000;101:159‑68.
52. Moscato S, Black DR, Blue CL, Mattson M, Galer‑Unti RA, Coster DC.
Evaluating a fear appeal message to reduce alcohol use among
“Greeks”. Am J Health Behav 2001;25:481‑91.
53. Witte K. Fear control and danger control: A test of the extended
parallel process model (EPPM). Commun Monogr 1994;61:113‑34.
54. Kotowski MR, Smith SW, Johnstone PM, Pritt E. Using the Extended
Parallel Process Model to create and evaluate the response efficacy
of brochures to reduce the risk for noise‑induced hearing loss in
college students. Noise Health 2011;13:261‑71.
55. Valente TW, Hoffman BR, Ritt‑Olson A, Lichtman K, Johnson CA.
Effects of a Social‑Network method for group assignment strategies
on Peer‑Led Tobacco prevention programs in schools. Am J Public
Health 2003;93:1837‑43.
56. Ulgen H, Ozturk C, Armstrong M. Effect of self‑efficacy on Turkish
children’s perceptions of the advantages/disadvantages of smoking.
Asian Pac J Cancer Prev 2012;13:795‑8.
57. Asad Pour M, Ghofrani Pour F, Haji Zadeh S. The effect of group
discussion on smoking in male students of high school in Rafsanjan
city. Daneshvar Med J 2001;8:1‑6.