Lifetime prevalence of tobacco use among high school students in Iran: a systematic review

The prevalence of smoking in the adolescence is a valuable indicator for prediction of national burden of smoking in the future. The aim of this systematic review is to determine the prevalence of lifetime smoking among high school students in Iran. Various search methods have been used including searching Pubmed, ISI, PsycINFO, CINAHL, Embase, IranMedex, IranPsych and database on drug abuse, as well as hand-searching. All original researches, which had described lifetime use of cigarette, hookah, and pipe among high school students were included in the study with no restriction on date of publication, and were qualitatively assessed. Subsequent to data extraction, heterogeneity test was carried out on indicators for which more than two studies were found and meta-analyses were performed. In total, 18 studies were included in this review. The combined prevalence of lifetime cigarette smoking for boys, girls and total high school students were calculated as 30.9% (95% confidence interval (CI): 25-36.8), 14% (95% CI: 7-20.9) and 21% (95% CI: 15.1-26.9), respectively. The combined prevalence of lifetime cigarette smoking for boys was significantly different (P<0.001) in the year 2001 and before (38.6%), with the years after 2002 (21.5%). In Iran, the prevalence of smoking in this age range is lower than many other countries and in recent years, a decreasing trend was found in boys. These findings can be attributed to the national control and prevention strategies. However, some studies have several qualitative limitations, which points to the necessity of high quality repeated surveys in the future.