Prevalence of smoking, alcohol consumption, and drug abuse in Iranian adults: Results of Azar Cohort Study.

Background: Substance abuse has significant health impacts on families and society as a whole. We aimed to provide detailed prevalence estimates of substance abuse among the Azar Cohort Study respondents in Tabriz, Iran. Methods: Data on 15006 participants of Azar Cohort Study were analyzed. The variables included tobacco smoking, alcohol use, drug abuse, and socio-demographic characteristics. The prevalence of substance abuse (with a 95% confidence interval) was calculated using the direct standardization method. Results: Overall, 9.3% and 6.2% of the participants were regular and heavy cigarette smokers, respectively. Also, 1.9% and 2.1% of participants reported a history of using illicit drugs and alcohol, respectively. Substance abuse was more prevalent among males than females. Substance abuse varied significantly with age and socioeconomic variables. Conclusion: We identified specific demographic and socioeconomic groups with a higher prevalence of all studied behaviors. Such high-risk groups should be targeted when designing substance abuse prevention programs.

Factors associated to patients' referral to public or private Covid-19 healthcare centers in Tabriz, Iran.

BACKGROUND: In Iran, tracking of patients and its associated data recording in private healthcare centers are poor, and thus a majority of patients suffering from Covid-19 are treated without any control on the isolation and quarantine processes. The present study aims to investigate the factors contributed to referral to private or public healthcare centers that provide Covid-19 care services. METHODS: This cross-sectional study was conducted from November 2021 to January 2022 in Tabriz, Iran. We invited a total of 258 and 202Covid-19 patients from governmental and private healthcare centers, respectively, to participate in the study by convenient sampling method. Applying a self-administered questionnaire, we collected data on the reason of referring to the healthcare centers, patient's waiting time, quality of healthcare services received by the patients, patients' level of satisfaction, accessibility, insurance coverage, perceived severity of the disease, and the level of staff compliance from health protocols. Logistic regression model was used for data analysis by using SPSS-26 software. RESULTS: Adjusted for other variables, higher socio-economic status (AOR (Adjusted Odds Ratio) = 6.64), older age (AOR = 1.02), referral of friends and family members (AOR = 1.52), shorter waiting time (AOR = 1.02) and higher satisfaction (AOR = 1.02) were contributed to referral to private centers. Better accessibility (AOR = 0.98) and wider insurance coverage (AOR = 0.99) were also contributed to referral to governmental centers. CONCLUSION: Providing more appropriate insurance coverage by private healthcare centers, and promoting their level of accessibility seems to promote patients' referral to such centers. Moreover, establishing an accurate system for recording patients' information and follow up in private centers might promote the role of private healthcare centers in managing the overload of patients on healthcare system during such epidemics.

Investigation of the Factors Related to Mortality and Length of Hospitalization among COVID-19 Patients in East Azerbaijan Hospitals, Iran.

BACKGROUND: It is of utmost importance to identify populations with an elevated risk for COVID-19 and the factors influencing its outcomes. The present study aimed to investigate factors affecting mortality and length of stay (LOS) among COVID-19 patients in the hospitals of East Azerbaijan province, Iran, during 15 months of this pandemic. STUDY DESIGN: The present study followed a retrospective cohort design. METHODS: This retrospective study was conducted using data in the integrated syndromic surveillance system (ISSS) on patients admitted to the hospitals from February 21, 2020, to April 11, 2021. The association between variables of interest and death, as well as LOS, was investigated via multiple logistic regression and multiple linear regression analyses. RESULTS: In total, 24 293 inpatients with a mean age of 54.0 ± 19.4 years were included in this study. About 15% of them lost their lives, whose mean age was 69.0 ± 14.6 years, significantly higher than the recovered ones (P < 0.001). Factors, such as above 49 years of age (P < 0.001), male gender (OR = 1.17; 95% CI: 1.08-1.26), and having chronic diseases (OR = 1.32; 95% CI: 1.22-1.42), were correlated with patient mortality. In addition, having chronic diseases (Beta = 0.06; 95% CI: 0.03-0.08) was associated with higher LOS in hospitals. CONCLUSION: In conclusion, older patients were at a higher risk of mortality and prolonged hospitalization. Furthermore, patients' underlying diseases could cause a severe form of COVID-19, which can lead to death and increase patients' LOS.

Psycho-behavioral predictors of uncontrolled blood pressure: A case-control study.

Background: We aimed to determine the role of demographic, lifestyle, and personality trait factors in predicting control of blood pressure (BP) among patients with hypertension (HTN) in West Azerbaijan, Iran. Methods: In this case control study we recruited participants from all primary health centers of Salmas city; who were at least 18 years of age, had a HTN diagnosis during the previous six months, and had a mandatory household record. Of 490 random subjects approached, 441 (84.2%) fulfilled our inclusion criteria (case: 221; control: 220). The age-matched controls were recruited from the same source population and were required to have controlled HTN. Data were collected through demographic Checklist, Ten-Item Personality Inventory (TIPI) and International Physical Activity Questionnaire (IPAQ). Results: Upon multivariate analyses, factors related to personality traits subdomains including extraversion personality (odd ratio [OR]: 0.85; CI: 0.73, 0.97) was effective in control of BP. Factors related to uncontrolled BP were agreement and consciences subdomains (OR 1.26 [CI: 1.07, 1.48] and OR 1.21 [CI: 1. 02, 1.44]), rare fruit consumption (OR 5.95 [CI: 1.24, 12.1]), Grade 1 and 2 obesities (OR 2.29 [CI: 1.28, 4.09] and OR 7.11 [CI: 2.21, 12.52]) and smoking (OR 3.27 [CI: 1.56, 6.89]). Conclusion: In addition to regular physical activity and fruit consumption and quitting smoking; personality traits such as Agreement and conscience personality traits were predictive of HTN control. We believe our work provides the required knowledge to design comprehensive HTN prevention programs by taking into account the multi-level causality approach.

Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio in Poststroke Depression: A Systematic Review and Meta-Analysis.

Objectives: Evidence shows that stroke-induced inflammatory responses play an essential role in the development of poststroke depression (PSD). The goal of this systematic review and meta-analysis was to critically evaluate the literature regarding the use of the neutrophil to lymphocyte ratio (NLR) as a reliable means to detect early PSD development, to help clinicians institute early interventions and improve outcomes. Methods: Electronic databases, including Web of Science, PubMed, Google Scholar, and Scopus, were searched, and eight studies were included. We assessed the certainty of the associations with GRADE methods. Results: We found that patients with PSD had higher NLR than the stroke patients with no depression (SMD = 0.51; CI 95% = 0.29-0.73, p < 0.001). Also, we found a significantly higher PLR in the patients with PSD when compared to the stroke patients with no depression (SMD = 0.66; CI 95% = 0.19-1.13, p < 0.001). Conclusion: These findings indicated that NLR and PLR could be considered inexpensive biomarkers for the prediction of PSD.

Psychometric properties of the Persian version of abridged Connor-Davidson Resilience Scale 10 (CD-RISC-10) among older adults.

BACKGROUND: Resilience is an ability of an individual to respond positively to environmental challenges. This ability could help elderly people to better cope with their age-related changes and diseases. The aim of this study was to examine the psychometric properties of Persian version of abridged Connor- Davidson scale of resilience among Iranian elderly people with chronic diseases. METHODS: Standard translation/back-translation procedure was applied to prepare the Persian version of abridged Connor-Davidson scale of resilience (CD-RISC 10-P) and its face and content validity were examined by an expert panel. The internal consistency and reliability of the drafted CD-RISC 10-P were investigated using the Cronbach's alpha and intra-class correlation coefficients. A sample of 400 Muslim and Zoroastrian Persian older adults residing in the city of Yazd, Iran was recruited to assess factor structure of CD-RISC 10-P using the confirmatory factor analysis. RESULTS: The calculated values of the Cronbach's alpha (0.89) and ICC (0.90) coefficients were in the within of acceptable range. The confirmatory factor analysis outputs also confirmed the unidimensionality of the CD-RISC 10-P (RMSEA = 0.073, SRMR = 0.030). CONCLUSIONS: The study findings showed that the CD-RISC 10-P is a valid and reliable scale to measure resilience with age-related challenges of chronic diseases among Persian-speaking elderly people. Cross-cultural adaptability of the CD-RISC 10-P is recommended to be assessed in different subgroups of the Iranian elderly people and possibly in other Persian-speaking populations of different countries.

Transition in Smoking Stages and Its Relationship with Family Psychological Function and Perceived Social Support in Adolescents of Tabriz, Iran.

BACKGROUND: There is limited information on the relationship between family psychological functions and perceived social support with progress in cigarette smoking stages in adolescents. This study was aimed to determine the relationship between family psychological function and perceived social support through a transition in different stages of cigarette smoking in adolescents of Tabriz, Iran. METHODS: In this study, 4,216 students (14-19 years old) from high schools were selected by multistage cluster sampling method. Initially, we used valid and reliable questionnaires for demographic characteristics, risk factors, Iranian family psychological function, and perceived social support. The smoking status questionnaire was administered twice, with an interval of 6 months. Data were analyzed using univariate and multivariate logistic regression analysis. RESULTS: Overall, 3,968 students with the mean (standard deviation) age of 15.96 (0.75) years completed the questionnaire in the first phase of the study. The results showed that lower levels of family psychosocial function (P < 0.001) and perceived social support (P < 0.001) in the univariate state were significantly associated with progress in cigarette smoking stages. By controlling the potential confounding factors, the weak and moderate family psychological function compared to the strong function increased the chance of progress in the cigarette smoking stages by almost 11 and 4 times, respectively (P < 0.001). The low and moderate level of perceived social support compared to the high level increased the chance of progress in cigarette smoking stages by almost 7 and 2 times, respectively (P < 0.001). CONCLUSIONS: It is suggested to perform an organized, precise, and operational planning for strengthening the family psychological functions and providing an appropriate social support condition among adolescents to prevent the tendency toward cigarette smoking and its more advanced phases.

Tendencies towards bottled drinking water consumption: Challenges ahead of polyethylene terephthalate (PET) waste management.

Background: The main objective of this study was to investigate the logics behind tendencies towards bottled drinking water usage in spite of availability of treated tap water. The amount of waste bottle is also estimated in Iran and managing principles for resolving the issue presented. Methods: A questionnaire was used to survey the logics behind tendencies toward bottled drinking water consumption among 120 participants. In order to estimate the quantities of the PET wastes produced in the country, data about bottled water production rate as well as volume of the imported and exported drinking bottled water were collected from 1962 to 2015 and applied in the calculations. Results: Findings suggested that about 0.026 to 3.86 billion liters (about 1.04 billion literson average) of bottled water was consumed annually between 2000 and 2015. Furthermore, bottled water consumption increased from 0.41 to 48.9 L/capita-year within the same time period. In the meantime, the plastic bottle waste generation rate rose from 12.84 to 1519.38 g/capita-year. There is no efficient and suitable system for managing and recycling waste bottles in the country. The perceived unreliability of tap water quality was the main reason of bottled water consumption among 74% of the respondents. Conclusion: To reduce bottled water consumption and the associated harmful environmental and health consequences, measures such as informing people, validating public water supply quality, preventive rules enactment, and establishing extended producer responsibility (EPR) are highly recommended.

Psychometric Rigor of the Brief Religious Coping Measure (RCOPE) in Persian-Speaking Older Adults.

Religious coping to deal with negative life events has gained considerable attention in recent years. This study was conducted to investigate psychometric properties of the Persian version of Brief RCOPE measure (RCOPE-P). The RCOPE-P was devised using a standard translation/back-translation procedure and its internal consistency and test-retest reliability were estimated using Cronbach's alpha and intraclass correlation coefficients. The instrument's factor structure was appraised in a sample population of 400 older adults with chronic diseases. Positive and negative subscales of the RCOPE-P indicated acceptable internal consistency (0.74, 0.80) and test-retest reliability (0.89, 0.91). Confirmatory factor analysis confirmed fitness of the original 2-factor model (root mean square error of approximation (RMSEA) = 0.046, CFI = 0.967, Tucker-Lewis index (TLI) = 0.953, and standardized root mean square residual (SRMR) = 0.052) to the data obtained from the study. The findings endorsed applicability of the RCOPE-P for the Persian-speaking older adults but its adaptability in other Persian-speaking population subgroups must be further examined.

Effects of a multi-level intervention on hookah smoking frequency and duration among Iranian adolescents and adults: an application of socio-ecological model.

BACKGROUND: The present study aimed to investigate the effects of a multi-level intervention on hookah smoking frequency and duration among Iranian adolescents and adults. METHODS: In this study, two comparable cities in Iran were selected to participate in an intervention program based on a social-ecological model (SEM). In each city, 133 hookah smokers in coffee houses were selected. Environmental changes in coffee houses such as serving light foods and games were conducted. A virtual group named "no hookah" was established on the Telegram application to train participants in the intervention group. Messages, pictures, and short videos were sent to the participants through that virtual network. The frequency and duration of hookah consumption were assessed in both groups at baseline and after the intervention. RESULTS: The frequency of hookah consumption decreased in 72.6% of participants in the intervention group (vs. 6.3% in the control group), and the duration of hookah consumption per session decreased in 39.5% of participants in the intervention group (vs. 5.5% in the control group). CONCLUSIONS: Using multi-level interventions through a social-ecological model can reduce hookah consumption in adults.

Health-risk behaviors among Iranian university students, 2019: a web-based survey.

BACKGROUND: High-risk behaviors are among the most serious threats for the physical and mental health of adolescents and young adults. Our aims in this study were to investigate the subgroups of students based on risky behaviors and to identify the prevalence rate of these subgroups. METHODS: This cross-sectional web-based survey was conducted from July to August 2019 in Tabriz, Iran. We performed proportional sampling in all nine universities of the city, according to the number of students in each university. Applying an online survey questionnaire, the data were collected from 3649 students and analyzed using Latent Class Analysis. RESULTS: For total sample, standardized prevalence rates of cigarette smoking, hookah use, alcohol consumption, substance abuse and unsafe sex were 18.5 (Confidence Interval (CI) 95%: 17.3-19.8), 9.1 (CI 95%: 8.2-10.1), 9.2 (CI 95%: 8.3-10.2), 8.3 (CI 95%: 7.4-9.3) and 14.5 (CI 95%: 13.3-15.7), respectively. Three latent classes of risky behaviors were determined among students: a) low risk b) smoking and c) high risk. About 18% of boys and 1.5% of girls were in the high risk class. Cigarette smoking (18.5%, CI 95%: 17.3-19.8) and substance abuse (8.3%, CI 95%: 7.4-9.3) were the most and the least common risky behaviors among the students. CONCLUSION: In this we-based survey, a considerable number of students, particularly boys (18%), was at high-risk class, stressing the need for preventive interventions for this group of youth. Our findings are beneficial for planning and development of risky-behavior preventive strategies to prevent high-risk behaviors among college students.

Relationship between Extraversion and Tobacco Smoking Among High School Students.

BACKGROUND: There is limited information about the relationship between extraversion, as a personality trait, and the modes of tobacco smoking. The aim of this study was to investigate the relationships between extraversion and cigarette and water-pipe smoking among a representative sample of Iranian high school students. METHODS: A sample of 2,312 tenth-grade students in Tabriz (Northwest of Iran) was selected through multistage proportional cluster sampling. Participants completed a self-administered questionnaire including information on cigarette smoking, water-pipe smoking, extraversion, socioeconomical information, as well as demographic characteristics. An ordinal logistic regression model was used for data analysis. RESULTS: In total, 4.2% and 3.5% of the students were regular cigarette and water-pipe smokers, respectively. The adjusted odds ratios were 1.10 (95% CI: 1.04-1.15, P < 0.001) and 1.10 (95% CI: 1.06-1.15, P < 0.001) for the relationships between extraversion and the stages of cigarette smoking and water-pipe smoking status, respectively. CONCLUSIONS: It seems that extraversion is in a positive relationship with a cigarette and water-pipe smoking among adolescents. Longitudinal studies are needed to examine the effect of this personality trait on the modes of tobacco smoking and the transition in the stages of cigarette and water-pipe smoking in adolescents.

Relationship Between Household Food Insecurity and Growth Disorders in Children Aged 3 to 6 in Qazvin City, Iran.

PURPOSE: Food insecurity, which is the inability to obtain food or inadequate food consumption in terms of quality and quantity, has physical and psychological consequences on children's health. This study aimed to investigate the relationship between children's growth disorders and food insecurity in Qazvin city, Iran. METHODS: A case-control study was conducted on 177 cases and 355 controls of children aged 3 to 6 years, who were referred to health centers in Qazvin city. The case group consisted of children with growth disorders. Data were obtained with the 18-item US Department of Agriculture questionnaire, a household socioeconomic questionnaire, a and growth monitoring card. The data were analyzed with using IBM SPSS Version 22.0, by independent sample t-test, chi-square test, and logistic regression. RESULTS: A significant relationship was found between children's growth disorders and household food insecurity with (p<0.05, odds ratio [OR]=17.0, confidence interval [CI]=5.9, 48.8) and without hunger (p<0.05, OR=2.69, CI=1.4, 4.9). There were also significant relationships between children's growth disorders and socioeconomic status (p<0.05, OR=3.4, CI=1.4, 8.5), the duration of breastfeeding (p<0.05, OR=0.94, CI=0.9, 0.98), and children's ages (p<0.05, OR=0.94, CI=0.92, 0.96). Sex and birth order, and the age of the parents was not found to be significantly related with growth disorders. CONCLUSION: Lower socioeconomic status and household food insecurity were the important predictors of children's growth disorders. Policymakers should focus more on promoting steady employment and income among family members. Nutritional education for mothers is also recommended, in order to better meet the nutritional needs of the children.

Environmental Tobacco Smoke and Educational Self-Regulation and Achievement in First Grade High School Students.

Environmental tobacco smoke, containing many toxic gases, suggests inevitable contact of humans with the damaging factors of cigarettes. On average, approximately 40% of children, 35% of women and 32% of men worldwide are exposed to environmental tobacco smoke. This study aims at investigating the relationship between environmental tobacco smoke in adolescents and their educational self-regulation and achievement. In this study, 770 students aged between 13 and 15 were selected and studied using the multistage sampling method. The tools used in this study consisted of four questionnaires, demographic characteristics, environmental tobacco smoke, educational self-regulation, and educational achievement. The validity and reliability of tools have been approved, and the data were analyzed using SPSS v22. The results indicated a significant inverse relationship between environmental tobacco smoke and students' educational self-regulation and achievement (p-value > 0.001). Given the relationship between exposure to environmental tobacco smoke and educational self-regulation and achievement, it is essential to keep children away from tobacco smoke. Family health and education policy-makers are recommended to design and operate fundamental schemes in order to deal with environmental tobacco smoke.

Development of a Hookah Smoking Obscenity Measurement Scale for Adolescents.

BACKGROUND: The worldwide trend of hookah use among adolescents is increasing, and literature shows a relationship between obscenity and adolescents' tendency toward hookah smoking. As there is a lack of appropriate instruments to measure the obscenity of hookah smoking, in the present study, we aimed to develop an instrument to measure hookah smoking obscenity among adolescents. METHODS: In this methodological study, a sequential exploratory design was used to conduct the study from February 2017 to July 2018 on adolescents in Tabriz, Iran. In the qualitative phase, we conducted semi-structured individual interviews (with 18 students) and a focus group discussion (FGD) (with 13 students) to explain the concept of obscenity and develop the items of hookah smoking obscenity scale (HSOS). We then examined the psychometric properties of the HSOS based on face, content, construct and predictive validities as well as internal consistency and repeatability. FINDINGS: The HSOS was developed with 21 items based on the results of qualitative data analysis. Applying confirmatory factor analysis (CFA), the χ2/degree of freedom (df) ratio was found to be 3.792 for the four-factor structure of the questionnaire and the fit indices of this structural model were satisfactory. The values of Cronbach's alpha and the intraclass correlation coefficient (ICC) for the constructs in the HSOS ranged 0.81-0.93 and 0.79-0.92, respectively. CONCLUSION: We found the HSOS with a good level of fit indices, validity, and reliability. The HSOS may be applied by school healthcare providers and health practitioners to find valid and reliable data on the obscenity of hookah smoking when developing hookah smoking prevention/cessation interventions among adolescents.

Non-Suicidal Self-Injury and Its Relationship with Family Psychological Function and Perceived Social Support among Iranian High School Students.

BACKGROUND: Non-suicidal self-injury (NSSI) has become one of the serious public health concerns among adolescents. Factors like family and social environment of adolescents may be important determinants of the NSSI. This study aimed to investigate the relationship between family psychological function and perceived social support with the NSSI experience among adolescents. STUDY DESIGN: A cross-sectional study. METHODS: Overall, 4216 high school students (15-18 yr old) of Tabriz City, northwestern Iran were selected using multi-stage cluster random sampling method in October and November 2017. Participants completed survey including demographic characteristics, NSSI status, Iranian family psychological function, and perceived social support. After six months, NSSI status was reassessed. The data were analyzed using logistic regression model. RESULTS: 8.5% of the students had NSSI experience. In addition, the weak family psychological function increased the odds of experiencing the NSSI by 13 times compared to the strong psychological function (OR = 13.15, 95% CI: 7.19, 23.80). Besides, the low level of perceived social support increased the odds of experiencing the NSSI by about 7 times compared to the high perception of social support (OR= 6.67, 95% CI: 4.01, 11.11). CONCLUSION: Low levels of psychological functioning of the families and perception of social support significantly can increase the odds of experiencing the NSSI among adolescents. Therefore, special attention should be paid to these factors in the development of relevant preventive programs in adolescence period.

Determinants of hookah smoking among men in the coffee houses: an application of socio-ecological approach.

BACKGROUND: Tobacco smoking is the second leading cause of death and is closely linked to fatal diseases. Hookah Smoking (HS) is a traditional way to smoke tobacco, especially in the Eastern Mediterranean region that is constantly rising around the world. This study aimed to evaluate the different levels of personal, interpersonal and social HS in Iranian urban men and determine the most important predictors of the levels through applying the socio-ecological approach (SEA). METHODS: This study was conducted in the coffee houses of Hashtrud and Qarah Aghaj counties in East Azerbaijan, Iran. Data collection was conducted from the entire coffee house (n = 18) from April to June 2017. Systematic sampling was employed to recruit 266 men in the coffee house. A valid and reliable instrument was used to investigate the frequency of HS and its determinants based on SEA. The SEA consists of three levels: personal (age, education, employment, income, and perceived severity and sensitivity), interpersonal (perceived reward), and social level (social support) intended to assess HS determinants. Hierarchical regression was used to determine the predictive value of SEA levels and frequency of HS. RESULTS: The mean age of daily hookah smokers (once per day and more than once per day) were (26.8) significantly lower than those (30.4) smokes weekly (once a week or more than once a week). The hierarchical logistic regression model showed that in the first step individual variables significantly predict 25.1% HS. In the second and third level interpersonal and social levels of SEA explained HS 30.1 and 30.8%, respectively. CONCLUSION: This study found that age, income, education, and perceived reward were all important factors influencing HS among men youth. Application of SEA to determine the factors associated with HS could contribute in the development of a holistic prevention program.

Epidemiology and Determinants of Self-Injury Among High School Students in Iran: a Longitudinal Study.

Non-suicidal self-injury (NSSI) among adolescents is a major health concern globally. The epidemiology and determinant of NSSI have not been studied extensively in Iran. Thus, this longitudinal study sought to investigate the prevalence, incidence and contributing factors of NSSI among adolescents in Iran. This study was conducted at high school students aged 14-18 years old in the metropolitan city of Tabriz, located in north western Iran. Data were collected from 6229 10th-grade students at two time-points, with 12 months interval in October and November 2017 and 2018. A self-administered questionnaire was used to collect information on demographic, NSSI and cigarette and hookah smoking from the study participants. The results showed that lifetime prevalence of NSSI among students was 6.2% (95% confidence interval [CI]: 5.7 to 6.9) at the first assessment. Scratching and hair pulling were the most and least common methods of self-injury, respectively. Over the one year, 206 students (3.6% CI 95%: 3.1-4.1) reported the onset of NSSI. Tobacco smoking and previous year average grade were related to the incidence of NSSI. Although gender was significantly associated with the prevalence of NSSI, the relationship between gender and incidence of NSSI was not significant. Although the prevalence of NSSI was low among adolescents, the incidence rate was considerable. Further studies are required to understand the risk factors of NSSI in Iran.

Development of a Cigarette Smoking Obscenity Scale (CSOS) in adolescents: an exploratory sequential mixed method design.

Background: Considering the increasing prevalence rate of smoking among Iranian adolescents,and recent evidence on the relationship between obscenity of smoking and tendency of adolescents towards the behavior, there is a need for an appropriate measurement tool to measure the level of obscenity on cigarette smoking among adolescents. This study was conducted to develop a valid and reliable questionnaire for measuring the obscenity of cigarette smoking in adolescents. Methods: This study was conducted in Tabriz, Iran, using an exploratory sequential mixed methods design. To explain the concept of obscenity and develop the questionnaire's items, 18 students attended semi-structured individual interviews and 13 others took part in focus group discussions (FGDs) in three groups of 4-5. Extracting and summarizing the codes derived from the interviews, an item pool was developed, from which the initial draft of the scale was provided.Next, the psychometric properties of the scale were assessed using face, content, construct, and predictive validity, as well as internal consistency, and reliability in a sample of 1013 high school students. Results: The 22-item Cigarette Smoking Obscenity Scale (CSOS) was developed based on thecodes derived from qualitative data. Explanatory factor analysis revealed five-factor structure(Negative Attitude; Negative Consequence; Negative Valuation; Inappropriate Relationship; Agateway to addiction). In confirmatory factor analysis, the χ2/df ratio was 3.911 for the CSOS five-factor structure. Suitable values were obtained for the goodness of fit indices (GFI = 0.88,AGFI = 0.85, NFI = 0.87, IFI = 0.90, CFI = 0.90, RFI = 0.85, and RMSEA = 0.072). The Cronbach's alpha and intraclass correlation (ICC) coefficients for the constructs ranged between 0.77 to 0.90 and 0.80 to 0.91, respectively. Conclusion: The validity and reliability of the CSOS was appropriate; therefore, it can be used infuture studies as a suitable tool for measuring the obscenity of cigarette smoking in adolescents.