![]() ![]() Usually to describe the relationship between risk factors and outcome, classical statistical models such as the linear regression model are used. Also we can point to the lack of an appropriate model to detect this relationship. Many studies, for example, have used binary or grouped variables to display age at onset 12, 13, 15, resulting in the loss of potentially valuable information about the onset path over time and the inability to assess a specific period of life, such as adolescence, when people are particularly vulnerable 14. Relevant researched, on the other hand, have either not explicitly tested this association or have been hampered by methodological flaws 14. Based on a considerable body of studies 12, 13, it is commonly believed that the early age at smoking onset predicts heavy smoking in the future. According to a study by Nash et al., the age at smoking onset was strongly associated with death after the age of 70, so that current smokers who started smoking at a younger age were at higher risk for death compared to smokers who started later 11. The age at smoking onset can significantly predict future smoking patterns and related health consequences 10. Identifying the factors influencing the intensity of smoking such as socio-demographic differences, type of smoking habit, age at smoking onset, and ability to quit smoking can provide the information needed to adopt and implement tobacco control policies 1. In addition, data from large population studies show that light smokers are 2 to 5 times more likely to experience respiratory symptoms and heart disease compared with nonsmokers 9. ![]() For example, heavy smokers are more exposed to the negative effects of smoking such as low quality of life and it is also very difficult for them to quit smoking 8. Based on the results of previous studies, there are important differences between these three groups. Smokers can be classified into three categories based on their smoking intensity: light, moderate, and heavy 7. This is because men could be more prone to turn to smoking as a result of a stronger predisposition to risky behaviours and dealing with numerous job-related difficulties, family and social duties. According to the latest reports in 2016, the prevalence of daily smoking in Iran is 9.7% and it is significantly higher among men (19.6%) than women (0.9%) 6. It is estimated that 1.2 million deaths per year worldwide are due to secondhand smoking (SHS), most of which occur in children under 10 years of age 5. Smoking is one of the main factors in causing and aggravating various diseases such as chronic obstructive pulmonary disease, neurological diseases ,cardiovascular diseases 3, and various cancers 4. Tobacco use accounts for 15.4% of all deaths worldwide in 2019 2. ![]() Smoking is a social epidemic 1 that, despite its adverse effects on health and the economy, continues to be one of the top causes of preventable disease and death globally 2. Tobacco control programs should be focused on young and adolescent groups and poorer socio-economic communities. GAM identified the nonlinear relationship between the age of onset of smoking and smoking intensity. ![]() but, smokers with high-income (ORβ=β0.742, 95% CI 0.552β0.998) had a low tendency to heavy smoking. According to the GAM results, the relationship was nonlinear and smokers who started smoking at a younger age were more likely to become heavy smokers. The results showed that 246 (26.9%) subjects were light smokers, 190 (20.8%) subjects were moderate smokers and 477 (52.2%) subjects were heavy smokers. A GAM was used to assess the relationship. Individuals were classified into: light, moderate, and heavy smokers. Data from 913 Iranian male current smokers over the age of 18 was evaluated from a national cross-sectional survey of non-communicable disease (NCD) risk factors in 2016. In GAM a latent variable with logistic distribution and identity link function was considered. Therefore the main purpose of this study is to evaluate the potential risk factors affecting the intensity of smoking, especially the age of smoking onset among Iranian adult male smokers over 18 years of age using a generalized additive model (GAM). However, it is still challenging to accurately prove this relationship due to limitations in the methodology of the performed studies. Because the age at which a person first starts smoking has such a strong correlation with future smoking behaviours, it's crucial to examine its relationship with smoking intensity. ![]()
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