Electronic Theses and Dissertations


Bandar Shukr



Document Type


Degree Name

Doctor of Philosophy


Public Health

Committee Chair

Fawaz Mzayek

Committee Member

Debra Bartelli

Committee Member

Kenneth Ward

Committee Member

Meredith Ray


Youth tobacco smoking remains a major global public health problem. Understanding predictors of youth smoking behavior is critical for the success of tobacco control programs. Given the dearth of information about the effect of tobacco smoking-related messages in media on the smoking behavior of both cigarettes and waterpipes among adolescents from countries in the Eastern Mediterranean Region (EMR), this research aims to address this knowledge gap. We analyzed longitudinal data from the Irbid Longitudinal Smoking Study that followed a random sample of 2,174 seventh-grade students to characterize their smoking habits. Data analyses were performed using unadjusted and adjusted Generalized Linear Mixed Models (GLMMs). For cigarette smoking, we found that girls who were exposed to anti-smoking media messages at baseline had lower odds of experimenting with cigarette smoking (AOR = 0.4; 95% CI: 0.2, 0.8). In addition, boys who were exposed to anti-smoking messages were more likely to report an intention to quit smoking (AOR = 2.0; 95% CI: 0.9, 4.1). The cumulative exposure to anti-smoking messages over time was associated with lower odds of intention to start smoking in the future among girls (AOR = 0.5; 95% CI: 0.3, 0.9) but with higher odds of future intentions to smoke among boys (AOR = 1.8; 95% CI: 1.0, 3.1). Furthermore, media messaging was not associated with the progression of the smoking habit. For waterpipe smoking, no significant association was found between anti-smoking messaging and intention-to-quit smoking. However, seeing health-warning labels on waterpipe tobacco packaging was associated with lower quitting intentions among girls (AOR = 0.3; 95% CI: 0.1, 1.0). Additionally, there was no significant association between pro-smoking messaging and the intention to start waterpipe smoking in the future. Despite having mixed findings, this comprehensive analysis of both pro- and anti-smoking media messages and their influence on cigarette and waterpipe smoking advances our understanding of the role of smoking-related media messages in influencing youths’ smoking behaviors and attitudes, and could guide the development and the implementation of effective, evidence-based, and product-specific tobacco control interventions and regulations to successfully address adolescent tobacco smoking in Jordan and similar EMR countries.


Data is provided by the student.

Library Comment

Dissertation or thesis originally submitted to ProQuest.


Embargoed until 6/13/2024

Available for download on Thursday, June 13, 2024