Environmental Science and Pollution Research

, Volume 26, Issue 18, pp 18921–18929 | Cite as

Decomposition of passive smoking inequality in Iranian children and adolescents: the CASPIAN-V Study

  • Mostafa Amini Rarani
  • Ramin Heshmat
  • Shirin Djalalinia
  • Mohammad Esmaeil Motlagh
  • Hasan Ziaodini
  • Armita Mahdavi-Gorabi
  • Majzoubeh Taheri
  • Zeinab Ahadi
  • Mostafa QorbaniEmail author
  • Roya KelishadiEmail author
Research and Education Highlights


To investigate the socioeconomic inequality in passive smoking in Iranian children and adolescents. Through a multistage random cluster sampling method, a representative sample of 14,400 school students, aged 6–18 years, were enrolled from urban and rural areas of 30 provinces of Iran. Using a non-linear principal component analysis (NLPCA), the correlated variables were summarized as socioeconomic status (SES). Normalized concentration index (NCI) was used to measure inequality in passive smoking at national and regional SES levels. We decomposed total socioeconomic inequality in passive smoking into explanatory variables to identify the main contributors of inequality in passive smoking in the population studied. Data of 12,327 students and parents were complete for the current study. The response rate was 85.6% (50.9% boys, 71.2% urban residents). About 44% of Iranian students were exposed to passive smoking. The NCI for passive smoking at a national level was − 0.043 (95% confidence interval − 0.035, − 0.012), indicating that passive smoking was more concentrated among poorer children and adolescents. This inequality was statistically significant at a national level and in all regions except for regions with lower middle- and lowest SES levels. Considering the decomposition analysis, the household SES (63%), mothers’ educational level (37%), fathers’ educational level (29%), and school type (18%) made the largest positive contribution to inequality in passive smoking of children and adolescents. Passive smoking was distributed unequally among Iranian children and adolescents; it was more concentrated among socioeconomically disadvantaged families. Public health policies attentions should be given to reduce passive smoking among low SES children and adolescents living with illiterate or low-educated parents.


Passive smoking Adolescents Children Iran Socioeconomic inequality Decomposition 



The authors are thankful of the large team working on this study and all participants in different provinces.

Source of funding

This study was conducted by using the data of a national school-based surveillance program.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Mostafa Amini Rarani
    • 1
  • Ramin Heshmat
    • 2
    • 3
  • Shirin Djalalinia
    • 4
  • Mohammad Esmaeil Motlagh
    • 5
  • Hasan Ziaodini
    • 6
  • Armita Mahdavi-Gorabi
    • 2
  • Majzoubeh Taheri
    • 7
  • Zeinab Ahadi
    • 2
  • Mostafa Qorbani
    • 8
    • 9
    Email author
  • Roya Kelishadi
    • 10
    Email author
  1. 1.Health Management and Economics Research CenterIsfahan University of Medical SciencesIsfahanIran
  2. 2.Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences InstituteTehran University of Medical SciencesTehranIran
  3. 3.Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences InstituteTehran University of Medical SciencesTehranIran
  4. 4.Deputy of Research and Technology, Ministry of Health and Medical EducationTehranIran
  5. 5.Department of PediatricsAhvaz Jundishapur University of Medical SciencesAhvazIran
  6. 6.Health Psychology Research CenterEducation MinistryTehranIran
  7. 7.Office of Adolescents and School HealthMinistry of Health and Medical EducationTehranIran
  8. 8.Non-communicable Diseases Research CenterAlborz University of Medical SciencesKarajIran
  9. 9.Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences InstituteTehran University of Medical SciencesTehranIran
  10. 10.Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable DiseaseIsfahan University of Medical SciencesIsfahanIran

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