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The global morbidity and mortality associated with asthma have been dramatically raised. We aimed to determine the prevalence of asthma symptoms in northwestern Iran and identify the potential risk factors. A cross-sectional survey was performed from November 2019 to February 2020 among 1,459 adolescents residing in areas representing urban and semi-urban communities. International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was used to identify the participants with asthma defined based on meeting the criteria of physician diagnosis or self-report of wheezing episodes previously. Multivariable logistic regression was applied for data analysis. The prevalence of current asthma, asthma ever in life, and severe asthma were 12.2, 4.9, and 5.7%, respectively, which varied with urbanization. Overall, asthma prevalence in urban area was 13.4%, whereas in the semi-urban area was 8.3%. The related risk factors for asthma were having a pet at home [OR: 1.75 (1.11, 2.74)], current smoking [OR: 1.91 (1.21, 3.02)], artificial ventilation at home [OR: 2.67 (1.02, 7.03)], intake of fast-foods [OR: 4.51 (1.19, 17.04)], and history of allergy [OR: 1.99 (1.36, 2.92)]. However, physical activity [OR: 0.37 (0.16, 0.90)] and fruit consumption [OR: 0.11 (0.02, 0.77)] were associated with lower odds of asthma. We found that the prevalence of asthma was more common in people living in urban area compared to those living in semi-urban area. [ABSTRACT FROM AUTHOR]