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Home > Vol 15, No 4 (2015) > Kubas

JRHS 2015; 15(4): 262-265        

Copyright© Journal of Research in Health Sciences

Comparison of Smoking and Khat Chewing Habits between Medical and Non-Medical Female Students at UST, Sana'a, Yemen

Mohammed Abdullah Kubas (MSc)a*, Majed Wadi (MBChB, MSc)b

a Department of Clinical Pharmacy, University of Science and Technology Hospital, Sana’a, Yemen

b Department of Medical Education, School of Medicine and Health Sciences, University of Science and Technology, Sana’a, Yemen

* Correspondence:  Mohammed Abdullah Kubas (MSc), E-mail: m7kubas_ph@yahoo.com

Received: 15 April 2015, Revised: 15 June 2015, Accepted: 23 July 2015, Available online: 01 August 2015

Abstract

Background: Smoking is a worldwide problem that kills millions of people. Women smoke much lower than males but the numbers of smoker women are growing up. The objectives of this study were to assess the prevalence of smoking and khat chewing in medical and non-medical female students at University of Science and Technology (UST), Sana'a, Yemen.

Methods: We used self-administrated questionnaire to collect cross-sectional data from a randomly selected sample of medical and non-medical female students of UST in 2012-2013. Overall, 480 students completed and returned the questionnaire, medical students represented 50% of them.

Results: The prevalence of smoking was significantly low among female medical students (P=0.045), however, not significantly difference was found between medical and non-medical female students in khat chewing habits (P=0.083). Non-smoker medical female students who tried smoking (45.6%) were significantly lower than non-medical students (54.4%), and curiosity was the main reason for trying smoking. Water pipe was the most common type of smoking among smoker students (78.6%). Out of 26 female students who smoke and chew khat, 18 students reported that they smoke more while they chew khat.

Conclusions: Our study highlights the need for increased health education, awareness, and knowledge of the risks of smoking and particularly khat chewing to reduce these habits among female university students especially in non-medical female students.

Keywords: Smoking, Female, Students, Yemen 

Introduction

Smoking is one of the most public health problems which lead to kill nearly 6 million people each year. More than 5 million deaths are due to direct tobacco use and more than 600,000 deaths are due to second-hand smoke 1. Furthermore, the numbers of deaths as a result of smoking are much higher than all deaths result from tuberculosis, human immunodeficiency virus (HIV/ADIS), and malaria 2. According to WHO report; by 2030, number of death will exceed eight million each year due to tobacco smoking, and 80% of the deaths will be from developing country 1. Most of the adult smokers start to smoke during their teenage years. Moreover, the majority of them start smoking at early age 16 years; indeed, they are less likely to quit smoking 3-4. Chewing khat is widely accepted in Yemen and East Africa 5. The active ingredients of khat plant (Catha edulis) are cathinone and cathine, which have stimulant effect that resemble amphetamine action 5-6. Khat is reported to induce euphoria and hypomania, as well as, alertness and arousal. For that reasons, chewing khat enhances memorization and preparation before exams. On the other hand, at the end of khat session, the user may feel depressed, irritable, and difficult of sleeping 5-6. Furthermore, khat has major socioeconomic negative consequence 5.

According to WHO epidemic, tobacco use in males of Arabic countries are more than males of western countries (24.8% to 61.7% vs. 19.8% to 46%)7, however, the opposites are observed in females of Arabic countries comparing to western countries (0.3% to 7.9% vs. 13.7% to 31.1%)8.

In general, the prevalence of smoking among women is less than men in Arabic nations that may be due to culture and tradition influence 8-9. However, now it is on the rise 10. Although smoker women less commonly use conventional tobacco, they are commonly use water pipes 8, 11. In Yemen, as other Arabic countries, the prevalence of tobacco smoking in adults is much higher in males than females (27.4% vs. 10.3%) 12. However, the rate of smoking in Yemen is considered as one of the top ten highest countries in the world between both men and women (men 77% and women 29%)10.

Increase knowledge about the risk of smoking and khat chewing may decrease these habits among population, as a result, medical students are expected to have lower prevalence of smoking and khat chewing compared to other group. However, tobacco use still high between medical students, although they have greater knowledge of the risk 8, 13-14.

The aim of this study was to evaluate the smoking and khat chewing in medical and non-medical female students at University of Science and Technology, Sana'a, Yemen, and to determine whether non-medical students are more likely to smoke and chew khat than medical students due to their unawareness of health risks.

Methods

A cross-sectional study using Arabic questionnaire, derived from the global tobacco survey (GATS, 2010), was distributed randomly to medical female students at Colleges of Medicine and Health Science, Dental, and Pharmacy, and non-medical female students at Colleges of Engineering, Administrative Sciences, Computing and Information Technology, as well as Humanities and Social Sciences at different education levels at University of Science and Technology, Sana'a, Yemen. A total of 460 female students filled and returned the survey (232 medical students, 228 non-medical students). The study was conducted during the academic year 2012-2013. We took permission from the university’s Research Ethics Committee before distributing the questionnaires.

The questionnaire contained questions about demographic details, parents and friends smoking habits, smoking behavior (use of cigarettes, water pipes, or both), reasons for smoking, frequency of smoking, thinking to quit smoking, khat chewing habits, whether they smoke more when they chew khat, and their knowledge about consequences of smoking and khat chewing. Student who had smoked any tobacco product or chew khat even daily or occasionally, and was still a smoker or khat chewer at the time of the study, we defined them as current smoker and khat chewer.

The data were analyzed using SPSS version 20 and P values <0.05 considered as statistically significant. Chi-square test used to test statistical significance.

Results

A total of 460 female students completed the questionnaires. Of 460 participants, 85.9% (n=395) were Yemeni, whereas 12.6% (n=58) were from Arabic countries, and only 1.1% (n=5) were from foreign countries. Mean age was 20.4 ±1.7 years. Students involved in the study were in their 1st to 6th level of study; participants in the first year were 137 students, second year 94 students, third year 117 students, fourth year 94 students, fifth year 11 students, sixth year 6 students, and one student was undetermined.

The results of relationship between smoking and khat chewing habits, and demographic characteristics of the study sample are displayed in Table 1. Smoking in medical students was significantly lower than non-medical students; 35.7% of them were smokers compared to 64.3% of non-medical students (P=0.045). On the other hand, no significant difference was noticed between medical and non-medical khat chewer female students, 40% of the medical students chewed khat compared to 60% of non-medical students (P=0.083). In comparison to non-medical female students, medical female students had more knowledge about the risks of both smoking and khat chewing. Furthermore, non-medical students had tried smoking more than medical students (P=0.032) (Table 2). Curiosity was the most common reason for having tried smoking which was cited by non-smokers (Table 2).

Smoking type among current smokers was as follows: 2.4% smoke cigarette, 78.6% smoke water pipe, 19% smoke both cigarette and water pipe (Table 3). The common reason given for smoking habits was enjoyment (14.3%), life stresses (9.5%), and influence of friends (9.5%). In addition, the majority of smokers smoked with friends (57.1%) and had smoker friends (85.7%). Most of the smokers had knowledge about the risks of smoking (88.1%). For the frequency of smoking, 9.5% of the smokers had smoked 1-5 cigarettes per day, and 47.6% of those who smoked water pipes smoked 1-2 in per day at last month. Moreover, 15 students of the smokers thought to quit smoking, and most of them (14 students) tried to stop smoking last year (Table 3).

Table 4 shows the characteristics of khat habits. Of the sixty khat chewers, 4 chew khat every day (6.7%), 12 chew khat weekly (20%) and 44 chew khat occasionally (73.3%). Eight chew khat once weekly (66.7%), and 4 chew khat twice or more per week (33.3%). Here, we found that 26 students of khat chewer were smokers, and most of them 18 students said they smoke more when they chew khat. Furthermore, 28 of students spend two to three hours chewing khat (46.7%).

Table 1: Demographic characteristics of smoking and Khat chewing habits among a sample of 460 students

Table 2: Demographic data for 418 non-smoking students and the reasons given by them for trying smoking

Table 3: Characteristics of smoking habits among a sample of 42 smoking students

Table 4: Characteristics of khat habits among a sample of 60 khat chewer students

Discussion

This study has demonstrated that the prevalence of smoking among medical female students was very low in compared to non-medical female students. 35.7% represented the medical students, whereas 64.3% represented the non-medical students (P=0.045). One of the reasons to increase tobacco use among non-medical students may be due to lack of medical knowledge. Our finding of prevalence is comparable to that mentioned in previous studies 8, 15. Furthermore, we revealed that most of the smokers smoked with their friends (58.5%) rather than their family (28.6%) or alone (4.8%) which implies that friends inspire smoking behavior more than family members. This agrees with other studies, which showed that most people started smoking due to the influence of friends 4, 8, 16-18.

The most common reasons given for smoking behavior were enjoyment (14.3%), stress factors (9.5%), and friends (9.5%). This agrees with other studies which showed that relaxation, ability to cope with stress, and friends were the main reasons to start smoking 8, 17. These reasons could illustrate why most of the smokers, in this study (88.1%), smoked, even they had knowledge about the risks of smoking.

Based on our findings, the majority of female students smokes water pipe (78.6%), whereas, 2.4% of the smokers were cigarette smokers and 19% smoke both water pipe and cigarette. Similarly, findings of other studies reported that the prevalence of either water pipe smoking alone or with cigarette was high 8, 15, 19. Increase in the water pipe smoking may due to the misconception that water pipe smoking is harmless. Actually, water pipe smoking may be more harmful than smoking cigarettes, as a water pipe smoker inhales equivalent of 100 cigarettes in one session of smoking 20. Therefore, it is strongly recommended that tobacco control programs should include all types of smoking, in addition to cigarettes smoking.

In the present study, we found that 35.7% of the current smokers were thought to quit smoking. Furthermore, 33.3% of them tried to stop smoking last year, and only 4.8% who could stop smoking for more than one month. This is may be due to increase the awareness among smokers about the hazard effects of smoking, which increase the attitude against it 21-23.

Our study showed that medical female students (24 students) chew khat less than non-medical students (36 students) but without significant difference (P = 0.083). This is in consistence with other reports, where medical students chew khat less than general population at same age and sex5-6 . However, the social view among many Yemenis that khat has a good effect on the concentration of the mind and keeps one awake for long time may explain why there is no big difference in chewing khat habits between the two groups.

We found most of the female students, 26 students (43.3%), who chewed khat were smokers. Moreover, most of them, 18 students (69.2%), stated that they smoked more while they chewed khat. Likewise, other studies mention that khat is often used with tobacco 24-25. However, in one study, they could not find any relationship between cigarette smoking and kaht chewing5. Therefore, in general, khat may be considered as a risk factor for smoking which include it in the tobacco control programs could minimize smoking behaviors among students.

Conclusions

Smoking behavior is very low among female medical students compared to non-medical female students at University of Science and Technology, Sana'a, Yemen. This may be due to increase awareness and knowledge about health risks that associate with smoking among medical students. However, for khat chewing, we did not find any significant difference between medical and non-medical female students and this is probably because social misunderstanding views. Current study emphasizes that programs that are more educational are needed to increase awareness and knowledge about hazard effect of smoking and khat chewing in order to reduce smoking and more essentially khat chewing habits among university students, especially non-medical students.

Acknowledgments

The authors would like to thank Professor Shamsul Azhar Shah who guide us and help us in editing this article. Moreover, we thank Pharmacy School students at University of Science and Technology for their helping in distributing and collecting the survey.

Conflict of interest statement

The authors have no conflict of interest.

References

1. World Heath Organization. Tobacco, fact sheet.WHO Website; 2014 [cited 30 September 2014]; Available from: http://www.who.int/mediacentre/factsheets/fs339/en/ .
2. World Heath Organization. WHO global report: mortality attributable to tobacco. Geneva: WHO; 2012.
3. Shaikh W, Nugawela MD, Szatkowski L. What are the main sources of smoking cessation support used by adolescent smokers in England? A cross-sectional study. BMC Public Health. 2015;15(1):562.
4. Moeini B, Poorolajal J, Gharlipour Gharghani Z. Prevalence of cigarette smoking and associated risk factors among adolescents in Hamadan City, west of Iran in 2010. J Res Health Sci. 2012;12(1):31-37.
5. Laswar AN, Darwish H. Prevalence of cigarette smoking and khat chewing among Aden university medical students and their relationship to BP and body mass index. Saudi J Kidney Dis Transpl. 2009;20(5):862-866.
6. National Institute on Drug Abuse. Drug facts: Khat. NIDA Website; 2014 [updated April, 2013; cited 30 September 2014]; Available from:

http://www.drugabuse.gov/publications/drugfacts/khat .

7. World Heath Organization. WHO report on the global tobacco epidemic. Geneva: WHO; 2009.
8. Azhar A, Alsayed N. Prevalence of smoking among female medical students in Saudai Arabia. Asian Pac J Cancer Prev. 2012;13:4245-4248.
9. Mandil A, BinSaeed A, Ahmad S, Al-Dabbagh R, Alsaadi M, Khan M. Smoking among university students: a gender analysis. J Infect Public Health. 2010;3(4):179-187.
10. Bahaj AA, Baamer AA, Bin Briek AS. Prevalence of Tobacco Use Among Young Students In Yemen. J Bahrain Med Soc. 2010;22(1):5-8.
11. Dar-Odeh NS, Abu-Hammad OA. The changing trends in tobacco smoking for young Arab women; narghile, an old habit with a liberal attitude. Harm Reduct J. 2011;8:24.

12. World Heath Organization. Tobacco control country profiles, Yemen. WHO Website [cited 30 September 2014];Available from:http://www.who.int/tobacco/surveillance/policy/country_profile/en/#Y .

13. Kusma B, Quarcoo D, Vitzthum K, Welte T, Mache S, Meyer-Falcke A, et al. Research Berlin's medical students' smoking habits, knowledge about smoking and attitudes toward smoking cessation counseling. J Occup Med Toxicol. 2010;5:9.
14. Taheri E, Ghorbani A, Salehi M, Sadeghnia HR. Cigarette smoking behavior and the related factors among the students of Mashhad University of Medical Sciences in Iran. Iran Red Crescent Med J. 2015;17(1):e16769.
15. Al-Turki YA, Al-Rowais NA. Prevalence of smoking among female medical students in the College of Medicine, Riyadh, Saudi Arabia. Saudi Med J. 2008;29(2):311-312.
16. Al-Haqwi AI, Tamim H, Asery A. Knowledge, attitude and practice of tobacco smoking by medical students in Riyadh, Saudi Arabia. Ann Thorac Med. 2010;5(3):145-148.
17. Dahlui M, Jahan N, Majid H, Jalaludin M, Murray L, Cantwell M, et al. Risk and protective factors for cigarette use in young adolescents in a school setting: what could be done better? PloS one.2015;10(6):e0129628.
18. Lim K, Sumarni M, Kee C, Christopher V, Noruiza Hana M, Lim K, et al. Prevalence and factors associated with smoking among form four students in Petaling District, Selangor, Malaysia. Trop Biomed. 2010;27(3):394-403.
19. Wali SO. Smoking habits among medical students in Western Saudi Arabia. Saudi Med J. 2011;32(8):843-848.
20. Al-Naggar RA, Bobryshev YV, Anil S. Pattern of shisha and cigarette smoking in the general population in malaysia. Asian Pac J Cancer Prev. 2013;15(24):10841-10846.
21. Jiang Y, Elton-Marshall T, Fong GT, Li Q. Quitting smoking in China: findings from the ITC China Survey. Tob Control. 2010;19(Suppl 2):i12-i17.
22. Durkin S, Brennan E, Wakefield M. Mass media campaigns to promote smoking cessation among adults: an integrative review. Tob Control. 2012;21(2):127-138.
23. Luo B, Wan L, Liang L, Li T. The Effects of Educational Campaigns and Smoking Bans in Public Places on Smokers’ Intention to Quit Smoking: Findings from 17 Cities in China. Biomed Res Int. 2015; 2015:853418.
24. Kassim S, Islam S, Croucher RE. Correlates of nicotine dependence in UK resident Yemeni khat chewers: a cross-sectional study. Nicotine Tob Res. 2011;13(12):1240-1249.
25. Nakajima M, al'Absi M , Dokam A, Alsoofi M, Khalil NS, Al Habori M. Gender differences in patterns and correlates of khat and tobacco use. Nicotine Tob Res. 2013;15(6):1130-1135.