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Patterns of Smoking Among Undergraduates of Suez Canal University, Egypt

Research Article Open Access
Hassan AE Abdelwahid*, Hend H Ali and Mohamed MA Diab
Suez Canal University (SCU), Ismailia, Egypt
*Corresponding author: Dr. Hassan AE Abdelwahid, MD
Family Medicine
Department of Family Medicine
Faculty of Medicine
Suez Canal University
Ismailia, Egypt
Tel: 002 01142231059
E-mail: hassan22220000@yahoo.com
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Received November 07, 2012; Published November 22, 2012
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Citation: Abdelwahid HAE, Ali HH, Diab MMA (2012) Patterns of Smoking Among Undergraduates of Suez Canal University, Egypt. 1:577 doi:10.4172/ scientificreports.577
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Copyright: © 2012 Abdelwahid HAE, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Abstract
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Background: Smoking is a major international public health problem and Egypt is not an exception according to published data.
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Objectives: The objectives of the present study were to determine the prevalence of smoking and assess its pattern among undergraduate students of Suez Canal University in Ismailia, Egypt.
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Methods: In this cross sectional study, 1450 students were randomly selected and subjected to pre-designed self-administered questionnaires to collect data regarding their smoking pattern, socioeconomic status, degree of nicotine dependence, and stage of readiness to change.
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Results: Out of the 1450 undergraduates who were screened for smoking, 1321 responded to the questionnaire with a response rate of 91%. The total number of males was 622 (47.1%) while that of the females was 699 (52.9%). The results illustrate that 16.9% of students (n=223) were current smokers, 1.4% (n=19) ex-smoker and 81.7% (n=1079) non-smokers. Regarding the transtheoretical model of behavior change, the current smokers (n=223) were found distributed in the pre-contemplation stage (50%) with no plan to quit smoking, contemplation stage (25%) and preparation stage (25%). Age, sex, total family income and type of faculty were the, only, significant independent predictors of smoking in the present study. Males were 66 times more likely to be current smokers than females (OR=66.03; 95% CI=28.9-150.7).
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Conclusion: Smoking is a common health problem among Suez Canal University students, so developing and implementing an effective and comprehensive cessation program should be a high priority.
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Keywords
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Tobacco; Smoking; Prevalence; University; Students; Egypt
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Introduction
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Smoking epidemic is a major international public health problem [1], killing up to half the people who are addicted to it. Half of those deaths occur between the ages of 30 and 69 years, resulting in a loss of 20-25 years of life for smokers [2,3]. It causes significant premature mortality and morbidity that can be prevented. Out of six million people who are killed yearly by tobacco, more than 600000 are nonsmokers exposed to second-hand smoke. Tobacco users who die prematurely deprive their families of income, raise the cost of health care and hinder economic development. Smoking is highly prevalent in low and middle-income countries where 80% of worldwide smokers (one billion) are found [1].
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Current data suggest that smoking prevalence is a public health problem in Egypt. The WHO report on the global tobacco epidemic 2009 concluded that the adult daily smoking prevalence was 14 % [4]. The 2009 Egypt Global Adult Survey (GATS) illustrated that 19.4% (9.7 million) of adults in Egypt currently smoked tobacco; 37.7% men and 0.5% women. Ninety-five per cent (95%) of current smokers were daily smokers. Manufactured cigarettes were the most popular type of product smoked by men (31.7%), followed by shisha (6.2%); on the other hand 0.2% of women smoked manufactured cigarettes and 0.3% smoked shisha [5].
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Tobacco smoking has significant effects on the morbidity and mortality of the users, for example, about one third of deaths resulting from cancer are caused by tobacco. Also, tobacco cardiovascular and respiratory diseases account for about 30% each [3]. In Egypt, tobaccorelated cancers as a percentage of all cancers have been significantly increased among men [6]. Tobacco-attributable deaths, in 2004, increased from 8% to 11% of total deaths after 34 years of age. In addition to years of potential life lost, tobacco use causes considerable economic loss through rising health costs and loss of productivity [7]. In conclusion, tobacco use has multiple health risks and adverse social and economic impacts on the lives of smokers, their families and communities, so it immensely needed to study the prevalence and pattern of smoking among undergraduates to collect baseline data for further interventions.
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Aim of the Work
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The objectives of the present study were to determine the prevalence of smoking and assess its pattern among undergraduate students of Suez Canal University in Ismailia, Egypt.
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Subjects and Methods
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A cross sectional design was used. The study was conducted in Ismailia City, Egypt, that is located about 120 km from Cairo along the coast of Suez Canal, midway between Port Said and Suez. The target population was undergraduate students in SCU campus that included 10 faculties, Medicine, Pharmacy, Veterinary medicine, Dentistry, Science, Commerce, Arts, Nursing Tourism and hotels, Computer and informatics, Agriculture and Education.
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A sample size of 1450 was calculated and selected from the target population with an estimated prevalence of depression to be 16% (from a previous study) [8], 95% confidence coefficient and 5% Confidence interval [9]. The expected non-response rate of the participants was taken in consideration in sample size calculation. The sample was selected by a multi-stage stratified random sampling technique with proportional allocation as follows. First, colleges were sub-classified by type of faculty (n=10), then by educational levels. Students were selected by systematic random sampling, choosing every tenth student from the list of registered students at each educational level, till the desired proportionate sample size was obtained. Data were collected by a pre-designed self-administered questionnaire in Arabic to collect data regarding their smoking, socioeconomic status, degree of nicotine dependence, and stage of readiness to change. The degree of nicotine dependence was determined brief Fagerstrom test [10] that includes 2-questions: 1) when do you smoke after walking up in the morning? 2) How many cigarettes do you smoke each day? There are 3 options in the answer of the first question (less than 5 minutes, 5-30 minutes and 31-60 minutes) that were scored 3, 2, and 1 respectively. Also the answer to the second question has 3 options (more than 30, 21-30, and 11-20) that were scored 3, 2, and 1 respectively. A Fagerstrom score of 5-6 means highly dependent; 3-4=moderately dependent and 1-2=lightly, minimally, dependent. The stage of readiness to quit smoking was determined by the transtheoretical model of behavior change that is based on discrete stages along the continuum of change in cigarette smoking behavior [10]. These stages are termed precontemplation, contemplation, preparation, action, maintenance and relapse. The field work was conducted from January 01, 2008 to March 10, 2008 and the study was completed in January 12, 2009. Verbal and written consents were obtained from the participants who completed the questionnaires.
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All statistical analyses were performed using the SPSS software package-version-10. Descriptive statistics and Measures of central tendency and dispersion, as well as, appropriate significance tests were applied according to the types of variables. Multiple logistic regression analysis was conducted to determine which factors were independent predictors for smoking among the study group. Logistic regression coefficients and estimated odds ratios for each of the independent variables in the model were determined. The P-value of
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Results
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Out of the 1450 undergraduates who were screened for smoking, 1321 responded to the questionnaire with a response rate of 91%. The total number of males was 622 (47.1%) while that of the females was 699 (52.9%). Their age ranged from 18-28 with a mean of 20.1 ± 1.1 years. All participants were single and Egyptians. Shisha smoking was highly prevalent (45%) among the study group, 30% smoked waterpipes (shisha) exclusively, and 15% smoked shisha and cigarettes. The smokers (n=223) started their 1st cigarette smoking at age of 14.4 ± 3.4 and became regular (daily) smokers at age of 16.6 ± 2.7; on the other hand age of stating shisha smoking was 17.2 ± 3.1. Out of 223 smokers 68 (30%), 95 (43%), and 60 (27%) were minimally, moderately and heavily nicotine dependent respectively. The above results are not illustrated in the tables and figures.
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The results illustrate that 16.9% (n=223) of students were current smokers, 1.4% (n=19) ex-smoker and 81.7% (n=1079) non-smokers (Figure 1). Regarding the transtheoretical model of behavior change, the current smokers (n=223) were found distributed in the pre-contemplation stage (50%) with no plan to quit smoking, contemplation stage (25%) and preparation stage (25%) (Figure 2).
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Figure 1: Prevalence of smoking among study group.
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Figure 2: Distribution of smokers according to stage of readiness to quit.
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The bivariate analysis illustrated that current smokers were significantly older than non-smokers. Out of 223 current smokers, 217 (97%) were males. Out of 622 males, 217 (34.9) were current smokers while in females 6 out of 699 (0.9%) were smokers. The smokers were found to have significantly higher Per capita monthly income on comparison with non-smokers. The 10 colleges were classified into two groups, medical and non-medical colleges. The medical colleges included medicine, dentistry, pharmacy and veterinary. The prevalence of smoking (17.7%) was insignificantly higher in the undergraduates of non-medical colleges than medical ones (14%) (Table1).
 
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Table 1: Comparison between smokers and non smokers regarding baseline socio-demographic variables.
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Table 2: Multiple logistic regression analysis: Risk factors for smoking in Suez Canal University students.
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The following independent variables were subjected to the multiple logistic regression analysis with smoking as dependent variable: participants’ age; gender; residency; total family income per month; family size; and type of college. Table 2 illustrates that the student’s age, gender, total family income and type of faculty were the, only, significant independent predictors of smoking in the present study. In another wods; older students ≠years, male sexuality, family income ≠Pounds per month, and non-medical colleges were the independent risk factors for smoking among the study group.
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Discussion
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The present study included 1321 participants who were selected randomly from different faculties of Suez Canal University. Their age ranged from 18-28 with a mean of 20.1 ± 1.1 years. The results illustrate that 16.9% (n=223) of students were current smokers, 1.4% (n=19) ex-smoker and 81.7% (n=1079) non-smokers. The current data suggests that smoking prevalence is a public health problem in Egypt and is consistent with other studies. For example in Alexandria, more than a quarter (27.2%) were current smokers (25.5% daily smokers and 1.7% occasional smokers) and 3.5% were ex-smokers in 2000 [11]. The WHO non-communicable disease survey 2006 reported that the overall prevalence of daily tobacco smoking was 15.6% (34.6% among males and 0.7% among females) [12].
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The present study illustrates that shisha smoking was highly prevalent (45%) among the study group, 30% smoked waterpipes exclusively, and 15% smoked shisha and cigarettes. The overall prevalence rate of shisha smoking observed in this study was high compared to a group of studies. For example, in a national study conducted in the Nile Delta in 2003-2004, the overall prevalence of shisha smoking was 9% [13]. The results of the national survey carried out by the Egyptian Smoking Prevention Research Institute in 2005 revealed that in rural areas, shisha smoking among males was 15.3% and 0.1% among females, while in urban areas it was 10.9% among males and 0.2% among females [14]. In Egypt, use of shisha is the second most common type of tobacco consumed. In the past, shisha smoking was generally limited to older low socioeconomic males in rural areas. However, the pattern of shisha smoking has been changed and nowadays there is an increase in shisha use in urban areas and among females, young peoples and those from high socioeconomic status [15].
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Regarding the transtheoretical model of behavior change, the current smokers (n=223) of the present study were found distributed in the pre-contemplation stage (50%) with no plan to quit smoking, contemplation stage (25%) and preparation stage (25%). These results should be the bases of smoking cessation interventions for the smokers and are consistent with several studies that were conducted to assess the readiness of smokers to quit. In a group of studies, the prevalence range of the pre-contemplation, contemplation, and preparation stages were 31-56%, 34-39; and 16-29%, respectively [16-19].
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Age, sex, total family income and type of faculty were the, only, significant independent predictors of smoking in the present study. Males were 66 times more likely to be current smokers than females (OR=66.03; 95% CI=28.9-150.7). Despite rapid modernization in Egypt, smoking is highly prevalent among males than females, similar to other studies conducted in Egypt [14,20,21] and other countries [22]. However, the prevalence of smoking among female may be underestimated because the social norms of the Egyptian community that regard female smoking as misbehavior [13]. In addition the risk of smoking was significantly doubled in older student (≠years), a result that is consistent with that of a Turkish longitudinal study of tobacco consumption in which one-third of non-smokers in the 1st year had become smokers by the end of the 6th year of study among medical students [23]. Similar findings were detected in India where the smoking prevalence increased from 17% during the 1st year to 43% in the 5th year [24]. More research is needed to explain the increase in smoking prevalence in older students that may be due to peer- group pressure, perceived relaxation and better mood, as usually reported by smokers [25]. The non- medical students in the present study were more prone to smoking than medical students (OR=1.9 and 95% CI=1.35-2.72). This result is consistent with that of other studies that were conducted in Saudi Arabia [25] and Sharjah, United Arab Emirates (UAE) [26]. This may reflect the impact of health related curricula on raising awareness of students regarding hazards of smoking. Also it was found that students with high income, ≠Egyptian pound per month, were more risky to smoke than low income students. This result is accepted because they were finically dependent on their families.
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In conclusion smoking is a common health problem among the study group of Suez Canal University students, so developing and implementing an effective and comprehensive cessation program should be a high priority. Further research is needed to study the disease attributes deeply to be bases for primary prevention of smoking and assist smokers stopping smoking.
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The study has some limitations. Although the study sample was reasonably large, the study tools were self-report questioners, the participants my underreport data. Also, it was a cross sectional study.
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References
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