Prevalence of Khat chewing in college and secondary (high) school students of Jazan region, Saudi Arabia

Structure-Activity Relationship of Synthetic Cathinones: An Updated Review

The escalating prevalence of new psychoactive substances (NPSs) poses a significant public health challenge, evidenced by the vast chemical diversity, with over 500 substances reported annually to the United Nations Office on Drugs and Crime-Early Warning Advisory (UNODC-EWA) in the past five years. Among NPSs, synthetic cathinones are gaining a lot of popularity among users. Notably, synthetic cathinones accounted for approximately 50% of the total quantity of NPSs reported as seized by EU Member States in 2021. Preliminary data from UNODC indicates that a total of 209 synthetic cathinones have been reported to date. As their popularity grows, studying the structure-activity relationship (SAR) of synthetic cathinones is essential. SAR studies elucidate how structural features impact biological effects, aiding in toxicity prediction, regulatory compliance, and forensic identification. Additionally, SAR studies play a pivotal role in guiding drug policies, aiding authorities in categorizing and regulating newly emerging synthetic cathinones, mitigate public health risks and offer valuable insights into potential therapeutic applications. Thus, our Review consolidates recent findings on the effects of different substitutions in the chemical scaffold of synthetic cathinones on their mechanism of action as well as pharmacological and toxicological effects of synthetic cathinones, thus enhancing understanding of the SAR of synthetic cathinones' pharmacology and potential implications.

Epidemiology of Khat (Catha edulis) Chewing in Ethiopia: A Systematic Review and meta-analysis

In several countries, including Ethiopia, the shrub Catha edulis (khat) leaves are chewed for their stimulant properties. The present review summarizes evidence on the prevalence of khat use in Ethiopia and forwards recommendations for future action. PubMed, Embase, and Scopus were searched for studies examining the prevalence of Khat chewing among adolescent and/or adult populations in Ethiopia. A random-effects model was employed to estimate the pooled prevalence of khat chewing. Of the 568 articles identified, 26 were included in the review. The pooled prevalence of current and lifetime khat use was 19.55% (95% CI 14.62-25.64) and 26.14% (CI 17.66-36.87), respectively. The current prevalence of khat use was higher in men, 23.72% (CI 13.42-38.41), than in women 8.45% (CI 4.94-14.08). Lifetime prevalence of khat use was higher in men, 29.8% (CI: 22.80-37.99) than in women 13.02% (CI 8.96-18.56). The results of the meta-analysis demonstrated a higher odds of current (OR = 4.00, CI 2.80-5.73) and lifetime (OR = 2.84, CI 2.50-3.23) khat use in men than in women. Our review found a high prevalence of current (19.55%) and lifetime (26.14%) khat chewing in Ethiopia and demonstrated higher odds of current and lifetime khat use in men than in women. Awareness creation and integrated management of khat use problems at the primary health-care level is highly recommended.

Patterns and Sociodemographic Characteristics of Substance Abuse Among the Adult Population in Makkah City, Saudi Arabia: A Cross-Sectional Study

BACKGROUND

Substance abuse is a term that refers to the harmful or hazardous use of psychoactive substances, including alcohol and illicit drugs. One of the key impacts of illicit drug use on society is the negative health consequences experienced by its members.

OBJECTIVE

This study recorded the pattern of substance abuse and the sociodemographic characteristics of adult substance abusers in Makkah City.

METHODS

An online self-administered survey was provided to the general population through social media platforms between March 2023 and August 2023. Males and females living in Makkah over the age of 18 were included in it. The participants who refused to take part or those who were younger than 18 were not included in the study.

RESULTS

The number of participants in this study was 720; 73.5% were under the age of 30 and 424 were females (58.9%). The significant variables between substance abuse and sociodemographic data were gender (P=0.001), depression (P≤0.000), anxiety (P≤0.000), stress (P=0.025), and bad/shocking experience during childhood (P=0.004).

CONCLUSION

Substance abuse positively correlates with sociodemographic data, with males having a higher risk, and psychiatric neurosis is associated with childhood trauma and anxiety.

Khat chewing and associated factors among public secondary school students in Harar town, Eastern Ethiopia: a multicenter cross-sectional study

Background

Khat is a huge, evergreen tree that grows at high altitudes throughout the Arabian Peninsula and in the region stretching from eastern to southern Africa. Cathinone, cathine, and norephedrine are psychoactive ingredients contained in khat. Ethiopian teenagers, especially those in secondary school, frequently use khat. This use of khat may lead to students frequently missing class and experiencing subpar academic performance. However, the study area lacks information regarding the prevalence of khat use and the factors associated with it.

Objective

This study's primary goal is to determine the prevalence of khat chewing and related factors among secondary school students in public schools in Harar, Eastern Ethiopia, in 2022.

Methods

A multicenter cross-sectional study design was employed from June 01-June 30, 2022, in three public secondary schools in Harar town in a sample of 485 students. Systematic random sampling was used to choose the study sample. Data were gathered using self-administered questionnaires, and the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) was used to assess khat chewing. Epidata version 4.6 was used to enter the data, while STATA version 14 was used to analyze them. To determine the factors related to khat chewing, bivariate and multivariate logistic regression analysis was conducted, and statistical significance was determined at a 95% confidence level with a P-value under 0.05.

Results

Out of 485 eligible participants, 455 responded to this survey, giving a response rate of 93.8%. Overall, 33.2% (95% CI: 29.2%-37.6%) of the sample's participants reported currently chewing khat. Age ranged from 20 to 25 years (AOR = 2.04; 95% CI: 1.19-3.48), male students (AOR = 7.03; 95% CI: 4.35-12.57), current alcohol user (AOR 6.48; 95% CI: 2.30-18.28), presence of chewer friends (AOR 3.86; 95% CI: 2.38-6.24), and depression (AOR 1.84, 95%CI: 1.02-3.30), were strongly associated with khat chewing at a p-value of < 0.05.

Conclusion

Khat chewing was very common among students in Eastern Ethiopia's public secondary schools. Ages between 20 and 25 years, being a male, being current alcohol users, having chewer buddies, and depression are all significantly linked to khat use. Thus, schools should create and implement audience-specific behavioral change communication to deter and stop students from chewing khat. Additionally, it is important to ban the sale of khat to young adults and adolescents, promote medical care for khat users, and foster peer advocacy for support services.

Fatalities Involving Khat in Jazan, Saudi Arabia, 2018 to 2021

Interpreting fatalities involving khat is challenging due to a lack of data on cathinone and cathine reference concentrations in postmortem tissues. This study investigated the autopsy findings and toxicological results of fatalities involving khat in Saudi Arabia's Jazan region from 1 January 2018 to 31 December 2021. All confirmed cathine and cathinone results in postmortem blood, urine, brain, liver, kidney, and stomach samples were recorded and analyzed. Autopsy findings and the manner and cause of death of the deceased were assessed. Saudi Arabia's Forensic Medicine Center investigated 651 fatality cases over four years. Thirty postmortem samples were positive for khat's active constituents, cathinone and cathine. The percentage of fatalities involving khat was 3% in 2018 and 2019 and increased from 4% in 2020 to 9% in 2021, when compared with all fatal cases. They were all males ranging in age from 23 to 45. Firearm injuries (10 cases), hanging (7 cases), road traffic accident (2 cases), head injury (2 cases), stab wounds (2 cases), poisoning (2 cases), unknown (2 cases), ischemic heart disease (1 case), brain tumor (1 case), and choking (1 case) were responsible for the deaths. In total, 57% of the postmortem samples tested positive for khat only, while 43% tested positive for khat with other drugs. Amphetamine is the drug most frequently involved. The average cathinone and cathine concentrations were 85 and 486 ng/mL in the blood, 69 and 682 ng/mL in the brain, 64 and 635 ng/mL in the liver, and 43 and 758 ng/mL in the kidneys, respectively. The 10th-90th percentiles of blood concentrations of cathinone and cathine were 18-218 ng/mL and 222-843 ng/mL, respectively. These findings show that 90% of fatalities involving khat had cathinone concentrations greater than 18 ng/mL and cathine concentrations greater than 222 ng/mL. According to the cause of death, homicide was the most common fatality involving khat alone (77%). More research is required, especially toxicological and autopsy findings, to determine the involvement of khat in crimes and fatalities. This study may help forensic scientists and toxicologists investigate fatalities involving khat.

Dental caries experience among qat chewers in dental college clinics, Jazan, Saudi Arabia

AIMS

There is a considerable debate on the impact of qat chewing on dental and oral health. Thereby, this study aimed at assessing the dental caries among qat chewers (QC) and non-qat chewers (NQC) who attend outpatient dental clinics, College of Dentistry, Jazan, Saudi Arabia.

MATERIALS AND METHODS

A sample of 100 QC and 100 NQC were recruited amongst those attended dental clinics, college of dentistry, Jazan University during the 2018-2019 academic year. Their dental health was assessed by three pre-calibrated male interns using DMFT index. The Care Index, Restorative Index and Treatment Index were calculated. Comparisons between both subgroups were done using independent t test. Multiple linear regression analyses were further conducted to stand on the independent determinants of the oral health among this population.

RESULTS

QC were unintentionally older (36.55 ± 8.74 years) than NQC (32.96 ± 8.49 years; P = 0.004). Fifty-six percent of QC reported brushing their teeth compared to only 35% (P = 0.001). NQC with university and postgraduate educational levels were more than QC. The mean Decayed [5.91 (5.16)] and DMFT [9.15 (5.87)] were higher among QC compared to NQC [3.73 (3.62) and 6.7 (4.58); P = 0.001 and 0.001, respectively]. The other indices were not different between both subgroups. The multiple linear regression revealed that qat chewing and age, individually or together, as independent determinants for the dental decay, missing, DMFT and TI.

CONCLUSION

Qat chewing habit has a detrimental impact on dental health. It is associated with higher dental caries and missing teeth, and a lower treatment index.

Prevalence of Khat (Catha edulis) Chewing and Its Determinants: A Respondent-Driven Survey from Hossana, Ethiopia

BACKGROUND

Ethiopia is a leading khat producer in East Africa, and almost all regions are involved in khat production. Hossana, a small town in Southern Ethiopia, is also actively involved in khat production and its use. However, very few studies have been conducted to investigate the habit of khat chewing in this area. This study was conducted to assess the prevalence and predictors of khat chewing among Hossana residents.

METHODS

The study was conducted on 1700 individuals in Hossana town from March 2018 to June 2019. A structured pre-tested self-administered questionnaire was designed and used for data collection. Descriptive statistics and logistic regression were carried out to study the prevalence and predictors of khat chewing in the study area.

RESULTS

The overall prevalence of khat chewing among the respondents was 58.0% (95% CI 53.4-63.3) of which 68.4% were daily khat users and 31.5% used it occasionally. About 24.7% of females and 75.2% of males had chewed khat. Muslim religion (AOR 2.37; 95% CI 1.58-4.32), male gender (AOR 3.48; 95% CI 2.16-5.61), Older age (AOR 1.36; 95% CI 0.84-2.21), participants having habitual khat chewing friends or a khat chewer family associate (OR 1.70; 95% CI 1.17-2.20) were found to be independent predictors of chewing.

CONCLUSION

Significant portion of the population in the study area chew khat. Khat use is significantly associated with the Muslim religion, gender, age, and habit of family and friends. Further studies with larger demographic area are warranted from the study area to reproduce these findings.

Prevalence of Substance Use in University Students, Ethiopia

BACKGROUND

Although substance use is a known public health problem and a pressing issue in Ethiopia, its real extent and magnitude are not yet properly explored. The current study aimed to determine the extent and predictors of substance use among regular undergraduate students in the Institute of Technology, Addis Ababa University.

METHODS

An institution-based cross-sectional study was carried among 794 undergraduate regular students at the Institute of Technology, Addis Ababa University, using a self-administered structured questionnaire filled by study participants. Data entry, cleaning, and coding were performed by EPI-INFO version 3.5.1. Statistical Package for Social Sciences; AOR: Adjusted odds ratio (SPSS) SPSS version 21 software was used to analyze data by performing descriptive statistics, bivariate, and multivariate analysis.

RESULTS

73.7% of the study participants used substances at least once. The lifetime use of each substance includes alcohol (68.2%), khat (53.6%), cigarettes (46.1%), and illicit drugs (23.3%). Loss of family (AOR [95%CI], 34.50 [7.569, 157.263]), pocket money between 500 and 999 Ethiopian birr (AOR [95%CI], 9.978 [1.240, 80.280]), and above 1000 Ethiopian birr (AOR [95%CI], 10.831 [1.333, 87.971]) were identified predictors for khat use. The odds of lifetime alcohol use was higher among students coming from a divorced family (AOR [95%CI], 9.346 [3.162, 27.625]), lost one (AOR [95%CI], 37.406 [11.375, 123.008]), or both of their parents (AOR [95%CI], 18.750 [5.798, 60.633]). Students of urban origin (AOR [95%CI], 3.214 [1.950, 5.296]), and students with anxiety symptoms (AOR [95%CI], 2.655 [1.981, 3.557]) have a higher odds of lifetime cigarette smoking. The lifetime exposure to illicit drugs is higher among students in age groups between 20 and 24 years (AOR [95%CI], 5.963 [1.361, 26.135]), students coming from substance user family (AOR [95%CI], 2.172 [1.161, 4.063]), and students of urban origin (AOR [95%CI], 2.661 [1.202, 5.889]).

CONCLUSION

A higher prevalence of substance use requiring administrative and educational interventions was observed. Awareness creation interventions on the potential impacts of substance abuse should be performed.

Effects of Khat on Surface Roughness and Color of Feldspathic and Zirconia Porcelain Materials under Simulated Oral Cavity Conditions

Background and Objectives: Khat chewing is considered as a daily habit that is practiced by more than five million people globally. The effect of khat chewing on the surface roughness and the color stability of natural teeth and the material used in the fabrication of dental prosthesis remains unknown. This study was conducted to explore and compare the effect of khat homogenate (KH) on the surface roughness (Ra) and the average color changes (ΔE*) amongst natural teeth and selected shades from different porcelain types, namely, feldspathic metal ceramic (MC) VM13, computer-aided design/computer assisted manufacture (CAD/CAM) feldspathic (Vitablocs Mark II), and multilayer zirconia (Ceramill Zolid PS) porcelains. Materials and Methods: Seventy samples were prepared from natural teeth, feldspathic MC, CAD/CAM Vitablocs Mark II, and zirconia porcelain. The Ra values were measured using a profilometer and expressed in micrometers, whereas the ΔE* values were measured using VITA Easyshade® V spectrophotometer for all samples before and after frequent immersion and thermocycling in KH for 30 days. The surface topography was used to assess the materials surfaces (glazed or polished) after KH immersion by using a white light interferometry machine. Results: Results revealed that the Ra and the ΔE* values of the different types of tested porcelain were influenced by KH. The order of surface roughness values was glazed or polished MC > polished Zircon > polished Vitablocs Mark II > natural teeth. The lowest ΔE* values were recorded for glazed Vitablocs Mark II and MC, and the values could be arranged as polished zircon > natural teeth > glazed zircon > polished MC > polished Vitablocs Mark II. P values were significantly varied (< 0.001) among all the tested groups, except the zircon group (>0.05) for both Ra and ΔE*. Conclusion: KH significantly affected both surface parameter and color of glazed or polished porcelain materials and natural teeth.

Khat chewing prevalence and correlates among university staff in Ethiopia: a cross-sectional study

OBJECTIVES

Khat is an herbal cultivated plant growing mainly in Eastern Africa and Arabians. Chronic khat chewing leads to the development of liver toxicity, cardiovascular disease, sleeping disorder, psychosis, memory impairment, poor academic performance and variety of social and economic problems affecting the consumers and their families. Therefore, this study aimed to determine the prevalence of khat chewing and associated factors among Jimma university staff. An institution-based cross-sectional study was employed on 354 university staff. A self-administered questionnaire was used to collect the data. The analysis was done using Stata 14. A multivariable logistic regression model was used to identify associated factors of khat chewing among university staff. p ≤ 0.05 was employed to declare statistically significant factors.

RESULTS

The lifetime prevalence of khat chewing among university staff was 41.0% (95% CI 35.9-46.1%). The odds of khat chewing was higher among males (AOR = 2.66 95%, CI 1.52-4.68), participants who had khat chewer friends (AOR = 2.15 95% CI 1.18-3.93), alcohol users (AOR = 9.02, 95% CI 4.96-16.42) and participants who had khat chewer family member (AOR = 4.03, 95% CI 1.16-13.99). Since a significant proportion of staff chew khat, appropriate measures need to be taken to reduce its prevalence and adverse social and health consequences.

Impact of khat price increases on consumption behavior - price elasticity analysis

Background

The long border of Saudi Arabia with Yemen is the primary route for khat entry to the Kingdom. As of April 2015, the government of SA tightened the border, making it more difficult to import khat into the country. As a result, local user prices of khat probably increased due in part to higher supply costs and perhaps lower quantities. One anti-drug strategy is to increase consumption cost by increasing the price of supply. We aim in this study to measure the responsiveness of khat demand to price changes.

Methods

This study used a cross-sectional survey design. Two stage sampling was used to recruit 350 khat chewers from four selected primary healthcare centers in Jazan province (South western province of Saudi Arabia). The data were collected during the first quarter of 2017. This study used both contingent valuation and revealed preference methods to assess the impact of price increases on the purchasing of khat. Graphical analysis, paired-samples t-test, and one-way repeated measures analysis of variance (ANOVA) were used to assess the impact of price increases on khat consumption.

Results

The study results showed a significant decrease in khat consumption amount (t = 8.63, p ≤ 0.05), frequency (t = 30.42, p ≤ 0.05), and expenditure (t = 34.67, p ≤ 0.05) after the tightening of the Saudi–Yemeni border. Hence khat demand is price elastic. The price elasticity of khat demand in Jazan is estimated to be between − 2.38 and − 1.07. Therefore, each 1% increase in price is associated with 1–2% reduction in quantity demanded. This means khat chewers are relatively responsive to price changes (i.e., khat demand is price elastic). Repeated measures analysis of variance showed price increases significantly affect the quantity {F(4, 2.58) = 257, p ≤ 0.05, ηp² = 0.423} and frequency {F(4, 1.83) = 415, p ≤ 0.05, ηp² = 0.543} of khat chewing.

Conclusions

Increased prices for khat would significantly decrease demand. Accordingly, we recommend implementing law enforcement strategies focused on disrupting the khat supply chain to realize high prices and so discourage use, hence reducing the incidence of khat-related illnesses.

Epidemiology of khat (Catha edulis) consumption among university students: a meta-analysis

BACKGROUND

Khat is amphetamine-like substance commonly consumed by students when they wish to study for long hours especially during examination periods. Khat consumption is associated with increased rates of cardiovascular problems, stroke, myocardial infarction, cardiomyopathy, periodontal disease, gastritis, poor oral hygiene, psychosis, decreased quality of life, and poor academic performance.

METHODS

PubMed, EMBASE, and SCOPUS were systematically searched without restriction by publication status. Publications were screened according to predefined inclusion criteria. Twenty-five articles were included. Random effect model was used to calculate weighted prevalence, odds ratio (OR) and corresponding 95% confidence interval (CI). We assessed the risk of publication bias by using funnel plot and Eggers's regression tests.

RESULTS

The pooled prevalence of current khat use among university students was 14.16% (95% CI; 11.87-16.81). The pooled prevalence of current khat use was highest in Saudi Arabia 18.85% and it was 13.59% in Ethiopia and 13.04% in Yemen. In addition, the current pooled prevalence of khat use was higher in men at 19.26% than in women 6.41%. Regarding lifetime khat use, in this study, the pooled prevalence of lifetime khat use was 27.31%. The lifetime prevalence was higher in men at 31.47% than in women 11.79%. Moreover, the lifetime prevalence of khat use was 43.27% in Yemen, 37.32% in Saudi Arabia, and 24.82% in Ethiopia. We found significantly increased odds of current (OR 3.59; 95%CI 2.01-6.41) as well as lifetime (OR 3.48; 95%CI 2.09-5.78) khat chewing in men as compared to women.

CONCLUSION

The pooled prevalence of current and lifetime khat consumption was 14.16 and 27.31%, respectively. Both the current and lifetime prevalence of khat use was higher in men than in women. In addition, both the current and lifetime prevalence estimates of khat consumption were low in Ethiopia than in Saudi Arabia. Moreover, the odds of both current and lifetime khat consumption were higher in male students than in female students. Programmes that specifically aim at increasing awareness and that most motivate reduced khat consumption among university students were recommended.

Prevalence and associated factors of khat chewing among students in Ethiopia: a protocol for systematic review and meta-analysis

INTRODUCTION

These days, in Ethiopia, khat chewing is one of the widely spreading public health problems affecting the most productive segment of the population. The health implications of khat chewing among students are strongly linked with poor mental, physical and social performances. However, the national magnitude of khat chewing and the associated factors among Ethiopian students are unknown. Therefore, this systematic review and meta-analysis will answer the national prevalence of khat chewing and the associated factors among students in Ethiopia.

METHODS

Published primary relevant articles will be accessed using various databases, such as Medline, PubMed, EMBASE and Scopus. Other electronic search engines, for instance, Google Scholar and Google, will be used. Furthermore, additional studies will be collected by communicating with the author(s) and following the references of relevant articles. To select eligible studies, the Joanna Briggs Institute quality appraisal checklist will be used. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist will be followed to keep the scientific rigour of the study. Heterogeneity between studies will be examined through forest plot and I² heterogeneity tests. To identify influential studies, sensitivity analysis will be done. For substantial heterogeneity (I²>50%), the DerSimonian and Laird random-effects model will be employed. Subgroup analyses will be conducted using the random-effect model. Moreover, small studies' publication bias will be checked by funnel plots and objectively by Egger's regression test. If in case Egger's test was found to be statistically significant (p<0.05), trim and fill (Duval and Tweedie) analysis will be performed. The presence of association will be declared using p≤0.05 and OR with corresponding 95% CI.

ETHICS AND DISSEMINATION

Since the intention of the study is to describe earlier primary studies qualitatively and pool the results of those articles, ethical clearance will not be a concern. The results of the study will be published in a reputable peer-reviewed journal and presented at different scientific research conferences. It will also be disseminated to academic as well as other concerned institutions.

PROSPERO REGISTRATION NUMBER

CRD-42,017,081,886.

Depression, anxiety, and stress and their association with khat use: a cross-sectional study among Jazan University students, Saudi Arabia

BACKGROUND

Depression, anxiety, and stress levels are considered important indicators for mental health. Khat chewing habit is prevalent among all segments of Jazan population in Saudi Arabia. Few studies have been conducted to evaluate depression, anxiety, and stress among Jazan University students, and information about the correlation between khat use and these disorders is scarce. Thus, this study aims to evaluate the prevalence of depression, anxiety, and stress and their correlation with khat chewing and other risk factors among Jazan University students.

METHODS

A cross-sectional study was conducted on 642 students from Jazan University. Multistage sampling was used, with probability proportional to size-sampling technique. The Depression, Anxiety, and Stress Scale 21 questionnaire was used to collect the data, which were analyzed using SPSS Version 20.0 software.

RESULTS

Moderate depression was prevalent among 53.6% of the sample, anxiety was found among 65.7%, while 34.3% of the students suffered from stress. Female gender was strongly associated with higher mean scores for symptoms of depression, anxiety, and stress, with P-values <0.05 for all. Moreover, anxiety symptoms scores were statistically associated with grade point average and caffeine consumption. Khat use was statistically associated with higher mean scores of anxiety among males and a higher mean score of depression and anxiety among females.

CONCLUSION

The results indicate a high rate of symptoms of depression, anxiety, and stress among Jazan University students. Khat use was associated with anxiety, and a higher rate of symptoms of depression, anxiety, and stress was indicated among female students. Therefore, strategy for the prevention and management of depression, anxiety, and stress is highly recommended to minimize the impact of these serious disorders.

DARK Classics in Chemical Neuroscience: Cathinone-Derived Psychostimulants

Cathinone is a plant alkaloid found in khat leaves of perennial shrubs grown in East Africa. Similar to cocaine, cathinone elicits psychostimulant effects which are in part attributed to its amphetamine-like structure. Around 2010, home laboratories began altering the parent structure of cathinone to synthesize derivatives with mechanisms of action, potencies, and pharmacokinetics permitting high abuse potential and toxicity. These "synthetic cathinones" include 4-methylmethcathinone (mephedrone), 3,4-methylenedioxypyrovalerone (MDPV), and the empathogenic agent 3,4-methylenedioxymethcathinone (methylone) which collectively gained international popularity following aggressive online marketing as well as availability in various retail outlets. Case reports made clear the health risks associated with these agents and, in 2012, the Drug Enforcement Agency of the United States placed a series of synthetic cathinones on Schedule I under emergency order. Mechanistically, cathinone and synthetic derivatives work by augmenting monoamine transmission through release facilitation and/or presynaptic transport inhibition. Animal studies confirm the rewarding and reinforcing properties of synthetic cathinones by utilizing self-administration, place conditioning, and intracranial self-stimulation assays and additionally show persistent neuropathological features which demonstrate a clear need to better understand this class of drugs. This Review will thus detail (i) historical context of cathinone use and the rise of "dark" synthetic derivatives, (ii) structural features and mechanisms of synthetic cathinones, (iii) behavioral effects observed clinically and in animals under controlled laboratory conditions, and (iv) neurotransmitters and circuits that may be targeted to manage synthetic cathinone abuse in humans.

The Physiological and Ergogenic Effects of Khat (Catha edulis Forsk) Extract

BACKGROUND

Khat (Catha edulis Forsk) is a natural psychoactive substance which contains two main addictive substances; Cathine and Cathinone. Khat is widely used in east Africa and southern Arabian Peninsula. Khat chewers believe that it improves work capacity and increases energy level and alertness. That is why we aimed in this study to investigate the physiological and ergogenic effects of khat extract.

METHODS

This study is an experimental study conducted at the Substance Abuse Research Centre in Jazan University, Saudi Arabia. Thirty healthy young volunteers were randomly assigned into two experimental groups. The first group ingested 45 g of grounded khat leaves extract mixed with juice in the first session then placebo (juice only) in the second session. While the second group ingested the placebo in the first session and the grounded khat leaves with juice in the second session. Experiments were done between December 2012 and March 2013. We recorded the blood pressure, heart rate, grip strength, and reaction time every 15 min for 75 min after each ingestion. The study proposal was reviewed and approved by Research Ethics Committee (REC) of the Medical Research Centre in Jazan University.

RESULTS

The results showed the consumption of 45 g of grounded khat leaves contributed to the increase in blood pressure (SBP & DBP) and reaction time (p < 0.05); but had no significant effect on heart rate and grip strength (p > 0.05).

CONCLUSIONS

The findings of this study showed that Khat has an acute effect on some physiological parameters. These findings support the prohibition of cathinone and cathine by the World Anti-Doping Agency (WADA, 2016).

Prevalence of khat chewing and its effect on academic performance in Sidama zone, Southern Ethiopia

BACKGROUND

Khat use is a well-established public health problem in Yemen, Arabian Peninsula, and Ethiopia. Along with its large scale production, the magnitude of khat use is increasing among students.

OBJECTIVE

This study was intended to assess the prevalence, determinants, and effect of khat use on academic performance of high school students in Sidama Ethiopia.

METHODOLOGY

A cross-sectional study was conducted from April to June 2015. We used a stratified sampling technique to draw a total of 1,577 students. The data was collected using self-administered questionnaires and analyzed using SPSS version 20. Descriptive statistics and logistic regression models were used to determine the prevalence, effects, and predictors of khat use.

RESULT

The life time and current prevalence of khat use were 14.6% and 13%, respectively. Smoking cigarette (AOR=5.1, 95% C.I: 2.3-14.3), drinking alcohol (AOR=3.0, 95% C.I: 1.4-6.3), having a family growing khat (AOR=2.0, 95% C.I: 1.1-2.5), having friend chewing khat (AOR=3. 95% C.I: 2.0-4.6), were some of factors that increased the odds of students' khat use. Student's khat use increased the odds of student's poor academic performance (AOR=2.1, 95% C.I: 1.1-3.9).

CONCLUSION

The prevalence of khat use in high khat producing districts of Sidama and its contribution to poor academic performance demand prompt intervention.

Determinants of alcohol use and khat chewing among Hawassa University students, Ethiopia: a cross sectional study

BACKGROUND

Students' alcohol and khat use have been associated with various health related problems. However, its magnitude and associated factors among Ethiopian students are not yet well documented.

OBJECTIVE

The study aimed to assess the prevalence of alcohol use, khat chewing and its associated factors among Hawassa University students.

METHODS

A cross-sectional study was conducted from June to July 2011. Multistage stratified sampling technique was employed to select 590 students. Self administered questionnaires were used to collect data. Data was entered and analysed by SPSS version 20.0. Logistic regression analyses were used to identify the association of different variables.

RESULTS

The current prevalence of student's alcohol and khat use were 29.5% (95% CI: 25.8-33.3) and 16.3% (95% CI: 13.7-20.0) respectively. Being male (AOR 1.8; 95% CI 1.1-3.0) and living alone (AOR 20.1; 95% CI 2.5-166.7) had a higher odds of alcohol use. Similarly, family substance use history (AOR 4.8; 95% CI 2.5-9.3) and peer influence (AOR 4.6; 95% CI 2.3-9.0) had also higher odds of khat use.

CONCLUSION AND RECOMMENDATION

The proportion of student's khat chewing and alcohol use was significant. Hence, higher education in collaboration with other stakeholders should work on convincing students about the ill effects of these substances.

Prevalence of substance abuse among regular degree health science students in Sheba University College in Mekelle Town, Tigray - Ethiopia

Background:

Substance abuse (SA) refers to the harmful or hazardous use of psychoactive substances, including alcohol and illicit drugs. The most common substances which are usually abused are alcohol and tobacco. Herein, we assessed the prevalence of SA among regular degree health science students of the Sheba University College (SUC).

Materials and Methods:

A cross-sectional survey was carried out among 1076 SUC students using self-administered structured questionnaire. The simple sampling technique was used to select students. Descriptive statistics, bivariate, and multivariate analysis were done.

Results:

The overall prevalence of “ever used substance” for at least one was 45.5%. The most commonly used drugs in descending order were alcohol (25.1%), cigarette (11.4%), and khat (9.2%). Male participants, urban setting, peer pressure, personal pleasure, and academic dissatisfaction and pocket money were highly associated with SA.

Conclusion:

This study showed a lower magnitude (45.6% ever use and 21% still using) of SA among students' compared to other studies. Even if a considerable decrease in SA among study subjects, the creation of awareness and health education should be continued to fully combat the problem of abuse.

Prevalence, Reasons, and Perceived Effects of Khat Chewing Among Students of a College in Gondar Town, Northwestern Ethiopia: A Cross-Sectional Study

Background:

The estimate of the number of people chewing Khat globally ranges from 5 to 10 million people. Its use may result in a variety of effects due to the different compounds in it with effects on the gastro-intestinal system and nervous system being the principal ones.

Aim:

To assess the prevalence, factors, and effects of Khat chewing among students of a college in Gondar town, northwestern Ethiopia.

Subjects and Methods:

An institution-based cross-sectional study was conducted from 15^th to 20^th of April 2009 on a total sample of 424 students who were selected using stratified random sampling technique. Data were collected by three of the principal investigators using a structured pretested data collection instrument and analyzed by Epi Info version 3.5.2.

Results:

The lifetime and current prevalence of Khat chewing among the respondents were 42% (168/400) and 32.5% (130/400), respectively. Sex (P < 0.01), religion (P < 0.001), and income (P < 0.01) showed statistically significant variation in Khat chewing. The commonest frequency of Khat chewing was once a day 33.1% (43/130) while alcohol (40.8% [53/130]) and cigarette (40.0% [52/130]) were the mostly used substances with Khat. More than half of the chewers (53.85% [70/130]) reported spending 1–4 h for one Khat chewing ceremony. Financially majority of the chewers reported spending up to 10 Ethiopian Birr (ETB) (1.13 United States Dollar) on Khat ( 54.6% [71/130]) and other substances (64.6% [84/130]). Nearly two-thirds (62.3% [81/130]) of the chewers mentioned seeking concentration during study as their main reason for chewing. Among chewers, 83.1% (108/130) reported they faced problem associated to sleep disturbance, 82.3% (107/130) loss of appetite, and 80.8% (105/130) constipation.

Conclusion:

The prevalence of Khat chewing was fairly high among the students and the majority among them used other substances together with Khat. Spending of a significant amount of money and facing health problems were reported to be consequences of the habit. The college should take steps to make students aware of the ills of Khat chewing and associated habits.

Association of Awake Bruxism with Khat, Coffee, Tobacco, and Stress among Jazan University Students

Objective. The objective is to assess the prevalence of bruxism among the university students and to check its association with their khat chewing habit. Materials and Methods. A cross-sectional descriptive study is designed using cluster random sampling. Pretested questionnaire was administered by a trained interviewer to assess awake bruxism and the use of variables like khat, coffee, tobacco, and stress. Chi-square test at 5% significance was used for assessing the association. Logistic regression was also performed after adjusting for covariates. Results. A high response rate (95%) was obtained as the distribution and collection of questionnaire was within an hour interval. 85% (63%, males; 22%, females) experienced an episode of bruxism at least one time in the past six months. Regression analysis revealed an association of stress (P = 0.00; OR = 5.902, 95% CI 2.614-13.325) and khat use (P = 0.05; OR = 1.629, 95% CI 0.360-7.368) with bruxism. Interestingly, it is observed that the one who chew khat experienced 3.56 times (95% CI; 2.62-11.22) less pain when compared to the nonusers. Conclusion. This study is the first of its kind to assess the association of bruxism with khat chewing. High amount of stress and khat use can be considered as important risk indicators for awake bruxism.

Clinical and cytological study of the oral mucosa of smoking and non-smoking qat chewers in Yemen

OBJECTIVE

The study was conducted to investigate the role of qat and smoking habits on the prevalence of visible and cytological abnormalities in the oral mucosa among Yemenites.

METHODS

We recruited 30 non-smoking and 30 smoking Yemenites chewing qat unilaterally for at least 5 years. We inspected oral cavities for the presence of lesions and took brush biopsies from the buccal mucosa/gingiva of the chewing/non-chewing region.

RESULTS

All visible oral lesions were flat and homogeneous, and cytological changes were detected frequently. Among both non-smokers and smokers, white lesions and cytological changes were detected in 77% of all cases. On the chewing area, the proportion with white lesions ranged--depending on anatomical area and smoking status--between 47 and 93% and was significantly more frequent than on the non-chewing side (range 3-47%). The proportion of regions with changes was similar in non-smokers and smokers. Kappa statistics for "interobserver" agreement between visual inspection and cytological specimens of brush biopsies was at best fair (≤0.25).

CONCLUSIONS

The high prevalence of visible lesions and cytological abnormalities among qat chewers was independent of smoking status.

CLINICAL RELEVANCE

The moderate level of agreement between visual inspection and exfoliative cytology demonstrates the still challenging clinical management of chronic qat chewers, though brush biopsies including adjuvant techniques like DNA cytometry may support the clinical decision-making process in future.

Khat (Catha edulis Forsk.) Dependence Potential and Pattern of Use in Saudi Arabia

Background. Catha edulis Forsk. (Khat) is used for its psychoactive effects among people in Africa and the Arabian Peninsula, although its utilization is illegal in some countries such as Saudi Arabia. This study examined the pattern of Khat use and assessed the applicability of the Drug Abuse Screening Test-10 (DAST-10) to measure Khat dependence. Methods. A pretested questionnaire was used to gather data from 603 respondents. Variables included demographic characteristics, pattern of use, reasons for Khat chewing, and DAST-10. Stepwise-logistic regression was used to explore predictors of Khat dependence. Results. The majority of the respondents were married, had a secondary school level of education, were employed, were younger than 35 years old, and were living in rural areas. Many chewers gave more than one reason for using Khat. It was mainly used to increase mental capacity, physical strength, and social entertainment, as well as enhance cheerfulness and orgasms. Statistical modeling of Khat dependence suggested that the most significant predictors were residence (OR = 1.67, P < 0.02), frequency of Khat chewing (OR = 4.8, P < 0.01), age of starting Khat chewing (OR = 1.15, P < 0.01), and time of Khat effect (OR = 1.15, P < 0.04). Conclusion. Our study provides important information on the pattern of Khat use and its potential to cause dependence.

Khat Chewing Habits in the Population of the Jazan Region, Saudi Arabia: Prevalence and Associated Factors

The use of khat (Catha edulis) is a major public health and social problem that is believed to be growing globally. The khat chewing habit is prevalent in all areas of the Jazan region, Kingdom of Saudi Arabia (KSA). However, few studies have been conducted at the community level to investigate the khat chewing habits in this area. This study was conducted with the aim of assessing the prevalence and predictors of khat chewing among the Jazan community population. A cross-sectional study was conducted with a sample (n = 4,500) of the Jizani population who attended primary heath care centers in Jazan region. The participants were selected using a two-stage cluster random sampling. A structured questionnaire was used for data collection. The overall lifetime prevalence of khat chewing was 33.2% (95% CI 31.8-34.7) and was significantly higher for males 42.2% (95% CI 40.4-43.9) than for females 11.3% (95% CI 9.6-13.1) (P < 0.001). Current khat chewers accounted for 28.7% (95% CI 27.4-30.1) of the population sampled; 36.9% (95% CI 35.2-38.6) of whom were males, which is a significantly higher percentage than the 8.7% (95% CI 7.3-10.4) of current khat chewers who were females (P < 0.001). The multivariate logistic regression analysis suggests that the most important independent predictors of khat chewing were having a friend who chewed khat (OR = 20.1, P < 0.001), participant's smoking status (OR) = 3.9, P < 0.001), friend's smoking status (OR = 2.2, P < 0.001), gender (OR = 2.2, P < 0.001) and educational level (OR = 1.5, P < 0.05). A large proportion of the Jizani populations chew khat. Government and non-governmental organizations NGOs should design and strengthen community prevention programs to curb the high prevalence of khat use.

Khat chewing among Ethiopian University Students--a growing concern

Background

Khat has amphetamine like effect. Students chew khat to stay alert. It has various negative physical, mental, social and cognitive effects. Poor academic performance has been associated with khat. The purpose of this study was to determine the prevalence and identify factors associated with khat chewing among Ethiopian University students.

Methods

A cross sectional study was conducted on Bahir Dar University Students. A self-administered questionnaire was completed by 3268 students. Proportion was calculated to estimate prevalence of khat chewing. Logistic regression was used to identify factors associated with khat chewing.

Results

Lifetime prevalence of khat chewing was 24% (95% Confidence Interval: 22.5%, 26.6%). Half of these are current khat users with a prevalence of 12.7% (95% Confidence Interval: 11.5%, 13.9%). Male students Adjusted Odds Ratio (AOR) = 3.3 (95% Confidence Interval: 1.8, 6.0), students living in off campus housing AOR = 3.0 (95% Confidence Interval: 1.5, 6.0), students who have khat user friends AOR = 4.2 (95% Confidence Interval: 2.6, 6.9), and students who perceive khat use improves academic performance AOR = 6.6 (95% Confidence Interval: 4.6, 9.5) are more likely to use khat.

Conclusions

Prevalence of current use of khat reported in this study is higher than recent study done on university students in Ethiopia and heavily influenced with peer practice.

High prevalence of substance use and associated factors among high school adolescents in Woreta Town, Northwest Ethiopia: multi-domain factor analysis

BACKGROUND

Substance use is a major public health concern in global settings, and is very common during adolescence period leading to physical and/or mental health complications. This study assessed the prevalence of substance use and associated factors among high school adolescents in Woreta Town, Northwest Ethiopia, 2012.

METHODS

A school based cross-sectional study was conducted from April 7 to April 15, 2012 amongst 684 9th to 12th grade high school students in the town of Woreta. Participants were selected by stratified sampling, and data were collected using an anonymous questionnaire adapted from the 2008 Community That Care Youth Survey. Bivariate and multivariate logistic regression analysis was performed to identify factors associated with substance use.

RESULTS

A total of 651 students participated in the study with a response rate of 95.2%. The current prevalence of substance use among Woreta high school students was 47.9% and life-time prevalence was 65.4%. The current and lifetime prevalence of alcohol use was 40.9% and 59% respectively. Siblings' use of substances (AOR [95% CI]: 2.72 [1.79, 4.14]), family history of alcohol and substance use (AOR [95% CI] 2.24 [1.39-3.59]) and friends' use of substances (AOR [95% CI] 2.14 [1.44-3.18]) were factors positively associated with substance use. On the other hand, religiosity and social skill were found to be 54% (AOR [95% CI] 0.46, [0.31-0.68]) and 39% (AOR [95% CI] 0.6 [0.40-0.91]) negatively associated with substance use.

CONCLUSIONS

The prevalence of substance use amongst adolescents was high for the three substances namely alcohol, cigarette and khat with alcohol being the most common. Community norms favorable to substance use, family history of alcohol and substance use, siblings' substance use, poor academic performance, low perceived risk of substances and friends' use of substances had positive association with adolescent substance use while religiosity and social skills were found to have negative association with adolescent substance use. Initiate public awareness campaigns to inform adolescents and adults, particularly parents, of the risk of substance use. Developing culture friendly, gender based adolescent and family based programs and initiating public awareness are recommended to decrease substance use by adolescents.

Prevalence and factors determining psychoactive substance (PAS) use among Hawassa University (HU) undergraduate students, Hawassa Ethiopia

Background

Use of psychoactive substances (PAS) early in school age implies drug dependence in later life. Although no studies have been conducted on undergraduate students of Hawassa University, a few studies in Ethiopia have reported that alcohol, khat, and cigarette are the commonly abused PASs among young high school/undergraduate university students. Therefore, this study was designed to establish the prevalence of and predictors for PAS use among undergraduate HU Students.

Methods

An institution-based quantitative cross-sectional study using the self-administered WHO Model Core Questionnaire to collect information on use of various Psychoactive Substances (PASs) was conducted from June to July 2011. A multistage stratified sampling method was employed to select a total of 586 undergraduate HU students as study participants. Bivariate and multivariate logistic regression analysis were done to determine factors affecting PAS use.

Results

Lifetime, past 12 months, and current prevalence rate for overall PAS were 53.6%, 45.7%, and 35.5% respectively. The study depicted that in the past 12 months of the study period 40.8% used alcohol, 20.3% chewed khat, 11.9% smoked cigarettes, and 0.9% used marijuana. The prevalence of other illicit PASs such as Ecstasy, lysergic diethylamide (LSD), cocaine, crack, heroin, solvents or inhalants and un-prescribed psycho active medications was found zero percent (0%). Having family members who used PAS, peer influence, being male, and living alone during school age were found to be positively associated with overall PAS use in the past 12 months.

Conclusion

The prevalence of PAS use among undergraduate HU students is high. Designing effective strategies to reduce PAS use should be everyone’s priority.

Why would khat chewers quit? An in-depth, qualitative study on Saudi Khat quitters

Background: Khat chewing, which has many adverse health and social consequences, is highly prevalent and socially accepted in the Jazan region of the Kingdom of Saudi Arabia. Methods: A qualitative study was conducted with 47 adult male former khat users regarding their khat initiation, continuance, and cessation, the amounts of khat they had used, and the health and social consequences of their use and cessation of use. Results: Participants noted a desire to show maturity, ease of availability of khat, and peer pressure as reasons for initiating khat chewing. Many noted long leisure times with little to do as a reason for continuing use. Negative consequences of khat use were seen in economic, health, familial, and sexual areas of their lives. After quitting khat use, participants saw improvements in all of these areas. Conclusions: A comprehensive community development program (CCDP) tackling, among other issues, the normalization of khat use, substantial leisure times with few positive activities, and misinformation about the “benefits” of khat use, as well as developing peer and family training programs to help prevent or stop khat use, would be useful to reduce khat chewing in this community.

Sociodemographic factors associated with tobacco smoking among intermediate and secondary school students in Jazan Region of Saudi Arabia

BACKGROUND

The objectives of this study were to (i) determine the prevalence of and characteristics associated with tobacco smoking; (ii) identify the factors associated with tobacco smoking; and (iii) evaluate the association between tobacco smoking and khat chewing among intermediate and secondary school students in Jazan Region, Saudi Arabia.

METHODS

A cross-sectional study was conducted with a representative sample (N = 4100) of intermediate and secondary school students in Jazan Region. The data were collected using a pretested modified version of the global youth tobacco survey questionnaire.

RESULTS

A total of 3923 students from 72 intermediate and secondary schools for males and females in Jazan Region, Saudi Arabia, were included in this study. The ever having smoked prevalence was 17.3%, and the current smoking prevalence was 10.7%. The most important independent predictors of smoking were academic performance (odds ratio [OR]: 5.32), having friends who used khat (OR: 3.23), and having friends who used tobacco (OR: 2.88).

CONCLUSIONS

Understanding the factors and predictors associated with tobacco use are crucial to identifying high-risk groups to design tobacco prevention and control programs. For the first time, a strong and statistically significant association was identified between tobacco smoking and khat chewing among intermediate and secondary school students in Jazan Region. Because the use of khat is increasingly spreading outside of its traditional areas to Europe and America, this finding may have an important impact on tobacco control efforts internationally.

Substance use and associated factors among preparatory school students in Bale Zone, Oromia Regional State, Southeast Ethiopia

INTRODUCTION

The use of cigarettes, alcohol, khat, and other substances is a worldwide threat which especially affects young people and which is also common among the youth of Ethiopia. However, its prevalence and associated factors have not been addressed well yet. Thus, this study aimed to assess the prevalence and associated factors of substance use among preparatory school students in Bale Zone, Oromia Regional State, Southeast Ethiopia.

METHODS

An institutional-based cross-sectional study was conducted among 603 randomly selected students from five of eight preparatory schools of Bale Zone, Oromia Regional State, Southeast Ethiopia, in March 2013. The sample size was calculated by a single population proportion formula and allocated proportionally for the schools based on the number of students. A pretested structured questionnaire was used to collect the data. The data were analyzed using SPSS version 16.0. Descriptive, bivariate, and multivariate logistic regressions were employed to identify the predictors of substance use.

RESULT

The overall current prevalence of substance use among the respondents was 34.8% (210). Specifically, 23.6% (102) and 4.6% (28) of the respondents chewed khat and smoked cigarette, respectively. Sex, age, and substance use status of the respondents' father, mother, siblings, and best friend had an association with substance use. Male respondents were about ten times more at risk of practicing substance use compared to female respondents [adjusted odds ratio (AOR) 11.37, 95% confidence interval (CI) 4.42-29.23]. Respondents whose sibling(s) smokes cigarette were four times more likely to use substance (AOR 4.44, 95% CI 1.11-17.79). Respondents whose best friend chews khat were 11 times more likely to use substance when compared with those whose best friend does not practice the given factor (AOR 11.15, 95% CI 4.43-28.07).

CONCLUSION

Respondents whose family uses one or more substances were more likely use substance(s). Respondents whose best friend uses substance(s) were more prone to practice substance use. Fifteen years of age of the respondents was the critical age when they began to practice substance use. Sex and family of the respondents were the predicting factors for them to practice substance use or not. Hence, health extension workers and district health workers should tackle substance use of the respondents through focusing the identified factors.

Tobacco use among university students of Jazan Region: gender differences and associated factors

Objectives. The main objectives of this study were to estimate the prevalence of tobacco use and behavioral patterns among undergraduate students at higher education institutions in the Jazan Region of Saudi Arabia during the 2011-2012 academic year and to investigate factors that contribute to tobacco use by gender. Methods. A cross-sectional study of 4100 undergraduate students was conducted. An anonymous self-administered questionnaire was used to collect information on the extent and pattern of tobacco consumption and factors associated with tobacco use. Results. Current smokers accounted for 16.8% (95% CI: 15.6–18.1) of the population sampled; 25.6% (95% CI: 23.8–27.5) of males were current smokers, whereas only 4.6% (95% CI: 3.6–5.8) of females were current smokers (P = 0.000). Multivariate analysis revealed that the most important variables explaining tobacco use among study participants were the use of khat (OR = 14.05; P = 0.000), smoking status of friends (OR = 2.25; P = 0.000), and substance use by friends (OR = 1.81; P = 0.001). Conclusions. The results demonstrated that khat use was the main predictor for smoking in Jazan for both males and females. Interventions should be designed to reduce the use of tobacco among university students.

Substance Use and Associated Factors among University Students in Ethiopia: A Cross-Sectional Study

Studies indicate that substance use among Ethiopian adolescents is considerably rising; in particular college and university students are the most at risk of substance use. The aim of the study was to assess substance use and associated factors among university students. A cross-sectional survey was carried out among 1040 Haramaya University students using self-administered structured questionnaire. Multistage sampling technique was used to select students. Descriptive statistics, bivariate, and multivariate analysis were done. About two-thirds (62.4%) of the participants used at least one substance. The most commonly used substance was alcohol (50.2%). Being male had strong association with substance use (AOR (95% CI), 3.11 (2.20, 4.40)). The odds of substance use behaviour is higher among third year students (AOR (95% CI), 1.48 (1.01, 2.16)). Being a follower of Muslim (AOR (95% CI), 0.62 (0.44, 0.87)) and Protestant (AOR (95% CI), 0.25 (0.17, 0.36)) religions was shown to be protective of substance use. Married (AOR (95% CI), 1.92 (1.12, 3.30)) and depressed (AOR (95% CI), 3.30 (2.31, 4.72)) students were more likely to use substances than others. The magnitude of substance use was high. This demands special attention, emergency preventive measures, and targeted information, education and communication activity.

Khat chewing and health related quality of life: cross-sectional study in Jazan region, Kingdom of Saudi Arabia

Background

The chewing of Khat leaves, a natural psychoactive substance is widely chewed in countries of East Africa and the southern Arabian Peninsula, and is reported to be associated with a range of unfavorable health outcomes including khat dependence. The impact of Khat chewing on Health Related Quality of Life is yet to be explored. Aims: to measure and compare the quality of life of the khat chewers and non-khat chewers using a short form health survey (SF36), and to assess factors associated with Khat chewing using SF36 in a sample of adult population in Jazan region, Kingdom of Saudi Arabia.

Methods

A total of 630 participants from two independent male populations of khat chewers and non-khat chewers were recruited into a cross-sectional survey study. A self administrative survey based on the SF-36 questionnaire was used to collect data on measures of health-related quality of life (HRQoL). Socioeconomic data of the respondents were also collected for detailed analysis. Data analysis include: descriptive statistics, reliability tests (Cronbach’s alpha and intraclass correlation coefficient), and bivariate analysis (Chi square and Mann–Whitney U-test) to compare HRQoL of Khat chewers and non-Khat chewers.

Results

The odds of being a khat chewer were higher in respondents with a lower socioeconomic status. The SF-36 scores were significantly lower in all domains for respondents with khat chewing, indicating that non-khat chewers had higher health perceptions compared with those chewing khat. The overall mean score of HRQoL for non-khat chewers was 92.7% (SD 5.53) compared with 63.5% (SD 21.73) for the khat chewing group. The study had shown good internal consistency and reproducibility across the eight subscales of SF-36 questionnaire (α 0.74-0.95). The Mann–Whitney U-test showed a significant difference between khat chewers and non-khat chewers (P < 0.001).

Conclusions

This study measured and compared the quality of life of khat chewers and non-khat chewers using a generic health survey (SF36). The study had shown that khat chewing is associated with lower quality of life (HRQoL) and lower socioeconomic status. However in future a more refined SF36 developed especially for Khat chewers can provide more useful information.

Barriers to the delivery of optimal antidiabetic therapy in the Middle East and Africa

BACKGROUND

The prevalence of type 2 diabetes is increasing worldwide, but developing nations will bear a disproportionate share of this burden. Countries in the Middle East and Africa are in a state of transition, where marked disparities of income and access to education and healthcare exist, and where the relatively young populations are being exposed increasingly to processes of urbanisation and adverse changes in diet that are fuelling the diabetes epidemic. Optimising diabetes care in these nations is crucial, to minimise the future burden of complications of diabetes.

METHODS

We have reviewed the barriers to effective diabetes care with special relevance to countries in this region.

RESULTS

The effects of antidiabetic treatments themselves are unlikely to differ importantly in the region compared with elsewhere, but economic inequalities within countries restrict access to newer treatments, in particular. Values relating to family life and religion are important modifiers of the physician-patient interaction. Also, a lack of understanding of diabetes and its treatments by both physicians and patients requires more and better diabetes education, delivered by suitably qualified health educators. Finally, sub-optimal processes for delivery of care have contributed to a lack of proper provision of testing and follow-up of patients in many countries.

CONCLUSION

Important barriers to the delivery of optimal diabetes care exist in the Middle East and Africa.

Factors associated with Khat use among youths visiting HIV testing and counseling centers in Gamo Gofa, Southern Ethiopia

Background

The use of khat among youths can be harmful leading to decreased academic performance, increased risk of contracting HIV and other sexually transmitted diseases or other psychiatric symptoms. It is believed to be one of the factors associated with unprotected risky sexual behavior predisposing the youth for HIV infection and transmission.

Methods

A cross-sectional study was conducted in South West Ethiopia. A total of 410 participants were recruited in the study using stratified sampling technique. Data were collected by using interviewer administered structured questionnaire. Multiple logistic regression and Cox regression were used to assess the association of independent variables with the outcome variable.

Result

Khat use was positively associated with male gender (OR 2.9; C.I. 1.4 to 6.0), alcohol use (OR 4.8; C.I. 2.1 to 10.6), no education level (OR 2.6; C.I. 1.1 to 6.2) and not having communication with parents about khat chewing (OR 2.6; C.I. 1.1 to 6.2).

Conclusion

Strategies should be designed to increase awareness of factors associated with khat use among youths and their parents in order to reduce the prevalence of khat use and its adverse social and health consequences.

Psychoactive substances use and associated factors among Axum University students, Axum Town, North Ethiopia

BACKGROUND

The use of substances such as alcohol, khat leaves and tobacco have long been recognized as one of the leading causes of human suffering and become one of the rising major public health and socio-economic problems worldwide. Even though substances use occurs in all segments of all societies, it is more spreading in an alarming rate among the young generation. This study aimed to establish the prevalence and associated factors of substances use among undergraduate students in Axum University.

METHODS

Institution based quantitative cross sectional study design was conducted among Axum University students in April 2012. A sample of 764 students was selected by using multi- stage sampling technique. Data were collected using pre- tested self- administered questionnaires. The data were cleaned, coded, entered into EPI-INFO version 3.5.1 and transferred and analysed using SPSS computer soft ware package version 20.

RESULTS

The lifetime prevalence of khat chewing, alcohol drinking and cigarette smoking among the study participants were 28.7%, 34.5% and 9.5% respectively. Similarly, the current prevalence of khat chewing, alcohol drinking and cigarette smoking were 27.9%, 32.8% and 9.3% respectively. The commonest reasons for khat, alcohol and cigarette using were to keep alert while reading 40.6%, for relaxation 65.5% and to relief stress 37.7% respectively. Having peer friends who chew khat was strongly and positively associated with khat use [AOR: 10.18, 95%CI: (5.59, 18.54)].Family members and peer friends alcohol use were strongly associated with alcohol drinking [AOR: 2.61, 95%CI: (1.56, 4.34) and [AOR: 14, 95%CI: (8.09, 24.24)] respectively. Ever alcohol use was strongly associated with cigarette smoking [AOR: 6.54, 95%CI: (2.66, 16.05)].

CONCLUSION

This study revealed that psychoactive substances use became an urgent problem among undergraduate university students. Universities need to monitor and teach their students with special focus on fresh man students, about the health risks and socioeconomic problems associated with psychoactive substances use.

Khat chewing among students of higher education in Jazan region, Saudi Arabia: prevalence, pattern, and related factors

OBJECTIVES

(1) To estimate the prevalence and behavioral patterns of Khat chewing and (2) to investigate factors that influenced the pattern of Khat use among undergraduate students in different higher education institutions in Jazan region, Saudi Arabia.

MATERIALS AND METHODS

A cross-sectional study using a pretested structured self-administered quantitative questionnaire was used to collect data. SPSS version 17 software program was used for data analysis.

RESULTS

The overall current Khat chewing prevalence among higher education students was found to be 23.1%, significantly higher among males at 38.5% than among females at 2.1% (P < 0.001). Lifetime Khat chewer students were 24.8% for males at 40.5%, significantly higher compared with females at 3.7% (P < 0.001). Univariate analysis revealed that the gender of student, smoking status of student, a friend's smoking, and Khat chewing were associated with a significant high risk of Khat chewing (P < 0.001   for all).

CONCLUSIONS

The use of Khat trend is increasing among higher education students in Jazan region. A multilevel, value based, comprehensive, and strategic long-term intervention plan is needed. The comprehensive plan may include social interventions geared by creating recreations alternatives and opportunities for youth and a critical review for current authorities' interventions and services.

Khat chewing habit among school students of Jazan region, Saudi Arabia

BACKGROUND

The use of Khat leaves (Catha edulis) in Jazan, southwest of KSA, is prevalent among all segments of the population.

OBJECTIVE

This study was conducted to assess the prevalence and predictors of Khat chewing among intermediate and secondary school students of Jazan region.

METHODOLOGY

A cross-sectional survey was conducted in late 2011 in Jazan region. A random sample of 3923 students was selected from 72 intermediate and upper secondary schools representing the different educational sectors of the region. A structured self-administered questionnaire was used for data collection. Descriptive statistics, a chi-squared test and logistic regression were performed to examine the prevalence, associations and predictors of Khat chewing.

RESULT

The overall Khat chewing prevalence among students was 20.5% (95% C.I.: 19.27-21.79). The prevalence was significantly higher among males, at 33.1% (95% CI: 31.16-35.08), than among females 4.3% (95% C.I.: 3.39-5.31) ( P <0.001). Univariate analysis revealed that gender, age, academic performance, friends' smoking and Khat chewing, and students' smoking status were associated with a significantly high risk of Khat chewing ( P <0.001 for all). The multivariate logistic regression analysis suggested that the most important independent predictors of Khat chewing among the students in our sample were students' smoking status (OR = 13.02, P <0.001), friends' use of Khat (OR = 5.65, P <0.001), gender (OR = 4.62, P <0.001), and friend's use of tobacco (OR = 1.43, P <0.001).

CONCLUSION

A significant percentage of students chew Khat. The abuse of Khat is significantly associated with gender, peer influence, and cigarette smoking. Intervention programs are needed to create awareness among school students and to reduce the prevalence of the habit and its unfavorable consequences.

The role of family background on adolescent khat chewing behavior in Jazan Region

BACKGROUND

Khat is a well-known natural stimulant from the Catha edulis plant and is widely used in certain Red Sea countries, including Yemen and the province of Jazan in Saudi Arabia. Jazan is located in the southwestern part of the Kingdom of Saudi Arabia adjacent to Yemen, where the practice of khat chewing is deeply rooted throughout the entire population. The main objective of this paper was to assess the association between family background, i.e., parent and sibling khat use, and adolescents' khat chewing behavior in Jazan. Other variables were also tested for association, including parents' education levels, family income, and peer influence.

MATERIAL AND METHODS

A cross-sectional study was conducted with a representative sample (n = 4,100) of intermediate and upper secondary school students of Jazan. The participants were selected using a three-stage cluster random sampling. A structured self-administered questionnaire was used for data collection. Descriptive statistics, a chi-squared test, and logistic regression were performed to examine the associations and predictors of khat chewing.

RESULTS

A total of 3,923 students of both genders from 72 intermediate and upper secondary schools in Jazan were involved in this study. Of these participants, 42.8% (1,678) were from intermediate schools and 43.8% (1,717) were females. The prevalence of current khat chewing among the students was 20.5% (95% confidence interval (CI) 19.27-21.79) and was significantly higher for males at 33.1% (95% CI 31.16-35.08) than for females, of whom 4.3% (95% CI 3.39-5.31) (P < 0.001) chew khat. The multivariate logistic regression analysis suggests that the most important independent predictors of student khat chewing included the students' smoking status (odds ratio (OR) = 14.03, P < 0.001), a friend using khat (OR = 5.65, P < 0.001), a sister using khat (OR = 2.04, P < 0.05), a father using khat (OR = 1.45, P < 0.001), and a brother using khat (OR = 1.56, P < 0.05).

CONCLUSION

The results highlight the significant impact of peer and familial khat abuse in adolescent khat chewing behavior. The findings suggest that khat control programs need to focus on peers and family members to reduce the prevalence of the habit along with its unfavorable consequences.

Prevalence and determinants of khat (Catha edulis) chewing among high school students in eastern Ethiopia: a cross-sectional study

BACKGROUND

Use of psychoactive drugs such as khat leaves (Catha edulis) alter moods and emotional state and lead to adverse effects on the health and social life of users. Ethiopia is a major producer and exporter of khat in east Africa and the majority of the khat comes from the eastern part of the country, however, no studies have been conducted to investigate the habit in this area. This study was conducted to assess the prevalence and predictors of khat chewing among high school students in Harar, eastern Ethiopia.

METHODOLOGY

The study was conducted among 1,890 secondary school students in Harar town in April 2010. A structured self-administered questionnaire was used for data collection. Descriptive statistics and logistic regression were performed to examine the prevalence and predictors of khat chewing.

RESULT

The overall prevalence of khat chewing among the sample was 24.2% (95% CI 22.2%-26.2%). About 28.5% of females and 71.5% of males had chewed khat. Older age (OR 1.31; 95% CI 1.16-1.49), male gender (OR 2.10; 95% CI 1.50-2.93), Muslim religion (OR 1.88; 95% CI 1.17-3.04), having friends who chewed khat (OR 7.93; 95% CI 5.40-11.64), and availability of someone with a similar habit in the family (OR 1.50; 95% CI 1.07-2.11) were found to be independent predictors of chewing.

CONCLUSION

A significant proportion of students chew khat. The use of khat is significantly associated with age, gender, Muslim religion, peer influence and habit of family and other relatives among students. Measures such as educational campaigns need to be instituted to create awareness among school adolescents and their parents in order to reduce the prevalence of the habit and its adverse social and health consequences.

Chemistry, pharmacology, and toxicology of khat (catha edulis forsk): a review

Catha edulis (khat) is a plant grown commonly in the horn of Africa. The leaves of khat are chewed by the people for its stimulant action. Its young buds and tender leaves are chewed to attain a state of euphoria and stimulation. Khat is an evergreen shrub, which is cultivated as a bush or small tree. The leaves have an aromatic odor. The taste is astringent and slightly sweet. The plant is seedless and hardy, growing in a variety of climates and soils. Many different compounds are found in khat including alkaloids, terpenoids, flavonoids, sterols, glycosides, tannins, amino acids, vitamins and minerals. The phenylalkylamines and the cathedulins are the major alkaloids which are structurally related to amphetamine. The major effects of khat include those on the gastro-intestinal system and on the nervous system. Constipation, urine retention and acute cardiovascular effects may be regarded as autonomic (peripheral) nervous system effects; increased alertness, dependence, tolerance and psychiatric symptoms as effects on the central nervous system. The main toxic effects include increased blood pressure, tachycardia, insomnia, anorexia, constipation, general malaise, irritability, migraine and impaired sexual potency in men. Databases such as Pubmed, Medline, Hinary, Google search, Cochrane and Embase were systematically searched for literature on the different aspects of khat to summarize chemistry, pharmacology, toxicology of khat (Catha edulis Forsk).

Khat chewing, cardiovascular diseases and other internal medical problems: the current situation and directions for future research

The leaves of khat (Catha edulis Forsk.) are chewed as a social habit for the central stimulant action of their cathinone content. This review summarizes the prevalence of the habit worldwide, the actions, uses, constituents and adverse health effects of khat chewing. There is growing concern about the health hazards of chronic khat chewing and this review concentrates on the adverse effects on health in the peripheral systems of the body, including the cardiovascular system and gastrointestinal tract. Comparisons are made with amphetamine and ecstasy in particular on the detrimental effects on the cardiovascular system. The underlying mechanisms of action of khat and its main constituent, cathinone, on the cardiovascular system are discussed. Links have been proposed between khat chewing and the incidence of myocardial infarction, dilated cardiomyopathy, vascular disease such as hypertension, cerebrovascular ischaemia and thromboembolism, diabetes, sexual dysfunction, duodenal ulcer and hepatitis. The evidence, however, is often based on limited numbers of case reports and only few prospective controlled studies have been undertaken. There is therefore an urgent need for more thorough case-control studies to be performed. This review outlines the current knowledge on the adverse health effects of khat chewing on the cardiovascular system and other internal medical problems, it assesses the evidence and the limitations of the studies and identifies the questions that future studies should address.