Determinants of cigarette smoking among school adolescents in eastern Ethiopia: a cross-sectional study

Prevalence of tobacco smoking and associated factors among adults in Ethiopia: a systematic review and meta-analysis

Introduction

The public health concern of tobacco smoking is more prevalent in low- and middle-income countries including Ethiopia. Various studies have investigated tobacco smoking in various parts of Ethiopia. However, the findings have been inconsistent and characterized by significant variability. Besides, there is no nationally representative data on the subject, which could deter the design of effective intervention strategies to reduce tobacco-related problems. Therefore, this study aimed to estimate the pooled prevalence of tobacco smoking and associated factors among adults in Ethiopia.

Methods

The study was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols Guideline. A detailed search was conducted from international databases including PubMed, Cochrane Library, Science Direct, CINAHL, African Journals Online, HINARI, Global Health, and Google Scholar. The extracted data was analyzed using STATA 14 software. A random-effects model was used to estimate the effect size. The Egger regression test and I2 statistics were used to determine potential publication bias and heterogeneity among the reviewed articles, respectively.

Results

A total of 32 studies with 69,897 study participants were included in this systematic review and meta-analysis. The pooled prevalence of lifetime tobacco smoking among adults in Ethiopia was 16.0% (95% confidence Interval (CI): 13.6-18.39) and there was significant heterogeneity among the included studies (I2 = 99.1%, p < 0.001). Male adults were three times more likely to smoke tobacco as compared with females [OR = 3.22 (95% CI: 2.06-5.03)]. Being an alcohol user [OR = 3.78 (95%CI: 1.27-11.24)] and having tobacco-smoking friends [OR = 7.21 (95%CI: 5.56-9.35)] are potential determinant factors for tobacco smoking.

Conclusion

The pooled prevalence of lifetime and current tobacco smoking among adults in Ethiopia was high, which calls for urgent intervention. Therefore, prioritization of tobacco control strategies, such as creating awareness about the public health importance of tobacco smoking, can help prevent and mitigate the effects of tobacco smoking. Alcohol control law enforcement should also be strengthened.

Tobacco use and behaviour among South African adolescents and young adults: systematic review and meta-analysis

OBJECTIVE

Tobacco use, particularly the initiation of smoking during adolescence and young adulthood, represents a significant public health concern in South Africa. This study aims to conduct a comprehensive review of published literature about tobacco use and behaviour among adolescents and young adults and to determine an aggregated prevalence estimate of tobacco use within this demographic.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

PubMed/MEDLINE, EMBASE, Cochrane Library, Scopus and Google Scholar were searched from 1 January 2000 through 31 October 2023.

ELIGIBILITY CRITERIA

Studies were eligible for inclusion if they were cross-sectional studies conducted in South Africa and measured the prevalence and determinants of tobacco use among adolescents and young adults aged 12-24 years.

DATA EXTRACTION AND SYNTHESIS

Two reviewers independently extracted information for each article and saved it into an Excel spreadsheet. Risk of bias analysis was conducted using the Risk of Bias Assessment Tool for non-randomised studies. The methodology quality of each selected study was evaluated using the Joanna Briggs Institute checklist. The heterogeneity of prevalence estimates was assessed using I2 statistic (random-effects DerSimonian-Laid approach).

RESULTS

Out of 73 articles identified, 12 articles were included in the analysis. The pooled prevalence of current tobacco use among South African adolescents and young adults was estimated to be 22%. The pooled prevalence of tobacco use among school dropouts, university students and secondary school learners was 51%, 20% and 16%, respectively. Stratifying using gender, boys (26%) were two times more likely to use tobacco than girls (13%).

CONCLUSION

The elevated occurrence of tobacco usage among South African adolescents and young adults is a relevant public health concern. There is a need for more population-based prevalence studies at a national level to estimate the burden of tobacco use in South Africa.

PROSPERO REGISTRATION NUMBER

CRD42023428369.

Tobacco use in Haiti: findings from demographic and health survey

INTRODUCTION

Although tobacco has harmful effects on the physical and mental health of individuals, its use remains significant, according to the World Health Organization. To understand this phenomenon, studies have been carried out in many countries around the world, while in Haiti where more than 5,000 people die each year due to tobacco use, little is known about the use of this substance. The aim of this study was to examine the prevalence and the factors associated with tobacco use in Haiti.

METHODS

We used data from the 2016/17 Haitian Demographic Health Survey. Both descriptive and multivariate analyses were conducted using STATA 16.0 software to assess the prevalence and identify factors associated with tobacco use. Results were reported as adjusted odds ratios with 95% confidence intervals. Statistical significance was declared at p < 0.05.

RESULTS

The prevalence of tobacco use was estimated at 9.8% (95% CI: 9.2-10.4) among men and 1.7% (95% CI: 1.5-1.9) among women. Although the prevalence of tobacco use was low among young people, it increased with age. Respondents aged 35 and above, with no formal education, non-Christians, divorced/separated/widowed, from poorest households, rural areas, "Aire Métropolitaine de Port-au-Prince" region, with high media exposure had a higher likelihood of tobacco use.

CONCLUSION

The low prevalence of tobacco use among Haitian women and youth represents a public policy opportunity to prevent these vulnerable groups from starting smoking. Adult male smokers should also be targeted by appropriate policy to reduce the different health burdens associated with tobacco, both for the smokers and other people they may expose to passive smoking. Government and health sector stakeholders, along with community leaders, should create and enforce awareness strategies and rules to control advertisements that encourage irresponsible and health-risky consumption behaviors.

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.

Prevalence of Cigarette Smoking and Influence of Associated Factors among Students of the University of Banja Luka: A Cross-Sectional Study

Background and Objectives: Cigarette smoking among the youth population has increased significantly in developing countries, including Bosnia and Herzegovina. However, no extant literature assesses the prevalence of tobacco use, nor identifies factors associated with smoking. This study determined the prevalence of cigarette smoking among a specific cohort of students and assessed factors related to tobacco use in this population. Materials and Methods: This cross-sectional study included 1200 students at all faculties of Banja Luka University. Data were collected from questionnaires adapted from the Global Youth Tobacco Survey (GYTS) and the Global Health Professional Student Survey (GHPSS) standardized questionnaires and were analyzed using descriptive statistics, Pearson's χ2 test, and logistic regression. Results: When the prevalence of cigarette smoking within the last thirty days was recorded, we found that 34.1% of students smoked within this period. Nearly three-quarters (74.9%) of the student population had smoked or experimented with cigarette smoking. However, medical students were 27.2% less likely to smoke than their counterparts from other faculties. Overall, 87% of all students were aware of the harmful effects of cigarette smoking, 79% were aware of the harmful effects of secondhand smoke, and 65% reported that it was difficult to quit. Increased spending of personal money was associated with a higher probability of smoking, while exposure to secondhand smoke increased the odds of smoking by 62%. Conclusion: Policies, strategies, and action plans should be introduced in order to reduce the prevalence of smoking among university students and to create a smoke-free environment at the various universities involved.

What Factors Encourage Young People to Engage in Substance Use? Substance Use and Associated Factors Among Youth in Southwest Ethiopia: A Community-Based Study

Background

Substance use indicated the use of psychoactive substances such as alcohol, cigarettes, khat, and illegal drugs. Substance use has varying impacts on the health and socio-economics of countries, and is a major public health concern globally. Currently, substance use is a common public health problem among Ethiopian youth mainly in the city of Jimma. Therefore, this study aimed to assess the magnitude of Cigarette smoking, alcohol drinking, khat chewing, and associated factors among the youth of Jimma town in 2019.

Methods

A community-based cross-sectional study was conducted among youth of Jimma town from March 2019 to April 2019. A simple random sampling technique was used to select 423 study participants. Data were collected using a structured interviewer-administered questionnaire. The collected data were entered into EPI data manager version 4.4.1 and transported to SPSS version 23 for data cleaning and analyses. The disruptive study was carried out to determine the prevalence of cigarette smoking, alcohol consumption, and khat chewing. Binary and multivariable analyses were carried out to identify factories associated with cigarette smoking, alcohol consumption, and khat chewing. Finally, adjusted odds ratios (AOR) with 95% confidence intervals (CI) were used to determine the presence and strength of association.

Results

The current prevalence of cigarette use, alcohol use, and khat use was 16.0, 30.6, and 45.7%, respectively. Factors associated with current smoking use were substance use by siblings, subjective norm factors, and perceived benefits of substance use. Factors associated with current alcohol consumption were youth who highly perceived substance use as important. Factors associated with current khat use were male, substance use by siblings, out-of-school youth, and subjective norms.

Concussion

The study findings indicated that the prevalence of khat, alcohol, and cigarettes was high among the youth of the city of Jimma. To reduce the prevalence of khat, alcohol, and cigarettes among youth, coordinated efforts from the youth, the government, health professionals, and the community at large are needed.

[Predictors of tobacco use in a high school in Guinea]

INTRODUCTION

Youth smoking is a public health issue. However, the extent of smoking among young people, particularly among high school students, remains little known in Guinea.

OBJECTIVE

The objective of this study was to determine the prevalence and predictive factors of tobacco consumption in a high school in the Middle Guinea region in 2019.

STUDY METHODS

This was a cross-sectional study with analytical aims, focusing on 353 high school students selected from the high school of Mali-center. A questionnaire adapted from the standardized questionnaire validated by the WHO and the CDC as part of the global student health surveys was used for data collection in November 2019. Logistic regression was used to identify predictive factors.

RESULTS

The prevalence of smoking was 9.92% [95% CI: 6.80-13.00]. Note that 76.20% of respondents did not know of any harmful effects of tobacco on health. Male sex [OR = 5.60 (95% CI: 3.25-7.15)], alcohol consumption by the student [OR = 12.94 (95% CI: 10.32-15.78)] and smoking by close friends [OR = 5.40 (95% CI: 3.77-7.49)] were the predictors of tobacco use.

CONCLUSION

The prevalence of smoking and the ignorance of the effects of tobacco on health among high school students in central Mali should draw the attention of actors. Interventions based on education for personal development, youth entrepreneurship and tobacco legislation should be undertaken.

Prevalence of Cigarette Smoking and Associated Factors Among Adolescents in Eastern Ethiopia, 2020

Background

Cigarette smoking is one of the leading causes of preventable morbidity and mortality globally, and it is accountable for many causes of premature deaths. Despite the negative consequences of cigarette smoking, studies to identify factors associated with cigarette smoking are scanty and little is known about this practice in the Somali region so far, so this study aimed to assess the prevalence of cigarette smoking and associated factors among adolescents in the Gode, eastern Ethiopia 2020.

Methods

A community-based cross-sectional study design was employed among 341 adolescents in the Godey administration of the Somali Region, Eastern Ethiopia from July to August 2020. A systematic sampling technique was used to select study participants. Data were collected using a pretested interviewer administered questionnaire. The collected data were entered with Epi-Data version 3.1 and exported to SPSS version 22 software for statistical analysis. Multivariable logistic regression analyses were done to identify the true effect of predictor variables on the outcome variable after controlling for possible confounders. Statistical significance was declared at a p-value < 0.05.

Results

Over all, the prevalence of current cigarette smoking among adolescents was found to be 21.1% (95% CI: (16.7−25.5). Having smoker parents [AOR = 2.57, 95% CI: (1.32–5.02)], whose friends smoke cigarette [AOR = 4.78, 95% CI: (2.12–10.76)], and currently chewing khat [AOR = 6.01, 95% CI: (2.96–12.23)] were significantly associated predictors of current cigarette smoking in the final model of multivariable analysis.

Conclusion

The prevalence of cigarette smoking was relatively high in this study area. This study reported having smokers’ parents, having smokers’ friends and chewing khat were found to be independent predictors for cigarette smoking. Therefore, effective smoking prevention and intervention programs are required in this area.

Why are Youth Engaged in Substance Use? A Qualitative Study Exploring Substance Use and Risk Factors Among the Youth of Jimma Town, Southwest Ethiopia

INTRODUCTION

Substance use refers to the use of psychoactive substances such as khat, alcohol, cigarettes, and illicit drugs. Young people are more vulnerable to substance use than older people. Substance use has varying impacts on the health and socio-economics of countries, and is a major public health concern globally. Currently, substance use is a common public health concern among the youth of Ethiopia, mainly in Jimma town. Therefore, this study aimed to explore the substance use and risk factors among the youth of Jimma town in 2019.

METHODS

The study was conducted in Jimma town among youth who were engaged in substance use, from March to April 2019. A descriptive qualitative study design was employed and the study participants were acquired using purposive/judgmental sampling techniques. In total, 20 interviews were conducted with young people using in-depth and key informant interview methods. The data were analyzed by using ATLAS.ti version 7. Thematic analyses were performed in order to extract the main themes and categories. Direct quotations were presented with a thick description of the findings.

RESULTS

The findings of this study were discussed under six themes and 12 categories, which emerged from thematic analysis of the data: substance use setting, time and means of distribution, substance-related factors, social and economic factors, individual factors, psychological factors, and legal and policy factors.

CONCLUSION

The study indicated that khat, alcohol, cigarettes and shisha or water pipes were the most commonly used substances. Different factors that drive the youth to engage in substance use were identified; individual factors, social and economic factors, substance-related factors, and legal and policy factors were most common. Generally, to overcome this problem, the community, lawyers, and policemen should participate in the implementation and enforcement of rules and regulations on substance use. Family should monitor their children and need to act as good role models by avoiding substance use.

Khat Chewing Practice and Associated Factors among Medical Students in Gondar Town, Ethiopia, 2019

Background:

Globally, khat chewing practice becoming an alarming and common among the youth generation, especially in higher educational institutions. It may also lead to frequent misbehavior, poor academic performance, and memory impairment among students. This study aimed to determine the prevalence of khat chewing practice and associated factors among medical students in Gondar town, Ethiopia, 2019.

Method:

A cross-sectional study was employed on 422 medical students. Data were collected using a self-administered questionnaire and analyzed using SPSS 20 software. Stratified followed by random sampling was employed to select the samples. A multivariable logistic regression model was fitted to identify the predictors. P ⩽ .05 was used to select statistically significant factors.

Result:

The current prevalence of khat chewing practice among medical students was 21.5%. The odds of khat chewing practice was higher among males (AOR = 3.353; 95%CI [1.460-7.701]), Muslims (AOR = 6.390; 95%CI [1.903-21.460]), fifth and 6 year students (AOR = 3.391; 95%CI [1.354-8.488]), smokers (AOR = 5.081; 95%CI [1.898-13.601]), alcohol users (AOR = 4.872; 95%CI [2.094-11.332]), students who had khat chewer close friends (AOR = 30.645; 95%CI [12.261-76.589]).

Conclusion:

Since a significant proportion of students were found to be khat chewers, continuous awareness creation on the impact of khat chewing and counseling services are recommended.

Determinants of cigarette/bidi smoking among youth male in rural Mymensingh of Bangladesh: A cross-sectional study

BACKGROUND

Smoking cigarette/bidi, is a serious health threat, causes preventable premature morbidity and mortality. Higher prevalence of smoking among the youth hampers a country's development, as the youth are the main drivers of socio-economic development. An effective understanding of factors associated with youth smoking is precious to prevent youth smoking. This study aims to identify the determinants of smoking cigarette/bidi among the youth male of the rural areas of Mymensingh district in Bangladesh.

METHODS

The primary data from the project "Knowledge, awareness and practices among youth smokers in Trishal Upazila under Mymensingh district: A micro-survey study", funded by the Research and Extension Center, Jatiya Kabi Kazi Nazrul Islam University, Bangladesh was utilized in the current study. The data consists of 385 youth males aged 15-24 years who were interviewed face-to-face from the rural areas of Mymensingh district in Bangladesh. Univariate distribution, chi-square tests, and binary logistic regression model were employed to identify the factors associated with smoking cigarette/bidi among the youth male.

RESULTS

The prevalence of smoking cigarette/bidi among the youth male is 40.3% [95% CI: 35.0%-45.0%]. Age, occupation, monthly income, family's monthly income, cigarette/bidi smoking status of father, brother and close friends, and knowledge about harmfulness of smoking are revealed as the determinants of cigarette/bidi smoking. For instance, the odds of being smoker increases with the increase in age (Odds ratio [OR]: 1.33 [1.17-1.51]). Business owner is less likely (OR: 0.15 [0.03-0.68]) to smoke than the day labourer. Having smoker fathers (OR: 2.51 [1.39-4.53]), smoker brothers (OR: 2.88 [1.39-5.96]), smoker friends (OR: 9.85 [5.85-1.27]) are significantly associated with smoking cigarette/bidi.

CONCLUSION

As the first study, it provides the determinants of cigarette/bidi smoking among youth male of the rural areas of Mymensingh district in Bangladesh. Relevant authorities are suggested to consider the study's findings and recommendations to revise the existing smoking policies so that smoking among youth can be prevented for future development of the country.

Prevalence and factors associated with tobacco use among men in India: findings from a nationally representative data

BACKGROUND

Tobacco consumption causes almost 638,000 premature deaths per year in India. This study sought to examine the prevalence and determinants of tobacco use among men in India.

METHODS

We analyzed data from the fourth round of the National Family Health Survey in India. These nationally representative cross-sectional sample data were collected from January 20, 2015, to December 4, 2016. A total of 112,122 men aged 15-54 years were included in this study. Primary outcomes were tobacco use categorized into smoking, smokeless, any tobacco, and both smoked and smokeless tobacco use. Complex survey design and sampling weights were applied in both the descriptive analyses and logistic regression models. We present the findings using odds ratios.

RESULTS

The prevalence of tobacco use among men in India for the studied period was 45.5% (95% CI 44.9-46.1), smoking was 24.6% (95% CI 24.1-25.1), smokeless tobacco use was 29.1% (95% CI 28.6-29.6), and both smoked and smokeless tobacco use was 8.4% (95% CI 8.1-8.7). The prevalence of tobacco use among men was higher among the elderly, separated/divorced/widowed individuals, those with lower education and wealth status, alcohol consumers, manual workers, and residents of the northeast region. Multivariate analysis showed that age, lower education, occupation, region, alcohol consumption, separated/divorced/widowed status, and economic status were substantially associated with tobacco use among Indian men.

CONCLUSIONS

Innovative and cost-effective strategies targeting high-risk groups are crucial to curbing the tobacco epidemic in India. Anti-smoking campaigns should also focus on mitigating alcohol abuse. Reducing tobacco marketing and implementing formal education about the dangers of tobacco use, progressive taxing, packaging, and labeling of tobacco products and price strategies should be harmonized in legal provisions.

Smoking Intensity and Associated Factors among Male Smokers in Ethiopia: Further Analysis of 2016 Ethiopian Demographic and Health Survey

Background

Smoking invariably has health, social, economic, and environmental consequences in Ethiopia. Reducing and quitting cigarette smoking improves individual health and increases available household funds for food, education, and better economic productivity. Therefore, this study is aimed at assessing cigarette smoking intensity and associated factors among male smokers in Ethiopia.

Methods

The data were extracted from the 2016 national cross-sectional Ethiopian Demographic and Health Survey. Our study used data from the standardized and adapted men's questionnaire. The study included a total of 391 (weighted) smokers who at least smoked one manufactured cigarette per day. The data were collected using a two-stage cluster design which includes selection of enumeration areas and then selection of households. The number of manufactured cigarettes smokers smoked per day was used to measure smoking intensity. Descriptive statistics were used to summarize the study findings. Bivariable and multivariable truncated negative binomial Poisson regression models were employed to determine smoking intensity.

Results

The finding showed that on average men smoked weighted nine cigarettes per day. One in every five of the smokers (21.2%) smoked 10 cigarettes per day. Smokers living in rural areas (IRR = 0.43, 95% CI: 0.244, 0.756), currently married (IRR = 0.64, 95% CI: 0.46, 0.91), formerly married (IRR = 0.54, 95% CI: 0.30, 0.96), richer men (IRR = 0.63, 95% CI: 0.43, 0.90), and richest men (IRR = 0.49, 95% CI: 0.28, 0.87) were associated with lower smoking intensity. Smokers in the Somali (IRR = 2.80, 95% CI: 1.29, 6.11), Harari (IRR = 3.46, 95% CI: 1.14, 10.51), and Dire Dawa (IRR = 3.09, 95% CI: 1.23, 7.80) regions; older age (IRR = 1.77, 95% CI: 1.31, 2.40); affiliated with Protestant religion (IRR = 1.81, 95% CI: 1.12, 2.92); poorer men (IRR = 1.64, 95% CI: 1.19, 2.27); watched television (IRR = 1.18, 95% CI: 1.04, 1.35); drunk alcohol (IRR = 1.37, 95% CI: 1.03, 1.82); and completed primary (IRR = 1.15, 95% CI: 1.01, 0.317) and higher education (IRR = 2.96, 95% CI: 1.88, 4.67) were positively associated with smoking intensity.

Conclusion

Male smokers in Ethiopia smoked intensively with an average of nine manufactured cigarettes per day. Tobacco control interventions should target the following: Eastern Ethiopia regions, older aged, affiliated with Protestant religion, poorer men, watched television, drunk alcohol, and primary and higher educational level.

Current and former smokers among adolescents aged 12-17 years in Iran: a systematic review and meta-analysis

Background

Smoking, especially among adolescents, is considered a serious public health concern worldwide being associated with increased mortality. The present study was designed as the first systematic review and meta-analysis of the prevalence of current and former smoking behavior among adolescents in Iran.

Methods

Seven international scholarly databases, namely Scopus, Embase, Pubmed/Medline, ISI/Web of Science (WOS), the Cochrane Library, Psyc Info and Cinahl, were extensively searched from January 2000 to September 18, 2019. Google Scholar was also mined. Iranian databases were searched as well (namely, MagIran, Scientific Information Database (SID), and Barakatkns). The DerSimonian-Laird’s approach, via the Freeman-Tukey double arcsine method, was used to synthesize the prevalence estimates.

Results

The prevalence of current smokers among Iranian adolescents was estimated to be 9% (95% CI: 7 to 10). Stratifying based on gender, the prevalence was 12% among boys (95% CI: 10 to 14) and 6% among girls (95% CI: 5 to 8). The prevalence of former smokers among Iranian adolescents using the random-effect model was computed to be 24% (95% CI: 21 to 27).

Conclusion

The findings of this study showed that the prevalence of current and former smoking behavior among Iranian adolescents is a relevant public health concern. The country’s young population should be given more attention by health policy- and decision-makers and implementation of ad hoc prevention and control policies should be on their agenda.

Prevalence of lifetime substances use among students in Ethiopia: a systematic review and meta-analysis

BACKGROUND

The use of substances is a growing concern in Ethiopia, and their impacts on younger generation have been a concern of different professionals. Even though students are at high-risk of substance abuse, there is lack of comprehensive evidence for policy decision on substance use among students. Therefore, the aim of this systematic review and meta-analysis was to estimate the prevalence of common substances among students in Ethiopia.

METHOD

A comprehensive literature searches were done from biomedical databases: PubMed/Medline, African Journal Online, HINARI, Science Direct, and Google Scholar for article published until Dcember 31, 2017, and Addis Ababa Uiversity's electronic library search of unpublished thesis and dissertations. Two authors autonomously selected studies, extracted data, and evaluated quality of studies. The prevalence of lifetime substances use was estimated using the random effects model. Q and I2 statistics were computed to measure the extents of heterogeneity.

RESULTS

A total 676 study articles were identified from electronic databases, and 28 of them were included in meta-analysis. The analysis revealed that the lifetime prevalence of any substance use was 52.5% (95% CI 42.4-62.4%), khat 24.7% (95% CI 21.8-27.7%), alcohol 46.2% (95% CI 40.3-52.2%), and smoking cigarette 14.7% (95% CI 11.3-18.5%). Significant heterogeneity was observed but there was no significant publication bias. The lifetime prevalence of khat, alcohol, and cigarette smoking among high school vs university students was 22.5% (95% CI 15.2-30.7%) vs 25.1% (95% CI 21.9-28.5%), 41.4% (95% CI 22.1-62.1%) vs 47.8% (95% CI 39.9-55.7%), and 21.5% (95% CI 12.6-32.1%) vs 12.9% (95% CI 10.1-16.0%), respectively.

CONCLUSION

This meta-analysis highlighted the extent of lifetime prevalence of any substance, khat, alcohol, and cigarettes smoking among students in Ethiopia. Significant percent of high school students have exposed to substances. Policy makers should devise and implement strictly binding regulation to curb widespread of substances around educational institution premises at national level. Priority should be given to intervention strategies that help delay first use of substance to prevent problems later in life. Besides, the problem warrants regular national-level educational institutions based studies focusing on the magnitude, trajectory, and consequences of substance use among students. Systematic review registration: PROSPERO CRD42018082635.

The impact of peer pressure on cigarette smoking among high school and university students in Ethiopia: A systemic review and meta-analysis

BACKGROUND

Cigarettes and their by-products (i.e., smoke; ash) are a complex, dynamic, and reactive mixture of around 5,000 chemicals. Cigarette smoking potentially harms nearly every organ of the human body, causes innumerable diseases, and impacts the health of smokers and those interacting with the smokers. Smoking brings greater health problems in the long-term like increased risk of stroke and brain damage. For students, peer pressure is one of the key factors contributing to cigarette smoking. Therefore, this systematic review and meta-analysis assessed the impact of peer pressure on cigarette smoking among high school and university students in Ethiopia.

METHODS

An extensive search of key databases including Cochrane Library, PubMed, Google Scholar, Hinari, Embase and Science Direct was conducted to identify and access articles published on the prevalence of cigarette smoking by high school and university students in Ethiopia. The search period for articles was conducted from 21st September, 2018 to 25th December 25, 2018. All necessary data were extracted using a standardized data extraction checklist. Quality and risk of bias of studies were assessed using standardized tools. Heterogeneity between the included studies was assessed using Cochrane Q-test statistic and I2 test. To estimate the pooled prevalence of cigarette smoking, a random effects model was fitted. The impact of peer pressure on cigarette smoking was determined and was reported in Odds Ratio (OR) with 95% Confidence Interval (CI). Meta-analysis was conducted using Stata software.

RESULTS

From 175 searched articles, 19 studies fulfilled the eligibility criteria and were included in this study. The pooled prevalence of cigarette smoking among Ethiopian high school and university students was 15.9% (95% CI: 12.21, 19.63). Slightly higher prevalence of cigarette smoking was noted among university students [17.35% (95% CI: 13.21, 21.49)] as compared to high school students [12.77% (95% CI: 6.72%, 18.82%)]. The current aggregated meta-analysis revealed that peer pressure had a significant influence on cigarette smoking (OR: 2.68 (95% CI: 2.37, 3.03).

CONCLUSION

More than one sixth of the high school and university students in Ethiopia smoke cigarette. Students who had peer pressure from their friends were more likely to smoke cigarette. Therefore, school-based intervention programs are needed to reduce the high prevalence of cigarette smoking among students in Ethiopia.

Determinants of cigarette smoking among adolescents in Ethiopia: A cross-sectional study

INTRODUCTION

Cigarette smoking is an important health hazard and major preventable cause of morbidity and mortality. This study aimed to assess the prevalence of cigarette smoking among Tabor secondary and preparatory school students in Hawassa City, Ethiopia, 2018.

METHODS

A school-based cross-sectional study was conducted among 564 students aged 15-22 years using simple random sampling techniques, in the period 5-19 March 2018. Global Youth Tobacco Survey (GYTS) was used to assess smoking behaviours. Logistic regression analyses were employed to identify factors associated with cigarette smoking.

RESULTS

The student prevalence of cigarette smoking was found to be 11% (95% CI: 8.5-13.9) of which 9.4% were current smokers. The proportion of cigarette smoking among male and female students was 8.2% and 2.8%, respectively. An age ≥18 years (AOR = 3.0, 95% CI: 1.29-7.00), students having friends who smoke (AOR= 4.04, 95% CI: 2.04-7.45), khat chewing (AOR=5.57, 95% CI: 2.44-12.76), alcohol consumption (AOR=4.14, 95% CI: 1.84-9.70) and illegal or illicit drug use (AOR=5.84, 95% CI: 1.96-17.36) were found to be significantly associated with cigarette smoking.

CONCLUSIONS

Cost-effective programs that involve the participation of families, teachers and other stakeholders to deliver health education and which restrict accessibility, advertising and use of substances like alcohol, cigarettes, and other illicit drugs, are highly recommended.

Prevalence and risk factors for initiating tobacco and alcohol consumption in adolescents living in urban and rural Ethiopia

Objectives

African countries are potential high growth markets for the alcohol and tobacco industries. This study aimed to identify exposures that are associated with initiating use of alcohol and tobacco products in young people living in Ethiopia. As televised football and Internet viewing are media through which products can be promoted to this population efficiently, these risk factors were of particular interest.

Study design

This is a cross-sectional study.

Methods

Data were collected using a self-administered questionnaire of 3967 children aged 13–19 years in 20 high schools in urban and rural Ethiopia on consumption and risk factors for alcohol and tobacco use in 2016, as well as exposure to potential sources of advertising.

Results

Eight percent of respondents reported having ever smoked and 3% were current smokers. Twenty-nine percent reported ever having used alcohol, and 14% were current users. Risk factors for ever smoking included father smoking (odds ratio [OR] 1.95; 95% confidence interval [CI]: 1.21 to 3.15), mother smoking (OR 3.90; 95% CI: 1.63 to 9.33), best friend smoking (OR 5.86; 95% CI: 4.31 to 7.96) and home Internet access (OR 1.75; 95% CI: 1.35 to 2.27). There was a very strong positive association between ever having smoked cigarettes and ever having tried alcohol (P < 0.001). Risk factors for currently drinking alcohol included father drinking (OR 1.45; 95% CI: 1.05 to 2.01), mother drinking (OR 2.00; 95% CI: 1.44 to 2.77), home Internet access (OR 1.53; 95% CI: 1.24 to 1.90) and regular watching of televised football (OR 2.44 compared to those who do not; 95% CI: 1.58 to 3.78).

Conclusions

As in rich countries, tobacco and alcohol use among Ethiopian teenagers increases among those exposed to family and peer use but are also more common among those accessing the Internet and, for alcohol, those watching televised football. The effect of watching televised football on alcohol use, at least, is likely to be due to exposure to advertising.

•

Rapid economic development is changing the environment in developing countries rapidly, generating a new potential market for the alcohol and tobacco industries.

•

Fourteen percent of adolescents living in Ethiopia are regular consumers of alcohol, and 3% regularly smoke cigarettes.

•

Regular watching of international football on television is associated with being a current consumer of alcohol.

•

Public health strategies to modify alcohol and tobacco usage in adolescents living in Ethiopia need to consider that the Internet and televised football matches are potential sources of exposure to advertising aiming to promote consumption.

Factors affecting tobacco smoking in Ethiopia: evidence from the demographic and health surveys

Background

Tobacco smoking is growing at an alarming rate in the developing world and sub-Saharan Africa. Although Ethiopia has a relatively low rate in the region, it is not immune to the tobacco epidemic. The government of Ethiopia passed an anti-tobacco bill in 2015 that includes measures governing tobacco consumption, advertising, packaging, and labeling. To effectively address the challenge of tobacco control, the government should consider a number of aspects of tobacco production and consumption, such as local production in rural areas, as well as the complementarity nature of tobacco and khat use.

Methods

Using the World Bank’s Demographic and Health Surveys (2011 and 2016), this paper analyzes the key determinants of tobacco smoking in Ethiopia, emphasizing possible differences in various social contexts, across regions. More specifically, we assess the association between khat use and tobacco smoking while controlling for various observed individual-level, household-level, and community-level covariates. Using GPS data, we are able to capture the neighboring effects of smoking behavior in community clusters bordering other administrative regions as well as differences in smoking patterns between lowland and highland residents. We utilize a multilevel modeling framework and use a two-stage residual inclusion estimation method that accounts for the endogeneity of khat and tobacco use.

Results

The results suggest that chewing khat and geographic regions are statistically significant determinants of tobacco smoking even after controlling for various socioeconomic and demographic factors. Altitude information analysis suggests that people living in lowlands are more likely to smoke compared to those living in highland areas. Additional analysis including interactions between regions and khat use indicate wide inter-regional variations in tobacco smoking by khat users. We also extend our analysis by interacting khat use with religious adherence. Results indicate a wide variation in tobacco smoking by khat chewers across different religious groups.

Conclusions

To effectively control tobacco smoking of the diverse communities in Ethiopia, policymakers should consider a multi-pronged policy approach that combines various policy tools that account for regional variation, the local social contexts, as well as the complementary nature of smoking and khat chewing practices.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-7200-8) contains supplementary material, which is available to authorized users.

Practice and predictors of self-care behaviors among ambulatory patients with hypertension in Ethiopia

BACKGROUND

Despite the benefits of evidence-based self-care behaviors in the management of hypertension, hypertensive patients have low rate of adherence to the recommended self-care behaviors. Studies related to self-care behaviors among hypertensive patients are limited in Ethiopia.

OBJECTIVE

To assess the rate of adherence to self-care behaviors and associated factors among hypertensive patients.

METHOD

A cross-sectional study was conducted at the cardiac clinic of Ayder comprehensive specialized hospital among ambulatory hypertensive patients. Self-care behaviors were assessed using an adopted Hypertension Self-Care Activity Level Effects (H-SCALE). Data were collected through patient interview and review of medical records. Binary logistic regression analysis was performed to identify predictors of self-care behaviors.

RESULT

A total of 276 patients were included in the study. The majority of the participants were nonsmokers (89.9%) and alcohol abstainers (68.8%). Less than half of the participants were adherent to the prescribed antihypertensive medications (48.2%) and recommended physical activity level (44.9%). Moreover, only 21.45% and 29% were adherent to weight management and low salt diet recommendations, respectively. Our finding indicated that rural resident (adjusted odds ratio [AOR]: 0.45, 95% confidence interval [CI]: 0.21-0.97), comorbidity (AOR: 0.16, 95% CI: 0.08-0.31), and negative medication belief (AOR: 0.25, 95% CI: 0.14-0.46) were significantly associated with medication adherence. Female sex (AOR: 0.46, 95% CI: 0.23-0.92), old age (AOR: 0.19, 95% CI: 0.06-0.60) and lack of knowledge on self-care behaviors (AOR: 0.13, 95% CI: 0.03-0.57) were significantly associated with adherence to weight management. Female sex (AOR: 1.97, 95% CI: 1.03-3.75) and lack of knowledge on self-care (AOR: 0.07, 95% CI: 0.03-0.16) were significantly associated with adherence to alcohol abstinence. Female sex (AOR: 6.33, 95% CI: 1.80-22.31) and khat chewing (AOR: 0.08, 95% CI: 0.03-0.24) were significantly associated with non-smoking behavior. There was also a significant association between female sex and physical activity (AOR: 0.22, 95% CI: 0.12-0.40).

CONCLUSION

The rate of adherence to self-care behaviors particularly weight management, low salt intake, physical exercise, and medication intake was low in our study. Elders, females, khat chewers, rural residents, and patients with negative medication belief, comorbidity, and inadequate knowledge of SCBs were less adherent to self-care behaviors compared to their counterparts. Therefore, health care providers should pay more emphasis to patients at risk of having low self-care behaviors.

Current Cigarette Smoking and Its Predictors among School-Going Adolescents in East Africa: A Systematic Review and Meta-Analysis

BACKGROUND

In developing countries, tobacco smoking has its own contribution to the burden of noncommunicable causes of morbidity and mortality. Studies estimated the burden of cigarette smoking among school-going adolescents in different geographical areas of East Africa. However, due to discrepancies found among those different findings, there is no representative data about the burden of smoking in the continent.

OBJECTIVES

This systematic review and meta-analysis aimed to assess the pooled prevalence of current cigarette smoking and its associated factors among school-going adolescents in East Africa.

METHODS

PubMed, Google Scholar, and the Web of Science Library were searched to access included articles. A weighted inverse-variance random-effects model was used to estimate the prevalence of current cigarette smoking. Variations in the pooled estimates of the prevalence were adjusted through subgroup analysis according to the specific country, where the study was conducted. Funnel plot and Egger's regression test were used to check publication bias. STATA version 14 statistical software was used for meta-analysis.

RESULTS

A total of 26,875 school-going adolescents were included. The pooled prevalence of current cigarette smoking among school-going adolescents in East Africa was found to be 9.02% (95%CI: 6.34-11.70). Based on the subgroup analysis, current cigarette smoking among school-going adolescents was estimated at 9.8% in Kenya, 7.72% in Ethiopia, 10.83% in Uganda, 13.6% in Sudan, and 4% in Tanzania.

CONCLUSIONS

This meta-analysis revealed that the prevalence of current cigarette smoking is increasing among school-going adolescents in East Africa. Therefore, countries have to realize sale prevention policies, establishing and/or strengthening antismoking campaigners designed for school-going adolescents, and providing training for teachers to be antismoking campaigners.

Prevalence of smoking among male secondary school students in Arar City, Saudi Arabia

INTRODUCTION

Tobacco is one of the leading preventable cause of death worldwide. Tobacco consumption among teenagers is a major public health problem, especially in developing countries. Younger smokers are more liable to smoking complications. The objectives were to evaluate the prevalence of smoking among male secondary school students in the Northern Borders region, KSA.

METHODS

A cross-sectional study was conducted in Arar city. Four schools were chosen randomly from 21 secondary schools. A total of 240 students responded to the pre-designed questionnaire. The questionnaire included questions on demographic factors, smoking behavior and knowledge about smoking hazards.

RESULTS

Prevalence of current smoking among male secondary school students is 40.8%. Cigarette smoking was the most common type (67.3%) followed by Shish smoking (22.4%). Few students (2.1%) reported other forms of smoking, example (Hashish). Of the studied group, 39.8% smoke on a daily basis with 29.6% of them smoke more than five cigarettes per day.

CONCLUSION

Smoking is a prevalent habit among teenagers. Special concern should be directed to smoking cessation campaigns with behavioral, legal and economic interventions.

An exploratory study of knowledge, attitudes, and beliefs related to tobacco use and secondhand smoke among women in Aleta Wondo, Ethiopia

BACKGROUND

By 2030, the Sub-Saharan African region is projected to be the epicenter of the tobacco epidemic. While smoking prevalence is currently low among women (< 2%), the prevalence among men (7.7% overall and up to 27% depending on region) makes exposure to secondhand smoke a pressing concern for women and children. To prevent the uptake of smoking among women and address tobacco-related risks, including secondhand smoke exposure, a greater understanding of women's related perceptions is needed. The purpose of this study was to explore Ethiopian women's knowledge, attitudes, and beliefs related to tobacco use and secondhand smoke exposure, and the potential influence of contextual factors including; khat use, exposure to pro- and anti-tobacco messaging, and religious affiliation.

METHODS

A cross-sectional study using a systematic household sampling technique and an adapted interviewer-administered survey was conducted in Southern Ethiopia. The survey was administered to 353 women, 18-55 years of age, in Aleta Wondo town and surrounding districts between August-October 2014 (95.2% cooperation rate).

RESULTS

General awareness of harm associated with personal tobacco use and exposure to secondhand smoke was high (> 94%); however, specific knowledge of associated health-risks was limited. More than 96% perceived female tobacco use as socially unacceptable. At the same time, more than 70% were able to name potential benefits of using tobacco for both personal consumption and non-personal use. Respondents reported greater experimentation with khat versus tobacco and 73% reported that their religion significantly influenced their tobacco-related attitudes. Overall, there were higher reports of exposure to anti-tobacco (70%) versus pro-tobacco (49%) messaging, in the last 30 days.

CONCLUSIONS

The high level of awareness of health risks associated with tobacco use and SHS exposure and the high exposure to anti-tobacco messaging are community-level strengths that can proactively be built on to prevent the projected disease burden associated with tobacco. Findings have implications for the development of contextualized gender-specific tobacco control interventions, particularly in relation to the promotion of smoke-free homes.

Determinants of cigarette smoking and smoking intensity among adult males in Ghana

BACKGROUND

In spite of the adverse health and financial implications of smoking, it still remains one of the leading causes of preventable diseases and deaths in the world. Key to discouraging the habit of smoking is knowledge of the drivers of smoking. In Ghana, though smoking behaviours are relatively more associated with adult males than youth and adolescents, studies on smoking behaviours of adult males are scant. This study, therefore, investigates the determinants of cigarette smoking and smoking intensity among adult males in Ghana.

METHODS

Data were obtained from the most recent Ghana Demographic and Health Survey (DHS) conducted in 2014. Based on the 2014 GDHS, a negative binomial-logit hurdle model was estimated to explore the socioeconomic and demographic characteristics associated with cigarette consumption and smoking intensity among adult males in Ghana. To ensure robustness, separate estimations were performed for the respective logit and negative binomial models used in the two-part model.

RESULTS

We find that men in lower socioeconomic category (poor and low education) have a higher likelihood to smoke. Also, age proved significant in explaining smoking behaviors in Ghana. Moreover, religion and region of residence are reported to affect cigarette consumption decision. Furthermore, we find that among the men who smoke, those between the ages of 44 and 60 years and have attained approximately primary education have a higher likelihood to smoke greater quantities of cigarette daily. Also, the smokers who reside in the Upper East and Upper West regions are reported to smoke more intensely than their counterparts in the Greater Accra region.

CONCLUSION

Since smoking remains one of the major causes of diseases and deaths the world over, the current study provides recent empirical evidence based on a nationally representative sample for public health policies geared towards smoking reduction and ultimately cessation. This study suggests that public policies that promote higher educational attainment and improved incomes (wealth) are crucial in smoking reduction and cessation in Ghana.

Prevalence of Smoking among Men in Ethiopia and Kenya: A Cross-Sectional Study

While tobacco use remains the largest single cause of premature death in the industrialized countries, low-and-middle income countries are also experiencing a rising burden of the tobacco epidemic and are making various programmatic efforts to tackle the issue. Evidence-based policy making is critical to the long-term success of tobacco intervention programs and is reliant on regular monitoring of the trends and prevalence rates of tobacco use though population-based surveys, which are sparse for countries in eastern Africa. Therefore, in the present study we aimed to (1) estimate the trends in the prevalence of self-reported smoking status; and (2) explore the sociodemographic factors associated with smoking among adult men in Ethiopia and Kenya. Methods: Subjects were 26,919 adult men aged between 15 and 59 years from Ethiopia and Kenya. Nationally representative cross-sectional data on self-reported smoking and relevant sociodemographic indicators were collected from the Demographic and Health Surveys (DHS) conducted in these two countries. Data analysis was performed by descriptive, bivariate, and multivariable methods. Results: In Ethiopia, the prevalence rate of smoking increased from 8.5% in 2005 to 11.7% in 2011. While in Kenya, the rate declined albeit slowly from 22.9% in 2003 to 18.8% in 2008–2009 and 17% in 2014. The prevalence was significantly different in urban and rural areas. In majority of the surveys, prevalence of smoking was highest in the age group of 25–34 years. The prevalence of smoking varied widely across several socioeconomic characteristics. Conclusions: The findings indicate a high rate of smoking among men especially in urban areas, and call for policy actions to address the socioeconomic factors as a part of the policy to strengthen tobacco-control efforts.

Understanding tobacco use and socioeconomic inequalities among men in Ghana, and Lesotho

Background

Tobacco use is one of the leading causes of preventable deaths and has become a significant public health issue. Previous studies have paid less attention to tobacco use and socio-economic equalities among men in developing countries. This study examines the relationship between tobacco use and socio-economic inequalities among men in Ghana and Lesotho.

Methods

The study made use of data from the 2014 Demographic and Health Survey (DHS) from Ghana, and Lesotho. Binary logistic regression was employed to examine the associations between socio-economic inequality characteristics of respondents and tobacco use.

Results

The results showed that the prevalence of tobacco use was high in Lesotho (47.9%) as compared to that of Ghana (6.3%). Tobacco use was generally high across all age groups in Lesotho and in contrast, it was relatively low across all ages in Ghana. A statistically significant association was found between all the socio-economic variables and tobacco use in both countries. The prevalence of tobacco use was smaller in age group 15–24 years compared to the age groups 25–34 years and 35–59 years in both Ghana and Lesotho, although the association is stronger in Ghana. The AOR’s in Ghana are respectively 5.3 (95% CI: 3.29–8.59) and 9.7 (95% CI: 6.20–15.06), compared to respectively 1.7 (95% CI: 1.32–2.11) and 1.7 (95% CI: 1.36–2.12). Smoking prevalence was smaller in men with higher level of education compared to men with no education in both Ghana and Lesotho, although the association was weaker in Ghana. The AOR in Ghana is 0.1 (95% CI: (0.02–0.11), compared to 0.2 (95% Cl: (0.17–0.30). The prevalence of tobacco use was smaller among men in urban areas compared to rural areas in both Ghana and Lesotho, although the association is stronger in Ghana. The AOR in Ghana is 2.1 (95% CI: 1.67–2.73), compared to 1.6 (95% CI: (1.31–1.95). In both countries, prevalence of tobacco use was higher in men who are traditionalist/spiritualists or who had no religion compared to Christians, although the association was stronger in Ghana. The AOR in Ghana is 6.2 (95% CI: (4.42–4.09) compared to 1.7 (95% CI: (1.21–2.47). The prevalence of tobacco use was low among men with richest wealth status compared to men with poorest wealth status in both Ghana and Lesotho, although the association is weaker in Ghana. The AOR in Ghana is 0.1 (95% Cl: (0.06–0.17) compared to 0.4 (95% CI: (0.51–1.12). In relation to occupation, prevalence of tobacco use was smaller among professional workers compared to men in the Agricultural sector in both Ghana and Lesotho, although the association is stronger in Ghana. The AOR in Ghana is 9.3 (95% Cl: (4.54–18.99), compared to 3.5 (95% CI: (2.27–5.52). Formerly married men in both countries were more likely to use tobacco compared to currently not married men, although the prevalence was higher in Ghana. The AOR in Ghana is 1.6 (95% CI: (0.99–2.28)], compared to 1.4 (95% CI: (0.89–2.28) in Lesotho.

Conclusion

Although similar socio-economic inequality factors provided an understanding of tobacco use among men in Ghana and Lesotho, there were variations in relation to how each factor influences tobacco use.

Electronic supplementary material

The online version of this article (doi:10.1186/s13690-017-0197-5) contains supplementary material, which is available to authorized users.

Substance Use as a Strong Predictor of Poor Academic Achievement among University Students

BACKGROUND

Substance use is a growing concern globally and its association with students' academic performance is not well studied.

OBJECTIVE

This study was aimed to assess the prevalence of substance use (alcohol, tobacco, and khat) and its association with academic performance among university students.

METHODS

Cross-sectional study was conducted among Wolaita Sodo University students. A total of 747 students were selected by using cluster sampling technique. Data were collected by pretested self-administered questionnaire and examined using descriptive statistics and linear regression with 95% confidence intervals. Variables with p value of less than 0.05 were considered as statistically significant.

RESULT

Prevalence of substance use (alcohol, tobacco, and khat) was 28.6%. Substance use (current smoking, chewing khat at least weekly, drinking alcohol on a daily basis, and having intimate friend who uses substance) was significantly and negatively associated with students' academic performance.

CONCLUSION

Substance use among Wolaita Sodo University students was as common as other studies in Sub-Saharan countries and negatively associated with students' academic achievement. The common practice of substance use and its association with poor academic performance demand the universities to have a good control of substance and to implement youth friendly activities.

Predictors of Treatment Failure among Adult Antiretroviral Treatment (ART) Clients in Bale Zone Hospitals, South Eastern Ethiopia

Background

Treatment failure defined as progression of disease after initiation of ART or when the anti-HIV medications can’t control the infection. One of the major concerns over the rapid scaling up of ART is the emergence and transmission of HIV drug resistant strains at the population level due to treatment failure. This could lead to the failure of basic ART programs. Thus this study aimed to investigate the predictors of treatment failure among adult ART clients in Bale Zone Hospitals, South east Ethiopia.

Methods

Retrospective cohort study was employed in four hospitals of Bale zone named Goba, Robe, Ginir and Delomena. A total of 4,809 adult ART clients were included in the analysis from these four hospitals. Adherence was measured by pill count method. The Kaplan Meier (KM) curve was used to describe the survival time of ART patients without treatment failure. Bivariate and multivariable Cox proportional hazards regression models were used for identifying associated factors of treatment failure.

Result

The incidence rate of treatment failure was found 9.38 (95% CI 7.79–11.30) per 1000 person years. Male ART clients were more likely to experience treatment failure as compared to females [AHR = 4.49; 95% CI: (2.61–7.73)].Similarly, lower CD4 count (<100 m³/dl) at initiation of ART was found significantly associated with higher odds of treatment failure [AHR = 3.79; 95% CI: (2.46–5.84).Bedridden [AHR = 5.02; 95% CI: (1.98–12.73)] and ambulatory [AHR = 2.12; 95% CI: (1.08–4.07)] patients were more likely to experience treatment failure as compared to patients with working functional status. TB co-infected clients had also higher odds to experience treatment failure [AHR = 3.06; 95% CI: (1.72–5.44)]. Those patients who had developed TB after ART initiation had higher odds to experience treatment failure as compared to their counter parts [AHR = 4.35; 95% CI: (1.99–9.54]. Having other opportunistic infection during ART initiation was also associated with higher odds of experiencing treatment failure [AHR = 7.0, 95% CI: (3.19–15.37)]. Similarly having fair [AHR = 4.99 95% CI: (1.90–13.13)] and poor drug adherence [AHR = 2.56; 95% CI: (1.12–5.86)]were significantly associated with higher odds of treatment failure as compared to clients with good adherence.

Conclusion

The rate of treatment failure in Bale zone hospitals needs attention. Prevention and control of TB and other opportunistic infections, promotion of ART initiation at higher CD4 level, and better functional status, improving drug adherence are important interventions to reduce treatment failure among ART clients in Southeastern Ethiopia.

Subgrouping High School Students for Substance Abuse-Related Behaviors: A Latent Class Analysis

The aim of the current study was to characterize the prevalence of latent groups in terms of smoking, hookah, and alcohol in a sample of Iranian high school students. In this cross-sectional study, 4,422 high school students were assessed in East Azerbaijan Province, Iran. Latent class analysis was applied to determine the subgroups and prevalence of each class using the procLCA in SAS 9.2 software. The prevalence of hookah smoking was the highest among the other substances and had the greatest abuse among males than females. Nearly 86%, 9.5%, and 4.6% of the participants were low risk, tobacco experimenter, and high risk, respectively. The odds ratio indices of membership in each class, compared with the first class, associated with the independent variables. A fair number of students, males in particular, were identified as high risk-takers. Considering the simultaneous incidence of multiple high-risk behaviors, interventions must cover multiple aspects of the issue at the same time.

Prevalence and determinants of cigarette smoking among college students: a cross-sectional study in Douala, Cameroon

Background

Tobacco is the most important avoidable risk for non communicable diseases. While tobacco consumption is stable or declining in developed countries, it is increasing in the developing world with a rate of 3.4 % per annum. The objective of this study was to estimate the prevalence and factors associated with cigarette smoking among college students.

Methods

A cross-sectional study was conducted from December 2012 to April 2013 in secondary schools in Douala, Cameroon. A self-administered questionnaire was used to collect sociodemographic data, smoking behavior and peer smoking among college students. Logistic regression analyses was employed to identify factors associated with cigarette smoking.

Results

Of a total of 2623 students included, 1579 (60.2 %) were female. The mean age of participants was 19.2 ± 2.53 years. The prevalence of current smoking was 11.2 % [95 % confidence interval (CI) 10 – 12], with 20 % in males and 5.3 % in females. Cigarette smoking was with significantly associated with friends smoking [Odds ratio (OR) 6.66; 95 % CI 4.69 – 9.45)], male gender (OR 3.61; 95 % CI 2.52 – 5.16), increase in age (OR 1.10; 1.03 – 1.17), parental smoking 1.69 (1.04 – 2.76), and attending general education (OR 1.85; 1.23 – 2.78).

Conclusions

Cigarette smoking constitutes a significant health hazard in college students in Douala. Youth population and especially male students should be continuously targeted by preventive measures and sensitization campaigns against tobacco use. Parents should be aware on the influence of their smoking behavior on initiation of smoking in their children and should be encouraged to quit smoking.

Determinant factors of tobacco use among ever-married men in Bangladesh

Background

The burden of tobacco use is shifting from developed to developing countries. This study aimed to explore the different types of tobacco use, and to identify the determinant factors associated with the tobacco use among ever-married men in Bangladesh.

Data and methods

Data of 3,771 ever-married men, 15–54 years of age were extracted from the Bangladesh Demographic and Health Survey 2007. Prevalence rate, chi-square (χ²) test, and binary logistic regression analysis were used as the statistical tools to analyze the data.

Results

Tobacco use through smoking (58.68%) was found to be higher than that of chewing (21.63%) among men, which was significantly more prevalent among the poorest, less educated, and businessmen. In bivariate analysis, all the socioeconomic factors were found significantly associated with tobacco use; while in multivariate analysis, age, education, wealth index, and occupation were identified as the significant predictors.

Conclusion

Tobacco use was found to be remarkably common among males in Bangladesh. The high prevalence of tobacco use suggests that there is an urgent need for developing intervention plans to address this major public health problem in Bangladesh.

Tobacco use and associated factors among adults in Ethiopia: further analysis of the 2011 Ethiopian Demographic and Health Survey

Background

Tobacco is one of the leading preventable causes of non-communicable diseases. Previous studies gave due emphasis only for cigarette smoking with little attention given for other types of tobacco use. This study describes the prevalence of all common forms of tobacco use and identify associated factors among adults in Ethiopia.

Methods

The study used data from the 2011 Ethiopian demographic and health survey. An index was constructed from yes or no responses for common types of tobacco use. Bivariate and multivariate logistic regression statistical models were employed to determine associated factors with tobacco using adjusted odds ratios (AOR) and their 95 % confidence intervals (CI).

Results

The overall prevalence of tobacco use was 4.1 % [95 % CI: (3.93–4.37)]. The highest prevalence 16.9 % [95 % CI: (11.02–23.76)] in Gambella and the lowest 0.8 % [95 % CI: (0.48–1.29)] in Tigray regions were reported. The odds of tobacco use in the age group 20–24 and 45–49 years were [AOR = 2.3; 95 % CI: (1.60–3.21)] and [AOR = 9.1; 95 % CI: (6.06–13.54)] more likely to use tobacco, respectively, as compared to the age group 15–19 years. Traditional religion [AOR = 5.5; 95 % CI: (3.96–7.55)], Catholics [AOR = 3.40; 95 % CI: (2.03–5.69)] and Islamic followers [AOR = 2.8; 95 % CI: (2.31–3.32)] had higher odds of using tobacco as compared to Orthodox religion followers. Adults in the poorest wealth quintile were [AOR = 1.4; 95 % CI: (1.05–1.79)] more likely to use tobacco as compared to the richest wealth quintile. The odds of tobacco use among males were higher as compared to females [AOR = 13.08; 95 % CI: (10.24–16.72)]. Formerly married adults were [AOR = 1.71; 95 % CI: (1.20–2.34)] more likely to use tobacco as compared to never married. Adults who were professionally working [AOR = 0.49; 95 % CI: (0.29–0.85)] had less likely to use tobacco as compared to non-working adults. However, adults who were working in sales, skilled and unskilled occupations had [AOR = 1.6; 95 % CI: (1.18–2.24)], [AOR = 1.7, 95 % CI: (1.21–2.50)] and [AOR = 3.8 95 % CI: (2.27–6.23)] more likely to use tobacco, respectively, as compared to non-working adults. Individuals who had experience of child death were [AOR = 1.4; 95 % CI: (1.17–1.63)] more likely to use tobacco as compared to their counterparts.

Conclusion

The overall prevalence of tobacco use seems low in Ethiopia. However, a significant regional variation of tobacco use was observed. A tailored public health interventions targeting regions with high prevalence of tobacco use is recommended.

Predictors of Mortality among Adult Antiretroviral Therapy Users in Southeastern Ethiopia: Retrospective Cohort Study

Background. Although efforts have been made to reduce AIDS-related mortality by providing antiretroviral therapy (ART) services, still people are dying while they are on treatment due to several factors. This study aimed to investigate the predictors of mortality among adult antiretroviral therapy (ART) users in Goba Hospital, Southeast Ethiopia. Methods. The medical records of 2036 ART users who enrolled at Goba Hospital between 2007 and 2012 were reviewed and sociodemographic, clinical, and ART-related data were collected. Multivariable Cox proportional hazards regression model was used to measure risk of death and identify the independent predictors of mortality. Results. The overall mortality incidence rate was 20.3 deaths per 1000 person-years. Male, bedridden, overweight/obese, and HIV clients infected with TB and other infectious diseases had higher odds of death compared with their respective counterparts. On the other hand, ART clients with primary and secondary educational level and early and less advanced WHO clinical stage had lower odds of death compared to their counterparts. Conclusion. The overall mortality incidence rate was high and majority of the death had occurred in the first year of ART initiation. Intensifying and strengthening early ART initiation, improving nutritional status, prevention and control of TB, and other opportunistic infections are recommended interventions.

Prevalence of cigarette smoking and its predictors among school going adolescents of North India

Background:

Cigarettes smoking is a common mode of consuming tobacco in India. This habit usually starts in adolescence and tracks across the life course. Interventions like building decision making skills and resisting negative influences are effective in reducing the initiation and level of tobacco use.

Aims and Objectives:

The purpose of this study was to assess the prevalence of adolescent current cigarette smoking behavior and to investigate the individual and social factors, which influence them both to and not to smoke.

Methodology:

A cross-sectional study was carried out among school going adolescents in Shimla town of North India. After obtaining their written informed consent, a questionnaire was administered.

Results:

The overall prevalence of current cigarette smoking was 11.8%. The binary logistic regression model revealed that parents’ and peers’ smoking behavior influence adolescent smoking behavior. Individual self-harm tendency also significantly predicted cigarette smoking behavior. Parental active participation in keeping a track of their children's free time activities predicted to protect adolescents from taking this habit.

Conclusion:

Our research lends support to the need for intervention on restricting adolescents from taking up this habit and becoming another tobacco industries’ addicted customer. Parents who smoke should quit this habit, which will not only restore their own health, but also protect their children. All parents should be counseled to carefully observe their children's free time activities.

The prevalence of and factors associated with current smoking among College of Health Sciences students, Mekelle University in northern Ethiopia

Background

Tobacco smoking is one of the greatest causes of preventable morbidity and mortality globally, and is responsible for many causes of untimely deaths. This survey was aimed to determine prevalence and factors associated with current smoking among the students of College of Health Sciences, Mekelle University, Ethiopia.

Methods

A cross-sectional study was employed using a structured self-administered questionnaire among College of Health Sciences students in March 2013. A stratified random sampling method was employed to select study participants. Data were entered and analysed using of Statistical Package for Social Sciences (SPSS) version 20.0.

Results

Of the 193 students, 57 (29.5%) of the students were current smokers. Most of the current smokers (89.4%) smoked between 1–10 sticks of cigarette per day. The two main reasons cited for smoking cigarettes were peer pressure (43.9%) and to relieve stress (36.8%). Being female (adjusted OR [AOR] = 0.49; 95% CI: 0.25, 0.95) and Tigre by ethnicity (AOR = 0.32; 95% CI: 0.14, 0.74) were significantly less associated with current smoking. On the other hand, being second year students (AOR = 3.84; 95% CI: 1.41, 10.46), khat chewing (AOR = 8.36; 95% CI: 2.60, 26.85) and taking illicit drugs (AOR = 10.59; 95% CI: 2.77, 40.51) were positively associated with current smoking cigarettes.

Conclusions

The current smoking prevalence among students in College of Health Sciences, Mekelle University is high and therefore, effective smoking prevention and cessation intervention programs are required to reduce smoking among university students.

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.

Trends in smoking among university students between 2005-2012 in Sakarya, Turkey

Turkey protects its entire population of 75 million people with all the MPOWER measures at the highest level. The aim of this study is to make a comparison of smoking and addiction data obtained from Sakarya University students in 2005-6 and 2012-13. A total of 4,200 (2,500 and 1,700 for each academic year) students at Sakarya University in Sakarya, Turkey, were randomly selected for sampling purposes. The selected participants represented Sakarya University students. Data were collected using a pretested anonymous and confidential, self-completed questionnaire which took 15-20 minutes to complete and Fagerstrom Test for nicotine dependence. Chi-squared, Spearman correlation, and binary logistic regression tests were used to define associations, if any. The level of significance was kept at alpha=0.05. Smoking prevalence dropped by 8.5% (from 26.9% to 18.5%). Male gender, older age, high family smoking index, low self-rated school success, and high peer smoker proportion were common variables that have correlation with smoking status. In the binary logistic regression test the highest contributor to "being a smoker" was found to be the rate of peer smokers. Having all friends smoking puts the student a a 47.5 and 58.0 times higher risk for smoking for males and females, respectively. Our results suggest an admirable diminution of smoking prevalence among Sakarya University students, which can be attributed to MPOWER protection.

Social determinants of tobacco consumption among Nepalese men: findings from Nepal Demographic and Health Survey 2011

Background

In the 20th century, 100 million people across the globe lost their lives due to consumption of tobacco. Every year 15,000 deaths in Nepal are attributable to tobacco smoking and using other products of tobacco. This study aimed to establish the proportion and the social determinants of tobacco use among Nepalese men based on the Nepal Demographic and Health Survey (NDHS), 2011.

Methods

This study used the NDHS 2011 data. The prevalence of cigarette smoking, other forms of tobacco 16 smoking and use of tobacco in any form is reported as a percentage (%). The significance of association of the statistically significant variables established using Chi-square test was further tested by using multiple logistic regression.

Results

Of the 4121 participants, the prevalence of consuming any form of tobacco was 51.9% [95% confidence interval (CI) (49.6%- 54.3%)]; chewing/sniffing tobacco was 34.8% (95% CI: 32.4%- 37.3%) and tobacco smoking was 33.6% (95% CI 31.3%-36.0%).

Men with no education [Odds Ratio (OR) 3.477; 95% CI (2.380-5.080)], from an older age group (36–49) [OR 2.399; 95% CI (1.858-3.096)] who were from a manual occupation [OR 1.538; 95% CI (1.188-1.985)], who were married[OR 1.938; 95% CI ( 1.552-2.420)], and who were from the Terai region [OR 1.351; 95% CI (1.083-1.684)] were more likely to consume tobacco. Men who watched television at least once a week [OR 0.642; 95% CI (0.504-0.819)] were less likely to consume tobacco.

Conclusions

The current study showed that over half of Nepalese men consume tobacco. There is an urgent need to fully implement Nepal’s Tobacco Control and Regulation Act which will ban smoking in public places; enforced plain packaging and display of health warnings over 75% of the packaging, and has banned selling of tobacco products to those under 18 years of age. There is a need to increase the social unacceptability of tobacco in Nepal by raising awareness through different electronic and cultural media. Anti-tobacco campaigns should focus on those who are less educated, have manual occupations, are in poorer economic groups, and are from the Terai region of Nepal.