Prevalence of Tobacco Smoking and Factors Associated with the Initiation of Smoking among University Students in Dhaka, Bangladesh

Prevalence of smoking among undergraduate students in the Kingdom of Saudi Arabia: A meta-analysis

INTRODUCTION

In recent years, tobacco smoking has become a major public health concern in the Kingdom of Saudi Arabia (KSA), particularly among adolescents and college students. Hence, the current study aimed to collect the available evidence of smoking prevalence in KSA over the past decade (2014-2023) among college students in KSA and to find its pooled prevalence.

METHODS

This meta-analysis obtained relevant studies from PubMed, published during the period April 2014 to June 2023. All articles published in English in study venues within the Kingdom of Saudi Arabia on smoking prevalence/ epidemiology/factors among undergraduate and/or college-going students were included. Systematic review and review articles were excluded. MedCalc was used to calculate the pooled prevalence (95% CI).

RESULTS

Among the 258 initial pool of articles, 34 fulfilled the eligibility criteria. Further screening revealed only 34 articles met the inclusion criteria for this meta-analysis. These studies' minimum and maximum sample sizes were 208 and 3322, respectively. The lowest prevalence was 7.9%, and the highest was 59.57%. Hence, using the random effect model, the pooled prevalence of this study was 24.5% (95% CI: 21.013-28.09).

CONCLUSIONS

The pooled prevalence of smoking is found to be 24.5%. Periodical educational seminars and related content must be arranged for college/university students to minimize the prevalence; hence, by reducing the smoking prevalence, morbidity and mortality can be minimized.

Smoking Susceptibility and Anti-Smoking Awareness in Adolescents and Young Adults of Bangladesh

OBJECTIVE

The present study addressed the shortcomings of strictly defined criterion and survey-based approaches of previous smoking susceptibility measures and accordingly, developed and validated two scales, Smoking Susceptibility Measure (SSM) and Anti-Smoking Awareness Scale (ASAS).

METHODS

Firstly, the generation of SSM and ASAS items followed an extensive literature review, expert opinions and agreement, resulting in the retention of eight items for SSM and seven items for ASAS to administer them on a large sample (n=312). Average inter-item correlations, corrected item-total correlations, and internal consistency reliabilities of the measures fall within the recommended ranges. The data were found suitable to factorize the sample through exploratory factor analysis. To determine the structural validity of the measures, confirmatory factor analysis (CFA) was done, and the data had an adequate model fit for unifactorial solution. Multi-group CFA revealed that both measures can be applied in the same way across age and sex of the participants.

RESULTS

An inverse association of school connectedness with smoking susceptibility and positive association with anti-smoking awareness reflected the convergent validity of the measures. Hierarchical regression analysis showed that smoking susceptivity was negatively predicted by anti-smoking awareness and school connectedness whereas, positively predicted by self-esteem of the participants.

CONCLUSION

The SSM and ASAS were found to be psychometrically sound tools to objectively measure never-smoking youths' smoking susceptibility and anti-smoking awareness, targeting effective intervention strategies to prevent adolescents and young adults from being a regular smoker.

Male adolescents' (Aged 15-24 years) smoking habit and its determinant: analysis of Indonesia demographic and health survey data, 2017

Objectives

The aim of the study was to examine the factors influencing cigarette consumption among male adolescents aged 15-24 years in Indonesia.

Methods

This study used the Indonesia Demographics and Health Survey 2017, which included 8,488 male adolescents aged 15-24 years. The survey used multi-stage cluster sampling. Data were analyzed by using multivariable logistic regression adjusted for covariates and a complex survey design.

Results

There is 70.4% of male adolescents who smoke any tobacco products daily or occasionally. The male adolescents who aged 20-24 years (p<0.001; AOR=2.26, 95%Cl=1.96-2.59), had low education level (p<0.001; AOR=5.90, 95%Cl=3.91-8.92), start smoking at 18-24 years (p-value<0.001; AOR=3.09, 95%Cl=2.25-4.23), had been influenced by friend/someone to smoke (p<0.001; AOR=5.60, 95%Cl=4.77-6.58), used the internet at least once a week (p<0.001; AOR=1.28, 95%Cl=1.11-1.49), did not read newspaper/magazine (p<0.001; AOR=1.55, 95%Cl=1.28-1.87) had a higher odds of current smoking.

Conclusions

Factors of smoking tobacco, such as age, age at first smoking, low education, the influence of smoking, and access to information on the internet and newspapers/magazines, had a significant impact on the current tobacco of male adolescents. Our findings support the enforcement of health warnings and laws related to tobacco restrictions for adolescents.

Past-year substance use behaviors among university admission test-takers: insights from Bangladesh

University entrance test-takers are a vulnerable group of students transitioning from adolescence to youth, a peak time for adopting unhealthy behaviors. However, limited studies investigate substance use behaviors among this group. This study aimed to investigate the current (past 12 months) prevalence, associated risk factors, and geographic distribution of substance use behaviors, employing spatial analysis to identify regional disparities. A cross-sectional study was conducted utilizing convenience sampling in February 2024 among university entrance test-takers at Jahangirnagar University, Dhaka, Bangladesh (N = 1485). Participants provided information on socio-demographics, admission-related, depression (PHQ-9), anxiety (GAD-7), and substance use. Chi-square tests and logistic regression were employed to explore significant associations, with spatial analysis using ArcGIS to map substance use across districts. About 20.8% reported smoking, 10.1% reported drug use, and 9.9% reported alcohol consumption over the past 12 months. Males exhibited higher rates of smoking (23.1% vs. 17.6%) and alcohol consumption (10% vs. 9.7%), while females reported slightly higher rates of drug use (10.2% vs. 10%). Being female (AOR = 0.56; 95% CI: 0.40-0.79; p = 0.001), living in rural areas (AOR = 0.68; 95% CI: 0.49-0.94; p = 0.020), having a higher monthly family income (AOR = 1.72; 95% CI: 1.01-2.91; p = 0.042), a history of physical illness (AOR = 2.65; 95% CI: 1.87-3.76; p < 0.001), being a repeat test-taker (AOR = 1.49; 95% CI: 1.08-2.05; p = 0.014), and satisfaction with previous mock tests (AOR = 1.66; 95% CI: 1.20-2.28; p = 0.002) were significant risk factors for smoking. For drug use, belonging to a joint family (AOR = 1.71; 95% CI: 1.08-2.71; p = 0.021), having a history of physical illness (AOR = 2.57; 95% CI: 1.64-4.02; p < 0.001), and satisfaction with previous mock tests (AOR = 1.84; 95% CI: 1.20-2.83; p = 0.005) increased the risk. Additionally, a history of physical illness (AOR = 5.12; 95% CI: 3.27-8.02; p < 0.001) and satisfaction with previous mock tests (AOR = 1.78; 95% CI: 1.13-2.80; p = 0.013) were contributing factors to alcohol consumption. Spatial analyses indicated higher rates of substance use in border districts. The findings warrant targeted interventions, such as mental health support and substance use prevention programs, particularly in high-risk regions. By understanding the factors driving substance use, tailored strategies can be developed to reduce risk behaviors among university entrance test-takers, ultimately enhancing public health outcome in this vulnerable population.

Prevalence and associated factors of cigarette smoking and substance use among university entrance test-taking students: A GIS-based study

BACKGROUND

Numerous studies have examined substance use and smoking behavior among adolescents and university students. However, little is known about these behaviors among students undergoing university entrance tests, a critical transition period from adolescence to adulthood. The entrance test can significantly affect students' mental health, potentially leading to substance use. This study aims to investigate the prevalence of cigarette smoking and substance use among students taking these exams and the associated factors.

METHODS

A cross-sectional survey was carried out on September 4th and 11th, 2022 to collect data from 1,480 university entrance test-taking students using a convenience sampling technique. Chi-square tests and logistic regression were conducted using SPSS software. Besides, GIS mapping was used to visualize the distribution of substance use and smoking behavior across districts via ArcGIS.

RESULTS

The study found a 10% prevalence of current tobacco smoking and 4% substance use. Females (OR = 1.98; 95% CI: 1.38-2.85), urban residence (OR = 2.03; 95% CI: 1.42-2.88), repeater (OR = 1.45; 95% CI: 1.02-2.06), anxiety (OR = 1.55, 95% CI: 1.10-2.19), burnout (OR = 1.51, 95% CI: 1.00-2.12), and suicidal behavior (OR = 1.57; 95% CI: 1.03-2.40) were the significant factors for cigarette use. Whereas the urban residence (OR = 1.91; 95% CI: 1.11-3.31), anxiety (OR = 2.47, 95% CI: 1.45-4.20), and suicidal behavior (OR = 2.76; 95% CI: 1.55-4.92) significantly increased the risk of substance use. GIS analysis revealed males varied in substance use and females in tobacco smoking by district. Repeat test-takers were associated with district variations in both smoking and substance use.

CONCLUSIONS

Educational institutions, public health authorities, and policymakers must implement mental health support and substance use prevention programs for students. Integrating mental health education, providing resources, and enforcing regulations can promote healthier coping strategies and reduce substance use risks among students.

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.

Compliance status of tobacco control laws in the university setting of Bangladesh: an analytical study followed a mixed-method approach

Background

Implementation of National Tobacco Control Laws (NTCLs) in university settings was found to be worse in Bangladesh.

Objectives

This study aimed to depict the compliance status of tobacco control laws (TCLs) and the associated factors following the university setting approach in Bangladesh.

Methods

This cross-sectional study was conducted with a mixed-method approach among the 385 students (quantitative method), 10 teachers and 10 administrative staff (qualitative method) of Northern University Bangladesh. Data were collected through mobile phone calling (quantitative) and in-depth interviews method (qualitative). Appropriate ethical issues were addressed. Logistic regression analysis was performed to find out the determinants. The study revealed non-satisfactory compliance with TCLs among 56.4% of study subjects which was strongly supported by the outcome of the qualitative approach. Predominant non-satisfactory compliance was found through the explorations of the conditions of buying and selling tobacco (78.4%), pasting no-smoking signage (3.2%), antitobacco advertisement within the university (34.8%) and specific university policy to implement NTCL. Non-satisfactory compliance was found significant among the younger aged (≤21 years: COR/p=2.74/0.01; 95% CI 1.27 to 5.92) from the first-year group (adjusted odds ratio (AOR)/p=2.28/0.02; 95% CI 1.15 to 4.49) who had moderate nicotine dependency (AOR/p=4.04/0.01; 95% CI 1.28 to 12.74), poor knowledge on TCLs (AOR/p=3.57/0.02; 95% CI 1.28 to 9.95) and the respondents who suggested family guidance (AOR/p=1.77/0.06; 95% CI 0.97 to 3.22) might be a sustainable way to minimise tobacco consumption in the university setting.

Conclusions

The study revealed some crucial factors for the non-satisfactory compliance status towards TCLs in the university setting. This empirical outcome and evaluation strategy can guide to plan of future large-scale studies, which may lead to implementing effective intervention programmes focusing on the development of a tobacco-free environment in the university setting.

Prevalence and Associated Factors Related to Tobacco Consumption Among University Students in Malaysia

Tobacco consumption is one of the major public health concerns worldwide. Moreover, alternative tobacco and nicotine products (ATNPs) are growing in popularity, especially among young adults in the past decade. The study aimed to determine the prevalence and associated sociodemographic factors of tobacco consumption among university students. A cross-sectional study was carried out among 338 university students of a private Malaysian university from March to April 2021. Data was collected using a self-administered online questionnaire with items including sociodemographic information, user status of tobacco consumption and types of tobacco product used. Descriptive statistics, Pearson's chi-square test, Fisher's exact test and simple and multiple logistic regression analyses were performed using the IBM SPSS version 26.0 to analyse the data. The prevalence of tobacco consumption in this study was 8.6% and the main tobacco product used was manufactured cigarettes. In Pearson's chi square test and Fisher's exact test, current use of tobacco was significantly associated with nationality, ethnicity, religion, school, current level of education and parents, siblings and friends use of tobacco (p<0.05). In simple and multiple logistic regression analysis, being non-Malaysian, Indian, Muslim, year 4 student and having parents or siblings who used tobacco, all had statistically significant associations with the current use of tobacco (p<0.05). Findings of this study showed that the use of tobacco among university students is concerning and warrants the need to develop and implement a strategic anti-tobacco program to limit this behaviour among university students.

Factors Influencing the Consumption of Tobacco amongst the Khasi Indigenous People in Northeast India

Background

Tobacco use in any form is a major public health concern. It accounts for nearly 1.35 million deaths every year. Many chronic illnesses occur due to the consumption of tobacco, either smoke or smokeless form. The study aims to explore how smoking and smokeless tobacco consumption are distributed across a range of demographic and socioeconomic markers among Khasi indigenous people in Northeast India.

Materials and Methods

It is a case-control study conducted in adults over 31 years of age. The study was carried out between June 2020 and August 2021. An Independent t-test was performed to determine the significant difference in age between smoking/smokeless tobacco users and non-tobacco users. Univariate and Multivariate analyses were conducted to determine the significant predictors affecting the use of smoking/smokeless tobacco in the respondents.

Results

A total of 505 respondents were included in the present study. There was a high statistically significant difference in the income level of tobacco and non-tobacco users (P value- 0.002). In Univariate analysis, it was found that the odds of consuming both forms of tobacco were significantly lower in the respondents aged between 51-60 (OR = 0.61, P value = 0.0453). The participants who studied till graduation and above had lower odds of both using forms of tobacco as compared to respondents who were illiterate/primary educated only (OR = 0.85, P value = 0.046).

Conclusion

In conclusion, smoking and smokeless tobacco consumption are still widely prevalent in this region and strongly associated with age, gender, level of education, and place of residence. There is a need for further detailed analysis to identify risk factors that are strongly associated with the use of smoke and smokeless tobacco so that the community will be conscious about the hazardous effects of tobacco use in any form.

Effect of Glycemic Disorders and Habits on the Concentration of Selected Neurotrophic Factors in Patients with Lumbosacral Intervertebral Disc Degeneration

BACKGROUND

Unhealthy habits, such as overeating processed and high-calorie foods, alcohol abuse, and smoking, negatively impact human health. It has been suggested that the inflammatory process and the resulting growth of nerve fibers within the intervertebral disc (IVD) fissures is the main reason for the pain accompanying IVD degeneration (IVDD).

OBJECTIVES

The aim of this study was to determine whether smoking, alcohol consumption, overweight/obesity, or diabetes comorbidity contribute to the development of IVDD and how the aforementioned factors affect the levels of brain-derived neurotrophic factor (BDNF), glial cell-derived neurotrophic factor (GDNF), and growth associated protein 43 (GAP-43) in the study and control groups (intervertebral discs, IVDs from cadavers, and serum samples from voluntary blood donors).

METHODS

The study group comprised 113 patients diagnosed with IVDD who qualified for microdiscectomy. Two control groups (I and II) were used in this study. The first included 81 IVDs obtained from Caucasian human cadavers. Control group II, on the other hand, included serum samples obtained from 113 voluntary blood donors. The expression profiles of BDNF, GDNF, and GAP-43 were determined by enzyme-linked immunosorbent assay (ELISA).

RESULTS

Our statistical analysis confirmed that patients who were overweight/obese, smoked tobacco, consumed alcohol, or had diabetes had a higher risk of IVDD (OR > 1). Statistical analysis showed that BDNF, GAP-43, and GDNF concentrations were significantly higher in the IVDs and serum samples obtained from the study group compared to the control group (p < 0.05). In addition, higher levels of BDNF, GDNF, and GAP-43 were noted in IVDD patients who consumed alcohol, smoked tobacco, were overweight/obese, or had comorbid diabetes compared to patients without these risk factors (p < 0.05).

CONCLUSION

We showed that changes in energy metabolism, habits, and lifestyle, as well as the degenerative process of IVD in the lumbosacral spine contribute to changing the concentration profile of the analyzed neurotrophic factors.

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.

Cigarette Smoking among Medical Students from the Western Balkan

University student's smoking is a significant public health problem. It is estimated that, globally, every fifth medical student is a smoker. So far, no research dealing with cigarette smoking among medical students has been conducted in the countries of the Western Balkans. The aim of this study was to examine the prevalence and risk factors of cigarette smoking among Western Balkans medical students. A cross-sectional study was conducted among 2452 students from 14 medical faculties in the Western Balkans (Republic of Slovenia, Republic of Croatia, Bosnia and Herzegovina, Republic of North Macedonia and Republic of Serbia). The data were gathered through an online survey. There were significantly more non-smokers than smokers among medical students. Only gender and parents smoking status were statistically significantly associated with students smoking status. The smokers were more often male students, who lived in urban areas prior their studies, and whose parents were both smokers. With the aim of monitoring and enhancing student population health, it is necessary for public health activists and health officials to continually survey the students' smoking status in order to recognize the smoking influencing factors, and form and take on appropriate activities to improve the prevention of cigarette smoking among students, as well as motivate those who smoke to give up smoking, which would contribute to improving the health of the student population.

Cigarette smoking prevalence and associated factors among college students, Amhara, Ethiopia

INTRODUCTION

tobacco is the only legal drug that kills many of its users when used exactly as intended by the manufacturers. It is estimated that of the 1.1 billion smokers worldwide, nearly 80% of them live in low and middle-income countries. This trend increases in college and university students with most smokers starting to smoke during adolescent. The aim of this study is to assess cigarette smoking prevalence and associated factors among a select group of college of teachers´ education students.

METHODS

a cross-sectional study was conducted. Multistage sampling was used to select 605 study participants from across the eight departments of the Injibara College of Teachers´ Education. Each subject was selected by simple random sampling technique after proportional allocation to each class. EpiData version 4.2 was used for data entry and Stata version 14 was used for data cleaning and analysis. Variables with p-value < 0.2 in bi-variable analysis were selected for multi-variable analysis. Adjusted odds ratio (AOR) with 95% confidence interval (CI) was reported to show the strength of association.

RESULTS

the current prevalence of cigarette smoking is 6.8% amongst the Injibara College of Teachers´ Education students. Males [AOR: 2.84 (95% CI: 1.13, 7.14)], divorced marital status [AOR: 7.27 (95% CI: 1.23, 42.85)], food source in hostel [AOR: 11.62 (95% CI 3.23, 41.71)] and exposure to family/other smokers [AOR: 6.17 (95% CI: 2.17, 16.06)] were statistically significant factors for cigarette smoking.

CONCLUSION

the prevalence of cigarette smoking was relatively low. Male, marital status, source of food, and exposure to family/other smokers were identified associated factors. Policy makers and health regulatory body are strongly encouraged to consider this evidence and the associated factors for smoking in their efforts to develop and implement tobacco control laws.

The current state of mental healthcare in Bangladesh: part 1 - an updated country profile

Mental health is a significant factor for a sound and productive life; nevertheless, mental disorders do not often receive adequate research attention and are not addressed as a serious public health issue in countries such as Bangladesh. Part 1 of this two-part profile describes the current situation of mental health in Bangladesh in its wider sociocultural context, outlining existing policies and highlighting mental illness as a neglected healthcare problem in the country using a narrative synthesis method. The prevalence of mental disorders is very high and augmented in nature among different population groups in Bangladesh. A lack of public mental health facilities, scarcity of skilled mental health professionals, insufficient financial resource distribution, inadequately stewarded mental health policies and stigma contribute to making current mental healthcare significantly inadequate in Bangladesh. The country has few community care facilities for psychiatric patients. Furthermore, the current mental health expenditure by the Bangladeshi government is only 0.44% of the total health budget. Less than 0.11% of the population has access to free essential psychotropic medications.

Tobacco smoking initiation among students in Samoa and health concerns

Background

High prevalence of tobacco smoking among young students remains a serious health concern given the positive association between smoking and NCDs. More recently, some studies also noted young smokers were more likely to get infected with COVID-19 compared to non-smokers. This study aims to assess the factors that influence smoking uptake among young students in Samoa. Findings from this study will provide valuable insight to policymakers and health authorities on policies and strategies to combat smoking among youth in Samoa and the Pacific Island Countries (PICs).

Methods

The 2017 Global Youth Tobacco Survey data of Samoa, available from the World Health Organization is used in the analysis. We use the multinominal logistic model to investigate the effects of socio-economic and demographics factors on young students’ uptake of smoking in Samoa.

Result

The main findings of this study indicate that sex, age, friendship, parental smoking, family discussion, outside influence, pocket money, and mother’s education are important determinants of tobacco smoking initiation among youths in Samoa.

Conclusion

Our findings contribute towards the evidence of the imperative health impact of friends, parents, and public smoking on students in Samoa. This warrants strategies that are effective in discouraging parents from smoking and implement measures that prevent smoking in public places. Moreover, educational efforts, particularly those that encourage more discussion at home settings on the harmful effects of smoking are strongly recommended. Parents are strongly encouraged to regularly monitor children’s spending behaviour.

"We cannot stop smoking": Female university students' experiences and perceptions

BACKGROUND

While findings are available about smoking in young females, there is a dearth of research reporting this problem among Jordanian females, particularly university students. Also, there is lack of studies that describe the daily experience and the causative factors for smoking among female university students.

PURPOSE

The purpose of this study is to describe the experience of smoking as perceived by female Jordanian university students. In addition, this study aimed to describe the predisposing factors for initiating smoking and feelings toward that experience.

METHOD

A descriptive qualitative study was employed. A purposive sample of 12 female Jordanian university students who smoke cigarettes were asked to participate in this study. A semi-structured, face-to-face interviews were conducted.

RESULTS

Five themes of the study included: (1) living and enjoying smoking with other females, (2) hazardous effect of smoking, (3) our culture stigmatizing female smoking, (4) why we don't stop smoking, and (5) strategies to combat smoking among females.

CONCLUSION

Female university students disclosed peer pressure and stress as intensifying factors for smoking. Also they were unable to quit smoking because they were attached and addicted to smoking cigarettes.

STUDY IMPLICATIONS

The findings of our study have several implications for nursing education, policymaking, and practice. An important target would be to motivate university students who are smokers to attempt smoking cessation leveraging cultural leaders as role models. Policy makers also should revise policies related to importing and taxation of cigarettes is essential. In addition, policy makers should enforce legislation for smoking fee areas and prevention of smoking in closed areas.

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.

Familial and socio-cultural barriers in maintaining tobacco-free homes in Bangladesh: a comparative cross-sectional study

OBJECTIVES

Children, pregnant women and the elderly at a global level are all being dangerously exposed to tobacco use in the household (HH). However, there is no understanding of the familial and socio-cultural factors that provide barriers to ensuring tobacco-free homes in Bangladesh either in urban or rural areas (U&RAs). This study therefore investigates those barriers to help enable a move towards tobacco-free homes in Bangladesh.

DESIGN

Comparative cross-sectional study.

SETTINGS

Data were collected from both urban and rural settings in Bangladesh.

PARTICIPANTS

A probability proportional sampling procedure was used to select 808 participants in U&RAs out of a total of 3715 tobacco users. Semi-structured interviews through the use of a questionnaire were conducted with the participants followed by a multivariate logistic regression analysis of the data in order to explore the familial and socio-cultural factors associated with tobacco use at home.

RESULTS

The prevalence of tobacco use at home was 25.7% in urban areas and 47.6% in rural areas. In urban areas: marital status (adjusted OR (AOR)=3.23, 95% CI 1.37 to 6.61), education (AOR=2.14, 95% CI 1.15 to 3.99), the smoking habits of elderly family members (AOR=1.81, 95% CI 0.91 to 2.89), offering tobacco as a traditional form of leisure activity at home (AOR=1.85, 95% CI 0.94 to 2.95) and lack of religious practices (AOR=2.39, 95% CI 1.27 to 4.54) were identified as significant socio-cultural predictors associated with tobacco use at home. In rural areas: age (AOR=5.11, 95% CI 2.03 to 12.83), extended family (AOR=3.08, 95% CI 1.28 to 7.38), lack of religious practices (AOR=4.23, 95% CI 2.32 to 7.72), using children to buy or carry tobacco (AOR=3.33, 95% CI 1.11 to 9.99), lack of family guidance (AOR=4.27, 95% CI 2.45 to 7.42) and offering tobacco as a traditional form of leisure activity at home (AOR=3.81, 95% CI 2.23 to 6.47) were identified as significant determinants for tobacco use at home.

CONCLUSION

This study concludes that socio-cultural traditions and familial norms in Bangladesh provide significant barriers for enabling tobacco-free homes. The identification of these barriers can aid policymakers and programme planners in Bangladesh in devising appropriate measures to mitigate the deadly consequences of tobacco use in the home. The consequences also include the dangers involved in family members being exposed to secondhand smoke.

Puff or pass: do social media and social interactions influence smoking behaviour of university students? A cross-sectional mixed methods study from Dhaka, Bangladesh

OBJECTIVE

To determine whether the odds of being a smoker differ based on social media use and social interactions among urban university students in Bangladesh.

HYPOTHESIS

Social media use and social interactions influence the smoking behaviour of Bangladeshi university students, particularly in starting and maintaining cigarette smoking.

DESIGN AND SETTING

A cross-sectional study using mixed methods on 600 student smokers and non-smokers recruited from two public and two private universities in Dhaka, Bangladesh, a lower middle-income country with limited resources. Exclusion criteria were those who did not use any form of social media and PhD students.

RESULTS

Odds of smoking were significantly higher for those who socialised more than 4 hours/day (p<0.05; OR 1.75; 95% CI 1.12 to 2.75) and typically at night (p<0.05; OR 2.80; 95% CI 1.95 to 4.00). Odds of smoking were also higher for those who liked (p<0.05; OR 4.85; 95% CI 3.32 to 7.11), shared (p<0.05; OR 20.50; 95% CI 13.02 to 32.26) and followed (p<0.05; OR 2.88; 95% CI 1.36 to 6.11) tobacco-related content on social media. Qualitative analysis resulted in emergent themes of smokers imitating tobacco-related photos or videos seen on social media and peers as an influence for smoking initiation.

CONCLUSION

This study suggests social media and social interactions may influence smoking behaviour in university students in Dhaka, Bangladesh. Future research should continue to investigate the roles social media and social interaction have on smoking in order to explore social media-based smoking cessation interventions or dissemination of smoking health hazards through social media.

Prevalence and Drivers of Self-Medication Practices among Savar Residents in Bangladesh: A Cross-Sectional Study

BACKGROUND

Self-medication practice (SMP) is widely adopted among residents of such countries as Bangladesh. However, the major determinants of SMP have only scarcely been evaluated. Therefore, this cross-sectional study aimed to fill this knowledge gap by assessing the prevalence and determining factors of SMP.

METHODS

A convenience sample of individuals residing in Savar (Dhaka, Bangladesh) >16 years of age and suffering from an illness >2 months underwent face-to-face interviews during January-February, 2019.

RESULTS

Among 520 interviewees fulfilling entry criteria, the prevalence of SMP was reported as 60.2%. Drug shops, previous knowledge or prescription, and consulting with peers (friends or relatives) were the most sought sources of SMP, whereas simple illness, higher consulting fees, unsatisfactory health-care services, and delayed access were reported as the motives. From the regression analysis, the sociodemographic risk factors of SMP were reported as being older (compared to <18 years), married, illiterate (compared to having higher education), having engaged in any occupation (ie, service, business, homemaker, and others compared to student), and suffering from chronic illness.

CONCLUSION

SMP is highly prevalent and exhibits significant socioeconomic determinants. Development of proper health care-access systems and public education should be implemented to reduce the rate of SMP.

Determining correlates of the average number of cigarette smoking among college students using count regression models

College students, as a large part of young adults, are a vulnerable group to several risky behaviors including smoking and drug abuse. This study aimed to utilize and to compare count regression models to identify correlates of cigarette smoking among college students. This was a cross-sectional study conducted on students of Hamadan University of Medical Sciences. The Poisson, negative binomial, generalized Poisson, exponentiated-exponential geometric regression models and their zero-inflated counterparts were fitted and compared using the Vuong test (α = 0.05). A number of 1258 students participated in this study. The majority of students were female (60.8%) and their average age was 23 years. Most of the students were non-smokers (84.6%). Negative binomial regression was selected as the most appropriate model for analyzing the data (comparable fit and simpler interpretation). The significant correlates of the number of cigarettes smoked per day included gender (male: incident-rate-ratio (IRR = 9.21), birth order (Forth: IRR = 1.99), experiencing a break-up (IRR = 2.11), extramarital sex (heterosexual (IRR = 2.59), homosexual (IRR = 3.13) vs. none), and drug abuse (IRR = 5.99). Our findings revealed that several high-risk behaviors were associated with the intensity of smoking, suggesting that these behaviors should be considered in smoking cessation intervention programs for college students.

Prevalence of tobacco use in urban and rural areas of Pakistan; a sub-study from second National Diabetes Survey of Pakistan (NDSP) 2016 - 2017

Objective:

To assess age standardized prevalence of tobacco use in urban and rural areas of Pakistan.

Methods:

This is a sub-study of second National Diabetes Survey of Pakistan (NDSP) 2016-2017. Prevalence of tobacco, ex-tobacco and non-tobacco users was determined in urban/rural areas of four provinces (Punjab, Sindh, Khyber Pakhtunkhwa, and Baluchistan) of Pakistan amongst people aged greater than or equal to 20 years. Information regarding tobacco and non-tobacco users were obtained from second NDSP (2016-2017) predesigned questionnaire. Detailed methodology for demographic, anthropometric and biochemical parameters remained same as reported in second NDSP (2016-2017).

Results:

The age-standardized prevalence of tobacco use in Pakistan was found to be 13.4%. Tobacco use in urban areas was 16.3% and rural areas was 11.7%. Tobacco use in urban and rural males was 26.1% and 24.1%, while in females was 7.7% and 3.1%, respectively. The age-standardized prevalence of ex-tobacco use in Pakistan was found to be 2.3%. Ex-tobacco use in urban areas was 2.6% and rural areas was 2.3%. Similarly, ex-tobacco use in urban and rural males was 4.6% and 4.6%, while in females was 0.7% and 0.5%, respectively. Multinomial logistic regression analysis shows that increasing age does not relate towards addiction of tobacco. Males were found to be 7 times (OR 6.94, 95% CI 5.68-8.49) and urban residents twice (OR 2.09, 95% CI 1.73-2.52) more tobacco users than females and those living in rural areas, respectively. From the likelihood ratio test, all variables were found to be statistically significant except for dysglycemia, dyslipidemia and hypertension.

Conclusion:

The prevalence of tobacco use is high. As a sub paper of a large national survey, this evidence is expected to serve as an important tool to plan larger studies leading in turn to develop strategies for a successful tobacco control program in the country.

Tobacco - Use Prevalence, Exposure, Attitudes, Behaviour/Cessation, Curriculum among Health Professional Students in Mangalore City, Karnataka, India

Background

Tobacco use is one of the leading preventable causes of premature death, disease and disability around the world. Medical and Dental graduates have an important role to play in tobacco cessation and prevention. Hence, the present study was undertaken to assess the tobacco use prevalence, practice, attitudes towards policy making and curriculum in medical and dental interns (house surgeons).

Methods

A cross sectional questionnaire based survey was carried out among interns in all the medical and dental colleges of Mangalore city. Global Health Professional Students Survey (GHPSS) questionnaire given by the Center for Disease Control (CDC) was modified and adopted.

Results

In the present study among 512 interns, 263 and 249 interns belonged to dental and medical fraternity respectively The prevalence of current smokers of cigarette was significantly higher among medical interns (32.1%) than the dental interns (20.2%), whereas no significant difference was evident amongst the dental (44.9%) and medical (41.8%) interns under the ever smokers category. A significant difference (p < 0.001) in the attitude of dental and medical college interns was observed towards tobacco use, policy making and their knowledge about the curriculum.

Conclusion

This study shows health professionals lacking specific training in tobacco counseling, all of which indicate a need for including a standardized syllabus to train health professionals in medical and dental schools related to tobacco its ill-effects, cessation and policy making.

Tobacco smoking and its drug interactions with comedications involving CYP and UGT enzymes and nicotine

Tobacco smoking is a global public health threat causing several illnesses including cardiovascular disease (Myocardial infarction), cerebrovascular disease (Stroke), peripheral vascular disease (Claudication), chronic obstructive pulmonary disease, asthma, reduced female infertility, sexual dysfunction in men, different types of cancer and many other diseases. It has been estimated in 2015 that approximately 1.3 billion people smoke, around the globe. Use of medications among smokers is more common, nowadays. This review is aimed to identify the medications affected by smoking, involving Cytochrome P450 (CYP) and uridine diphosphate-glucuronosyltransferases (UGTs) enzymes and Nicotine. Polycyclic aromatic hydrocarbons (PAHs) of tobacco smoke have been associated with the induction of CYP enzymes such as CYP1A1, CYP1A2 and possibly CYP2E1 and UGT enzymes. The drugs metabolized by CYP1A1, CYP1A2, CYP2E1 and UGT enzymes might be affected by tobacco smoking and the smokers taking medications metabolized by those enzymes, may need higher doses due to decreased plasma concentrations through enhanced induction by PAHs of tobacco smoke. The prescribers and the pharmacists are required to be aware of medications affected by tobacco smoking to prevent the toxicity-associated complications during smoking cessation.

Prevalence and Risk Factors of Chronic Obstructive Pulmonary Disease in Bangladesh: A Systematic Review

Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality and morbidity in low- and middle-income countries (LMICs) including Bangladesh. But no systematic review has been carried out in Bangladesh, which portraits the burden of COPD and its risk factors. Therefore, this systematic review was conducted to find out the prevalence and risk factors of COPD in Bangladesh. We searched PubMed, Google Scholar, Popline, and Banglajol from January 1, 1972 to April 30, 2017. We included studies that reported the prevalence and/or risk factors of COPD among Bangladeshi people. Two researchers independently searched and screened all the articles and extracted data from nine eligible studies. The whole process was verified by another researcher. Quality assessment was performed using a checklist adopted from published articles on quality assessment guidelines of observational studies. Discrepancies were resolved by consensus. Data analysis was done thematically. The pooled COPD prevalence among Bangladeshi adult was 12.5% (95% CI, 10.9-14.1) using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria and 11.9% (95% CI, 11.4-13.6) using the lower limit of the normality (LLN) criteria. The prevalence was higher among males, low socio-economic group, rural residents, and biomass fuel users. Tobacco consumption, exposure to biomass fuel, old age, and history of asthma were identified as major risk factors of COPD. COPD prevalence is high in Bangladesh. It is a timely need for the policy-makers and public health professionals to take pertinent steps for prevention and control of COPD in Bangladesh.

Peer Smoking and Smoking-related Beliefs Among College Students in Bangladesh

Objectives

Smoking is a significant public health issue in Bangladesh. The purpose of this study was to examine peer smoking and smoking-related beliefs among college students in Bangladesh.

Methods

College students at two universities in Dhaka, Bangladesh participated in a self-administered survey in May and June 2017.

Results

First, being a current or former smoker is associated with lower levels of beliefs among respondents that they would not smoke even with smoker friends or nervousness, and lower levels of intentions that they would not smoke, while current smokers and former smokers have different smoking-related beliefs. Second, having smoker friends is associated with lower levels of intentions that they would not smoke. Third, higher levels of normative beliefs that it is important not to smoke are associated with higher levels of beliefs that they would not smoke even with smoker friends or nervousness, higher levels of intentions that they would not smoke, and higher levels of avoidance of smoking.

Conclusions

Smoking-related beliefs and perceived norms in individuals’ social networks are important components in promoting tobacco cessation in Bangladesh. But it is challenging to prevent or intervene in smoking because of the high rates of smoking in this country and the high prevalence of smokers in individuals’ social networks. Future studies should examine the most effective interventions to combat smoking in high-smoking social networks, such as using mobile apps or social media, and evaluate the effectiveness of such interventions.

Cigarette smoking patterns in relation to religiosity and familial support among Iranian university students: A Latent Class Analysis

INTRODUCTION

Entering University is an important developmental milestone that might be associated with cigarette smoking. The aim of this study was to identify the subgroups of university students on the basis of cigarette smoking patterns, and to assess the role of familial support and religious beliefs on membership in specific subgroups.

METHODS

This cross-sectional study was performed in 2016 using multistage random sampling among students of Bushehr University (n=977). Anonymous, structured questionnaires were distributed to the students in each selected class. Cigarette smoking prevalence was assessed in three time intervals: lifetime, last year, and last month. All of the analyses were performed using PROC LCA in the SAS software.

RESULTS

The lifetime, last-year and last-month prevalence of cigarette smoking was 13.7%, 10.0% and 7.0%, respectively. In this study, the prevalence of passive smoking was relatively high (15.3%) among students. Four latent classes were identified: 1) non-smoker 58.2%, 2) passive smoker 31.3%, 3) moderate smoker 3.4%, and 4) heavy smoker 7.1%. The prevalence of cigarette smoking of close friends was: 73% among passive smokers, 81% for heavy smokers and 63% for moderate smokers. Being male (OR=4.42, 95% CI; 2.90-6.74) and a higher score of religious beliefs (OR=0.97, p<0.001 95% CI; 0.96-0.98) were associated with the heavy smoker class.

CONCLUSIONS

Among students at Bushehr University in Iran, 10.5% were either moderate or heavy smokers in 2016. These results point out the critical importance of designing specific preventive interventional programs for university students. Higher level of religiosity may serve as a preventive factor in engaging in cigarette smoking.

Tobacco: Consumption pattern and risk factors in selected areas of Shillong, Meghalaya

Background:

The percentage of adults above 15 years who consume tobacco in Meghalaya as per the Global Adult Tobacco survey is 55.2%.

Aim:

In the context of the high burden of tobacco use in Meghalaya, this study aims to study the consumption pattern and the sociodemographic correlates of tobacco use in the urban slums of Shillong, Meghalaya.

Materials and Methods:

This study is a cross-sectional study conducted in adults over 15 years of age. Data collection was done by personal interview using a pretested questionnaire during house-to-house visit after taking informed verbal consent.

Results:

A total of 400 people were included in this study. Most of the study population belonged to the age group 15–24 years (120, 30%). The majority of the study population (322, 80.5%) were aware of the health hazards of tobacco consumption. Most of the population (287, 71.75%) were tobacco consumers with 265 (76.4%) of them having co-addictions. In the study, 35% consumed smokeless forms, 30% were into smoking, and 35% consumed both forms. A significant association was observed between the status of tobacco consumption and knowledge of second-hand smoke harm (P = 0.019) as well as knowledge of any law regulating tobacco consumption (P = 0.026).

Conclusion:

It was observed that despite having a basic knowledge of the ill effects of tobacco, its consumption is still widely prevalent in the region. There is a need for stringent laws regarding tobacco consumption and proper measures should be taken to enforce these laws.