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Cigarettes and Waterpipe Smoking Among Medical Students in Syria: a Cross-Sectional Study

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Cigarettes and Waterpipe Smoking Among Medical Students in Syria: a Cross-Sectional Study INT J TUBERC LUNG DIS 12(9):1085–1091 © 2008 The Union Cigarettes and waterpipe smoking among medical students in Syria: a cross-sectional study M. Q. Almerie,* H. E. Matar,* M. Salam,* A. Morad,* M. Abdulaal,* A. Koudsi,* W. Maziak†‡ * Department of Family & Community Medicine, Damascus University, Damascus, † Syrian Centre for Tobacco Studies, Aleppo, Syria; ‡ Department of Health & Sports Sciences, Memphis University, Memphis, Tennessee, USA SUMMARY OBJECTIVES: To investigate tobacco use, beliefs and at- and 27%) compared to their younger counterparts (6.6% titudes among medical students in Syria. and 19.7%). Regular smoking patterns predominated for METHODS: A cross-sectional study of a random sample cigarettes (62%), while occasional use patterns predomi- of 570 medical students (fi rst and fi fth year) registered at nated for waterpipes (83%). More than two thirds of stu- the Damascus University Faculty of Medicine in 2006– dents (69%) thought they might not address or would have 2007. We used a self-administered questionnaire for demo- diffi culty addressing smoking in their future patients. graphic information, smoking behaviour (cigarette, water- CONCLUSION: The level of tobacco use among Syrian pipe), family and peer smoking, attitudes and beliefs medical students is alarming and highlights the rapidly about smoking and future role in advising patients to quit changing patterns of waterpipe use, especially among fe- smoking. male students. Medical schools should work harder to RESULTS: The overall prevalence of tobacco use was tackle this phenomenon and address it more effi ciently 10.9% for cigarettes (15.8% men, 3.3% women), 23.5% in their curricula. for waterpipe (30.3% men, 13.4% women) and 7.3% for KEY WORDS: cigarette smoking; waterpipe smoking; both (10.1% men, 3.1% women). Both smoking methods medical students; prevalence; Syria were more popular among the fi fth year students (15.4% TOBACCO USE is the leading preventable cause of at the development of tobacco use among medical death worldwide and, according to latest estimates, students and how their education may have infl uenced more than 80% of the 8.3 million tobacco-attributable their beliefs and practices. Evidence suggests that to- deaths in 2030 will occur in low- and middle-income bacco use remains widespread among medical students countries.1 This alarming prediction highlights the need despite their better knowledge of the risks involved.8,9 for developing nations to examine patterns and deter- This situation obviously represents a missed opportu- minants of tobacco use, understand local tobacco use nity and highlights the inadequacies of tobacco control methods, develop effective cessation interventions teaching in medical curricula. The recent emergence and train their own tobacco control scientists.2 of waterpipe use in Syria and other Arab countries, In many developing countries, including Syria, and its associated claims of reduced harm, represent a physicians constitute an important asset in the fi ght new threat for tobacco control efforts in this region. against tobacco, owing to their status in the society as Today, young men and women in the Arab world are a credible source of health information.3 Studies have increasingly using waterpipes, a habit that they view repeatedly shown the positive role of physicians in as fashionable.10–12 infl uencing tobacco use in patients, assisting in their A recent study of tobacco use practices among uni- smoking cessation efforts and infl uencing national to- versity students in Syria showed worrying trends, bacco control policies.4–6 This positive role is clearly with 23% of students smoking cigarettes and 15% hindered by physicians’ own tobacco use, which places smoking waterpipes.13 No study, however, has docu- their messages at confl ict with their behaviour.7 In mented tobacco use, beliefs and attitudes among medi- Syria, respectively 41% and 11% of men and women cal students in this country. The importance of this physicians smoke cigarettes, testifying to the serious- knowledge in informing medical schools in Syria and ness of the problem.3 the surrounding region about the adequacy of their As tobacco use practices and beliefs about tobacco tobacco control training and curricula was the main are formed early in life, it would be interesting to look reason for conducting this study. Correspondence to: Muhammad Qutayba Almerie, Department of Family & Community Medicine, University of Damascus, PO Box 11719, Damascus, Syria. Tel: (+963) 11 666 6223. Fax: (+963) 11 461 0922. e-mail: [email protected] Article submitted 2 February 2008. Final version accepted 19 May 2008. 1086 The International Journal of Tuberculosis and Lung Disease METHODS Table 1 Patterns of use of tobacco among medical students in Damascus according to year of study at university (fi rst vs. fi fth) This cross-sectional study was carried out in 2006– Tobacco smoking 2007 among students at the Damascus University School of Medicine, Syria’s largest medical school established First year Fifth year Total ( n = 274) (n = 259) (N = 533) more than 100 years ago in the capital, Damascus. % % % Age, years (SD) 18.3 (0.7) 23.0 (0.9) 20.5 (2.5) Study design Smoking status The study cohort consisted of medical students in their Cigarette smokers fi rst and fi fth year registered at the Damascus Faculty Occasional 3.3 5.0 4.1 of Medicine for the university year 2006–2007. It was Regular 3.3 10.4* 6.8 thought that the 4-year interval between fi rst and fi fth Waterpipe smokers Occasional 17.2 22.5 19.7 years would give us information about smoking trends Regular 2.5 5.0 3.8 at different ages and levels of medical knowledge among Smokers of both cigarette the study target group. We aimed to recruit about half and waterpipe 5.1 9.8 7.3 of the students registered in these years, totalling 1173, First smoking attempt to have suffi cient numbers for sex- and smoking First cigarette (n = 17) (n = 40) (n = 57) ⩽9 years 17.7 7.5 10.5 method-based comparisons. Accordingly, 612 students 10–15 years 17.7 7.5 10.5 (364 males, 248 females; 320 fi rst year students, 292 16–18 years 58.8 40.0 45.6 fi fth year students) were randomly selected from the ⩾19 years 5.6 45.0* 33.4 First waterpipe (n = 53) (n = 71) (n = 124) university register and were invited to participate in ⩽9 years 7.6 0.0 3.2 the survey. Students were approached during the clin- 10–15 years 28.3 15.5 21.0 ical training sessions for fi fth year students and the 16–18 years 60.4 29.6* 42.7 ⩾ laboratory sessions for fi rst year students. Of these, 19 years 3.8 53.4* 33.1 Tobacco consumption by 570 students agreed to participate (93.1% response regular smokers, mean (SD) rate, male:female 340:230; fi rst:fi fth year 303:267) Cigarettes/day 12.1 (6.8) 11.1 (7.8) 11.9 (7.5) and provided adequate responses for the analysis. An Waterpipes/week 3.7 (3.0) 5.4 (5.6) 4.8 (4.8) anonymous self-administered questionnaire was used * P < 0.05 for comparisons across year of study (fi rst vs. fi fth). after verbal informed consent had been obtained, in SD = standard deviation. agreement with the protocol approved by the Review Committee of Damascus School of Medicine. smokers included subjects who did not smoke at the Questionnaire time of the survey. Those were further categorised into ex-smokers, who were formerly smokers but currently The questionnaire was developed in Arabic from rel- did not smoke, and never-smokers, who had never evant instruments used for the assessment of tobacco smoked at all. use, including the Global Health Professionals Survey (GHPS) and the Global Youth Tobacco Survey (GYTS), Statistical analysis in addition to previous questionnaires used in Syria Statistical analysis was performed using SPSS 13 soft- for the assessment of waterpipe smoking.12,14–16 ware (SPSS, Chicago, IL, USA). Continuous variables The questionnaire inquired about the participants’ were presented as means. Dichotomous variables were demographic details, their smoking behaviour (ciga- compared using the χ2 test, and continuous variables rette, waterpipe), smoking among family members using the t-test (Table 1). Univariate regression analy- and peers, attitudes and beliefs about smoking and sis was performed separately for cigarette and water- quitting, the role of students as future physicians in pipe smokers to assess correlates of smoking among advising their patients to quit smoking and the stu- students. Variables showing association in the univari- dents’ position on a smoking ban in public places. Smok- ate analysis at P < 0.2 level were entered in two multi- ers were also asked about their fi rst smoking attempt, variate logistic regression models for cigarettes and tobacco consumption (number of cigarettes per day, waterpipe, separately. Adjusted odds ratios (ORs) and waterpipes per week), and preferred cigarette brands. 95% confi dence intervals (95%CIs) were reported for correlates of the outcome variable (current smoker, Defi nitions non-smoker). Tests were considered signifi cant when Smoking status was established in accordance with two-sided P value < 0.05. the World Health Organization (WHO) criteria for cigarette smoking and the criteria set by Maziak et al. RESULTS for waterpipe smoking:16,17 smokers were subjects who, at the time of the survey, smoked either regularly (⩾1 Of the 570 participants (average age 20.5 years, SD cigarette/day or ⩾1 waterpipe/week) or occasionally 2.5), the overall prevalence of tobacco smoking was (<1 cigarette a day or <1 waterpipe/week). Non- 10.9% for cigarettes (15.8% males, 3.3% females), Smoking among medical students in Syria 1087 Table 3 Multivariate logistic regression analysis for predictors of tobacco use among medical students in Damascus, Syria OR* 95%CI Cigarette smoking Waterpipe smoker 10.10 5.24–19.47 Male sex 3.99 1.68–9.50 Fifth year* 2.75 1.42–5.33 Age, years 1.21 1.06–1.39 Waterpipe smoking Cigarette smoker 10.34 5.40–19.78 Male sex 2.36 1.43–3.91 * Because of multi-colinearity, year at university and age were entered in the models separately.
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