Knowledge and Perception about Health Risks of Cigarette Smoking among Youngsters in Jazan Region, Saudi Arabia

ABSTRACT

Context:

Cigarette smoking is a global public health concern, particularly in developing countries. Saudi Arabia has a high prevalence of smoking among young individuals, highlighting the need for interventions to address this issue.

Aims:

This study aimed to evaluate the awareness, attitude, smoking rates, and perception of health risks among young individuals in the Jazan region of Saudi Arabia. The goal was to identify areas for improvement and develop effective strategies to combat smoking and promote healthier lifestyles.

Methods and Materials:

A cross-sectional survey was conducted at the out-patient department of the College of Dentistry, Jazan University, over a 3-month period. A questionnaire consisting of 15 open-ended questions was administered to eligible patients.

Statistical Analysis Used:

Statistical analysis was performed using the Chi-squared test with a P- value of <0.05.

Results:

Out of 300 participants, the majority were males, university students, and non-smokers. Among smokers, electronic cigarettes were the most used form. Starting smoking with friends was a common trend. Females smoked fewer times per day compared to males. Participants expressed concerns about the damaging effects of smoking on health.

Conclusions:

Targeted interventions and educational programs are needed to address smoking behaviors among young individuals in the Jazan region. Gender-specific interventions, family involvement, and promoting school connectedness are crucial in reducing smoking rates. Graphic health warnings on cigarette packs have the potential to improve knowledge and quitting intentions. Continued research and surveillance are necessary to inform evidence-based policies and interventions to combat youth smoking.

INTRODUCTION

Cigarette smoking is a significant public health concern worldwide, contributing to numerous diseases and causing millions of deaths annually.[1] Despite efforts to raise awareness about the risks associated with smoking and implement tobacco control policies, smoking continues to be a prevalent issue, especially in developing countries.[2]

Saudi Arabia is one such country where the prevalence of smoking, particularly among young people, is a growing concern. While the prevalence of tobacco use among adults is reported to be 19.8%, with higher rates among men (30.1%) compared to women (4.2%), the prevalence of cigarette use among youth aged 13–15 is estimated to be 8.9% (boys: 13%, girls: 5%).[2] Other studies conducted in Saudi Arabia have also highlighted a higher prevalence of smoking among boys compared to girls.[3]

The knowledge and perception of health risks associated with cigarette smoking play a crucial role in motivating smokers to quit and preventing the initiation of smoking behavior among adolescents.[4] It is well established that quitting smoking at an early stage can significantly reduce the risk of various health complications, including stroke, cardiovascular disease, and smoking-related cancers.[5]

SUBJECTS AND METHODS

This cross-sectional survey was conducted at the out-patient department of the College of Dentistry, Jazan University, Saudi Arabia, over a period of 3 months from November 2022 to February 2023. The study protocol was approved by the institutional ethical board of the College of Dentistry, Jazan University. A questionnaire consisting of 15 open-ended questions was developed for this study. To ensure content validity, a pilot questionnaire was initially used. The final survey questionnaire, comprising three parts, was formulated as a Google Form. The three parts included (1) questions on socio-demographic data, (2) questions to determine smoking behavior, and (3) questions to assess smokers’ knowledge and perception of smoking-related health effects.

RESULTS

A total of 300 patients participated in the survey conducted at the out-patient department of the College of Dentistry, Jazan University. Among the respondents, 64.7% were males and 35.3% were females. The majority of participants (67.3%) were between the ages of 22 and 25, and 87% of the respondents were university students. In terms of smoking status, 76.3% of the respondents were non-smokers, while 23.7% were smokers. Among the smokers, electronic cigarettes (32.4%) were the most commonly used form, followed by shisha (28.2%) and cigarettes (25.4%). Approximately 14.1% of the respondents reported using more than one form of smoking. Table 1 presents the frequency distribution of the survey participants.

Table 1.

Frequency Distribution

Variable		Number	Percentage
Gender	Female	106	35.3
	Male	194	64.7
Age (Years)	18–21 years	98	32.7
	22–25 years	202	67.3
Education Level	Intermediate	1	0.3
	Secondary	38	12.7
	University	261	87.0
Smoking	No	229	76.3
	Yes	71	23.7
Smoking Type	Cigarette	18	25.4
	EC	23	32.4
	More than one type	10	14.1
	Shisha	20	28.2

Tables 2-4 provide the associations between gender, age, educational level, and the survey questions. While no significant association was found between gender and how respondents started smoking, the majority of both females (66.7%) and males (73.2%) reported starting smoking with friends. A similar trend was observed across different age groups (18–22 years: 61.5%, 22–25 years: 74.1%) and among secondary (72.7%) and university students (71.7%).

Table 2.

Gender association of survey questions

Question		Female		Male		x2	P
		n	%	n	%
How did you start?	Friends	10	66.7	41	73.2	0.451	0.930; NS
	Parents and/or relatives	3	20.0	9	16.1
	Sign of maturity	1	6.7	4	7.1
	TV/Videos	1	6.7	2	3.6
Times per day	1–2 times	12	80.0	20	35.7	11.845	0.003*
	3–5 times	3	20.0	11	19.6
	More than 6	-	-	25	44.6
Smoking time	Afternoon	4	26.7	3	5.4	6.421	0.093; NS
	Before bedtime	4	26.7	17	30.4
	Evening	4	26.7	16	28.6
	Morning	3	20.0	20	35.7
Response when seeing others smoking	Nothing	10	66.7	39	69.6	1.077	0.783; NS
	Oppose them	2	13.3	4	7.1
	Scold	2	13.3	11	19.6
	Support them	1	6.7	2	3.6
Do you find difficulty to stop	No	10	66.7	27	48.2	1.614	0.204; NS
	Yes	5	33.3	29	51.8
Benefit if you stop	Not at all	7	46.7	8	14.3	7.846	0.020*
	Somewhat	3	20.0	12	21.4
	Very much	5	33.3	36	64.3
Smoking damages health	Not at all	5	33.3	5	8.9	12.005	0.002*
	Somewhat	7	46.7	13	23.2
	Very much	3	20.0	38	67.9
Worry about smoking	Not at all	5	33.3	7	12.5	6.431	0.040*
	Somewhat	7	46.7	19	33.9
	Very much	3	20.0	30	53.6
Every cigarette damages the body	Agree	13	86.7	49	87.5	0.341	0.843; NS
	Disagree	1	6.7	2	3.6
	Neither	1	6.7	5	8.9
Tobacco is addictive	Agree	12	80.0	41	73.2	0.327	0.849; NS
	Disagree	1	6.7	6	10.7
	Neither	2	13.3	9	16.1
Smoking is dangerous to non-smokers	Agree	13	86.7	47	83.9	0.068	0.795; NS
	Disagree	-	-	-	-
	Neither	2	13.3	9	16.1

Chi-Square Test: NS: P>0.05; Not significant; *P<0.05; Significant

Table 4.

Education level association of survey questions

Question		Secondary		University		x2	P
		n	%	n	%
How did you start?	Friends	8	72.7	43	71.7	1.278	0.734
	Parents and/or relatives	1	9.1	11	18.3
	Sign of maturity	1	9.1	4	6.7
	TV/Videos	1	9.1	2	3.3
Times per day	1–2 times	4	36.4	28	46.7	0.622	0.733
	3–5 times	2	18.2	12	20.0
	More than 6	5	45.5	20	33.3
Smoking time	Afternoon	1	9.1	6	10.0	2.851	0.415
	Before bedtime	1	9.1	20	33.3
	Evening	4	36.4	16	26.7
	Morning	5	45.5	18	30.0
Response when see other smoking	Nothing	6	54.5	43	71.7	3.268	0.352
	Oppose them	1	9.1	5	8.3
	Scold	4	36.4	9	15
	Support them	0	0	3	5.0
Do you find difficulty to stop	No	5	45.5	32	53.3	0.231	0.438
	Yes	6	54.5	28	46.7
Benefit if you stop	Not at all	2	18.2	13	21.7	1.824	0.402
	Somewhat	4	36.4	11	18.3
	Very much	5	45.5	36	60.0
Smoking damage health	Not at all	3	27.3	7	11.7	2.091	0.351
	Somewhat	2	18.2	18	30.0
	Very much	6	54.5	35	58.3
Worry about smoking	Not at all	3	27.3	9	15.0	2.219	0.330
	Somewhat	2	18.2	24	40.0
	Very much	6	54.5	27	45.0
Every cigarette damages the body	Agree	11	100	51	85.0	1.890	0.389
	Disagree	0	0	3	5.0
	Neither	0	0	6	10.0
Tobacco is addictive	Agree	7	63.6	46	76.7	1.385	0.500
	Disagree	1	9.1	6	10.0
	Neither	3	27.3	8	13.3
Smoking is dangerous to non-smokers	Agree	11	100	49	81.7	2.386	0.134
	Disagree	0	0	0	0
	Neither	0	0	11	18.3

Chi-Square Test: NS: P>0.05; Not significant; *P<0.05; Significant

Table 3.

Age association of survey questions

Question		18–21 yrs		22–25 yrs		x2	P
		n	%	n	%
How did you start?	Friends	8	61.5	43	74.1	1.056	0.788
	Parents and/or relatives	3	23.1	9	15.5
	Sign of maturity	1	7.7	4	6.9
	TV/Videos	1	7.7	2	3.4
Times per day	1–2 times	7	53.8	25	43.1	1.028	0.598
	3–5 times	3	23.1	11	19.0
	More than 6	3	23.1	22	37.9
Smoking time	Afternoon	3	23.1	4	6.9	3.207	0.361
	Before bedtime	3	23.1	18	31.0
	Evening	3	23.1	17	29.3
	Morning	4	30.8	19	32.8
Response when seeing others smoking	Nothing	8	61.5	41	70.7	2.161	0.540
	Oppose them	1	7.7	5	8.6
	Scold	4	30.8	9	15.5
	Support them	0	0	3	5.2
Do you find difficulty to stop	No	10	76.9	27	46.6	3.925	0.045*
	Yes	3	23.1	31	53.4
Benefit if you stop	Not at all	5	38.5	10	17.2	2.882	0.237
	Somewhat	2	15.4	13	22.4
	Very much	6	46.2	35	60.3
Smoking damages health	Not at all	3	23.1	7	12.1	1.322	0.516
	Somewhat	4	30.8	16	27.6
	Very much	6	46.2	35	60.3
Worry about smoking	Not at all	3	23.1	9	15.5	1.599	0.450
	Somewhat	6	46.2	20	34.5
	Very much	4	30.8	29	50.0
Every cigarette damages the body	Agree	12	92.3	50	86.2	0.729	0.695
	Disagree	0	0	3	5.2
	Neither	1	7.7	5	8.6
Tobacco is addictive	Agree	12	92.3	41	70.7	2.859	0.239
	Disagree	0	0	7	12.2
	Neither	1	7.7	10	17.2
Smoking is dangerous to non-smokers	Agree	12	92.3	48	82.8	0.740	0.354
	Disagree	0	0	0	0
	Neither	1	7.7	10	17.2

Chi-square Test: NS: P>0.05; Not significant; *P<0.05; Significant

Significant gender differences were observed in the number of times respondents smoked per day, with the majority of females (80%) smoking 1–2 times a day, while most male participants (44.6%) smoked more than 6 times a day. No significant associations were found between age, educational level, and the time of smoking.

In summary, the study included 300 participants from the out-patient department of the College of Dentistry, Jazan University. The majority of respondents were males, university students, and non-smokers. Among the smokers, electronic cigarettes were the most prevalent form of smoking. Starting to smoke with friends was a common trend, regardless of gender or age group. Females tended to smoke fewer times per day compared to males. While perceptions about the health effects of smoking and the benefits of quitting varied slightly between genders, the majority of participants expressed concerns about the damaging effects of smoking on health.

DISCUSSION

The findings of the current study, in conjunction with previous studies conducted in different countries, provide valuable insights into the awareness, attitude, and smoking behavior among young individuals. The results indicate the need for targeted interventions and educational programs to address the misconceptions and promote healthier behaviors.

The study conducted in Bhilai, India, revealed that 64% of the participating youngsters admitted to smoking cigarettes, which is a significant proportion considering the high prevalence of smoking in India.[6] Similar studies conducted in southern India and Iraq also reported relatively high smoking rates among the young population, with 41.03% and 52.6% of participants admitting to smoking, respectively.[1,7] These findings highlight the urgent need for effective smoking cessation programs and awareness campaigns in these regions.

One concerning aspect observed in the current study and the study conducted in Iraq was the low level of awareness regarding the health effects of smoking. Participants were primarily aware of the link between smoking and lung cancer but had limited knowledge about other health consequences, such as stroke, stained teeth, impotence in male smokers, and the risks of second-hand smoking.[7] Similar findings were observed in other countries, including China, where only half of the smokers were aware of the harm of second-hand smoking.[4,8] This lack of awareness underscores the importance of comprehensive education campaigns that address the full spectrum of health risks associated with smoking.

The study findings also shed light on the behavioral perception of smokers. The teenage population was found to be more prone to adopting smoking, and peer pressure emerged as a significant factor contributing to smoking initiation. This emphasizes the need for targeted counseling and education to combat the influence of peers and to disseminate accurate information about the harms of smoking. By focusing on educating young smokers, it is possible to create a ripple effect within their peer circles, promoting healthier choices.[9]

While the majority of participants in the current study demonstrated awareness of the ill effects of smoking, it is noteworthy that most preferred to continue smoking. This indicates a gap between knowledge and behavior change, highlighting the importance of thorough education and exclusive counseling to address misconceptions and promote quitting among youngsters.[10] Similar studies in Iraq and China also found that smokers with higher knowledge scores were more likely to have plans to quit smoking, emphasizing the link between knowledge and intentions to quit.[8,10]

Comparing the findings of different studies, it becomes evident that the level of awareness and intentions to quit smoking vary across countries. For instance, in Malaysia, the introduction of new health warnings on cigarette packs resulted in short-term improvements in knowledge and concerns about the harms of smoking as well as an increased interest in quitting. This is consistent with previous studies in high-income countries, indicating the effectiveness of graphic health warnings in improving knowledge and promoting cessation.[11] However, it is important to note that these findings are based on immediate reactions, and longer-term effects and the specific impact of individual warnings remain to be explored.

Another significant aspect highlighted in the discussion is the gender disparity in smoking behavior. Studies conducted in Saudi Arabia, India, and neighboring countries consistently show higher smoking prevalence among adolescent boys compared to girls.[1,11] This reinforces the need for gender-specific interventions and strategies to target boys, improve school connectedness, and engage family members as positive role models to reduce adolescent smoking rates.

CONCLUSIONS

In conclusion, this study highlights the need for targeted interventions and educational programs to address smoking behaviors among young individuals in the Jazan region of Saudi Arabia. The findings indicate a prevalence of smoking, particularly among males and university students, with electronic cigarettes being the most common form of smoking. Peer pressure plays a significant role in smoking initiation. There is a gap between knowledge and behavior change, emphasizing the importance of comprehensive education and counseling. Gender-specific interventions, family involvement, and promoting school connectedness are crucial in reducing smoking rates. Graphic health warnings on cigarette packs show potential in improving knowledge and quitting intentions. Continued research and surveillance are necessary to inform evidence-based policies and interventions to combat youth smoking.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.