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Original Research (Original Article) 


Hanadi Mufakkir ALMutair et al, 2019;3(7):586–591.

International Journal of Medicine in Developing Countries

Smoking and related diseases in Saudi Arabia

Hanadi Mufakkir ALMutair1*, Abdullah Aedh Aftan2, Lamya Ayidh Alqarni3, Fatimah Abdulkareem Bin Amer4, Maryam Abdullah Alhajji4, Razan Hussein AlSaihati5, Narjes Ali Alismail4,Maha Mohammed Alduayji1, Arwa Saleh Alobaid1

Correspondence to: Hanadi Mufakkir ALMutair

*College of Medicine, Qassim University, Qassim, Saudi Arabia.

Email: hidiy17 [at] gmail.com

Full list of author information is available at the end of the article.

Received: 20 January 2019 | Accepted: 03 February 2019


ABSTRACT

Background:

Smoking harms nearly every organ of the body. Tobacco consumption is a major risk factor for morbidity and mortality. The main objective of this study was to estimate the current status of; prevalence, age at beginning, causes, and factors affecting smoking among the general population of Saudi Arabia.


Methodology:

We conducted a survey on 1,089 individuals aged 15 years or older (55.2% were males). The survey was performed between May and July 2018. Data were collected through a self-administered online distributed questionnaire. The questionnaire included questions on socio-demographic characteristics, tobacco consumption, period of smoking (in years), age at the beginning of smoking, causes of smoking, personal opinion on smoking, trial to stop smoking, previous experience of stopping smoking and frequency of smoking per day, and if the participant has any chronic disease, which affected by smoking.


Results:

Overall prevalence of current smoking was 45.4% and males were more likely to smoke than females, as 78.3% were males (p = 0.001). Mean age of smoking initiation was 16.4 ± 11.8 years with 20.8% of ever smokers starting at the age of 11–15 years. Daily shisha smoking was reported by 5.1% of the population. Among even smokers, 71.1% of individuals reportedly attempted to quit smoking. Of those, 28.5% were successful by the time of the study. The reported causes of smoking were for entertainment in 32.8%, to relieve stress in 20.0%, for experience in 18.8%, and for simulating family members and relatives in 18.6%. Smoking is a bad habit and also harmful was reported as a personal opinion of 80.0% of the participants.


Conclusion:

The prevalence of tobacco consumption in Saudi Arabia is considerably high as nearly half (45.4%) are smokers but there are a good percentage of the people who are trying to quit.


Keywords:

Tobacco, smoking, shisha, quitting, Saudi Arabia.


Introduction

There is no doubt that smoking harms nearly every organ of the body. Cigarette smoking causes 87% of lung cancer deaths. It is also responsible for many other cancers and health problems. Smoking is mainly tobacco inhalation. Tobacco contains nicotine, a highly addictive drug that makes it difficult for smokers to kick the habit. Tobacco products also contain many poisonous and harmful substances that cause disease and premature death. The rate of smoking in developing countries is still high despite its decline in developing countries [1]. The World Health Organization (WHO) has described tobacco smoking as an epidemic [1]. The global smoking epidemic is expected to remain as one of the greatest causes of premature death, disease, and suffering for decades to come. The youth form the main target for these companies to ensure that smoking persists in developing countries. When a person begins to smoke before the age of 18 years, he is likely to continue into adulthood and quitting becomes more difficult [2]. This undoubtedly increases the burden of chronic illnesses later in life [3]. The socio-demographic factors that interact with smoking behavior were studied extensively in those countries that have succeeded in combating smoking [4,5]. Tobacco, a preventable cause of morbidity and mortality, kills 6 million people annually [6]. If this trend continues, it will cause more than 8 million deaths each year by 2030, 80% of which will be premature deaths in low- and middle-income countries [6]. Although Saudi Arabia does not grow tobacco or manufacture cigarettes, smoking has existed in this country for more than 50 years. Tobacco imports in the form of manufactured cigarettes have increased dramatically over the years, and an average of 600 million Saudi Riyals (about $150 million) is spent annually on tobacco [7]. We conducted this study to estimate the current status of prevalence, age at the beginning, causes, and some affecting factors of smoking among the general population of Saudi Arabia.

Table 1. Socio-demographic characteristics among studied population (1,089).

No. %
Sex
  • Female
  • 488 44.8
  • Male
  • 601 55.2
    Age group
  • <21
  • 171 15.7
  • 21–30
  • 539 49.5
  • 31–40
  • 232 21.3
  • >40
  • 147 13.5
    Education
  • Basic education
  • 82 7.5
  • High school
  • 233 21.4
    University or more 721 66.2
  • Illiterate
  • 53 4.8
    Marital status
  • Widow/divorced
  • 21 2.0
    § Single 551 50.6
  • Married
  • 517 47.5
    Working status
  • Employed
  • 440 40.4
  • Retired
  • 84 7.7
  • Student or not employed
  • 565 51.9
    Economic status
  • Good
  • 343 31.5
  • Very good
  • 319 29.3
  • Within average
  • 44 4.0
  • Excellent
  • 245 22.5
  • Low
  • 138 12.7
    Smoking
  • Yes
  • 494 45.4
  • No
  • 595 54.6

    Table 2. Smoking-related variables among smokers (N = 494).

    Variables No. %
    Period of smoking (in years)
  • <1
  • 114 23.1
  • 1–5
  • 99 20.2
  • 5–10
  • 130 24.4
  • >10
  • 161 32.6
    Age at the beginning of smoking
  • 11–15
  • 103 20.8
  • 21–25
  • 131 26.5
  • >25
  • 260 52.6
    Mean ± SD 16.4 ± 11.8
    Causes of smoking
  • Peer pressure
  • 48 9.7
  • For entertainment
  • 162 32.8
  • Stress
  • 99 20.0
  • For experience
  • 93 18.8
  • Simulating family members and relatives
  • 92 18.6
    Personal opinion on smoking
  • Bad habit and harmful
  • 395 80.0
  • Preferred habit and not harmful
  • 26 5.3
  • No problem to smoke
  • 73 14.8
    The trial of stop smoking
  • No
  • 143 29.0
  • Yes
  • 351 71.1
    Previous experience of stopping smoking
  • Yes
  • 141 28.5
  • No
  • 353 71.5
    The frequency of smoking per day
  • 1–3 packs of tobacco/day (shisha)
  • 25 5.1
  • <10
  • 172 34.8
  • 10–20
  • 155 31.3
  • >20
  • 142 28.7

    Subjects and Methods

    A cross-sectional community-based study was carried out on 1,089 participants in Saudi Arabia, during the period from May 1 to July 30, 2018. Data collection was done using a pre-designed online questionnaire which was distributed among the targeted population around Saudi Arabia. The questionnaire was self-administered by participants after a brief introduction or explanation of the idea of the research. It included the relevant questions to collect data about:

    • Socio-demographic characteristics of the participants, including age, marital status, educational status, working status, and economic status.
    • Smoking history; period of smoking (in years), age at the beginning of smoking, causes of smoking, personal opinion on smoking, trial to stop smoking, previous experience of stopping smoking, and frequency of smoking per day.
    • If the participant has any chronic disease, which affected by smoking as DM, hypertension, obesity, atherosclerosis, lung cancer, or bronchial asthma.

    Table 3. Relationship between smoking and socio-demographic characteristics among the studied population.

    Variables Responses Smoking Total (N = 1,089) p-value
    Yes (n = 494) No (n = 595)
    Age group <20 54 117 171 0.001
    10.9% 19.7% 15.7%
    20–30 230 309 539
    46.6% 51.9% 49.5%
    31–40 135 97 232
    27.3% 16.3% 21.3%
    >40 75 72 147
    15.2% 12.1% 13.5%
    Sex Female 107 381 488 0.001
    21.7% 64.0% 44.8%
    Male 387 214 601
    78.3% 36.0% 55.2%
    Marital status Widow 2 3 5 0.005
    0.4% 0.5% 0.5%
    Single 222 329 551
    44.9% 55.3% 50.6%
    Married 260 257 517
    52.6% 43.2% 47.5%
    Divorced 10 6 16
    2.0% 1.0% 1.5%
    Economic status Good 173 170 343 0.000
    35.0% 28.6% 31.5%
    Very good 136 183 319
    27.5% 30.8% 29.3%
    Low 32 12 44
    6.5% 2.0% 4.0%
    Moderate 109 136 245
    22.1% 22.9% 22.5%
    Excellent 44 94 138
    8.9% 15.8% 12.7%

    Collected data were coded and analyzed using the Statistical Package for the Social Sciences (SPSS, version 15). Descriptive statistics for the prevalence of smoking and quantitative variables were used. The relationship between smoking and socio-demographic variables and chronic diseases was determined using the chi-square test. A p-value of less than 0.05 was considered statistically significant. The questionnaire had a brief introduction explaining the aims and significance of the study. Written consent was obtained from all participants. Confidentiality of data was maintained throughout the study.


    Results

    From the tables, it was clear that the overall prevalence of current smoking was 45.4% and males were more likely to smoke than females, as 78.3% were males and only 21.7% were females (p = 0.001). Mean age of smoking initiation was 16.4 years (±11.8 years) with 20.8% of ever smokers starting at the age of 11–15 years and 26.5% at the age between 15 and 25. Daily shisha smoking was reported by 5.1% of the population. Among ever smokers, 71.1% of individuals reportedly attempted to quit smoking. Of those, 28.5% were successful by the time of the study. The reported causes of smoking were for entertainment in 32.8%, to relieve stress in 20.0%, for experience in 18.8%, and for simulating family members and relatives in 18.6%. Smoking is a bad habit and also harmful was reported as a personal opinion by 80.0% of the participants. The correlation between smoking and each of marital and economic status was highly significant (p < 0.01).

    Table 4. Relationship between smoking and chronic diseases among the studied population.

    Variables Responses Smoking Total (N = 1,089) p-value
    Yes (n = 494) No (n = 595)
    Hypertension No 457 563 1020 0.09
    92.5% 94.6% 93.7%
    Yes 37 32 69
    7.5% 5.4% 6.3%
    Obesity No 349 472 821 0.01
    70.6% 79.3% 75.4%
    Yes 145 123 268
    29.4% 20.7% 24.6%
    Atherosclerosis No 491 591 1082 0.601
    99.4% 99.3% 99.4%
    Yes 3 4 7
    0.6% 0.7% 0.6%
    Lung cancer No 493 595 1088 0.454
    99.8% 100.0% 99.9%
    Yes 1 0 1
    0.2% 0.0% 0.1%
    Bronchial asthma No 454 548 1002 0.496
    91.9% 92.1% 92.0%
    Yes 40 47 87
    8.1% 7.9% 8.0%
    Other chronic diseases No 442 533 975 0.516
    89.5% 89.6% 89.5%
    Yes 52 62 114
    10.5% 10.4% 10.5%

    Discussion

    In this study, we included 1,089 participants, 55.2% of them were males and 44.8% were females. We included a large age group of participants from less than 15 years to more than 40 years old, who are at the high-risk age of smoking in general. Smoking was found to be quite high in the general population of Saudi Arabia, as 45.4% of our participants were smokers and this was reported from previous small-scale studies and community-based studies conducted in some regions in Saudi Arabia and other Arab countries [810]. A lower prevalence of smoking was recorded in Jamal S. Jarallah’s study done in Saudi Arabia [11], as he recorded that the overall prevalence of smoking in his study to be 12%. The prevalence of tobacco smoking in the general population in Malaysia was found to be 57% [12], which was higher compared to the present study result than ours. In a convenience sample of 2,120 individuals aged between 15 and 86 years in the general population of the city of Alexandria, Egypt, the overall prevalence of current tobacco smoking of all types combined was 48.5% among males and 1.5% among females [13]. In Lebanon, a study was carried out via a multilevel cluster sampling technique, stratified by district, and the authors reported an adult smoking prevalence of 53.6% [14]. A household survey carried out in urban areas in Sousse, Tunisia, a study using a two-stage systematic sampling method reported that 61.4% of adult males and 4.2% of adult females reported smoking [15]. Smoking starts at an early age. It was recorded that 20.8% of the smoker participants started smoking at the age between 11 and 15 years old and 26.5% of them were aged between 15 and 25. Relatively higher results were found in Egypt in a study done by El-Setouhy [16], who found that among males who had ever tried smoking, 60% were aged 15 years or younger, and 88% had tried it by age 20. Among females, the age at initiation shifted slightly to the older age categories, with 60% initiating by age 20% and 87% by age 25. Another similar study was done in Saudi Arabia by Jarallah et al. [11], who found that most smokers (66%) had smoked for 14 years or less, and 21% had smoked for 20 years or more; mean (standard deviation) duration of smoking was 12.2 (9.7) years.

    Regarding sex, being a male increases the risk of smoking and we found a very high significant correlation between sex and smoking with p-value = 0.001. We reported that 78.3% of the smoker participants were males and only 21.7% were females. Also, in Egypt, the prevalence of smoking in males was 53%; in contrast, very few adult women (2.7%) reported that they were current or former smokers of any type of tobacco product [16]. In Malaysia, Tobacco smoking was high in both genders; but higher in males. It was found that 12% females and 84% of males were smokers [12]. In Jordan, the results revealed that 51% of males and 8% of females reported currently smoking cigarettes [10]. As in other studies [8,17], males smoked significantly more than females in our study. In the Saudi community, there is a social stigma against smoking by women, which is seen as shameful. Other studies in Saudi Arabia and other Arab countries have reported similar findings [10,14]. This differs from Western societies where female smoking is more common [15,18].

    Marital and economic status had a very noticeable effect on smoking habits in our study. The correlation between smoking and each of marital and economic status was highly significant. We reported a higher prevalence of smoking in married people than others. The higher smoking prevalence among married people may increase the risk of smoking initiation among children. Jarallah et al. [11] and El-Setouhy [16] also reported a higher smoking prevalence in married participants in their studies. The higher smoking prevalence among married people also raises a concern about the health effects of passive smoking among those in the same household [19]. Children who are raised in a family where parents or other family members smoke are at greater risk of initiating smoking [9,15,20]. We studied the relationship between smoking and some chronic diseases like hypertension, obesity, atherosclerosis, lung cancer, bronchial asthma, and other chronic diseases among the studied population and we found no significant correlation between smoking and all of these chronic diseases, except for obesity. In Saudi Arabia, there is no clear policy for tobacco control at the national level. Although 80% from the total smoker participants had a negative opinion about smoking, there is not enough health education for the public about smoking and its complications in Saudi Arabia and current control efforts are sporadic, fragmented, and not well coordinated.


    Conclusion

    The prevalence of tobacco consumption in Saudi Arabia is considerably high as nearly half (45.4%) are smokers but there is a good percentage of trial for quitting. So, we recommend the implementation of aggressive health education of the public to encourage people to quit smoking and encourage smoking cessation. We also recommend decision makers to consider increasing taxation on tobacco products.


    List of abbreviations

    WHO World Health Organization
    SPSS Statistical Package for the Social Sciences

    Conflict of interest

    The authors declare that there is no conflict of interest regarding the publication of this article.


    Funding

    None.


    Consent for publication

    Informed consent was obtained from all the participants.


    Ethical approval

    The approval was from the Ministry of health directorate of Qassim region, Saudi Arabia.


    Author details

    Hanadi Mufakkir ALMutair1, Abdullah Aedh Aftan2, Lamya Ayidh Alqarni3, Fatimah Abdulkareem Bin Amer4, Maryam Abdullah Alhajji4, Razan Hussein AlSaihati5, Narjes Ali Alismail4, Maha Mohammed Alduayji1, Arwa Saleh Alobaid1

    1. College of Medicine, Qassim University, Qassim, Saudi Arabia
    2. College of Medicine, Al Maarefa University, Ad Diriyah, Saudi Arabia
    3. College of Medicine, University of Jordan, Amman, Jordan
    4. College of Medicine, Wroclaw Medical University, Wrocław, Poland
    5. College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia

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    How to Cite this Article
    Pubmed Style

    AlMutairi HM, Aftan AA, Alqarni LA, Amer FAB, Alhajji MA, AlSaihati RH, Alismail NA, Alduayji MM, Alobaid AS. Smoking and related diseases in Saudi Arabia. IJMDC. 2019; 3(7): 586-591. doi:10.24911/IJMDC.51-1548005162


    Web Style

    AlMutairi HM, Aftan AA, Alqarni LA, Amer FAB, Alhajji MA, AlSaihati RH, Alismail NA, Alduayji MM, Alobaid AS. Smoking and related diseases in Saudi Arabia. http://www.ijmdc.com/?mno=27190 [Access: August 20, 2019]. doi:10.24911/IJMDC.51-1548005162


    AMA (American Medical Association) Style

    AlMutairi HM, Aftan AA, Alqarni LA, Amer FAB, Alhajji MA, AlSaihati RH, Alismail NA, Alduayji MM, Alobaid AS. Smoking and related diseases in Saudi Arabia. IJMDC. 2019; 3(7): 586-591. doi:10.24911/IJMDC.51-1548005162



    Vancouver/ICMJE Style

    AlMutairi HM, Aftan AA, Alqarni LA, Amer FAB, Alhajji MA, AlSaihati RH, Alismail NA, Alduayji MM, Alobaid AS. Smoking and related diseases in Saudi Arabia. IJMDC. (2019), [cited August 20, 2019]; 3(7): 586-591. doi:10.24911/IJMDC.51-1548005162



    Harvard Style

    AlMutairi, H. M., Aftan, . A. A., Alqarni, . L. A., Amer, . F. A. B., Alhajji, . M. A., AlSaihati, . R. H., Alismail, . N. A., Alduayji, . M. M. & Alobaid, . A. S. (2019) Smoking and related diseases in Saudi Arabia. IJMDC, 3 (7), 586-591. doi:10.24911/IJMDC.51-1548005162



    Turabian Style

    AlMutairi, Hanadi Mufakkir, Abdullah Aedh Aftan, Lamya Ayidh Alqarni, Fatimah Abdulkareem Bin Amer, Maryam Abdullah Alhajji, Razan Hussein AlSaihati, Narjes Ali Alismail, Maha Mohammed Alduayji, and Arwa Saleh Alobaid. 2019. Smoking and related diseases in Saudi Arabia. International Journal of Medicine in Developing Countries, 3 (7), 586-591. doi:10.24911/IJMDC.51-1548005162



    Chicago Style

    AlMutairi, Hanadi Mufakkir, Abdullah Aedh Aftan, Lamya Ayidh Alqarni, Fatimah Abdulkareem Bin Amer, Maryam Abdullah Alhajji, Razan Hussein AlSaihati, Narjes Ali Alismail, Maha Mohammed Alduayji, and Arwa Saleh Alobaid. "Smoking and related diseases in Saudi Arabia." International Journal of Medicine in Developing Countries 3 (2019), 586-591. doi:10.24911/IJMDC.51-1548005162



    MLA (The Modern Language Association) Style

    AlMutairi, Hanadi Mufakkir, Abdullah Aedh Aftan, Lamya Ayidh Alqarni, Fatimah Abdulkareem Bin Amer, Maryam Abdullah Alhajji, Razan Hussein AlSaihati, Narjes Ali Alismail, Maha Mohammed Alduayji, and Arwa Saleh Alobaid. "Smoking and related diseases in Saudi Arabia." International Journal of Medicine in Developing Countries 3.7 (2019), 586-591. Print. doi:10.24911/IJMDC.51-1548005162



    APA (American Psychological Association) Style

    AlMutairi, H. M., Aftan, . A. A., Alqarni, . L. A., Amer, . F. A. B., Alhajji, . M. A., AlSaihati, . R. H., Alismail, . N. A., Alduayji, . M. M. & Alobaid, . A. S. (2019) Smoking and related diseases in Saudi Arabia. International Journal of Medicine in Developing Countries, 3 (7), 586-591. doi:10.24911/IJMDC.51-1548005162