Smoking habits and attitudes towards smoking among university students in Jordan

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Abstract

The aim of this study was to estimate the prevalence of smoking and to describe the habits, attitudes, and practices related to smoking among students of Jordan University of Science and Technology (JUST), Irbid, Jordan.

Students (n=650) were recruited in randomly selected, cluster samples drawn from the medical and engineering colleges of JUST. They were made familiar with a modified Arabic version of the World Health Organisation Smoking Questionnaire and the Attitudes towards Smoking Questionnaire to study their habits, attitudes, and beliefs in relation to smoking.

The study revealed that the prevalence of smoking was 28.6% (50.2% among males and 6.5% among females). Friends, not family, were the main source of the first smoking, and this most often occurred after 15 years of age (82.3%). Males preferred smoking in the cafeteria, females in the bathroom. The main advantage of smoking for males was calming down, while for females it was independence. Non-smokers chose not to smoke because of health and hatred of the habit. The non-smokers had more positive attitudes against smoking and were more aware of the adverse effects of smoking. The reasons smokers gave for starting smoking were pleasure, followed by stress and curiosity. Two-thirds of smokers intended to quit smoking in the future. Some smokers disagreed with some criticisms against smoking, and reasons why they did not want to quit included social attitudes, addiction, and not knowing how to quit.

Results of this study may provide baseline data to develop an anti-smoking program in the university and encourage policy makers to limit smoking in the university by strengthening the policies against smoking.

Introduction

Smoking and tobacco consumption is on the increase in countries of the Eastern Mediterranean Region (WHO, 1997). The same trend is expected to be occurring in Jordan, which suggests that the number of Jordanians who will die or be disabled as a result of tobacco-related diseases will increase.

Although smoking is a major health problem in Jordan its actual extent is not known. The last national survey in Jordan in 1996 found that smoking prevalence among people aged 25 years and over was 23.7% (48% among males and 12% among females) (Abbas and Kharabsha, 1996). A study (Ajlouni et al., 1998) on the prevalence of obesity in semi-urban communities in Jordan reported smoking prevalence among adults 25 years of age and older was 31.7% for males and 6% for females. A more recent study in 1999 found that 21% of school students were smokers (WHO, UNICEF, & Smoking Surveillance Committee, 1999). Except for these studies research on smoking among the different age groups is lacking. Baseline information is needed to quantify the size of the ‘smoking epidemic’ in Jordan in terms of its effect on various segments of the population. This information would enable targeting of anti-smoking programs to specific groups with messages appropriate to their habits and beliefs.

Prevalence of smoking in developing countries such as Jordan is noted to be increasing, especially among students, whereas surveys of students in developed countries are showing decline in smoking prevalence (Nelson et al., 1995; WHO, UNICEF, & Smoking Surveillance Committee, 1999). The increase of tobacco use in Jordan could be the result of several factors: growing population, rising income, increasing interest in smoking on the part of girls and women, relentless tobacco campaigns, and the lack of awareness of the dangers and hazards of smoking.

The purpose of this study was to focus upon the habits, attitudes, and practices related to smoking behaviours of students at a university in northern Jordan. The topic is new to Jordan, but has been investigated by other researchers in other Arab countries (Hashim, 2000; Abolfotouh et al., 1998; Felimban and Jarallah, 1994; Felimban, 1993).

Great majority of smokers starts the habit before 20 years of age (Young et al., 1989). There are many reasons for smoking, such as alleviation of stress, life problems, peer pressure, social acceptance issues, family history (parental modelling of smoking behaviour), lower educational attainment, and lower economic status. Young smokers desire to appear mature, self-confident and independent and to attain a high personality profile (Kegler et al., 1999). On the other hand, religion, sensory issues such as bad taste or smell, negative health consequences, impaired physical performance, negative physiological response, and issues related to family are considered as some of the reasons for not smoking (Felimban & Jarallah, 1994; Kegler et al., 1999).

Attitudes and beliefs towards smoking predict intentions and starting of smoking (Brownson et al., 1992). Attitudes towards smoking serve as a deterrent to initiating smoking and as a stimulus to quitting (Chassin et al., 1984; Hansen et al., 1985).

Great majority of pupils (smokers and non-smokers alike) recognise that smoking is harmful to the health (Smith, 1991). Contrarily, pupils who tried cigarettes had more adverse attitudes and beliefs about the effects of smoking compared to non-smokers (Greenlund et al., 1997). Smokers are responsible for their own health, yet most are still unaware of the grave dangers of smoking or of ways they could avoid them (Royal College of Physicians, 1983). Hill and Gray (1989) found most smokers did not believe that smoking caused illness and most of them thought that only those who smoke heavily (by which they meant those who smoke more cigarettes than they do themselves) are likely to get serious illnesses caused by smoking. In fact about one-third of all premature deaths caused by smoking occur in smokers who smoke less than 20 cigarettes per day (Royal College of Physicians, 1983).

Most smokers understood smoking as a strategy to cope with the social anxieties rather than as deviant or illegal behaviour (Leventhal et al., 1991). Use of cognitive coping and problem solving methods has been shown to be a deterrent to initiating smoking (Lotecka and MacWhinney, 1983) and to be maintaining abstinence among adults (Supnick & Colletti, 1984; Wewers, 1988).

Many studies focused on attitudes and beliefs towards smoking were conducted. Kegler et al. (1999) studied the functional value of smoking and non-smoking from the perspective of American Indian youth by using focus groups. The results indicated for smokers, the functional value of smoking was associated with peers, moods, image, addiction, family and sensory pleasures. For non-smokers, the functional value of non-smoking was related to sensory aspects, health consequences, physical performance, physiological response and family.

Felimban and Jarallah (1994) conducted a study in Riyadh, Saudi Arabia, to examine the attitudes and practice of secondary school boys towards smoking. They surveyed 1312 randomly selected students using a questionnaire and found a smoking prevalence of 21.8% in the study sample. They also noted that prevalence rates increased with increase in age with more than two-thirds of the ever-smoked group starting the habit after age 10 years. Of the participants as a whole more than 72% consumed less than 10 cigarettes per day and 67.3% never smoked at school. The most common cause of smoking suggested by the students was boredom (29.1%), followed by habit (23.5%) and imitation (17.1%). Despite participants’ concern about smoking hazards, 27.6% of the ever-smokers were still smoking on regular basis.

Felimban (1993) studied the attitudes towards smoking and smoking practices of female university students in Riyadh, Saudi Arabia. Of the 663 females who completed the questionnaire, 45.6% had a formal medical educational background and 54.4% had other scientific educational backgrounds. The smoking prevalence was 8.6% and 11.6% for medical and non-medical groups, respectively, and 53.8% and 71.4% for those who had ever-smoked were still smoking. Also, 46.2% of the former group and 28.6% of the latter group had quit smoking. Nearly all of those studied were aware of the hazards of smoking, and the media was the major source of this information. Religion, health and social considerations were important barriers which may inhibit an individual from smoking, as well as provide a potential pressure to quit.

Bener et al. (1999) studied cigarette-smoking habits among high school boys in the United Arab Emirates. The survey of 1500 public secondary school boys found that 18.9% were currently smoking and another 28.2% had smoking experience. Most of the smokers had begun smoking between the age of 10 and 15, and were much likely to have family members who smoked.

Hashim (2000) established a baseline data on the smoking habits of health science students in Saudia Arabian University environment. In a random sample of 647 students 29% were current smokers. Among major factors that influence the smoking prevalence were the smoking habits of peers, siblings, and parents. The major source of information on the health consequences of smoking was the media.

In summary, researchers in East Mediterranean countries have been working on building research-based knowledge particular to their local areas. Many studies have estimated the prevalence of smoking within general and particular populations, notably school and university students. The age of initiation of smoking has been determined for some populations; as well as reasons for smoking and related environmental factors that influence children and young adults to take up smoking are also determined. Also, student knowledge about the hazards of smoking and attitudes toward quitting has been investigated.

Smoking habits among university students have been described and predictors of smoking, such as peer group influences, explored. There are some studies about the prevalence, practices, and attitudes towards smoking university students. They assessed the knowledge about health consequences of smoking and explored important aspects of knowledge, attitudes and beliefs of smokers and non-smokers.

Little research has been conducted in the East Mediterranean area on the initiation of smoking and factors that may determine smoking frequency, such as type of school, academic achievement, social consequences of smoking, socio-economic status and presence of smokers at home. Research in this area has so far not assessed the relative contribution of such factors as self-image, peer pressure and dieting behaviour to frequency of smoking among school or university students.

Few studies have been conducted among females. Most East Mediterranean studies have concentrated and focused on males, and reports of gender differences should be viewed with a particular caution because these differences may be due to varying degrees of expressiveness by gender rather than true gender differences in factors and values of smoking.

Given the gaps found in the literature review, this research study is needed to understand the habits, attitudes, and practices in relation to smoking among university students. In addition, the need to examine gender differences in expressions and values of smoking will be addressed. Locally derived, gender-specific information gained through this study will be useful to develop anti-smoking education programs that are designed to meet the different needs of young men and women in relation to their attitudes toward smoking.

Section snippets

Materials and methods

A descriptive, exploratory study design was used to describe and identify smoking habits, beliefs, and attitudes towards smoking. The population under study was all students enrolled in Jordan University of Science and Technology (JUST), one of the largest governmental universities in Jordan. Given the total student population of 9898, assuming a prevalence of smoking of 50% and accepting a margin of error not exceeding 4% with a 95% confidence level, the needed sample size was 625. The

Results

The results are based on the questionnaire responses of 650 study participants. As seen in Table 1 half (50.6%) of the sample was male. The population age ranged from 17 to 28 years, with the majority between 20 and 24 years (58.5%). Overall, 28.6% of the students were smokers, with significant differences in prevalence rates by gender, 50.2% among males and 6.5% among females (χ2=151.270; P=0.000). Also, prevalence of smoking increased significantly according to year of studies: first year,

Smoking habits among students

The great majority of smokers in this study started smoking after the age of 15 years. This is consistent with studies in other Arab countries finding that the most common age of starting smoking was between 15 and 19 among all ever-smokers (Bawazeer et al., 1999; Felimban and Jarallah, 1994). Young et al. (1989) set the age of onset as 20 years for the great majority of smokers and described adolescence as the most vulnerable period for acquiring the smoking habit.

This study found the

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