Prevalence, Pattern & Risk Factors of Tobacco Smoking among Male Adult Population of Hayatabad Peshawar Khyber Pakhtunkhwa Pakistan
Adeela Mustafa1, Nadia Qazi2, Rubina Shah3, Waqas Mohyuddin4, Rashid Ahmad5, Owais Kareem6, Muhammad Ishtiaq7*, Jawad Ali8, Said Akbar Khan9, Syed Shahmeer Raza10
1Adeela Mustafa-Assistant Professor, Department of Community Medicine & Public Health, Khyber Medical College, Peshawar, Pakistan
2Nadia Qazi-Assistant Professor, Department of Community Medicine & Public Health, North West School of Medicine, Hayatabad Peshawar, Pakistan
3Rubina Shah-Clinical Psychologist, Department of Community Medicine & Public Health, North West School of Medicine, Hayatabad Peshawar, Pakistan
4Waqas Mohyuddin-Assistant Professor, Department of Community Medicine, Nowshera Medical College, Nowshera, Pakistan
5Rashid Ahmad-Assistant Professor, Department of Medicine, Lady Reading Hospital/MTI Peshawar Pakistan
6Owais Kareem-Senior Registrar, Department of Psychiatry & Behavioural Sciences, Nishtar Medical University, Multan, Pakistan
7Muhammad Ishtiaq-Professor & Head Of Department, Department of Community Medicine &
Public Health, North West School of Medicine, Hayatabad Peshawar, Pakistan
8 Jawad Ali-Assistant Professor, Environmental Science, Faculty of Life Sciences & Informatics, BUITEMS, Quetta, Balochistan, Pakistan
9Said Akbar Khan-Associate Professor, Department of Earth & Environmental Sciences, Bahria University, Islamabad, Pakistan
10Syed Shahmeer Raza-Lecturer, Department of Physiology, Khyber Medical College/ Khyber Teaching Hospital, Peshawar, Pakistan
Correspondence Author
7*Muhammad Ishtiaq-Professor & Head Of Department, Department of Community Medicine &
Public Health, North West School of Medicine, Hayatabad Peshawar, Pakistan Cell: +92-334-9121822; Email: [email protected]
ABSTRACT
Background: The prevalence of tobacco smoking is increasing day by day and it kills one third of its users. According to World Health Organization, 6.2 million deaths per year are attributed directly to tobacco smoking.
Objectives: To find the prevalence, pattern and risk factors of tobacco smoking among male adult population of Hayatabad District Peshawar Khyber Pakhtunkhwa Pakistan.
Study design: A cross-sectional descriptive study
Place and duration of study: Hayatabad district Peshawar Pakistan, from February 2021 to August 2021
Methods: After taking ethical approval, a cross-sectional study was conducted. Male adults of age more or equal to 18 were included in the study while those not permanent residents of district were excluded from the study. Samples were selected from two phases i.e. phase V &
VII. A total of 385 male adults were included in the study based on 50% prevalence and 95%
confidence interval. A structured was used to collect data and presented in form of tables.
Results: Out of 385 respondents, 39.48% had positive tobacco smoking status. Out of 152 current smokers, 71.71% were of age less than 30 years, 21.05% had no job, 37.50% were illiterate, 33.55% had monthly income of Rs. < 10000/ pm, 69.08% unmarried, & 54.61%
living in joint family system.
Conclusion: The prevalence of tobacco smoking is increasing and the key factors were young age, parental factors, exposure to second hand smoke at workplace, friends appreciating smoking, unemployment, being in an educational institute, low monthly income, separate family setup, and unmarried. Moreover, there was need of comprehensive anti- tobacco smoking campaigns and mass awareness to reduce the mortality and morbidity among the communities.
Keywords: Prevalence, Tobacco, Parents, stress, education, awareness
INTRODUCTION
Globally, tobacco smoking is a risk factor of many communicable and non-communicable diseases [1]. It kills one third to half of its users [2]. According to World Health Organization (WHO), 6.2 million deaths per year are attributed directly to smoking and this value is expected to rise in future. If proper measures are not taken, by 2030 the rate will rise to 8 million deaths per year, of which 80% will occur in developing countries [3]. It is reported by WHO that among the smokers worldwide the ratio of male is 47% and female is 12%.
However, the percentage in developing countries varies from that of developed countries:
48% males and 7% females in developing countries whereas, 42% males and 24% females in developed countries are smokers [1].
Pakistan ranks 10th in overall tobacco producing countries [4] and this industry are continuously expanding 5% per annum [5]. A study conducted in 1990-1994 showed prevalence of 21.6% (36% males and 9% females) in people aged 15 and above [5]. The report given by WHO (2011) asserts the prevalence of active tobacco smokers to be 32.4% in males and 5.7% in females [2]. A study conducted in Karachi in the year 2002 reckoned 32.7% of the overall population to be tobacco smokers [6]. According to this study, the highest percentage was that of male college going students whose ages were between 21-25, which shows the prevalence of tobacco smoking to be higher in adults as compared to others.
Further to this, a research was done in 2005, where the prevalence of smoking, exclusively focusing on adult population, was 13.7% [4]. Keeping in view the fluctuating results in adult population, a study was conducted in Peshawar among students of University of Peshawar showing the frequency of tobacco smoking was 15% [7].
Smoking is the risk factor of many diseases for instance coronary heart disease, peripheral vascular disease, cancers of mouth, throat, larynx, lungs, bladder and pulmonary emphysema [5]. Surprisingly, the non-smokers are prone to same hazards if exposed to second hand smoke butacute myocardial infarction and lung cancer are the most common risks in the passive smokers [8]. After being aware of the adverse effects of tobacco smoking, people continue to use tobacco all over the world. The environmental factors specified by the different researches include peer pressure, parental smoking [9, 10], sibling influence [10], uncle smoking [4], illiterate parents [1], non-working mothers [1, 9], low income [11, 12], social acceptability and marketing efforts [13], nuclear family setup [14] and governmental schooling [1, 4]. Whereas, the personal factors include self-confidence, relieving boredom, relaxation [15], old age, poor educational performance, availability to pocket money [16], spending leisure time outside home [4], illiteracy, being married and poor general health [5], adverse childhood experiences [17], mental illness [18] and nicotine dependence [19]
The tobacco smoking is highly prevalent in Pakistan and is causing many health issues. Each year large number of deaths are attributed to tobacco smoking for which immediate measures should be taken. Hence, the awareness programs for the cessation of smoking can be very effective in this respect. However, it is significant to find the determinants of smoking before designing any smoking cessation program. There has been plenty of research conducted on the federal, provincial as well as district level in Pakistan. However, looking at the drastic change in the prevalence and the changing factors of tobacco smoking (as mentioned above), there is a need to conduct a research in the present time. Thus this cross sectional study was
conducted to assess the prevalence, pattern and risk factors of tobacco smoking among male adult population of Hayatabad District Peshawar Khyber Pakhtunkhwa Pakistan.
METHODOLOGY
After taking ethical approval from the Institutional Ethical Approval Committee, a cross- sectional study was conducted from February 2021 to August 2021, in Hayatabad Peshawar Pakistan, in which out of seven phases two were randomly selected. A total of 385 male adults were included in the study based on 50% prevalence and 95% confidence interval. The non probability consecutive sampling technique was used to select the participants. Male adults of age more or equal to eighteen (18) years were included while those not permanent residents of Hayatabad were excluded. Those who gave informed written consent were included and were assured that their identity and personal information will not be disclosed and will solely be used for the purpose of study. A self structured questionnaire was used to collect data. The questionnaire comprised of questions relevant to the demographics including; name, age, address, contact number, occupation, marital status and their family setup. Moreover, questions on the educational status and monthly income of the respondents as well as of their parents. The status of current tobacco cigarette smoking, past cigarette smoking and number of cigarettes smoked per day was also inquired. In order to find out the factors responsible for smoking tobacco cigarettes, questions like parental smoking, sibling smoking, permission of smoking at home and second hand smoke at work place were asked.
Moreover, the reasons for tobacco smoking were investigated. The point of view of respondents about the harmful effects of tobacco smoking was also inquired. After data collection, data was entered and analyzed by SPSS 23.0, finally data was presented in form of tables.
RESULTS
Table No. 1. Frequency of Tobacco Smoking Among the study participants (n=385)
Tobacco Smoking
Response Frequency Percentage
Yes 152 39.48
No 233 60.52
Table No. 2. Frequency of Demographics of the Study Participants (n=385)
Variable Response F (385) Percentage F(152) Percentage
Age in years
< 30 249 64.68 109 71.71
30 to 40 93 24.16 28 18.42
40 to 50 29 7.53 11 7.24
> 50 14 3.64 4 2.63
Occupation
No Job 85 22.08 32 21.05
Govt 94 24.42 21 13.82
Pvt 109 28.31 32 21.05
Others 97 25.19 67 44.08
Educational status Literate 279 72.47 95 62.50
Illiterate 106 27.53 57 37.50
Monthly Income of Respondents
< 10000 123 31.95 51 33.55
10 to
20000 142 36.88 49 32.24
> 20 000 120 31.17 52 34.21
Marital Status Married 163 42.34 47 30.92
Unmarried 222 57.66 105 69.08
Parents Occupation
No Job 59 15.32 22 14.47
Govt 91 23.64 35 23.03
Pvt 124 32.21 51 33.55
Others 111 28.83 44 28.95
Parents Educational Status Literate 279 72.47 93 61.18
Illiterate 106 27.53 59 38.82
Respondents Parents Monthly Income
< 10000 51 13.25 20 13.16
10 to
20000 137 35.58 47 30.92
> 20 000 197 51.17 85 55.92
Parents condition
Both alive 195 50.65 58 38.16
Both dead 13 3.38 6 3.95
Father
alive 68 17.66 27 17.76
Mother
alive 109 28.31 61 40.13
Type of family setup Joint 224 58.18 83 54.61
Separate 161 41.82 69 45.39
Table No. 3. Tobacco Smoking Determinants among the Study Participants of Hayatabad Peshawar Pakistan (n=385)
Variables Response Frequency Percentage Frequency Percentage Using tobacco in any other
form (385)
Yes 206 53.51 133 87.5
No 179 46.49 19 12.5
If yes, in which form (206)
Snuff 162 78.64 91 93.81
Tobacco pipes 19 9.22 3 3.09
Chewing
tobacco 8
3.88 2
2.06
Cigar 17 8.25 1 1.03
Think smoking is harmful to health (385)
Yes 337 87.53 131 86.18
No 48 12.47 21 13.82
Passive Tobacco Smoking at work place (385)
Yes 237 61.56 105 69.08
No 148 38.44 47 30.92
If yes, who (237)
Parents 69 29.11 31 34.83
Brothers 14 5.91 2 2.25
Relatives 104 43.88 34 38.20
Friends/
Colleagues 25 10.55 20 22.47
Servant 25 10.55 2 2.25
Friends 145 87
Addicted to other drugs (385)
Yes 129 33.51 36 23.68
No 256 66.49 116 76.32
If yes, to which one (129)
Chars 84 65.12 28 77.78
Hashish 11 8.53 1 2.78
Cocaine 3 2.33 0 0.00
Alcohol 27 20.93 5 13.89
Opium 4 3.10 2 5.56
Table No. 4. Tobacco Smoking Determinants among the Study Participants of Hayatabad Peshawar Pakistan (n=385)
Variables Response Frequency Percentage
Past history of Tobacco Smoking (385) Yes 97 25.19
No 288 74.81
Number Of Cigarettes Smoked Per Day (152) 1 to 5 93 61.18
6 to 10 33 21.71
11 to 15 15 9.87
16 to 20 8 5.26
> 20 3 1.97
Places For Smoking (152)
At home 11 7.24
Friend’s place 84 55.26
Public places 107 70.39
At work 83 54.61
Any other 41 26.97
Tried to quit smoking in past 12 months (152) Yes 97 63.82
No 55 36.18
Anti-Smoking Media Messages (385)
A lot 247 64.16
Few 43 11.17
None 95 24.68
Received help or advice regarding tobacco smoking (385)
Yes, from a
professional 157 40.78
Yes, from a friend 75 19.48
Yes, from a family
member 87 22.60
No 66 17.14
Table No. 5. Reasons of Tobacco Smoking among the Participants of Hayatabad Peshawar Pakistan (n=385)
Reason for Tobacco Smoking f %age
Good taste 75 19.48
Habit 81 21.04
Relaxation 101 26.23
Concentration 47 12.21
Relief stress 93 24.16
Inspired by someone 14 3.64
Satisfaction 76 19.74
Relief craving 45 11.69
Get attraction 31 8.05
Impression 27 7.01
Look cool/ Smart 20 5.19
None of these 37 9.61
DISCUSSION
Result of this study shows that out of the sample population, 152 (39.48%) were current tobacco cigarette smokers and was less than studies conducted in District Peshawar, which showed 48.4% [20]. Moreover, our study results are more as compared to a study done in Karachi, which showed 32.7% [6] and another conducted in Peshawar University students which showed 27% prevalence status among the participants [21]. Furthermore, another study revealed the prevalence of tobacco use as 29.4% and thus our study results were more as compared this study [22] (Table No 1).
However, results of a study conducted in rural Sindh among male adults found a high prevalence of 55% of current tobacco cigarette smokers [23]. Many studies showed that prevalence of tobacco smoking more in Pakistan. In our study, the high prevalence of the tobacco smoking was found in 18-30 years of age group with majority being college or university students. This age range was considered the most susceptible for the indulgence of tobacco use. Similar results were reported by other studies as well, with 40% tobacco using population in the age group of 25-44 years [24] and in college going male students belonging to 21-25 years [6] (Table No 2).
Moreover, our study illustrated high prevalence of tobacco smoking in educated population as compared to the uneducated. On the contrary, a similar study reported high prevalence of smoking in uneducated population which suggests the difference between their and our study methodologies [25]. Furthermore, many studies conducted in colleges and universities showed higher frequency of tobacco smoking and thus suggested high prevalence among the educated communities as was reported by our study results [6, 7, 27]. According to our study results, 82.89% of the tobacco users were smoking 1-10 cigarettes and same findings were reported by many international studies [23, 26].
A study conducted in 2006, reported that tobacco smokers were more exposed to second hand smoke as compared to non-smokers which is evident from our study results showing 69.08%
exposed and 30.92% not exposed (Table No 3). Moreover, many international studies revealed that due to tobacco smoking of siblings or/ and parents, the tobacco smoking prevalence was high [21, 28], as reported by our study results (Table No 3)
In our study, 86.18% of tobacco use replied that it harmful to health, and similar findings were reported a study conducted in 2012 in which 87.9% respondents agreed to the harmful
effects of smoking [25]. Due to the knowledge of harmful effects of tobacco smoking, 63.82% tried to quit this hazardous habit and around 83.86% had received advice from friends, family members and health professionals and only 17.14% received no help or advice regarding tobacco smoking [6, 28]. Moreover, in our study, 75.32% of participants received antismoking awareness and health education (Table No 4).
In our study, 53.51% of the smokers were also using tobacco in other forms, most popular of which was snuff followed by tobacco pipes, chewing & cigar, and was supported by many international studies [20, 25, 29]. Among the other drugs the most popular drug was chars after which alcohol, hashish and opium were used. Moreover, in a study conducted among the students of District Banu also confirmed the use of such drugs in our community [7].
In our study results, the tobacco smoking replied that the most common reasons for initiation of tobacco smoking was for relaxation, relief craving, satisfaction, better taste, and concentration etc ( Table No 5).
CONCLUSIONS
From our study results, it was concluded that the prevalence of tobacco smoking was increasing and the important determinants of tobacco smoking were stress, parental smoking, sibling smoking, exposure to second hand smoke at workplace, friends appreciating smoking, unemployment, educational institute, monthly income, separate family setup, and unmarried etc. Moreover, the socio-economic determinants like parental education, parental monthly income, and parental current tobacco smoking were the variables showing significant relationship with tobacco smoking. Furthermore, most of the study participants smoked1-5 cigarettes per day; most popular tobacco product used were cigarettes, followed by snuff, cigar, tobacco pipes and chewing tobacco. Addiction regarding the different forms of drugs showed that the most commonly used drug was chars. Moreover, we also assess the reasons of tobacco smoking starting and also assessed the tobacco smoking users regarding its hazardous health effects and ever tried to quit smoking.
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