Predictors of Smoking among
Saudi Dental Students in Jeddah
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Ameerah Y. Mansour, PhD, MS, BDS
Objectives: The objective of this study
was to assess tobacco use, secondhand
smoke exposure, knowledge of health
risks, and smoking predictors among
dental students attending King Abdulaziz University, Jeddah, Saudi Arabia.
Methods: A cross-sectional study was
conducted and 420 dental students were
invited to participate. Binary logistic regression analyses assessed the predictors of smoking. Results: A total of 336
dental students completed the questionnaires with 25% reporting current or
previous tobacco use and 96% reporting
secondhand smoke exposure. Nearly half
of all smokers initiated smoking during
the dental program. The logistic regression results revealed that being a male
(OR = 7.1, p < .0001; 95%CI = 3.7-13.4)
and having a smoker in the family (OR =
H
ealthcare professionals play a vital role in
educating their patients about the health
risks of tobacco use1 and in acting as role
models for their patients. Dentists can influence
children and youth to adopt a tobacco-free lifestyle and can enhance the awareness of women of
childbearing age about the dangers of tobacco use
during pregnancy.2 In addition, patients perceived
that their dentists had a vital role in smoking cessation activities.3 Smokers were also more willing
to quit smoking if suggested by their dentist.3
Despite knowing the harmful effects of active
smoking and secondhand smoke exposure, healthcare professionals nevertheless smoke in high
numbers.4-6 For example, one study reported the
overall prevalence of smoking among Chinese doctors to be 36.3%.6 Tobacco use among students in
the healthcare professions has been reported for
different countries. Smoking rates among thirdyear medical students vary across countries, from
Ameerah Y. Mansour, Department of Dental Public Health,
Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia.
Correspondence Dr Mansour; [email protected]
Am J Health Behav.™ 2017;41(3):329-337
2.6, p = .005; 95%CI = 1.3-5.0) increased
the likelihood of smoking. In contrast,
knowledge of health risks decreased the
likelihood of smoking (OR = 0.90, p =
.014; 95%CI = 0.82-0.98). Conclusions:
Despite possessing knowledge about the
health risks of smoking, high numbers of
dental students continue to smoke and
were exposed to secondhand smoke. Sex
and family influence were the main prosmoking risk factors, whereas increased
knowledge of health risks was a protective factor. Tobacco control programs
to reduce and/or prevent tobacco use
among future dentists are needed.
Key words: tobacco use; secondhand
smoke; smoking predictors; dental students
Am J Health Behav. 2017;41(3):329-337
DOI: https://doi.org/10.5993/AJHB.41.3.12
5% to more than 40%.7 In over half of the countries
surveyed, more than 20% of students in the healthcare professions currently smoked cigarettes.7 In
addition, about 70% of students reported exposure
to secondhand smoke in public spaces.7 Similar
results also were reported among third-year dental
students around the world.8
In Saudi Arabia, the prevalence of smoking
among men attending 2 different medical schools
in Riyadh was 13% and 24% respectively.9,10 In addition, 38% were exposed to secondhand smoke.9
A cross-sectional study of medical students attending King Abdulaziz University (KAU) in Jeddah revealed that 14% of all students, and 25% of
male students, were current tobacco users.11 Many
studies report the prevalence of smoking but research on predictors of smoking among students
in the healthcare professions is deficient.7-11 The
prevalence of tobacco smoking in Saudi Arabia is
high. In addition, prevalence rates in the western
region are higher than in other regions of the country,12 therefore; the prevalence of smoking among
healthcare professionals in the western region is
likely to be higher than in other regions.
Smoking of different types of tobacco in differ-
329
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Predictors of Smoking among Saudi Dental Students in Jeddah
ent forms became more common over the past
few decades.13 Flavored tobacco smoked in waterpipes has become more prevalent among youth
around the world.14 Moassel is a flavored tobacco
mixed with molasses and glycerol, whereas jurak
is a plain moistened tobacco containing minced
fruits and molasses but no glycerol.14 The prevalence of waterpipe smoking ranges from 6% to 34%
among adolescents in the Eastern Mediterranean
region,15,16 and 10% to 20% among young adults
in the United States.17 As a result, questions about
waterpipe smoking are becoming an essential part
of tobacco use surveys worldwide.16
Although many studies evaluated tobacco use,
exposure to secondhand smoke, and knowledge of
health risks among students of the healthcare professions in different countries, there is still need
to assess determinants of smoking in this population.7-10 To date, limited research has evaluated
smoking rates among dental students in Saudi Arabia18 and no study has assessed tobacco use and
secondhand smoke exposure among dental students in Jeddah. The aim of the current study was
to estimate the prevalence of tobacco use and secondhand smoke exposure among dental students,
to evaluate their knowledge of health risks, and to
assess the predictors of smoking among dental students attending KAU in Jeddah, Saudi Arabia. The
findings of this study will help formulate healthprotective policies and design specific interventions.
METHODS
Research Design and Study Group
We conducted a cross-sectional study in the College of Dentistry at KAU, which is the largest and
oldest university in the western region and in the
city of Jeddah. We invited all senior dental students (N = 420) studying at KAU to participate in
this study.
Data Collection
We collected the data using a self-administered
questionnaire written in English, which included
4 sections with a total of 15 questions. The first
section included 4 questions about smoking habits such as smoking status, age of smoking initiation, frequency of smoking, and types of tobacco
used. The second section included 8 questions
about exposure to secondhand smoke, family influence (smoking in a household), and knowledge
of health risks. The third section contained 3 questions about the demographic characteristics such
as sex, age, and academic performance. The last
section was one open-ended question asking participants to write down any further comments or
suggestions they might have.
At the beginning of the questionnaire, participants
were informed that smoking refers to any type of
tobacco such as cigarettes, moassel, shisha, cigar,
pipe or any other form of tobacco. Smoking status
was categorized as current smoker, former smoker,
or nonsmoker. Current smokers were defined as in-
330
dividuals who reported smoking any tobacco product currently. Former smokers were defined as participants who reported smoking any tobacco product in the past but not currently; nonsmokers were
defined as participants who never smoked before.
We assessed age of smoking initiation, duration
of tobacco use (in years), types of tobacco used (waterpipe such as jurak and moassel, and cigarettes),
frequency of tobacco use (daily, a few times a week,
or a few times a month). Family influence was measured by the presence of a smoker in a household
(Yes/No). Knowledge of health risks items were
adapted from Gharaibeh et al19 and measured using
a 5-point Likert scale as follows: strongly agree = 5,
agree = 4, neutral = 3, disagree = 2, and strongly
disagree = 1 (Table 1). The respondents rated their
academic performance as being excellent, very
good, good, fair, or poor. Self-reported lifetime exposure to secondhand smoke was assessed using a
yes or no closed-ended question.
The questionnaire was pretested (N = 30) prior to
the final study to get feedback about the clarity of
the questions. In addition, face and content validity of the questionnaire were checked by 3 healthcare professionals who are experts in the field.
The final version of the anonymous self-administered paper-based questionnaire was distributed
with a cover letter explaining the aim of the study,
the researcher’s affiliation and contact information, and the voluntary nature of participation.
Students were asked to compile all questionnaires
together by one student and then have them returned to the investigator.
Statistical Analysis
We coded and analyzed all data using the Statistical Package for Social Sciences version 22.0
(SPSS Inc, Armonk, NY, USA). We assessed the internal consistency of the knowledge of health risks
scale using Cronbach’s alpha.
We used the chi-square test (χ2) to compare the
types of tobacco use among men and women. We
combined the strongly agree and agree responses for knowledge of health risks and used a chisquare test to compare men and women and to
compare smokers to non-smokers. Alpha was set
at .05, and all tests were 2-tailed.
We used binary logistic regression analyses to
assess the predictors of smoking. First, we carried
out univariate (simple) logistic regressions to identify variables significantly related to the dependent
variable, smoking status. The outcome variable was
overall tobacco smoking, a binary variable (current smokers vs non-smokers). The former smokers were added to non-smokers group because of
small numbers. The explanatory variables were sex
(men/women), family influence (having a smoker in
a household: yes/no), academic performance (excellent to very good, good, fair to poor) and the total score for knowledge of health risks (continuous
variable). The total score for knowledge of health
risks was calculated by adding the scores of all 6
Mansour
Table 1
Characteristics of 336 Saudi Dental Students Completing a
Survey Evaluating Predictors of Smoking
Non-smokers
(N = 253)
Former smokers
(N = 8)
Current smokers
(N = 75)
Total
(N = 336)
Women
171 (68)
4 (50)
18 (24)
193 (57)
Men
82 (32)
4 (50)
57 (76)
143 (43)
59 (23)
2 (25)
25 (33)
86 (26)
Fourth
56 (22)
0 (0)
15 (20)
71 (21)
Fifth
71 (28)
3 (38)
18 (24)
92 (27)
Sixth
67 (27)
1 (13)
23 (31)
91 (27)
Intern
59 (23)
4 (51)
19 (25)
82 (25)
1 (0.4)
0 (0)
0 (0)
1 (0.3)
Characteristic
Sex, N (%)
Smoker in a household, N (%)
Yes
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Class, N (%)
Self-rated academic performance, N (%)
Poor
Fair
10 (4)
0 (0)
4 (5)
14 (4)
Good
73 (29)
2 (25)
27 (36)
102 (30)
Very Good
134 (53)
3 (38)
40 (53)
177 (52)
Excellent
30 (12)
2 (25)
4 (5)
36 (10.7)
5 (2)
1 (13)
0 (0)
12 (3)
Not reported
items, dividing this score by the theoretical maximum (30 points) and multiplying the product by
100, we created a score that estimated the knowledge of health risks (in which a score of 100 was
the highest and a score of 20 was the lowest).
We then performed a multivariate logistic regression analysis using a forward stepwise variable selection method when more than one variable was
found to be statistically significant in the univariate analyses so as to obtain the relative contribution of each predictor variable while controlling for
the influence of other variables. Any variable with
p < .25 in the univariate analysis was included in
the multivariable analysis. The chi-square for entry
and removal was based on the likelihood ratio test.
We used the Hosmer-Lemeshow test to assess the
goodness of fit of the final model. We calculated the
odds ratio (OR) with 95% confidence intervals (CI).
RESULTS
All participants consented to participate by completing the questionnaire. A total of 336 dental students completed the self-administered questionnaires, with a response rate of 80%. The mean (SD)
age of participants was 23 (SD = 2) years of age.
Table 1 presents characteristics of participants
who completed the questionnaire. A total of 75 respondents (22%) reported current tobacco use, and
8 respondents (2%) reported former tobacco use.
Am J Health Behav.™ 2017;41(3):329-337
Smoking Initiation
The mean age of smoking initiation was 18.6
years of age (95% confidence interval [CI]: 18.1,
19.1), with a range of 13 to 24 years. Approximately 66% of dental students initiated smoking
at or after the age of 18. Almost half of all smokers
initiated smoking after joining the dental program.
The mean duration of smoking was 4.9 years (95%
CI: 4.3, 5.4) with a range of 6 months to 12 years.
In the last section, some students reported that
stress from their heavy course load was their primary reason for initiating tobacco use. Others suggested that faculty members should avoid smoking
in front of students, to serve as good role models.
Types of Tobacco Use
Data in Table 2 compare types of tobacco use
between former smokers and current smokers and
between men and women. Most cigarettes smokers (66%) smoked daily, but smaller percentages of
moassel smokers (13%) and jurak shisha smokers
(10%) smoked daily. Most of waterpipe (moassel or
Jurak shisha) smokers smoked less than daily.
Comparing Current Smoking Habits among
Men and Women
Figure 1 shows the frequency of self-reported
smoking status among men and women. It shows
a statistically significant relationship between sex
DOI:
https://doi.org/10.5993/AJHB.41.3.12
331
Predictors of Smoking among Saudi Dental Students in Jeddah
Figure 1
Comparing Self-reported Tobacco Use Status among Men and Women
using Chi-square Test (N = 336)
100
p < .0001*
Men (N = 143)
89
90
Women (N = 193)
* Significantly different at p < .05
80
70
Percentage (%)
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60
57
50
40
p < .0001*
30
30
20
p = .414
p = .673
10
3
0
Non smokers
10
7
2
Former smokers
2
Current non-daily
smokers
Current daily smokers
Smoking Status
and current daily smoking,χ2(1, N = 336) = 62.3,
p < .0001. Men were more likely to smoke daily
than women (30% versus 2%). In addition, current
non-daily smokers (N = 28) were equally distributed among both men and women and the chisquare test revealed that no significant differences
between men and women (p = .414).
We used the chi-square test to compare the types
of tobacco use among men and women (Table 2).
Results revealed a statistically significant relationship between sex and smoking moassel, χ2(1, N =
83) = 7.41, p < .0001, where women were more
likely to smoke moassel than men. There was also
a statistically significant relationship between sex
and smoking jurak shisha smoking, χ2(1, N = 83)
= 6.26, p = .012, where men were more likely to
smoke jurak shisha than women. However, there
was no statistically significant relationship between sex and cigarette smoking (p = .406).
Exposure to Secondhand Smoke
Of the 336 respondents, 323 (96%) reported ex-
332
posure to secondhand smoke and 186 of those respondents (69%) were women. A high percentage of
dental students reported exposure to secondhand
smoke in restaurants and cafes (80%), in public
spaces (74%), and at the university (40%).
Knowledge of Health Risks
High percentages of respondents were found to
strongly agree with the following health risk statements: smoking is dangerous to smokers’ health
(83.9%), tobacco smoke is dangerous for non-smokers’ health (70.8%), and parents or adults should
not smoke near children (88.1%). On the other
hand, less than 50% of respondents were found to
strongly agree with the following health risk statements: exposure to tobacco smoke can cause lung
cancer in non-smokers, smoke from other people’s
cigarettes will shorten my life, and children who are
exposed to tobacco smoke have more illnesses such
as colds.
Table 3 provides group comparisons for knowledge of health risks. Former smokers were com-
Mansour
Table 2
Comparing Types of Tobacco Use among Saudi Dental Students by
Smoking Status and Sex
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Smoking Status
Sex
Types of Tobacco
Total
Responses
N = 83
Former
smoker
(N = 8)
Current
Smoker
(N = 75)
(χ2) a
p
Men
(N = 61)
Women
(N = 22)
(χ2) b
p
Cigarettes, N (%)
55 (66)
7 (88)
48 (64)
2.08
.150
42 (69)
13 (59)
0.69
.406
Moassel, N (%)
61 (74)
7 (88)
54 (72)
1.02
.312
40 (66)
21 (96)
7.41
.006*
Jurak, N (%)
20 (24)
1 (13)
19 (25)
0.74
.390
19 (31)
1 (5)
6.26
.012*
Note.
a = χ2: Fisher’s exact test chi-square
b = χ2: Pearson chi-square
* = Values are significantly different at p < .05 in the 2-sided test of equality for column proportions. Tests do not
assume equal variances.
Table 3
Comparing Knowledge of Health Risks among Saudi
Dental Students by Smoking Status and Sex
Smoking status
Response a
Non-Smoker
(Total = 336), (Total = 261),
N (%)
N (%)
Smoker
(Total = 75),
N (%)
Sex
p
Men
(Total = 143),
N ( %)
Women
(Total = 193),
N (%)
p
Smoking is dangerous
to smokers’ health
315 (94)
248 (95)
67 (89)
.140
128 (90)
187 (97)
.010*
Tobacco smoke is
dangerous for nonsmokers health
308 (92)
247 (95)
61 (81)
.006*
123 (86)
185 (96)
.003*
Parents or adults
should not smoke
near children
324 (96)
256 (98)
68 (90)
.048*
131 (92)
193 (100)
< .0001*
Exposure to tobacco
smoke can cause lung 237 (71)
cancer in non-smokers
186 (71)
51(68)
.581
100 (70)
137 (71)
.155
Smoke from other
people’s cigarettes
will shorten my life
243 (72)
200 (77)
43 (57)
.003*
94 (66)
149 (77)
.016*
Children who are
exposed to tobacco
smoke have more
illnesses, such as colds
259 (77)
206 (80)
53 (70)
.158
104 (73)
155 (80)
.106
Note.
a = Respondents who answered strongly agree or agree. Total response, N = 336
* = significantly different at p < .05 in the 2-sided test of equality for column proportions.
Am J Health Behav.™ 2017;41(3):329-337
DOI:
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Predictors of Smoking among Saudi Dental Students in Jeddah
Table 4
Adjusted Odds Ratio for the Predictors of Smoking Using
Multivariate Logistic Regression Analysis a
Explanatory Variables b
N
Wald
Adjusted Odds ratio
(95% Confidence Interval)
p-value
143
36.2
7.1 (3.7, 13.4)
<.0001
86
7.8
2.6 (1.3, 5.0)
.005
336
6.0
0.90 (0.82, 0.98)
.014
Sex
Men
Smoking in a household
Yes
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Knowledge of Health risk score
Note.
a = The reference category of the dependent variable is: non-smokers and former smokers (N = 261)
b = T he parameters of sex = Women, and Smoking in the Family = No were the reference categories.
-2 Log likelihood= 296.7, NagelKerke R2 = 0.25
Hosmer and Lemeshow Test: χ2 = 3.8, degree of freedom (df)=8, p = .871
bined with non-smokers due to the small number
of participants. When we compared the responses
of non-smokers to smokers, the chi-square results
revealed a statistically significant relationship between smoking status and responding strongly
agree or agree to the following statements: tobacco
smoke is dangerous for non-smokers’ health and
smoke from other people’s cigarettes will shorten
my life. Non-smokers were more likely to select
strongly agree or agree for those statements (95%
vs 81%, p = .006 and 77% vs 57%, p = .003, respectively). A higher percentage of women than
men selected strongly agree or agree for the following statements: smoking is dangerous to smokers’
health (97% vs 90%, p = .010), tobacco smoke is
dangerous for non-smokers’ health (96% vs 86%,
p = .003), parents or adults should not smoke near
children (100% vs 92%, p < .0001), smoke from other people’s cigarettes will shorten my life (77% vs
66%, p = .16).
Knowledge of Health Risks Aggregate Score
Cronbach’s alpha was 0.70 for the 6-item scale,
indicating acceptable internal consistency.20 The
mean (SD) for the total score of knowledge of health
risks was 88.3 (SD = 10.3) with a range of 46.7.
The minimum was 53 points and the maximum
score was 100 points. Higher scores describe better knowledge of health risks.
Predictors of Smoking Status
The results of the univariate logistic regression
analyses used to identify which factors predicted
smoking status revealed that all factors except academic performance were statistically significant
(academic performance odds ratio (OR) = 0.7; p =
.211; 95% confidence interval (CI) = 0.4 -1.2). The
following factors increased the likelihood of smoking: being a male (OR = 6.4; p < .0001; 95% CI =
3.6-11.6), and having a smoker in the family (OR
334
= 1.6; p = .083; 95% CI = 0.9-2.9). On the other
hand, awareness of health risks reduced the likelihood of smoking (OR = 0.86; p < .0001; 95% CI
=0.79-0.93).
Table 4 shows the results of the multivariate
logistic regression analysis. The dependent variable was the binary outcome smoking status. Sex,
smoker in the family, awareness of health risks,
and academic performance were entered into the
model. Academic performance was removed due to
statistical insignificance. The final model for smoking status was statistically significant (χ2 = 296.7;
p < .0001). The goodness of fit (Hosmer-Lemeshow
test; results: χ2 = 3.8, p =.871) indicated that the
model adequately fit the data. Logistic regression
results revealed that being a male (OR = 7.1, p <
.0001; 95% CI = 3.7-13.4) and having a smoker in
the family (OR = 2.6, p < .005; 95% CI = 1.3-5.0)
increased the likelihood of smoking. In contrast,
knowledge of health risks decreased the likelihood
of smoking (OR = 0.90, p < .0001; 95% CI = 0.820.98). For every one point increase in knowledge of
health risk score, the odds of smoking decreased
by a factor of 0.90.
DISCUSSION
Our results revealed that more than 60% of dental students initiated smoking at or after the age
of 18, which was consistent with findings from a
nationwide population-based survey carried out in
Saudi Arabia.21,22 Al Obaikan 21 and Moradi-Lakeh
et al23 reported that the mean age of smoking initiation was 19 years and that only 9% of ever smokers
initiated tobacco use before the age of 15.24 However, Bassiony reported in a review article that other
studies found that the majority of smokers began
smoking at or prior to the age of 15.12 Our study
found that nearly 50% of smokers initiated smoking after joining the dental program. Furthermore,
some students commented that stress from their
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Mansour
heavy course load was a reason for smoking. This
was consistent with the finding of another study,
where stress was identified as the main factor that
triggered smoking in more than 50% of smokers.11
Our findings indicate an overall tobacco smoking
prevalence rate of 25%. This rate is higher than
what was reported in previous studies. 9-11,21-25 Two
different studies conducted among Saudi medical
students in the cities of Riyadh (13%)10 and Jeddah (14%)11 reported rates that were lower than
that which we found. Also, other nationwide population-based studies found the overall prevalence
of current smoking in Saudi Arabia to be 12%,2224
which was lower than the estimated prevalence
found in previous small-scale studies and community-based studies in various regions of Saudi Arabia.12 However, an overall population study would
probably have lower rates than a study of young
adults. Our findings are comparable to those reported by Warren et al.8 The authors surveyed
third-year dental students in 44 countries, the
Gaza Strip/West Bank, and 3 cities (ie, Baghdad,
Rio de Janeiro, and Havana) and found that over
20% of students smoked cigarettes in more than
half the sites.8 However, this study focused on cigarettes smoking, whereas our study assessed different types of tobacco use such as waterpipe (moassel and jurak) in addition to cigarettes.
Our study revealed that smoking was significantly more prevalent among male dental students
than female students. Several other studies have
reported similar findings.8,9,11,18,21 Warren et al8
found that the rate of smoking was higher among
male third-year dental students than female students in 30 of the 44 sites included in the survey.
Another study conducted among third-year medical students in 47 countries found that in 37 countries, men were more likely than women to smoke
cigarettes.7 Finally, we found that male and female
dental students smoked different types of water
pipes. While smoking moassel was more common
among women, smoking jurak shisha was more
prevalent among men. This finding suggests that
future studies into tobacco use should include
these other forms of tobacco to avoid underestimation of tobacco users.
Our findings revealed that a remarkably high
percentage of dental students (96%) were exposed
to secondhand smoke, which is higher than what
was reported in other studies.7,8 One study found
that over 60% of third-year dental students reported exposure to secondhand smoke in public
spaces in 37 of 48 countries.8 Similarly, in a different study by some of the same authors, Warren
et al7 reported that over 70% of third-year medical
students were exposed to secondhand smoke in
public spaces in 29 of 48 countries investigated.7
However, this percentage is higher than the rates
reported in many populations-based studies.22-24
For example, one study reported that approximately 23.3% of the entire population (32.3% of men
and 13.5% of women) was exposed to secondhand
smoke for at least one day during the past 7 days.25
With respect to knowledge of health risks, our
results revealed that dental students generally
had good awareness, especially of the commonly
known risks of secondhand smoke exposure. However, they were less aware of secondhand smoke’s
potential for reducing lifespan and causing lung
cancer in non-smokers. Non-smokers were significantly more knowledgeable about the following
risks: tobacco smoke is dangerous for non-smokers’
health, and smoke from other people’s cigarettes will
shorten their life. Many studies in different countries reported similar findings.11,30,31 Other studies
showed that current smokers were less likely than
non-smokers to acknowledge the consequences
of smoking.11,30,31 In addition, our findings showed
that a higher percentage of women than men were
aware of and agreed with the following statements:
smoking is dangerous to smokers’ health, tobacco
smoke is dangerous for non-smokers’ health, parents or adults should not smoke near children, and
smoke from other people’s cigarettes will shorten
their life. Another study found that female smokers had significantly greater knowledge than male
smokers about the association of tobacco smoking with lung and bladder cancer.11 Our findings
highlight the need to increase awareness of the
health risks associated with smoking and exposure to secondhand smoke, especially among men
and smokers.
Our results identified sex, family influence, and
knowledge of health risks as important predictors
for smoking. Both sex and family influence were
positively associated with smoking. Men were 7
times more likely to smoke compared to women,
which is consistent with previous findings that
found that sex to have a strong association with
smoking (OR = 27.3).23 In addition, our results
revealed that having a smoker in the family increased the likelihood of smoking (OR = 2.6; 95%
CI = 1.3-5.0). Many studies have found that family
influence is a major risk factor for initiating smoking.11,29,30 One study reported that parental smoking was associated with a significantly higher risk
of smoking initiation in their adolescent children
(odds ratio = 2.81, 95% CI = 1.78-4.41).29 Another
study indicated that parental smoking contributed
to smoking initiation for their teenagers.30 A 9-year
prospective study found that parental smoking
cessation was associated with reduced risk of their
children initiating smoking; however, parents who
are former smokers still place their children at
higher risk than non-smoking parents.31 In addition, our findings showed that knowledge of health
risks was negatively associated with smoking (OR
= 0.90; 95% CI = 0.82-0.98), suggesting the need
for more programs and policies to deter smoking.
Am J Health Behav.™ 2017;41(3):329-337
DOI:
Study Limitations and Recommendation for
Future Research
The study involved a convenience sample, which
might not represent dental students in different
https://doi.org/10.5993/AJHB.41.3.12
335
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Predictors of Smoking among Saudi Dental Students in Jeddah
settings and this limits the generalizability of the
study results. However, this study was conducted
in the College of Dentistry at KAU, which is the
largest and oldest university in the western region
and it invited all senior dental students studying at
KAU to participate. There was a 20% non-response
rate in the study; non-respondents might have
been smokers and this may have underestimated
the rate of tobacco use. Also, non-respondents
might have held different views from those of respondents. Although reporting bias such as social
desirability bias, other response bias, and recall
bias are potential limitations of survey research,
these problems are not unique to questionnaire
research. Nevertheless, this study used an anonymous questionnaire to minimize response bias and
social desirability bias.
We recommend that future researchers conduct
a multicenter study to enhance the generalizability, to design a preventive tobacco program for future dentists, and evaluate the impact of interventions. Also, it may be vital to assess whether people
have different beliefs about secondhand smoke
emanating from non-cigarette products, and to
what extent those possible differences contribute
to understanding people’s behavior and the efficacy of strategies to reduce exposure to secondhand
smoke.
Conclusions
In conclusion, results suggest that high numbers of dental students continue to smoke and become exposed to secondhand smoke and almost
half of all smokers initiated smoking after joining
the dental program. Also, dental students, especially male students who smoke, have insufficient
knowledge about some of the health risks associated with exposure to secondhand smoke. Sex,
family influence, and knowledge of health risks
were the main predictors of smoking. The results
indicate the need to design and implement tobacco
control programs and policies to reduce and/or
prevent tobacco use and secondhand smoke exposure among future dentists. This could be established initially during introductory courses teaching general health risks and then later emphasized
in subjects addressing tobacco associated diseases
including cancer.
In addition, the findings offer new insights that
might be beneficial for future research in other
countries, particularly the need to include forms
of tobacco other than cigarettes, such as moassel
and jurak. We recommend that future research include a multicenter study to obtain more generalizable results and to support policies to reduce
tobacco use or exposure to secondhand smoke.
Human Subjects Statements
The study was conducted in accordance with the
Declaration of Helsinki. The ethical research committee at the Faculty of Dentistry at KAU approved
our research protocol (Approval No. 012-12).
336
Conflicts of Interest
The authors declare no conflict of interest
Acknowledgments
This project was funded by the Deanship of Scientific Research (DSR), King Abdulaziz University,
Jeddah, Saudi Arabia, under grant no. (2-165D1432). Therefore, the author acknowledges with
thanks the DSR financial support.
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Am J Health Behav.™ 2017;41(3):329-337
DOI:
https://doi.org/10.5993/AJHB.41.3.12
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