Tobacco use is the leading preventable cause of death worldwide, and according to the latest estimates, more than 80% of the 8.3 million tobacco-attributable deaths in 2030 will occur in low-middle-income countries 1. Tobacco use continues to kill more than 5 million people worldwide each year, and this number is expected to grow. The burden of tobacco use is greatest in low- and middle-income countries, and will increase more rapidly in these countries in coming decades 2. Compared with nonsmokers smoking increases the risk of coronary heart disease, stroke, chronic obstructive pulmonary disease, emphysema, lung cancer, laryngeal cancer ,oral, esophageal and gastric cancer and many adverse reproductive and early childhood effects 3. Although the most serious health outcomes associated with smoking typically emerge later in life, studies have shown that the earlier individuals begin to smoke, the higher their risk for cancer, heart disease, stroke, and chronic obstructive lung disease 4; nicotine addiction5; and possibly their risk of developing anxiety disorders and depression.6,7.
In Palestine, the Palestinian Central Bureau of Statistics (PCBS) indicated that the rate of smoking among persons aged 12 years and over was 19.8%, of which 37.0% males and 2.2% females8.Information available on smoking and factors associated with initiating and maintaining such behavior in the Occupied Palestinian Territory are limited. The aim of this study is to explore the extent of smoking among university student in Palestine, and to look at factors affecting attitude and behavior of university students towards smoking.Methods
This is a cross-sectional study carried out during fall semester of 2009-2010 academic year among students at An-Najah National University ,the largest university in West Bank Palestine.Study Design
The study cohort consisted of all university students enrolled in all undergraduate programs provided by the University. We aimed to recruit about 5% of all registered full time students (17521) of the 16 faculties of different disciplines at the university. Taking in consideration the percentage of types of colleges and gender, 1000 students from all faculties were randomly selected from the university register and were invited to participate in the survey. Students were approached during the common breaks between lectures. Among those 954 (95.4% response rate) students agreed to participate and provided adequate responses for the analysis. An anonymous self-administered questionnaire was used after verbal informed consent according to the Review Committee of An-Najah National University approved protocol.Questionnaire
The questionnaire was developed in Arabic from relevant instruments used for the assessment of tobacco use including the Global Health Professionals Survey (GHPS), and the Global Youth Tobacco Survey (GYTS) 9.10.
The questionnaire inquired about demographic details of participants, their smoking behavior (cigarette, water pipe), positive and negative attitudes and beliefs about smoking and quitting, family history of smoking, and finally students' opinion about banning smoking in public places. Smokers in addition, were asked about their first smoking attempt, tobacco consumption (cigarettes per day, waterpipes per week, duration of smoking), smoking expenses, and smoking cessation attempts.
The positive and negative attitude component was composed of 12 questions for positive attitude and 12 questions for negative attitude . Every question had 5 possible answeres using likart scale which were given scores of 1-5 . The average score out of 10for all positive attitude questions and all negative as given for every participant
Smoking status was established in accordance to the WHO criteria for cigarette smoking and the criteria set by Maziak et al. for waterpipe smoking 11,12: smokers were subjects who, at the time of the survey, smoked either regularly (=1cigarette/day or =1 waterpipe/week) or occasionally (<1 cigarette a day or <1 waterpipe/week). Nonsmokers included subjects who at the time of the survey, did not smoke.Statistical analysis
Data of all components of questionnaire were entered and analyzed using minitab software version 14. Corelation between different variables and smoking applying Chi Square test were done . All results were considered statistically significant at P=0.05RESULTS
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- WHO report on the global tobacco epidemic 2009:implementing smoke-free environments. Geneva, World Health Organization, 2009 (http://whqlibdoc.who.int/publications/2009/9789241563918_eng.pdf accessed 14 January 2010).
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- Press release about the prevalence of smoking in the Palestinian Territory, the Palestinian Central Bureau of Statistics (PCBS),31,May,2009
- The Global Youth Tobacco Survey (GYTS), Tobacco Free Initiative (TFI). (accessed 14th January 2010) . Online: http://www.cdc.gov/tobacco/Global/GYTS/questionnaire.htm
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- Maziak W, Ward KD, Afifi Soweid RA, Eissenberg T. Standardizing questionnaire items for the assessment of waterpipe tobacco use in epidemiological studies. Public Health 2005;119(5):400-404. [PubMed: 15780328]
- WHO. Guidelines for controlling and monitoring the tobacco epidemic. Geneva: WHO; 1998.