Original Article
http://mjiri.iums.ac.ir
Medical Journal of the Islamic Republic of Iran, Vol. 27, No. 4, Nov 2013, pp. 168-178
Trend of smoking among students of Tehran University of Medical Sciences: results from four consecutive surveys from 2006 to 2009 Masoumeh Amin-Esmaeili1, Afarin Rahimi-Movaghar2, Masud Yunesian3 Elaheh Sahimi-Izadian4, Mahdieh Moinolghorabaei5 Department for Mental Health and Substance Use, Iranian Research Center for HIV/AIDS (IRCHA), Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran.
Received: 27 Jan 2013
Revised: 1 May 2013
Accepted: 14 May 2013
__________________________________________________________________________________________
Abstract Background: Smoking within students community of the medical sciences can negatively impact the attitudes of the society in future. The objectives of this study were to assess the prevalence and trends of smoking among students of Tehran University of Medical Sciences. Method: This study was conducted in four consecutive years from 2006 to 2009. The study sample was taken from the first- to fourth-year, undergraduate and graduate (doctorate) students of Tehran University of Medical Sciences. Census was applied for sampling. Structured questionnaires were distributed to students of each class. The study was anonymous and self-administered. Results: From 2006 to 2009, a total of 1568 to 1761 students participated in the study each year. Over the study period, i.e. 2006-2009, the prevalence of cigarette smoking was decreased (the overall prevalence was 12.5% in 2006, 12.9% in 2007, 10.8% in 2008, and 10.5% in 2009). The corresponding values for the one month prevalence were 8.2%, 7.8%, 6.1%, and 5.8%, while those for the prevalence of daily smoking were 3.4%, 4.0%, 2.9%, and 1.8%, respectively. The decreasing trend was particularly more significant for female students. Conclusion: The findings suggest that the prevalence of smoking among students of Tehran University of Medical Sciences was in the lower end of the spectrum, in comparison to other universities in Iran and other countries. Additionally, similar to the pattern observed in the developed world, this trend was decreasing, particularly among girls. Implementing preventive measures for accelerating the decreasing trend, as well as continuous monitoring is recommended. Keywords: Tobacco, Prevalence, Epidemiology, Medical Students, Iran. ________________________________________________________________________________________
Introduction Cigarette smoking is an important factor influencing the health of the smoker as well as that of the individuals around him/her. This effect, however, mostly takes place
later in life, especially in old ages, such that it has become the third leading risk factor, after increased cholesterol and blood sugar, in the global burden of disease for individuals aged above 25 years (1). In addition,
_______________________________________________________________________________________________________ 1. MD, Assistant Professor of Psychiatry, Department for Mental Health and Substance Use, Iranian Research Center for HIV/AIDS (IRCHA), Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran. [email protected] and [email protected] 2. (Corresponding author) MD, MPH, Associate Professor of Psychiatry, Department for Mental Health and Substance Use, Iranian Research Center for HIV/AIDS (IRCHA), Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences,Tehran, Iran. [email protected] 3. MD, PhD, Professor of Epidemiology, Center for Air Pollution Research, Institute for Environmental Research and School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. [email protected] 4. MD, Psychiatrist, Iranian Research Center for HIV/AIDS (IRCHA) Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran. [email protected] 5. MD, Assistant Professor of Psychiatry, Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran. [email protected]
M. Amin-Esmaeili, et al. students. The most common indicators of cigarette smoking used in epidemiologic studies are lifetime prevalence of cigarette smoking (even one puff), lifetime prevalence of smoking at least one cigarette, last year or last month prevalence of cigarette smoking, and prevalence of daily smoking, each of which are of particular importance. However, studies conducted in Iran have not presented any specific definition of the indicators used for their objectives, which highly limits the comparability of data as well as their use in systematic reviews to analyze the trends and to obtain a pooled prevalence. In the developed countries, the trends for cigarette smoking as well as those for alcohol and substance use have been evaluated through repeated surveys in certain time intervals using a specific methodology (16, 17). This allows for collecting useful and reliable data with high comparability, which can subsequently be used for planning and policy-making. The present study was the first repeated survey of cigarette smoking as well as alcohol and substance use in Iran. In this paper, we present the prevalence and trend of smoking among students of Tehran University of Medical Science (TUMS) over the period from 2006 to 2009.
cigarette smoking is one of the major causes of death; reports have indicated mortality rates of 14.6 per 1000 for men and 6.7 per 1000 for women due to cigarette smoking in the American continent (2). In Iran, smoking has been identified as one of the ten leading risk factors in the national study for burden of diseases (3). More attention should be paid to cigarette smoking, as a fatal habit with severe physical, mental, and financial consequences, in youth, and particularly in students. This population group is highly susceptible to smoking, due mainly to different types of stressors such as burden of educational and uncertainty of future work, on one hand, and the pressure from friends combined with ease of access, on the other hand. Although the prevalence of cigarette smoking has been reported to be lower among the students of the medical sciences compared to non-medical majors, these rates were still high; taking into consideration the fact that they will be in charge of delivering health services to the society, their smoking can negatively impact the attitudes towards this habit (4, 5). During the last decade, decreasing trends of cigarette smoking have been observed among students, including those of medical sciences, in some countries such as US and Republic of Ireland (6, 7), while other studies in Slovakia (8), Japan (9), and Brazil (10), have reported an increasing trends. Controversial findings have been reported on the prevalence and trends of cigarette smoking among Iranian youth. For example, a study conducted on the trend of cigarette smoking among individuals aged 1524 years between 1991 and 1999 revealed and an increasing trend (11); however, another study indicated a decreasing trend of cigarette smoking among high-school students in the years after 2001 compared to previous years (12). In addition, several studies have reported a significantly high prevalence of cigarette smoking among students of different universities (13-15). However, no evidence exists on the trend of cigarette smoking among Iranian university MJIRI, Vol. 27, No. 4, Fall, Nov 2013, pp. 168-178
Methods The present work was conducted in four consecutive years, from 2006 to 2009. The study population included all of the first- to fourth-year students at TUMS and census was applied for sampling. A researchermade, structured questionnaire was used to evaluate the status of cigarette smoking among individuals based on the following indicators: prevalence of smoking in different time periods, number of cigarettes smoked per day, and the age when first smoked. Demographic data were also collected for each case. The questionnaire used in the present study was prepared based on WHO Core Questionnaires and WHO-ASSIST (World Health Organization- Alcohol, Smoking and Substance In169
http://mjiri.iums.ac.ir
Smoking trend among students Table 1. Demographic characteristics of the sample population during the study period Demographic variables 2006 2007 2008 2009 N (%) N (%) N (%) N (%) Gender Male 599 (34.0) 629 (36.2) 591 (33.8) 518 (33.2) female 1162 (66.0) 1107 (63.8) 1159 (66.2) 1043 (66.8) Age Mean (±SD) 20.4 (± 2.6) 20.2 (± 2.1) 20.2 (± 1.9) 20.1 (± 1.9) Min 15 16 17 15 Max 43 41 42 40 Mode 20 20 20 21 Marital status Single 1636 (93.2) 1633 (94.1) 1640 (93.7) 1446 (93.5) Married 120 (6.8) 103 (5.9) 110 (6.3) 101 (6.5) Place of residence Home (with family) 862 (49.1) 772 (44.7) 811 (46.5) 706 (45.1) Home (alone or with other single 892 (50.9) 956 (55.3) 933 (53.2) 858 (54.9) roommates)/ in dormtory Field of study Medicine 837 (47.6) 738 (43.5) 633 (36.3) 408 (26.0) Pharmacy 257 (14.6) 303 (17.9) 300 (17.2) 288 (18.4) Dentistry 191 (10.9) 199 (11.7) 206 (11.8) 211 (13.5) Nursing and midwifery 172 (9.8) 183 (10.8) 224 (12.9) 213 (13.6) Health and hospital management 111 (6.3) 100 (5.9) 86 (4.9) 81 (5.2) Others* 192 (10.9) 174 (10.3) 294 (16.9) 367 (23.4) Year of study of the students First year 590 (33.5) 536 (30.9) 536 (30.6) 534 (34.1) Second year 476 (27.0) 519 (29.9) 471 (26.9) 373 (23.8) Third year 299 (17.0) 403 (23.2) 497 (28.4) 408 (23.0) Fourth year 397 (22.5) 278 (16.0) 246 (14.1) 253 (16.1) *
Includes bachelor degree in radiology, radiotherapy, speech therapy, physiotherapy, operating room technician, medical information, audiometry and nuclear medicine
volvement Screening Test) taking into account the situation of smoking in Iran. Content of the questionnaire was validated by group of researchers and validity face was assessed by pre-testing the questionnaire in a class of Master of Public Health (MPH) students. The questionnaires were distributed in each class after necessary explanations by a psychiatrist. The questionnaires were anonymous and self-administered. Response rate was also calculated based on the number of students present in each class and the number of questionnaires filled out and returned. All the field works were carried out in autumn each year. First-year students were studied in the first week of entering the university (first week of October), while second- to fourth-year students evaluated in the second month of the semester (i.e. in November). http://mjiri.iums.ac.ir
Statistical Analysis: For statistical analysis, the collected data were first transferred to SPSS software, and then analyzed using descriptive statistics. Trend of smoking for the all indices was tested by linear-bylinear association and p-value of less than 0.05 was considered as significant. Results The number of individuals who filled out the questionnaires was 1761 in 2006, 1741 in 2007, 1755 in 2008, and 1568 in 2009. The corresponding values for the response rate in each year were 96.8%, 96.1%, 90.7%, and 90.6%, respectively. Table 1 presents the demographic characteristics of the study population during the study period. As given in the table, in each year, female students accounted for two-third of the total number of participants, which is 170
MJIRI, Vol. 27, No. 4, Fall, Nov 2013, pp. 168-178
M. Amin-Esmaeili, et al. Table 2. Cigarette smoking among students of Tehran Medical University during the study period Cigarette use Lifetime prevalence of smoking cigarette (even one puff) Lifetime prevalence of smoking at least one complete cigarette Twelve months prevalence of smoking at least one complete cigarette Last month prevalence of cigarette Last week prevalence of cigarette Prevalence of daily cigarette use Age of first cigarette use (at least one complete cigarette) Mean (±SD) Median Mode Number of cigarette used per day* Mean (±SD) Median Mode * Among daily smokers
2007 N=1741 25.3% 17.6% 13.2%
2008 N=1755 19.6% 14.3% 10.8%
2009 N=1568 19.6% 13.3% 10.1%
8.2% 4.8% 3.4%
7.8% 5.2% 4.0%
6.1% 3.8% 2.9%
5.8% 3.2% 1.8%
17.3 (±3.4) 18 18
16.9 (±3.5) 18 18
16.4 (±3.7) 17 19
16.2 (±3.9) 17 20
9.2 (±7.2) 7 5
10.9 (±9.4) 7 5
12.4 (±7.2) 10 20
9.4 (±7.8) 6 5
rette) was 17 or 18, depending on the year of the study. Twelve-month prevalence of smoking at least one complete cigarette in the whole sample population had a decreasing trend (p=0.002). For female students, this prevalence was decreasing (p
http://mjiri.iums.ac.ir
Medical Journal of the Islamic Republic of Iran, Vol. 27, No. 4, Nov 2013, pp. 168-178
Trend of smoking among students of Tehran University of Medical Sciences: results from four consecutive surveys from 2006 to 2009 Masoumeh Amin-Esmaeili1, Afarin Rahimi-Movaghar2, Masud Yunesian3 Elaheh Sahimi-Izadian4, Mahdieh Moinolghorabaei5 Department for Mental Health and Substance Use, Iranian Research Center for HIV/AIDS (IRCHA), Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran.
Received: 27 Jan 2013
Revised: 1 May 2013
Accepted: 14 May 2013
__________________________________________________________________________________________
Abstract Background: Smoking within students community of the medical sciences can negatively impact the attitudes of the society in future. The objectives of this study were to assess the prevalence and trends of smoking among students of Tehran University of Medical Sciences. Method: This study was conducted in four consecutive years from 2006 to 2009. The study sample was taken from the first- to fourth-year, undergraduate and graduate (doctorate) students of Tehran University of Medical Sciences. Census was applied for sampling. Structured questionnaires were distributed to students of each class. The study was anonymous and self-administered. Results: From 2006 to 2009, a total of 1568 to 1761 students participated in the study each year. Over the study period, i.e. 2006-2009, the prevalence of cigarette smoking was decreased (the overall prevalence was 12.5% in 2006, 12.9% in 2007, 10.8% in 2008, and 10.5% in 2009). The corresponding values for the one month prevalence were 8.2%, 7.8%, 6.1%, and 5.8%, while those for the prevalence of daily smoking were 3.4%, 4.0%, 2.9%, and 1.8%, respectively. The decreasing trend was particularly more significant for female students. Conclusion: The findings suggest that the prevalence of smoking among students of Tehran University of Medical Sciences was in the lower end of the spectrum, in comparison to other universities in Iran and other countries. Additionally, similar to the pattern observed in the developed world, this trend was decreasing, particularly among girls. Implementing preventive measures for accelerating the decreasing trend, as well as continuous monitoring is recommended. Keywords: Tobacco, Prevalence, Epidemiology, Medical Students, Iran. ________________________________________________________________________________________
Introduction Cigarette smoking is an important factor influencing the health of the smoker as well as that of the individuals around him/her. This effect, however, mostly takes place
later in life, especially in old ages, such that it has become the third leading risk factor, after increased cholesterol and blood sugar, in the global burden of disease for individuals aged above 25 years (1). In addition,
_______________________________________________________________________________________________________ 1. MD, Assistant Professor of Psychiatry, Department for Mental Health and Substance Use, Iranian Research Center for HIV/AIDS (IRCHA), Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran. [email protected] and [email protected] 2. (Corresponding author) MD, MPH, Associate Professor of Psychiatry, Department for Mental Health and Substance Use, Iranian Research Center for HIV/AIDS (IRCHA), Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences,Tehran, Iran. [email protected] 3. MD, PhD, Professor of Epidemiology, Center for Air Pollution Research, Institute for Environmental Research and School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. [email protected] 4. MD, Psychiatrist, Iranian Research Center for HIV/AIDS (IRCHA) Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran. [email protected] 5. MD, Assistant Professor of Psychiatry, Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran. [email protected]
M. Amin-Esmaeili, et al. students. The most common indicators of cigarette smoking used in epidemiologic studies are lifetime prevalence of cigarette smoking (even one puff), lifetime prevalence of smoking at least one cigarette, last year or last month prevalence of cigarette smoking, and prevalence of daily smoking, each of which are of particular importance. However, studies conducted in Iran have not presented any specific definition of the indicators used for their objectives, which highly limits the comparability of data as well as their use in systematic reviews to analyze the trends and to obtain a pooled prevalence. In the developed countries, the trends for cigarette smoking as well as those for alcohol and substance use have been evaluated through repeated surveys in certain time intervals using a specific methodology (16, 17). This allows for collecting useful and reliable data with high comparability, which can subsequently be used for planning and policy-making. The present study was the first repeated survey of cigarette smoking as well as alcohol and substance use in Iran. In this paper, we present the prevalence and trend of smoking among students of Tehran University of Medical Science (TUMS) over the period from 2006 to 2009.
cigarette smoking is one of the major causes of death; reports have indicated mortality rates of 14.6 per 1000 for men and 6.7 per 1000 for women due to cigarette smoking in the American continent (2). In Iran, smoking has been identified as one of the ten leading risk factors in the national study for burden of diseases (3). More attention should be paid to cigarette smoking, as a fatal habit with severe physical, mental, and financial consequences, in youth, and particularly in students. This population group is highly susceptible to smoking, due mainly to different types of stressors such as burden of educational and uncertainty of future work, on one hand, and the pressure from friends combined with ease of access, on the other hand. Although the prevalence of cigarette smoking has been reported to be lower among the students of the medical sciences compared to non-medical majors, these rates were still high; taking into consideration the fact that they will be in charge of delivering health services to the society, their smoking can negatively impact the attitudes towards this habit (4, 5). During the last decade, decreasing trends of cigarette smoking have been observed among students, including those of medical sciences, in some countries such as US and Republic of Ireland (6, 7), while other studies in Slovakia (8), Japan (9), and Brazil (10), have reported an increasing trends. Controversial findings have been reported on the prevalence and trends of cigarette smoking among Iranian youth. For example, a study conducted on the trend of cigarette smoking among individuals aged 1524 years between 1991 and 1999 revealed and an increasing trend (11); however, another study indicated a decreasing trend of cigarette smoking among high-school students in the years after 2001 compared to previous years (12). In addition, several studies have reported a significantly high prevalence of cigarette smoking among students of different universities (13-15). However, no evidence exists on the trend of cigarette smoking among Iranian university MJIRI, Vol. 27, No. 4, Fall, Nov 2013, pp. 168-178
Methods The present work was conducted in four consecutive years, from 2006 to 2009. The study population included all of the first- to fourth-year students at TUMS and census was applied for sampling. A researchermade, structured questionnaire was used to evaluate the status of cigarette smoking among individuals based on the following indicators: prevalence of smoking in different time periods, number of cigarettes smoked per day, and the age when first smoked. Demographic data were also collected for each case. The questionnaire used in the present study was prepared based on WHO Core Questionnaires and WHO-ASSIST (World Health Organization- Alcohol, Smoking and Substance In169
http://mjiri.iums.ac.ir
Smoking trend among students Table 1. Demographic characteristics of the sample population during the study period Demographic variables 2006 2007 2008 2009 N (%) N (%) N (%) N (%) Gender Male 599 (34.0) 629 (36.2) 591 (33.8) 518 (33.2) female 1162 (66.0) 1107 (63.8) 1159 (66.2) 1043 (66.8) Age Mean (±SD) 20.4 (± 2.6) 20.2 (± 2.1) 20.2 (± 1.9) 20.1 (± 1.9) Min 15 16 17 15 Max 43 41 42 40 Mode 20 20 20 21 Marital status Single 1636 (93.2) 1633 (94.1) 1640 (93.7) 1446 (93.5) Married 120 (6.8) 103 (5.9) 110 (6.3) 101 (6.5) Place of residence Home (with family) 862 (49.1) 772 (44.7) 811 (46.5) 706 (45.1) Home (alone or with other single 892 (50.9) 956 (55.3) 933 (53.2) 858 (54.9) roommates)/ in dormtory Field of study Medicine 837 (47.6) 738 (43.5) 633 (36.3) 408 (26.0) Pharmacy 257 (14.6) 303 (17.9) 300 (17.2) 288 (18.4) Dentistry 191 (10.9) 199 (11.7) 206 (11.8) 211 (13.5) Nursing and midwifery 172 (9.8) 183 (10.8) 224 (12.9) 213 (13.6) Health and hospital management 111 (6.3) 100 (5.9) 86 (4.9) 81 (5.2) Others* 192 (10.9) 174 (10.3) 294 (16.9) 367 (23.4) Year of study of the students First year 590 (33.5) 536 (30.9) 536 (30.6) 534 (34.1) Second year 476 (27.0) 519 (29.9) 471 (26.9) 373 (23.8) Third year 299 (17.0) 403 (23.2) 497 (28.4) 408 (23.0) Fourth year 397 (22.5) 278 (16.0) 246 (14.1) 253 (16.1) *
Includes bachelor degree in radiology, radiotherapy, speech therapy, physiotherapy, operating room technician, medical information, audiometry and nuclear medicine
volvement Screening Test) taking into account the situation of smoking in Iran. Content of the questionnaire was validated by group of researchers and validity face was assessed by pre-testing the questionnaire in a class of Master of Public Health (MPH) students. The questionnaires were distributed in each class after necessary explanations by a psychiatrist. The questionnaires were anonymous and self-administered. Response rate was also calculated based on the number of students present in each class and the number of questionnaires filled out and returned. All the field works were carried out in autumn each year. First-year students were studied in the first week of entering the university (first week of October), while second- to fourth-year students evaluated in the second month of the semester (i.e. in November). http://mjiri.iums.ac.ir
Statistical Analysis: For statistical analysis, the collected data were first transferred to SPSS software, and then analyzed using descriptive statistics. Trend of smoking for the all indices was tested by linear-bylinear association and p-value of less than 0.05 was considered as significant. Results The number of individuals who filled out the questionnaires was 1761 in 2006, 1741 in 2007, 1755 in 2008, and 1568 in 2009. The corresponding values for the response rate in each year were 96.8%, 96.1%, 90.7%, and 90.6%, respectively. Table 1 presents the demographic characteristics of the study population during the study period. As given in the table, in each year, female students accounted for two-third of the total number of participants, which is 170
MJIRI, Vol. 27, No. 4, Fall, Nov 2013, pp. 168-178
M. Amin-Esmaeili, et al. Table 2. Cigarette smoking among students of Tehran Medical University during the study period Cigarette use Lifetime prevalence of smoking cigarette (even one puff) Lifetime prevalence of smoking at least one complete cigarette Twelve months prevalence of smoking at least one complete cigarette Last month prevalence of cigarette Last week prevalence of cigarette Prevalence of daily cigarette use Age of first cigarette use (at least one complete cigarette) Mean (±SD) Median Mode Number of cigarette used per day* Mean (±SD) Median Mode * Among daily smokers
2007 N=1741 25.3% 17.6% 13.2%
2008 N=1755 19.6% 14.3% 10.8%
2009 N=1568 19.6% 13.3% 10.1%
8.2% 4.8% 3.4%
7.8% 5.2% 4.0%
6.1% 3.8% 2.9%
5.8% 3.2% 1.8%
17.3 (±3.4) 18 18
16.9 (±3.5) 18 18
16.4 (±3.7) 17 19
16.2 (±3.9) 17 20
9.2 (±7.2) 7 5
10.9 (±9.4) 7 5
12.4 (±7.2) 10 20
9.4 (±7.8) 6 5
rette) was 17 or 18, depending on the year of the study. Twelve-month prevalence of smoking at least one complete cigarette in the whole sample population had a decreasing trend (p=0.002). For female students, this prevalence was decreasing (p
