Causes of the First Use and their Relationship to Continuing Smoking

doi:10.21203/rs.3.rs-2241672/v1

Background:

The objectives of the study lies on explaining the reasons for the first use of smoking by the study sample, and the reasons for continuing smoking, and identifying the differences in the views of the study sample according to a set of variables (gender, age, college year, number of family members, type of smoking, smoking times, feeling when quitting, Smoking, parents, number of smoking siblings, educational level of father and mother, parents' marital status, economic status, smoking friends).

Methods:

The study was applied through field application and the Internet, in the period from 6/6/2022 to 13/10/2022, on a sample of (563) students from the Syrian Private University, who were chosen in a random way that allows each individual in the university to be part of the sample, and the tool was a questionnaire composed of personal data related to the study sample, and two axes on the reasons for the first use of smoking and the reasons for continuing with it, and the data was analyzed through the statistical program Spss.

Results:

The reasons for the first use varied, as the item of tension got the highest percentage (95.51%), and in terms of the reasons for continuing to smoke, the item of desire to smoke when feeling angry got a percentage (96.06), and a high percentage found it difficult to give up smoking by (97.02), while there were no differences according to the study variables for each of the reasons for using and continuing to smoke, and there were differences according to the variable smoking times, it was regular, the number of smoking packets, it was one packet / day, friends in favor of the smoking friend, and the reasons for returning to smoking because of the desire to do so.

Conclusion:

The reasons for practicing and continuing the habit of smoking require working to address it by all possible means. There must be concerted efforts between the various private and public bodies and civil society institutions to stop this phenomenon, and to preserve society and its children and their health.

Psychiatry

smoking

first use

continuing to smoke.

The practice of smoking among university students is increasing significantly, for a variety of reasons, including scholastic, social, family and psychological reasons. The reasons for the first use as well as the continuation of smoking vary according to a set of variables, including (relating to parents and their social and economic status, brothers, their number, smoking friends, and other variables) despite The risks resulting from smoking, which may lead to death in some cases Scientific evidence confirms that smoking has a huge impact on public health, as smoking is the main preventable cause of disease at the global level, and the World Health Organization estimates that nearly one third of the number of adults in the world smoke, in developing countries (48%) of men smoke, and (7%) of women, while the proportion of smokers in developed countries is (42%) of men, and (24%) of women, and cigarette smoking remains the number one cause of death in developed countries1, where the number of deaths is more than 8 million people annually, It is divided into 7 million direct smokers and 1.2 million passive smokers. ⁽¹⁾ The Global Burden of Disease (GBD) 2015 study, a systematic analysis of 25 years of tobacco use in 195 countries and territories, determined that the worldwide prevalence of daily smoking for 2015 was 25% among men, and 5.4% among women ⁽²⁾. In spite of this, there was a big difference between different countries, with the daily prevalence rate of smoking among men (4–47%), and it ranges (1–44%) among women. Most studies in countries showed a reduction in the prevalence of smoking over the length of the study. The study did not evaluate smokeless tobacco nor electronic cigarettes. In the United States, two-thirds of adults use tobacco cigarettes. The prevalence of smoking among adults there decreased from 42.4% in 1965 to 15.5% in 2016 ^(3–4). More than 75% of smokers smoke every day ^(3–5). Smoking is more among men than women, but this gap has narrowed with time, but not yet. Tobacco use is also more common among young adults aged 18–24 years than among older adults ^(4–6). Childhood smoking is closely related to adolescence: 90% of adult smokers have smoked their first cigarette before age 18, and virtually all of them started before age 26 ^(7–8). Every day in the United States 4,000 adolescents smoke between the ages of 12 and 17 years and about 1,000 of them become daily smokers ^(9–10) The proportion of young smokers ^(11–12) in the United States who have never smoked increased from 65% between 1999–2001 to 76% between 2011–2012 (12).The World Health Organization (WHO) has reported a wide range of smoking rates among young people in various countries including the Russian Federation, Central and Eastern Europe, Chile, Bolivia and Indonesia as 30% or more ⁽¹³⁾ .

The importance of the study stems from the fact that it sheds light on an important topic, especially in light of the economic, social and psychological effects on students, which affect the possibility of resorting to smoking and other addicts as a result of the current circumstances. Therefore, the importance of this study lies in the following: Diagnosing the reality of the students of the Syrian Private University, with regard to the reasons for the first use of smoking in its various forms. the target group of the study is the youth group. current study can contribute to knowing the causes of smoking and thus contribute to presenting some suggestions that could limit or reduce smoking among the young group. Benefiting from the problems that will be identified by the study in relation to the variables of the study, as it is possible that social problems that need to be addressed and be the cause of abuse, and open the way for researchers to address them.

Objectives of the study:

The study seeks to achieve specific goals. The goal of any study or research is to be able to reach the required results and the information sought from it. The goals are specific matters for each research study that it seeks to achieve. The current study aims to achieve the following objectives: Explain the reasons for the first use of smoking by the study sample. And Explaining the reasons for continuing smoking by the study sample .and Identify the differences between the opinions of the study sample regarding the causes of abuse according to a set of variables (gender, age, college, school year, type of smoking, smoking times, attempts to stop and reason for return, smoking parents, educational level of the father and mother, economic status, friends).

Study design and preparation:

This study was conducted in two ways: A field study on the students of the Syrian Private University. and from an online form directed to students of the Syrian Private University. In terms of implementation, the study took the period between 6/6/2022 to 10/13/2022.

The study sample:

The study sample consisted of (563) students from the Syrian Private University, who were chosen by random method that allows each individual at the university to be part of the sample. But for all the tools for analyzing the data, the only valid tools for the analysis were (537) questionnaires, the rest being incomplete data.

statistical analysis:

The questionnaire was applied to the study sample and by using the Statistical Packages Program (SPSS) for statistical analysis as follows: Arithmetic means and standard deviations to know the point of view of the study sample members. Frequencies and percentages to know the opinions of the study sample. One-way analysis of variance (ANOVA) to test the significance of the differences between the average answers of the sample members according to the study variables.

Ethical considerations:

Ethical approval was obtained from the Institutional Review Board (IRB) Faculty of Medicine, Syrian Private University.

In the following, we will present our results, where we will start with the characteristics of the study sample. As for gender, the percentage of males was (40.22%) and the percentage of females was (59.78%), as shown in Table 1. Regarding age, the percentage of students aged (18–20) years was (57.17%), while the percentage of students aged (21–22) was (34.26%), and the percentage of students aged more than (23) a year was (8.57%) as shown in Table 1. As for the number of packets/year, the percentage of students who smoked one packet per day was (89.8%), and the percentage of students who smoked two packets per day was (10.2%), as shown in Table 1. As for the faculty of the study, the percentage of human medicine students was (40.78%), the percentage of dental students was (34.26%), and the percentage of pharmacy students was (24.96%), as shown in Table 1. When the differences in the mean scores of the sample members in the total score were studied according to the smoking times variable, we found that the arithmetic mean of smoking times among students who smoke regularly according to the reasons for use is 29.37 ± 1.86 and the arithmetic mean of smoking times among students who smoke sometimes according to the reasons The arithmetic mean of smoking times among students who smoke regularly according to continuity is 28.01 ± 1.67 and the mean of smoking times among students who smoke sometimes according to continuity is 26.13 ± 1.77 and the mean of smoking times among students who smoke regularly according to continuity Students who smoke regularly according to the total score 49.62 ± 4.08 and the arithmetic mean of smoking times of students who smoke occasionally according to the total score 43.02 ± 3.15 as shown in Table 2. When the differences in the mean scores of the sample members in the total scores according to the bucket/year variable were studied, we found that the arithmetic mean with respect to the bucket/year variable among the students who smoke one baguette according to the reasons for use is 31.07 ± 1.58 and the arithmetic mean is 31.07 ± 1.58 for the bucket/year variable among students smoking two packs according to the reasons for use 17.11 ± 1.49 and the mean for the variable packs/year among students smoking one pack by continuity 28.85 ± 1.37 and the mean for the variable packs/year in students smoking two packs according Continuity is 11.49 ± 1.91, the mean packs/year variable among students who smoke one pack by total score was 41.44 ± 4.08, and the mean packs/year variable among students who smoke two packs according to the total score is 23.13 ± 3.15 as indicated in Table 3. When the differences in the mean scores of the sample members in the total score were studied according to the variable of friends (smoker or non-smoker), we found that the arithmetic mean in relation to the variable of friends (smoker or non-smoker) among the students who smoke according to the reasons for use is 64.8 ± 1.42, and the arithmetic mean is 64.8 ± 1.42 For the variable friends (smoker or non-smoker) among the non-smoking students according to the reasons for using 37.97 ± 1.87 and the arithmetic mean for the variable friends (smoker or non-smoker) among the students who smoke according to continuity 54.32 ± 1.25 and the arithmetic mean for the friends variable (Smoker or non-smoker) among non-smokers according to continuity 29.18 ± 1.37 and arithmetic mean of friends (smoker or non-smoker) among students who smoke according to the total score 66.71 ± 2.63 and arithmetic mean of friends (smoker or non-smoker) ) among non-smokers students according to the total score 34.28 ± 2.24 as shown in Table 4. When the differences in the mean scores of the sample members in the total score were studied according to the gender variable, we found that the arithmetic mean in relation to the sex variable among male students according to the reasons for use was 38.82 ± (2.68), and the arithmetic mean in relation to the sex variable among female students according to the reasons for use (36.09) ±(1.47) and the arithmetic mean with respect to the sex variable among male students according to continuity (39.27) ±(2.88), and the arithmetic mean with respect to the sex variable among female students according to continuity (37.86) ±(2.96), and the arithmetic mean with respect to the sex variable among male students according to the degree The college is (63.95) ± (6.81) and the arithmetic mean for the gender variable among female students according to the total score is (58.28) ± (5.07) as shown in Table 5. When the differences in the mean scores of the sample members in the total score were studied according to the variable of the first cigarette at any age, we found that the arithmetic mean for the variable of the first cigarette at any age among the students who started smoking at the age of 18 according to the reasons for using is (28.93) ± (2.26) and The arithmetic mean for the variable first cigarette at any age among students who started smoking at age 20 according to the reasons for using (27.16) ± (1.66), and the mean for the variable first cigarette at any age among the students who started smoking at age 18 according to continuity (33.27) ± (1.34) and the arithmetic mean for the variable first cigarette at any age among students who started smoking at age 20 according to continuity (32.08) ± (1.76), and the arithmetic mean for the variable first cigarette at any age among students who started smoking at age 18 according to For the total score (56.11 ± (4.22) and the mean for the variable of the first cigarette at any age among students who started smoking at age 20 according to the total score (54.82) ± (3.19) as shown in Table 6.

In our study, we relied on five hypotheses as follows

The first hypothesis: There are statistically significant differences on the questionnaire about the causes of abuse among the sample members due to the variable smoking times. To find out whether there is a statistical significance between the mean scores of the responses of the study sample to the total score with regard to the reasons for and its continuity due to the variable smoking times, the Independent Samples TEST was used to clarify the significance of the differences. It is noted from the previous table that there are differences in favor of regular smokers, where all the averages were in their favor, in the causes, continuity and overall degree of use, and perhaps the fact that regular smokers have more continuity and abuse is a reason for this continuity because smoking has become part of their life and its continuity as well.

The second hypothesis: There are statistically significant differences on the questionnaire of the causes and continuity of abuse among the sample members due to the Bucket/year variable. To find out whether there is a statistical significance between the mean scores of the study sample’s responses to the total score with regard to smoking bags/year, the Independent Samples TEST was used to clarify the significance of the differences. It is noted through this hypothesis that there are statistically significant differences between the means of The responses of the sample members with regard to the use and its continuity according to the variable packet/year, where differences were found in favor of smokers for one packet as it begins the process of abuse and its continuity through one packet and is caused by the economic situation and the high prices in the types of smoking and the person’s love for a particular type and one who wants to smoke it, and the study of the Health Organization showed (2005) on a sample of 2160 individuals that smokers consume ⁽¹²⁾ cigarettes per day on average, and the study of Tomson T and H Helga son (2003) that (19%) smoke daily.

The third hypothesis: There are statistically significant differences on the questionnaire about the causes and continuity of abuse among the sample members due to the variable of friends (smoker, non-smoker). To find out whether there is a statistical significance between the mean scores of the study sample responses to the total score with regard to friends (smoker, non-smoker), Student's t-test was used to clarify the significance of the differences. It is noted from the previous results that there are statistically significant differences between the average responses of the sample members with regard to the use and its continuity according to the variable of friends (smoker, non-smoker), where differences were found in favor of smoking friends. The current study is consistent with the Jordanian study, which says that friends, not family, are the main source of first smoking Whereas, the majority of smokers have friends who smoke 78.7%, and the family has a percentage of 57.4%, as well as smoking with brothers by 27.9%. ⁽¹³⁾

Fourth Hypothesis: There are statistically significant differences on the questionnaire about the causes of abuse among the sample members due to the gender variable. To find out whether there is a statistical significance between the mean scores of the study sample’s responses to the total score with regard to the reasons for and continuation of abuse due to the gender variable, the Independent Samples TEST was used to clarify the significance of the differences. It is noted from the previous results that there are no differences in the causes of abuse and the reasons for the continuation of smoking among males and females, where the probabilistic value of the causes of abuse was 0.36, which is greater than 0.05, and the probabilistic value of the reasons for continuing smoking was 0.54, which is also greater than 0.05, and the total score was 0.94, which is also greater than 0.05, and thus the result College is not a function of either sex. The researchers explain this result that the reasons for the use and continuation of smoking are the same for males and females, perhaps due to stress, anxiety, anger and other psychological conditions, which are the cause of a situation, and may be accompanying a particular situation, as well as family, social and educational conditions, which greatly affected the situation. The prevalence of smoking among the young groups, the spread of tolerance by the parents to the use of the hookah, and others, which constituted another motive for males and females to use smoking in its various forms and the continuity of the use. And other negative feelings push some to smoke. This percentage is consistent with the Lebanese study, which says there was no difference by gender (59) and differs with the previous Jordanian study (50.2% among males and 6.5% among females) (58), and this is due to the stigma towards women who smoke and their behavior is described as dishonorable.

Fifth Hypothesis: There are statistically significant differences on the questionnaire on the causes of abuse among the sample members due to the variable of the first cigarette. To find out whether there is a statistical significance between the average scores of the study sample’s responses to the total score with regard to the reasons for using and continuing it due to the variable of the first cigarette, the Independent Samples TEST was used to clarify the significance of the differences. It is noted from the previous results that there is no Differences in the reasons for using and the reasons for continuing smoking among the study sample according to an age-related variable or cigarette. The researchers explain this result that the reasons for the use and the continuation of smoking are not related to the age at which the individual takes the first cigarette, since the process of consumption is governed by many influences, including psychological, social, family, peer group and others.

The reasons for practicing and continuing the habit of smoking require working to address it by all possible means. There must be concerted efforts between the various private and public bodies and civil society institutions to stop this phenomenon, and to preserve society and its children and their health.

Ethics approval and consent to participate:

The Research Ethics Committee in the Syrian Private University and the ethical committees in the concerned Syrian private university approved the study protocol. Verbal informed consent was obtained from every participant before participation. All procedures performed in studies involving human participants were by the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Consent for publication:

Not applicable.

Availability of data and materials:

All data related to this paper’s conclusion are available and stored by the authors. All data are available from the corresponding author on a reasonable request.

Conflict of interest:

The authors declare that they have no conflict of interest

Funding:

This research received no specific grant from SPU or any other funding agency in the public, commercial or non-profit sectors.

Authors’ contributions:

E.A and R.A conceptualized the study. E.A and R.A wrote the study protocol, performed the statistical analysis, participated in data collection, and did the literature search. M.A. participated in the literature search, interpret the results, wrote the main manuscript, and prepared the tables. Y.L. revised the draft. All authors read and approved the final draft.

Acknowledgments:

We are thankful to the management of the Syrian Private University and for their support in the field of medical training and research. We would also like to thank Dr. Youssef Latifeh for his help and supervision in the paper.

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Table (1) Demographic information and habits of sample members.

Demographic information		N	%
Age	18_20	307	57.17
	21_22	184	34.26
	Above 23	46	8.57
Gender	Female	321	59.78
Gender	Male	216	40.22
smoking amount baguettes / year	1	478	89.8
smoking amount baguettes / year	2	59	10.2
College	Medicine	219	40.78
	Dentistry	184	34.26
	Pharmacy	134	24.69

Table (2) T-test results for the differences in the average scores of the sample members in the total score according to the smoking times variable

Axes and total score	Time of smoking	N	Mean ± SD	P.value
Reasons for taking	regular	517	) ± (29.37)1.86)	(0.001)
Reasons for taking	sometimes	20	± (24.19) (1.79)	(0.001)
Continuity	regular	517	± (28.01)(1.67)	(0.000)
Continuity	sometimes	20	(26,13) ± (1.77)	(0.000)
Total marks	regular	20	) ± (49.62)4 08)	(0.001)
Total marks	sometimes	517	± (43.02) (3.15)	(0.001)

Table (3) T-test results for the differences in the average scores of the sample members in the total score according to the Bucket/year variable

Axes and total score	packets/year	N	Mean ± SD	P.value
Reasons for taking	1	478	(1.58) ± (31.07)	(0.000)
Reasons for taking	2	59	(1.49) ± (17.11)	(0.000)
Continuity	1	478	(1.37) ± (28.85)	(0.000)
Continuity	2	59	(1.91) ± (11.49)	(0.000)
Total marks	1	478	(4.08) ± (41.44)	(0.000)
Total marks	2	59	(3.15) ± (23.13)	(0.000)

Table (4) T-test results for the differences in the average scores of the sample members in the total score according to the variable of friends (smoker, non-smoker)

Axes and total score	friends(smoker/not)	N	Mean ± SD	P.value
Reasons for taking	Smoker	489	± (64.80)(1.42)	(0.000)
Reasons for taking	Not	39	± (37.97)(1.87)	(0.000)
continuity	Smoker	489	± (54.32)(1.25)	(0.000)
continuity	Not	39	± (29.18) (137)	(0.000)
Total marks	Smoker	489	) ± (66.71)2.63)	(0.000)
Total marks	Not	39	± (34.28)(2.24)	(0.000)

Table (5) The differences in the causes of smoking and the persistence of smoking among the study sample according to the gender variable

Axes and total score	Gender	N	Mean ± SD	P.value
Reasons for taking	Male	216	) ± (38.82)2.68)	(0.36)
Reasons for taking	Female	321	) ± (36.09)1.47)	(0.36)
continuity	Male	216	(39.27) ± (2.88)	(0.54)
continuity	Female	321	± (37,86)(2.96)	(0.54)
Total marks	Male	216	(63.95) ± (6.81)	(0.94)
Total marks	Female	321	(58.28) ± (5.07)	(0.94)

Table (6) The differences in the reasons for the use and persistence of smoking among the study sample according to the variable of the first cigarette

Axes and total score	First cigarette/age	N	Mean ± SD	P.value
Reasons for taking	18	161	± (28.93)(2.26)	(0.94)
Reasons for taking	20	376	(27.16) ± (1.66)	(0.94)
continuity	18	161	± (33.27)(1.34)	(0.41)
continuity	20	376	(32,08) ± (1.76)	(0.41)
Total marks	18	161	± (56.11)(4.22)	(0.39)
Total marks	20	376	± (54.82)(3.19)	(0.39)

Causes of the First Use and their Relationship to Continuing Smoking

Status:

Version 1

Abstract

Background:

Methods:

Results:

Conclusion:

Figures

Introduction

Methods

Objectives of the study:

Study design and preparation:

The study sample:

statistical analysis:

Ethical considerations:

Results

Discussion

Conclusion

Declarations

References

Tables

Status:

Version 1