Factors associated with the desire to quit tobacco smoking in Saudi Arabia: Evidence from the 2019 Global Adult Tobacco Survey

Prevalence and predictors of active and passive smoking in Saudi Arabia: A survey among attendees of primary healthcare centers in Riyadh

INTRODUCTION

Smoking remains a leading cause of preventable diseases worldwide, including cancer, heart disease, and respiratory disorders. In Saudi Arabia, the prevalence of smoking has been increasing, particularly among men and adolescents. However, limited research has focused on the prevalence and predictors of active and passive smoking in the region, particularly within the adult population. Understanding the sociodemographic and health-related factors that influence smoking behaviors can inform tobacco control strategies. The aim of the study is to investigate the prevalence and predictors of active and passive smoking among adults attending primary healthcare centers in Riyadh, Saudi Arabia.

METHODS

This cross-sectional study was conducted in Riyadh, Saudi Arabia, between March and July 2023, targeting patients aged ≥18 years who visited primary healthcare centers. Multistage cluster sampling was used to select 48 healthcare centers from an initial list of 103 centers. Participants were recruited from the waiting areas, and a total of 14239 individuals completed an electronic questionnaire. The questionnaire assessed sociodemographic information, smoking behavior, and health conditions. Data were analyzed using SPSS version 26.0 for Windows, with Descriptive statistics and multivariable logistic regression analyses to identify factors associated with active and passive smoking. Statistical significance was set at p<0.05.

RESULTS

The prevalence of active smoking was 17.3% and passive smoking was 16.5% among the participants. The multivariate logistic regression analysis identified several key predictors for both active and passive smoking. Male gender, larger household size, and lower income were significant factors for active smoking, with individuals in larger households (3-5 members) (AOR=1.48; 95% CI: 1.22-1.79) and those earning between 10000-19000 Saudi Arabian Riyals (AOR=0.56; 95% CI: 0.41-0.75) showing higher odds. Perceived health status also played a role, with those reporting good health (AOR=2.96; 95% CI: 1.68-5.25) having higher odds of smoking. Males were more likely to engage in active smoking compared to females (AOR=2.59; 95% CI: 2.23-3.02). For passive smoking, similar trends were observed, with larger households (AOR=2.27; 95% CI: 1.387-3.721) and male gender (AOR=2.59; 95% CI: 2.23-3.02) being significant predictors.

CONCLUSIONS

The study highlights male gender, larger household size, lower income, and better perceived health status as significant predictors for both active and passive smoking behaviors in Riyadh, Saudi Arabia. These factors should be prioritized in public health strategies aimed at reducing tobacco exposure and promoting cessation. Further research is needed to explore the broader societal factors contributing to smoking behavior and exposure to secondhand smoke in the country.

Global DNA Methylation and DNA Methyltransferase Status Among Cigarette Smokers in Saudi

Smoking is a serious public health concern worldwide. It is a common environmental factor causing epigenetic alterations. This study aimed to explore the effect of smoking on DNA methylation by quantifying global DNA methylation, measuring the concentrations of plasma DNA methyltransferases (DNMT1, DNMT3A, and DNMT3B) among cigarette smokers in Saudi, and comparing these results with those of nonsmokers. Whole blood specimens were collected from Saudi cigarette smokers (n = 36) and non-smokers as controls (n = 36). Global DNA alteration was determined by a 5-methylation Cytosine (5-mC) colorimetric assay, and the concentration of DNMT proteins was measured by enzyme-linked immunosorbent assay (ELISA). DNA hypomethylation was found in smokers compared with controls (p < 0.001). Cigarette smokers showed significantly increased DNMT concentrations (DNM-1, DNMT-3A, and DNMT-3B) (p < 0.005). Global DNA hypomethylation correlated significantly with smoking duration (r = -0.854, p = 0.040) but not with other clinical parameters. In addition, DNMTs also were significantly correlated with smoking duration DNMT1 (r = 0.033, p = 0.002), DNMT3A (r = 0.431, p < 0.001), and DNMT3B (r = 0.553, p = 0.015). Our findings suggest that cigarette smoke induces epigenetic dysregulation, a principal player in cancer and various diseases through global DNA hypomethylation and high concentrations of DNMTs among cigarette smokers compared with nonsmokers.

Predicting Smoking Cessation Stages: An Insight from the Transtheoretical Model Using a Cross-Sectional Approach Among Adults in Saudi Arabia

BACKGROUND

Smoking is a detrimental health behavior that can be addressed by designing stage-matched interventions with evidence-based behavioral change models such as the transtheoretical model (TTM). This study applied the TTM to predict smoking cessation stages among adults in Saudi Arabia.

METHODS

This social media-based cross-sectional study in Saudi Arabia used a convenient sample of 491 adult smokers (men and women). A digital questionnaire containing basic and smoking-related data and smoking scales (stages of change, cessation readiness, decisional balance, and self-efficacy) was used for data collection. The data were collected from 1 July to 30 October 2023 and were investigated using an ordinal regression analysis. The results illustrate that among the studied smokers, cigarette smoking was the prevalent method of smoking, especially among men (71.7%) compared to women (27.8%). Regarding stages of smoking, the pre-contemplation (35.8%) and contemplation (30.1%) stages were the highest, where men were more represented in both stages (37.9% and 40.8%, respectively). In comparison, women represented a higher percentage in the action (23.9%) and maintenance (21.1%) stages. The ordinal regression showed that increasing age (adjusted odds ratio; AOR = 1.045, p = 0.044), high quitting readiness (AOR = 1.134, p < 0.001), self-efficacy (AOR = 1.965, p = 0.028), decisional balance (AOR = 1.870, p < 0.001), and absence of psychological problems (AOR = 2.047, p < 0.001) increased the likelihood of being at higher smoking cessation stages. However, increased smoking duration (AOR = 0.756, p = 0.010), male gender (AOR = 0.340, p < 0.001), not working (AOR = 0.364, p = 0.013), adequate income (AOR = 0.535, p = 0.032), no chronic diseases (AOR = 0.430, p < 0.001), regular smoking (AOR = 0.052, p < 0.001), high smoking dependency (AOR = 0.775, p = 0.038), and hookah smoking (AOR = 0.032, p < 0.001) decreased the likelihood of being at higher smoking cessation stages.

CONCLUSIONS

Cigarette smoking is a prevalent problem among Saudi adults, especially men, with the highest percentage of these being at lower smoking cessation stages. Thus, this study recommends the development of stage-matched interventions to facilitate the move towards higher smoking cessation stages through efforts by, and collaboration between, community sectors to face this rising issue.

Characteristics of Waterpipe Smokers Who Are Willing to Quit: Population-Based Findings from Syria

Background

Many waterpipe users are willing to quit but have difficulty doing so. Little is known about the characteristics of those who are willing to quit.

Methods

Using two-stage cluster sampling, we conducted a secondary analysis of a population-based household survey of 2038 adults in Aleppo, Syria. We examined the prevalence of, and reasons for, willingness to quit and compared users who were willing with those were not willing to quit based on sociodemographic, psychosocial, tobacco-related, and health-related characteristics.

Findings

Twelve percent of adults smoked waterpipe (n=248), of these, 56% were willing to quit, and 25% had made a quit attempt in the past year. Friends/socializing (69%) and boredom/free time (16%) were the most reported obstacles to quitting. Those who were willing to quit walked more frequently (odds ratio [OR]=1.85; 95% confidence interval [CI]=1.24-2.77), ate less fruit (OR=0.56; CI=0.42-0.73), and were more likely to experience sneezing/blocked nose (OR=2.55, CI=1.22-5.34). Compared to users who did not also smoke cigarettes, dual users who were willing to quit cigarettes were more likely to be willing to quit waterpipe (OR=2.32; CI=1.24-4.34), whereas dual users who were not willing to quit cigarettes were less likely to be willing to quit waterpipe (OR=0.24; CI=0.10-0.58).

Conclusion

Many waterpipe users are willing to quit and perceive the loss of positive social functions as a major obstacle. Very few sociodemographic, tobacco-related, psychosocial, or health-related characteristics are associated with willingness to quit. However, quitting efforts may benefit from targeting dual users who are motivated to quit using all tobacco products.

Client's perception toward services of smoking cessation clinics in Riyadh, Saudi Arabia

Background

In Saudi Arabia, approximately 70,000 deaths yearly occur from diseases caused by smoking. Assessing patients' smoking behavior in primary care has apparent benefits. Assisting patients with smoking cessation is one of the essential roles of primary care. This study evaluated the quality of smoking cessation clinic counseling in Riyadh, Saudi Arabia, based on customer opinions of such services.

Methods

This research employed a cross-sectional approach involving individuals attending smoking cessation clinics located within primary health care centers in Riyadh city. The participants were chosen through random selection. They were informed about the study's objectives, and those who consented to take part were contacted and provided with an online questionnaire to complete.

Results

A total of 340 subjects participated (95.6%) of them were males, and 41.2% were in the age group of 25 to 35 years old. The common modality of tobacco use was cigarettes (82.6%), and 87.9% reported consuming tobacco daily. The mean (±SD) total score of the Fagerstrom Test of Nicotine Dependence was 5.03 (±2.36), and the highest percentage (44.4%) of the participants had a moderate level of nicotine dependence. The vast majority (93.8%) of the participants had former quitting experiences. Half (50.9%) of the participants showed complete satisfaction with the cessation clinics, while 13.2% and 9.1% of them were not satisfied or slightly satisfied, respectively.

Conclusion

The majority of smoking cessation clinic visitors were satisfied with the services provided, exceeding three-quarters of them, with half totally satisfied.

Barriers and facilitators for oral health screening among tobacco users: a mixed-methods study

OBJECTIVES

Tobacco consumption adversely affects general and oral health and is considered one of the significant public health burdens globally. The present study aims to assess the barriers and facilitators for attending oral and dental health screening among tobacco users who seek cessation advice.

METHODOLOGY

The present mixed-methods study used group concept mapping (GCM) to identify the facilitators/barriers to attending oral health screening among young adults attending face-to-face and virtual Tobacco Cessation Clinic at King Saud University (Riyadh, Saudi Arabia) between September 2022 and April 2023. Study investigators included healthcare social workers, dental interns, and oral and maxillofacial medicinists. Information about demographics, general health, oral/dental health and tobacco use were collected using self-completed questionnaires. The barriers and facilitators were assessed following GCM by brainstorming, sorting, rating, and interpretation activities. Descriptive, multidimensional scaling and hierarchical cluster analysis were used to describe the study participants and produce concept maps of the generated statements.

RESULTS

The study included 148 participants who generated 67 statements summarised into 28 statements as facilitators or barriers. Based on a 5-point importance scale, the participants indicated the importance of facilitators under health-related cluster [e.g. when I feel pain] as the highest, followed by personal [e.g. to maintain my mouth hygiene], social [e.g. the quality of treatment] and financial clusters [e.g. the reasonable cost]. Concerning barriers, financial factors [e.g. high cost] acted as the highest-rated barrier, followed by personal [e.g. lack of dental appointments] and health-related [e.g. worry that dental problems will worsen]. The social factors were the least considerable barrier [e.g. lack of time]. Clustering these facilitators/barriers on the concept map indicated their conceptual similarity by an average stress value of 0.23.

CONCLUSION

Pain was the most important facilitator to attending oral health screening by young adults seeking tobacco cessation advice. Notable barriers included the high cost of dental treatment and the lack of scheduled appointments. Thus, oral health care providers need to consider scheduling periodic and timely dental check-ups to prevent and reduce the burden of tobacco-associated and pain-causing oral diseases.

The association between cultural and social occasions and smoking cessation: The case of Saudi Arabia

INTRODUCTION

Tobacco use remains high in Saudi Arabia, necessitating an understanding of the influence of cultural and social events on smoking cessation. This study examined whether cultural and social events like Ramadan, Eids, and birthdays, motivate Saudi adults to quit smoking.

METHODS

Convenience sampling of 742 Saudi tobacco users was conducted between July 2021 and May 2022. A cross-sectional survey was used to assess self-reported desire to quit (1 = 'least desire' to 10 = 'highest desire') and behaviors in relation to special occasions. Multiple linear regression was performed to examine the association between cultural and social occasions and the desire to quit, while logistic regression was used to assess the relationship between cultural and social occasions and historical quit attempts, medicinal nicotine product use, visiting smoking cessation clinics, and calling the national Quitline. Demographic variables and tobacco types were controlled for in the analyses.

RESULTS

Considering quitting during Ramadan, Eids, and birthdays was associated with a higher desire to quit (Ramadan: B=2.99; 95% CI: 2.51-3.47, Eids: B=2.83; 95% CI: 2.12-3.54, and birthdays: B=2.76; 95% CI: 1.93-3.60, p<0.01) and a greater likelihood of past quit attempts (Ramadan: AOR=8.2; 95% CI: 5.5-12.1, Eids: AOR=5.8; 95% CI: 3.2-10.5, and birthdays: AOR=4.8; 95% CI: 2.4-9.4). Only considering quitting during Ramadan was associated with calling the national Quitline (AOR=2.9; 95% CI: 1.8-4.9).

CONCLUSIONS

Cultural and social events like Ramadan and Eids motivate adults in Saudi Arabia to attempt tobacco cessation. Targeting interventions around meaningful cultural occasions may promote successful quitting. These findings highlight the importance of understanding cultural and religious influences on cessation behaviors in Saudi Arabia and in other countries.

Unveiling the Tapestry of Tobacco Consumption: Exploring the Sociodemographic Factors Impacting Smokers at Smoking Cessation Clinics in Jeddah

Background The World Health Organization (WHO) has identified tobacco smoking as a global epidemic, causing an estimated three million deaths annually. This study aims to examine the sociodemographic characteristics and smoking-related behaviors among individuals attending smoking cessation clinics in Jeddah during 2022. By identifying these factors, appropriate interventions can be developed to combat the smoking epidemic. Methodology The study enrolled male and female participants who visited the Smoking Cessation Clinics in Jeddah from January 2022 to December 2022. Eligible participants were between 18 and 60 years old and agreed to take part in the study. Data on smoking status, medical history, previous attempts at quitting, and medication use were collected. Statistical analysis, including chi-square tests and P-values, was conducted to assess the associations between participants' medical history and smoking cessation attempts. Results A total of 5,869 participants were included in the study. The findings revealed that approximately one-fifth of the participants had previously attempted to quit smoking, while the majority 4,780 (81.4%) had not made any cessation attempts. Among those who had made quit attempts, the majority had tried quitting between one and four times 968 (16.5%). The duration of successful cessation reported by participants was generally short, with the majority 4,781 (81.5%) not experiencing any extended period of quitting. Common reasons for relapse included cravings, social influences, mood changes, stress, and withdrawal symptoms. The study also found significant associations between specific medical conditions and smoking cessation attempts. Conclusions The study identified significant associations between male gender, older age group (51-60 years), divorced marital status, intermediate educational levels, higher income levels, retired status, extreme body mass index (BMI) categories, and previous attempts at smoking cessation. Healthcare providers and policymakers should consider these findings when developing and implementing smoking cessation programs. The insights gained from this research can contribute to the development of targeted interventions to reduce smoking rates and improve public health outcomes.

Oral-malodor measurement and intention to quit smoking in men: A before-after study

INTRODUCTION

Few studies have examined the effect of feedback based on oral-malodor measurements on the motivation to quit smoking. Therefore, this study examined whether oral-malodor measurements were associated with the intention to quit smoking.

METHODS

This retrospective, uncontrolled before-after study invited smokers to a workplace health event in 2019 and 2020 to motivate them to quit smoking. They attended seminars on oral health and smoking cessation aids, and then underwent respiratory function and oral-malodor measurements using exhaled and oral cavity air, respectively. Intention to quit smoking was evaluated by answers to questions regarding the intention to quit in the next 1 or 6 months in questionnaires collected before and after the event. This study analyzed 241 men aged 20-54 years (mean: 33.2 ± 10.5) to examine factors associated with the intention to quit in multivariable logistic regression analyses for age, tobacco type (cigarettes and heated-tobacco products), and category of tobacco consumption.

RESULTS

Before the event, 8.7%, 17.0%, and 74.3% of smokers had intended to quit in the next month, the next six months, or had no intention to quit, respectively. After the event, the respective percentages were 17.8%, 26.6%, and 55.6%. A higher methyl mercaptan concentration, a volatile sulfide component of oral malodor, was significantly associated with the intention to quit in the next month (adjusted odds ratio, AOR=4.24; 95% CI: 1.52-11.8, p=0.006). The participants with higher daily tobacco consumption were less likely to acquire the intention to quit in the next six months (AOR=0.37; 95% CI: 0.15-0.92, p=0.032). Other variables, such as lung age deficit, exhaled CO concentration, and hydrogen sulfide concentration (another component of oral malodor), were not significantly associated.

CONCLUSIONS

Oral-malodor measurement feedback may help motivate men to quit smoking in the next 1 month rather than in the next six months.