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Roba HS, Gebremichael B, Adem HA, Beyene AS. Current Substances Use Among Students in Ethiopia: A Systematic Review and Meta-Analysis of 20-Years Evidence. Subst Abuse 2021; 15:11782218211050352. [PMID: 34671181 PMCID: PMC8521424 DOI: 10.1177/11782218211050352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 09/13/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The use of psychoactive substances is one of the main public health issues worldwide. However, there is a lack of evidence on the magnitude of current substance use among students in Ethiopia. Therefore, this study aimed to provide comprehensive views of the current prevalence of substance use among students in Ethiopia. METHODS We searched PubMed/Medline, Health InterNetwork Access to Research Initiative (HINARI), Google Scholar, and gray literature sources between 2000 and 2019. The prevalence of current substances with a 95% confidence interval (CI) was estimated using the random-effects model. The results were presented using forest plots, and Cochrane Q-test and I 2 were used to measure the extents of between-study variations. RESULTS A total of 1543 study articles were identified from electronic databases, and 32 cross-sectional studies were included in the meta-analysis. The prevalence of current use of at least 1 substance was 37.63% (95% CI: 33.66, 41.69), alcohol 27.61% (95% CI: 22.10, 33.48), khat 17.20% (95% CI: 14.03, 20.62), and smoking 9.74% (95% CI: 7.17, 12.64). The prevalence of any substance use in high school students versus university/college students was 41.55% (95% CI: 38.83, 44.29) versus 36.24% (95% CI: 32.37, 40.20), alcohol 24.21% (95% CI: 14.05, 36.11) versus 25.27% (95% CI: 19.76, 31.20), khat 13.82% (95% CI: 8.61, 20.02) versus 17.30% (95% CI:13.75, 21.16), and cigarette 8.30% (95% CI: 1.89, 18.60) versus 9.80% (95% CI: 7.32, 12.58). Meta-regression analysis revealed publication year, sample size, female proportion, and age were not significantly associated with the current use of substances. CONCLUSION Overall, the current substance use of any substance, alcohol, chewing khat, and smoking cigarettes was relatively high. A significant proportion of high school students were already using substances at an early age. Policymakers should formulate and implement regulations to control the pervasive use of substances by young people around educational institutions at all levels. PROTOCOL REGISTRATION The protocol has been registered on 19 August 2019 on the International Prospective Register of Systematic Reviews (PROSPERO) with ID: CDR42019130560.
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Affiliation(s)
- Hirbo Shore Roba
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Berhe Gebremichael
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Hassen Abdi Adem
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Addisu Shunu Beyene
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Research Centre for Generational Health and Ageing, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
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Rather RA, Berhanu S, Abaynah L, Sultan M. Prevalence of Khat ( Catha edulis) Chewing and Its Determinants: A Respondent-Driven Survey from Hossana, Ethiopia. Subst Abuse Rehabil 2021; 12:41-48. [PMID: 34429682 PMCID: PMC8375584 DOI: 10.2147/sar.s324711] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/03/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Ethiopia is a leading khat producer in East Africa, and almost all regions are involved in khat production. Hossana, a small town in Southern Ethiopia, is also actively involved in khat production and its use. However, very few studies have been conducted to investigate the habit of khat chewing in this area. This study was conducted to assess the prevalence and predictors of khat chewing among Hossana residents. METHODS The study was conducted on 1700 individuals in Hossana town from March 2018 to June 2019. A structured pre-tested self-administered questionnaire was designed and used for data collection. Descriptive statistics and logistic regression were carried out to study the prevalence and predictors of khat chewing in the study area. RESULTS The overall prevalence of khat chewing among the respondents was 58.0% (95% CI 53.4-63.3) of which 68.4% were daily khat users and 31.5% used it occasionally. About 24.7% of females and 75.2% of males had chewed khat. Muslim religion (AOR 2.37; 95% CI 1.58-4.32), male gender (AOR 3.48; 95% CI 2.16-5.61), Older age (AOR 1.36; 95% CI 0.84-2.21), participants having habitual khat chewing friends or a khat chewer family associate (OR 1.70; 95% CI 1.17-2.20) were found to be independent predictors of chewing. CONCLUSION Significant portion of the population in the study area chew khat. Khat use is significantly associated with the Muslim religion, gender, age, and habit of family and friends. Further studies with larger demographic area are warranted from the study area to reproduce these findings.
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Affiliation(s)
- Riyaz Ahmad Rather
- Department of Biotechnology, College of Natural and Computational Science, Wachemo University, Hossana, Ethiopia
| | - Solomon Berhanu
- Department of Biotechnology, College of Natural and Computational Science, Wachemo University, Hossana, Ethiopia
| | - Lemma Abaynah
- Department of Biotechnology, College of Natural and Computational Science, Wachemo University, Hossana, Ethiopia
| | - Mohammed Sultan
- Department of Statistics, College of Natural and Computational Science, Wachemo University, Hossana, Ethiopia
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Chong ZX, Ho WY, Yan P, Alshagga MA. Evaluation of Khat (Catha edulis) Use as a Risk Factor of Cancer: A Systematic Review. Asian Pac J Cancer Prev 2020; 21:881-895. [PMID: 32334447 PMCID: PMC7445961 DOI: 10.31557/apjcp.2020.21.4.881] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Indexed: 12/17/2022] Open
Abstract
Background: Conducting systematic review to evaluate plant use as a risk factor to cancer could be challenging. A systematic and well-balanced method should be applied to accommodate in vivo and in vitro studies to make a final decision. In this article, khat, a recreational plant used in some Arabic and African regions, was employed as an example to systematically determine its relationships to the premalignant and cancerous conditions. Methods: Systematic database search was performed to recruit original human, animal or in vitro studies on khat and cancer. Sixteen studies fulfilled the inclusion criteria and subjected to assessment using Risk of Bias (RoB). Office of Health and Translation (OHAT) approach was used to rate the confidence level in the body of evidence. The evidence was integrated to establish the relationships between khat, premalignant conditions and cancer. Results: Seven out of eight studies showed that khat causes premalignant oral lesions with moderate evidence level. Four studies showed that khat causes cancer with low evidence level and another three studies showed that khat has anti-cancer effect with moderate to high evidence level. Only one study suggested that khat is unrelated to cancer. Conclusion: RoB and OHAT approach are reliable systematic tools to evaluate plant risk to cancer and provide objective and uniform summary regardless of the study type. In conclusion, our pooled analysis did not find a direct relationship between khat and cancer but anti-cancer effect would require to be proofed on human studies.
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Affiliation(s)
- Zhi Xiong Chong
- Division of Biomedical Sciences, School of Pharmacy, University of Nottingham Malaysia
| | - Wan Yong Ho
- Division of Biomedical Sciences, School of Pharmacy, University of Nottingham Malaysia
| | - Pan Yan
- Division of Biomedical Sciences, School of Pharmacy, University of Nottingham Malaysia
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Alemu WG, Zeleke TA, Takele WW, Mekonnen SS. Prevalence and risk factors for khat use among youth students in Ethiopia: systematic review and meta-analysis, 2018. Ann Gen Psychiatry 2020; 19:16. [PMID: 32165908 PMCID: PMC7061479 DOI: 10.1186/s12991-020-00265-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 02/21/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Khat use is a widely spreading public health problem affecting the most economically productive population areas in Ethiopia. Khat use among students has been linked with mental, physical, social, and psychological problems. Reliable prevalence has not been recognized because of varying published rates. The objective of this systematic review and meta-analysis is to synthesize evidence on the prevalence and potential risk factors of khat use in Ethiopia. METHODS We found 284 studies of which 266 were removed due to duplication, irrelevant topics, and other reasons, respectively. All studies conducted in Ethiopia on khat chewing among students irrespective of time frame were included. Subsequently, 18 studies were used for synthesis of prevalence. Figures were extracted from published reports, and any lost information was requested from investigators. The quality of the included literature was evaluated by using the Newcastle-Ottawa Scale (NOS). Prevalence was pooled using random-effects meta-analyses. The presence of association was declared using P-values and an odds ratio with a corresponding 95% CI. RESULTS The pooled prevalence of khat use among students was 16.7% (13.7-19.7%). In the subgroup analysis, the highest prevalence was observed in the Oromia region, at 21.1% (15.5%, 26.7%), and an almost equal prevalence of 14.8% (10.6, 18.9) and 14.3% (10.3, 18.3) was observed in Amhara and the Southern Nation, Nationalities, and People's Region of Ethiopia, respectively. Being male (OR: 2.43 (1.73, 3.13)), being a Muslim religion follower (OR: 2.22 (1.6, 2.8)), being an alcohol user (OR: 2.3 (1.5, 3.0)), khat use by a family member (OR: 1.8 (1.4, 2.2)), peer pressure (OR: 4.4 (3.1, 5.6)), and being a cigarette smoker (OR: 8.5 (5.3, 11.7)) were found to be risk factors for khat chewing. CONCLUSIONS Khat use is a common problem among students. Health promotion, awareness on effect of khat, set policy on khat and substance use on the male sex, Muslim religion, alcohol user, having a family-member khat user, peer pressure, and being a cigarette smoker as possible risk factors for khat use among students. LIMITATIONS Irrespective of time restriction, all studies conducted in Ethiopia are included and cross-sectional in nature. Protocol no. CRD-42017081886.
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Affiliation(s)
- Wondale Getinet Alemu
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Tadele Amare Zeleke
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Wubet Worku Takele
- Department of Community Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Shegaye Shumet Mekonnen
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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Gizaw AT, Amdisa D, Lemu YK. Predictors of substance use among Jimma University instructors, Southwest Ethiopia. Subst Abuse Treat Prev Policy 2020; 15:2. [PMID: 31915036 PMCID: PMC6950981 DOI: 10.1186/s13011-019-0248-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 12/13/2019] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Use of substances such as alcohol, khat leaves (Catha edulis) and tobacco has become one of the rising major public health and socioeconomic problems worldwide and dramatically increased in developing countries. The aim of this study was to assess the predictors of substance use among Jimma University instructors. METHOD Institutional based cross-sectional study design was conducted in 2018 among Jimma University instructors. A two-stage cluster sampling procedure was employed to select study participants by their departments and data was collected using structured, self-administered questionnaire with severity assessed by the standardized fifth version of a diagnostic statistical manual of mental health criteria for substance use disorder. Multivariate logistic regression was used to identify independent predictors of substance use. Variables with a P-value < 0.05 in the final fitting model were declared to be associated with the outcome variable. RESULTS A total of 330 instructors were involved in this study, with a response rate of 96.2%. About 225 of the respondents have ever used the substance in life (khat, alcohol, or cigarette or all) making the lifetime prevalence of substance use 68.2%. The lifetime prevalence of khat chewing, alcohol use, and smoking cigarette was 51.6, 81.3, and 17.3% respectively. The prevalence of substance uses disorder among users was 36.9%. Living with family (AOR = 0.220 [2.004-8.536] 95%CI), no family substance use history (AOR = 0.220 [0.098-0.495] 95% CI), friends substance use (AOR = 9.047 [4.645-17.620] 95% CI), Social norm favors substance use, (AOR = 1.123 [1.020-1.238] 95% CI), perceived benefit of substance use (AOR = 1.077 [1.008-1.151] 95% CI) were predictors of substance use. CONCLUSION Perception toward substance, the influence of family and peer were associated with substance use. Therefore, designing a multifaceted approach directed to an individual, interpersonal and community-level intervention targeted to substance misperception and social norms contributing to substance use.
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Affiliation(s)
- Abraham Tamirat Gizaw
- Institute of Health, Faculty of Public Health, Department of Health, Behavior, and society, Jimma University, Jimma, Ethiopia.
| | - Demuma Amdisa
- Institute of Health, Faculty of Public Health, Department of Health, Behavior, and society, Jimma University, Jimma, Ethiopia
| | - Yohannes Kebede Lemu
- Institute of Health, Faculty of Public Health, Department of Health, Behavior, and society, Jimma University, Jimma, Ethiopia
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Prevalence of lifetime substances use among students in Ethiopia: a systematic review and meta-analysis. Syst Rev 2019; 8:326. [PMID: 31837700 PMCID: PMC6911280 DOI: 10.1186/s13643-019-1217-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 11/04/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The use of substances is a growing concern in Ethiopia, and their impacts on younger generation have been a concern of different professionals. Even though students are at high-risk of substance abuse, there is lack of comprehensive evidence for policy decision on substance use among students. Therefore, the aim of this systematic review and meta-analysis was to estimate the prevalence of common substances among students in Ethiopia. METHOD A comprehensive literature searches were done from biomedical databases: PubMed/Medline, African Journal Online, HINARI, Science Direct, and Google Scholar for article published until Dcember 31, 2017, and Addis Ababa Uiversity's electronic library search of unpublished thesis and dissertations. Two authors autonomously selected studies, extracted data, and evaluated quality of studies. The prevalence of lifetime substances use was estimated using the random effects model. Q and I2 statistics were computed to measure the extents of heterogeneity. RESULTS A total 676 study articles were identified from electronic databases, and 28 of them were included in meta-analysis. The analysis revealed that the lifetime prevalence of any substance use was 52.5% (95% CI 42.4-62.4%), khat 24.7% (95% CI 21.8-27.7%), alcohol 46.2% (95% CI 40.3-52.2%), and smoking cigarette 14.7% (95% CI 11.3-18.5%). Significant heterogeneity was observed but there was no significant publication bias. The lifetime prevalence of khat, alcohol, and cigarette smoking among high school vs university students was 22.5% (95% CI 15.2-30.7%) vs 25.1% (95% CI 21.9-28.5%), 41.4% (95% CI 22.1-62.1%) vs 47.8% (95% CI 39.9-55.7%), and 21.5% (95% CI 12.6-32.1%) vs 12.9% (95% CI 10.1-16.0%), respectively. CONCLUSION This meta-analysis highlighted the extent of lifetime prevalence of any substance, khat, alcohol, and cigarettes smoking among students in Ethiopia. Significant percent of high school students have exposed to substances. Policy makers should devise and implement strictly binding regulation to curb widespread of substances around educational institution premises at national level. Priority should be given to intervention strategies that help delay first use of substance to prevent problems later in life. Besides, the problem warrants regular national-level educational institutions based studies focusing on the magnitude, trajectory, and consequences of substance use among students. Systematic review registration: PROSPERO CRD42018082635.
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Yeshaw Y, Zerihun MF. Khat chewing prevalence and correlates among university staff in Ethiopia: a cross-sectional study. BMC Res Notes 2019; 12:673. [PMID: 31639065 PMCID: PMC6805344 DOI: 10.1186/s13104-019-4706-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 10/03/2019] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Khat is an herbal cultivated plant growing mainly in Eastern Africa and Arabians. Chronic khat chewing leads to the development of liver toxicity, cardiovascular disease, sleeping disorder, psychosis, memory impairment, poor academic performance and variety of social and economic problems affecting the consumers and their families. Therefore, this study aimed to determine the prevalence of khat chewing and associated factors among Jimma university staff. An institution-based cross-sectional study was employed on 354 university staff. A self-administered questionnaire was used to collect the data. The analysis was done using Stata 14. A multivariable logistic regression model was used to identify associated factors of khat chewing among university staff. p ≤ 0.05 was employed to declare statistically significant factors. RESULTS The lifetime prevalence of khat chewing among university staff was 41.0% (95% CI 35.9-46.1%). The odds of khat chewing was higher among males (AOR = 2.66 95%, CI 1.52-4.68), participants who had khat chewer friends (AOR = 2.15 95% CI 1.18-3.93), alcohol users (AOR = 9.02, 95% CI 4.96-16.42) and participants who had khat chewer family member (AOR = 4.03, 95% CI 1.16-13.99). Since a significant proportion of staff chew khat, appropriate measures need to be taken to reduce its prevalence and adverse social and health consequences.
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Affiliation(s)
- Yigizie Yeshaw
- Department of Medical Physiology, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Muluken Fekadie Zerihun
- Department of Biochemistry, College of Medicine and Health Sciences, Gondar University, Gondar, Ethiopia
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Dagnew B, Yeshaw Y. Predictors of isolated systolic hypertension among type 2 diabetes mellitus patients in Jimma University Specialized Hospital, Southwest Ethiopia. BMC Res Notes 2019; 12:510. [PMID: 31416481 PMCID: PMC6694682 DOI: 10.1186/s13104-019-4550-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 08/10/2019] [Indexed: 12/17/2022] Open
Abstract
Objectives Systolic blood pressure rise among T2DM patients was main risk factor for cardiovascular disease. Objective of this study was to identify predictors of isolated systolic hypertension among T2DM patients at Jimma University Specialized Hospital, 2016. We conducted cross sectional study using simple random sampling and interviewer administered questionnaire. Isolated systolic hypertension is SBP ≥ 140 mmHg and < 90 mmHg. Data entered and analyzed using Epi Data and SPSS respectively. Predictor factor was declared at p < 0.05. Results A total of 315 T2DM took part. Prevalence of ISH was 27.6% [95% CI (22.7, 32.5%)]. One hundred sixty and two (51.4%) patients were males with mean age of 54.1 from 22 to 87 years. Male sex [AOR = 2.4, 95% CI 1.21–4.72, p = 0.012], unemployment [AOR = 3.22, 95% CI 1.48–7.03, p = 0.003], age of 47–55 [AOR = 2.63, 95% CI 1.03–6.70, p = 0.044], single [AOR = 2.26, 95% CI 1.13–4.51, p = 0.021], ≤ Grade 8 [AOR = 2.94, 95% CI 1.10–7.85, p = 0.03] and income (ETB) 501–800 [AOR = 21.9, 95% CI 7.62–63.1, p < 0.001], 801–1500 [AOR = 5.78, 95% CI 2.55–13.1, p < 0.001] and > 1500 [AOR = 4.23, 95% CI 1.74–10.30, p = 0.001] were significant factors of ISH. The health sector has to establish preventive strategies for ISH among T2DM patients by giving special attention to predictor factors. Electronic supplementary material The online version of this article (10.1186/s13104-019-4550-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Baye Dagnew
- Department of Human Physiology, University of Gondar, P.O. Box 196, Gondar, Ethiopia.
| | - Yigizie Yeshaw
- Department of Human Physiology, University of Gondar, P.O. Box 196, Gondar, Ethiopia
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Guliani H, Gamtessa S, Çule M. Factors affecting tobacco smoking in Ethiopia: evidence from the demographic and health surveys. BMC Public Health 2019; 19:938. [PMID: 31299938 PMCID: PMC6624889 DOI: 10.1186/s12889-019-7200-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 06/19/2019] [Indexed: 01/27/2023] Open
Abstract
Background Tobacco smoking is growing at an alarming rate in the developing world and sub-Saharan Africa. Although Ethiopia has a relatively low rate in the region, it is not immune to the tobacco epidemic. The government of Ethiopia passed an anti-tobacco bill in 2015 that includes measures governing tobacco consumption, advertising, packaging, and labeling. To effectively address the challenge of tobacco control, the government should consider a number of aspects of tobacco production and consumption, such as local production in rural areas, as well as the complementarity nature of tobacco and khat use. Methods Using the World Bank’s Demographic and Health Surveys (2011 and 2016), this paper analyzes the key determinants of tobacco smoking in Ethiopia, emphasizing possible differences in various social contexts, across regions. More specifically, we assess the association between khat use and tobacco smoking while controlling for various observed individual-level, household-level, and community-level covariates. Using GPS data, we are able to capture the neighboring effects of smoking behavior in community clusters bordering other administrative regions as well as differences in smoking patterns between lowland and highland residents. We utilize a multilevel modeling framework and use a two-stage residual inclusion estimation method that accounts for the endogeneity of khat and tobacco use. Results The results suggest that chewing khat and geographic regions are statistically significant determinants of tobacco smoking even after controlling for various socioeconomic and demographic factors. Altitude information analysis suggests that people living in lowlands are more likely to smoke compared to those living in highland areas. Additional analysis including interactions between regions and khat use indicate wide inter-regional variations in tobacco smoking by khat users. We also extend our analysis by interacting khat use with religious adherence. Results indicate a wide variation in tobacco smoking by khat chewers across different religious groups. Conclusions To effectively control tobacco smoking of the diverse communities in Ethiopia, policymakers should consider a multi-pronged policy approach that combines various policy tools that account for regional variation, the local social contexts, as well as the complementary nature of smoking and khat chewing practices. Electronic supplementary material The online version of this article (10.1186/s12889-019-7200-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Harminder Guliani
- Department of Economics, University of Regina, 3737 Wascana Parkway, Regina, SK, Canada.
| | - Samuel Gamtessa
- Department of Economics, University of Regina, 3737 Wascana Parkway, Regina, SK, Canada
| | - Monika Çule
- Department of Economics, University of Regina, 3737 Wascana Parkway, Regina, SK, Canada
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Petersen AB, Thompson LM, Dadi GB, Tolcha A, Cataldo JK. An exploratory study of knowledge, attitudes, and beliefs related to tobacco use and secondhand smoke among women in Aleta Wondo, Ethiopia. BMC WOMENS HEALTH 2018; 18:154. [PMID: 30249233 PMCID: PMC6154788 DOI: 10.1186/s12905-018-0640-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 08/28/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND By 2030, the Sub-Saharan African region is projected to be the epicenter of the tobacco epidemic. While smoking prevalence is currently low among women (< 2%), the prevalence among men (7.7% overall and up to 27% depending on region) makes exposure to secondhand smoke a pressing concern for women and children. To prevent the uptake of smoking among women and address tobacco-related risks, including secondhand smoke exposure, a greater understanding of women's related perceptions is needed. The purpose of this study was to explore Ethiopian women's knowledge, attitudes, and beliefs related to tobacco use and secondhand smoke exposure, and the potential influence of contextual factors including; khat use, exposure to pro- and anti-tobacco messaging, and religious affiliation. METHODS A cross-sectional study using a systematic household sampling technique and an adapted interviewer-administered survey was conducted in Southern Ethiopia. The survey was administered to 353 women, 18-55 years of age, in Aleta Wondo town and surrounding districts between August-October 2014 (95.2% cooperation rate). RESULTS General awareness of harm associated with personal tobacco use and exposure to secondhand smoke was high (> 94%); however, specific knowledge of associated health-risks was limited. More than 96% perceived female tobacco use as socially unacceptable. At the same time, more than 70% were able to name potential benefits of using tobacco for both personal consumption and non-personal use. Respondents reported greater experimentation with khat versus tobacco and 73% reported that their religion significantly influenced their tobacco-related attitudes. Overall, there were higher reports of exposure to anti-tobacco (70%) versus pro-tobacco (49%) messaging, in the last 30 days. CONCLUSIONS The high level of awareness of health risks associated with tobacco use and SHS exposure and the high exposure to anti-tobacco messaging are community-level strengths that can proactively be built on to prevent the projected disease burden associated with tobacco. Findings have implications for the development of contextualized gender-specific tobacco control interventions, particularly in relation to the promotion of smoke-free homes.
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Affiliation(s)
- Anne Berit Petersen
- School of Nursing, Loma Linda University, West Hall, 11262 Campus Street, Loma Linda, CA, 92350, USA. .,Department of Physiological Nursing and Center for Tobacco Control Research and Education, University of California, San Francisco, 2 Koret Way, N611Q, San Francisco, CA, 94143, USA.
| | - Lisa M Thompson
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Suite 226, Atlanta, GA, 30322, USA
| | - Gezahegn Bekele Dadi
- School of Nursing and Midwifery, College of Medicine and Health Sciences, Hawassa University, PO Box 1560, Hawassa, Ethiopia
| | - Alemu Tolcha
- School of Public and Environmental Health, College of Medicine and Health Sciences, Hawassa University, PO Box 1560, Hawassa, Ethiopia
| | - Janine K Cataldo
- Department of Physiological Nursing and Center for Tobacco Control Research and Education, University of California, San Francisco, 2 Koret Way, N611Q, San Francisco, CA, 94143, USA
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Gebrie A, Alebel A, Zegeye A, Tesfaye B. Prevalence and predictors of khat chewing among Ethiopian university students: A systematic review and meta-analysis. PLoS One 2018; 13:e0195718. [PMID: 29649253 PMCID: PMC5896981 DOI: 10.1371/journal.pone.0195718] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 03/28/2018] [Indexed: 12/16/2022] Open
Abstract
Background Khat chewing has become a common practice among university students in developing countries like Ethiopia. It has a potential effect on physical, mental, social and cognitive aspects of student functioning. In Ethiopia, study findings regarding the prevalence of khat chewing were highly dispersed and inconsistent. Therefore, this systematic review and meta-analysis estimates the pooled prevalence of khat chewing and its predictors among Ethiopian university students. Method A systematic review and meta-analysis was conducted to assess the prevalence and predictors of khat chewing among university students in Ethiopia. We searched literature from the databases of PubMed, Google Scholar, Science Direct, and the Cochrane Library. A total of 24 Ethiopian studies reporting the prevalence of khat chewing among university students were included. Data were extracted using a standardized data extraction format prepared in Microsoft Excel and the analysis was done using STATA 14 statistical software. To assess heterogeneity, the Cochrane Q test statistics and I2 test were used. Since the included studies exhibit high heterogeneity, a random effect meta-analysis model was computed to estimate the pooled prevalence of khat chewing. Moreover, the association between predictor variables, and khat chewing practice were examined. Results The meta-analysis of 24 studies revealed that the pooled prevalence of khat chewing among university students in Ethiopia was 23.22% (95% CI: 19.5, 27.0). In the subgroup analysis, the highest prevalence was observed in Oromia region (31.6%; 95CI: 21.2, 41.9) whereas the lowest prevalence was observed in Amhara region (18.1%; 95%CI: 12.4, 23.8). Being male OR: 2.76 (95% CI 1.64, 4.63), family khat chewing practice OR: 2.91 (95% CI 1.06, 7.98), friend khat chewing habit OR: 4.74 (95% CI 3.48, 13.06), alcohol drinking OR: 7.06 (95% CI 5.65, 8.82) and cigarette smoking habit OR: 15.11 (95% CI 8.96, 25.51) were found to be predictors of khat chewing. Conclusion The study found that the prevalence of khat chewing among university students was quite common, with slightly more than 1 in 5 students engaging in the use of this substance. Being male, family khat chewing practice, friend’s khat chewing habit, alcohol drinking, and cigarette smoking were found to be predictors of khat chewing practice among university students.
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Affiliation(s)
- Alemu Gebrie
- Department of Biomedical Science, School of Medicine, Debre Markos University, Debre Markos, Ethiopia
- * E-mail:
| | - Animut Alebel
- Department of Nursing, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Abriham Zegeye
- Department of Biomedical Science, School of Medicine, Debre Markos University, Debre Markos, Ethiopia
| | - Bekele Tesfaye
- Department of Nursing, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
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Allen L, Williams J, Townsend N, Mikkelsen B, Roberts N, Foster C, Wickramasinghe K. Socioeconomic status and non-communicable disease behavioural risk factors in low-income and lower-middle-income countries: a systematic review. Lancet Glob Health 2017; 5:e277-e289. [PMID: 28193397 PMCID: PMC5673683 DOI: 10.1016/s2214-109x(17)30058-x] [Citation(s) in RCA: 346] [Impact Index Per Article: 49.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 11/24/2016] [Accepted: 12/12/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Non-communicable diseases are the leading global cause of death and disproportionately afflict those living in low-income and lower-middle-income countries (LLMICs). The association between socioeconomic status and non-communicable disease behavioural risk factors is well established in high-income countries, but it is not clear how behavioural risk factors are distributed within LLMICs. We aimed to systematically review evidence on the association between socioeconomic status and harmful use of alcohol, tobacco use, unhealthy diets, and physical inactivity within LLMICs. METHODS We searched 13 electronic databases, including Embase and MEDLINE, grey literature, and reference lists for primary research published between Jan 1, 1990, and June 30, 2015. We included studies from LLMICs presenting data on multiple measures of socioeconomic status and tobacco use, alcohol use, diet, and physical activity. No age or language restrictions were applied. We excluded studies that did not allow comparison between more or less advantaged groups. We used a piloted version of the Cochrane Effective Practice and Organisation of Care Group data collection checklist to extract relevant data at the household and individual level from the included full text studies including study type, methods, outcomes, and results. Due to high heterogeneity, we used a narrative approach for data synthesis. We used descriptive statistics to assess whether the prevalence of each risk factor varied significantly between members of different socioeconomic groups. The study protocol is registered with PROSPERO, number CRD42015026604. FINDINGS After reviewing 4242 records, 75 studies met our inclusion criteria, representing 2 135 314 individuals older than 10 years from 39 LLMICs. Low socioeconomic groups were found to have a significantly higher prevalence of tobacco and alcohol use than did high socioeconomic groups. These groups also consumed less fruit, vegetables, fish, and fibre than those of high socioeconomic status. High socioeconomic groups were found to be less physically active and consume more fats, salt, and processed food than individuals of low socioeconomic status. While the included studies presented clear patterns for tobacco use and physical activity, heterogeneity between dietary outcome measures and a paucity of evidence around harmful alcohol use limit the certainty of these findings. INTERPRETATION Despite significant heterogeneity in exposure and outcome measures, clear evidence shows that the burden of behavioural risk factors is affected by socioeconomic position within LLMICs. Governments seeking to meet Sustainable Development Goal (SDG) 3.4-reducing premature non-communicable disease mortality by a third by 2030-should leverage their development budgets to address the poverty-health nexus in these settings. Our findings also have significance for health workers serving these populations and policy makers tasked with preventing and controlling the rise of non-communicable diseases. FUNDING WHO.
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Affiliation(s)
- Luke Allen
- British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Julianne Williams
- British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Nick Townsend
- British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - Bente Mikkelsen
- WHO Global Coordination Mechanisms on the Prevention and Control of Non-communicable diseases, WHO, Geneva, Switzerland
| | - Nia Roberts
- Health Care Libraries, Bodleian Libraries, University of Oxford, Oxford, UK
| | - Charlie Foster
- British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Kremlin Wickramasinghe
- British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Duresso SW, Matthews AJ, Ferguson SG, Bruno R. Is khat use disorder a valid diagnostic entity? Addiction 2016; 111:1666-76. [PMID: 27061394 DOI: 10.1111/add.13421] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 12/08/2015] [Accepted: 03/31/2016] [Indexed: 11/26/2022]
Abstract
AIMS This study aimed to validate the presence of a khat use disorder syndrome using DSM-5 criteria and to examine its relationship with increased experience of harms. DESIGN Cross-sectional, purposive sample of current khat-chewers, recruited from khat markets and cafes. SETTING Participants were recruited from the general community and from Adama Science and Technology University in Ethiopia. PARTICIPANTS A total of 400 current khat consumers aged 16 and above were recruited between September 2014 and January 2015 MEASURES: Survey comprising current clinical symptoms (using a modified Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV), and validated measures of health, psychological distress, quality of life and academic functioning. FINDINGS A third [35.5% 95% confidence interval (CI) = 31.0-40.3] of respondents reported daily khat use and a quarter (25.4% 95% CI = 21.4-30.0) using three times or more per week. Using DSM-5 criteria, 10.5% (95% CI = 7.9-13.9) were categorized as experiencing mild, 8.8% (95% CI = 6.4-12.0) moderate and 54.5% (95% CI = 49.6-59.3) severe khat use disorder. Confirmatory factor analysis demonstrated a good fit of symptoms to a single underlying construct, consistent with other substance use disorders. Individuals categorized as experiencing khat use disorder demonstrated significantly greater frequency [odds ratio (OR) = 45.29; 95% CI = 10.97-19.01) and quantity of khat use (OR = 2.35; 95% CI = 1.29-4.29). They also demonstrated increased financial problems associated with use, greater problems with academic functioning and higher rates of self-reported mental health problems, higher psychological distress and poorer quality of life. Treatment access was poor, with only one-third (32.9%) of individuals with khat use disorder reporting life-time access, near-exclusively related to help-seeking from friends and relatives. CONCLUSION The construct of a substance use disorder syndrome for khat using DSM-5 criteria appears valid and performs in a manner consistent with other substances of dependence. Individuals with khat use disorder experience substantial problems in association with khat use. Despite this, there are low levels of help-seeking for these problems.
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Affiliation(s)
| | | | | | - Raimondo Bruno
- School of Medicine, University of Tasmania, Hobart, Australia
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Kassa A, Wakgari N, Taddesse F. Determinants of alcohol use and khat chewing among Hawassa University students, Ethiopia: a cross sectional study. Afr Health Sci 2016; 16:822-830. [PMID: 27917217 PMCID: PMC5111982 DOI: 10.4314/ahs.v16i3.24] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Students' alcohol and khat use have been associated with various health related problems. However, its magnitude and associated factors among Ethiopian students are not yet well documented. OBJECTIVE The study aimed to assess the prevalence of alcohol use, khat chewing and its associated factors among Hawassa University students. METHODS A cross-sectional study was conducted from June to July 2011. Multistage stratified sampling technique was employed to select 590 students. Self administered questionnaires were used to collect data. Data was entered and analysed by SPSS version 20.0. Logistic regression analyses were used to identify the association of different variables. RESULTS The current prevalence of student's alcohol and khat use were 29.5% (95% CI: 25.8-33.3) and 16.3% (95% CI: 13.7-20.0) respectively. Being male (AOR 1.8; 95% CI 1.1-3.0) and living alone (AOR 20.1; 95% CI 2.5-166.7) had a higher odds of alcohol use. Similarly, family substance use history (AOR 4.8; 95% CI 2.5-9.3) and peer influence (AOR 4.6; 95% CI 2.3-9.0) had also higher odds of khat use. CONCLUSION AND RECOMMENDATION The proportion of student's khat chewing and alcohol use was significant. Hence, higher education in collaboration with other stakeholders should work on convincing students about the ill effects of these substances.
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Affiliation(s)
- Andargachew Kassa
- School of Nursing and Midwifery, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Negash Wakgari
- School of Nursing and Midwifery, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Fiker Taddesse
- School of Medicine, Pharmacology Unit, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
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Hagos EG, Asfeha GG, Berihu BA. Prevalence of substance abuse among regular degree health science students in Sheba University College in Mekelle Town, Tigray - Ethiopia. J Neurosci Rural Pract 2016; 7:200-5. [PMID: 27114648 PMCID: PMC4821925 DOI: 10.4103/0976-3147.178670] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background: Substance abuse (SA) refers to the harmful or hazardous use of psychoactive substances, including alcohol and illicit drugs. The most common substances which are usually abused are alcohol and tobacco. Herein, we assessed the prevalence of SA among regular degree health science students of the Sheba University College (SUC). Materials and Methods: A cross-sectional survey was carried out among 1076 SUC students using self-administered structured questionnaire. The simple sampling technique was used to select students. Descriptive statistics, bivariate, and multivariate analysis were done. Results: The overall prevalence of “ever used substance” for at least one was 45.5%. The most commonly used drugs in descending order were alcohol (25.1%), cigarette (11.4%), and khat (9.2%). Male participants, urban setting, peer pressure, personal pleasure, and academic dissatisfaction and pocket money were highly associated with SA. Conclusion: This study showed a lower magnitude (45.6% ever use and 21% still using) of SA among students' compared to other studies. Even if a considerable decrease in SA among study subjects, the creation of awareness and health education should be continued to fully combat the problem of abuse.
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Affiliation(s)
| | - Gebrekidan Gebregzabher Asfeha
- Department of Biochemistry, College of Health Sciences, Institute of Biomedical Sciences, Mekelle University, Mekelle, Ethiopia
| | - Birhane Alem Berihu
- Department of Anatomy and Histology, College of Health Sciences, Institute of Biomedical Sciences, Mekelle University, Mekelle, Ethiopia
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Kassim S, Jawad M, Croucher R, Akl EA. The Epidemiology of Tobacco Use among Khat Users: A Systematic Review. BIOMED RESEARCH INTERNATIONAL 2015; 2015:313692. [PMID: 26273606 PMCID: PMC4529904 DOI: 10.1155/2015/313692] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 04/30/2015] [Indexed: 01/12/2023]
Abstract
Khat, an "amphetamine-like green leaf," may influence the consumption of tobacco. This study reviews the epidemiology of tobacco use among khat users. Electronic database searches using appropriate keywords/terms were conducted to identify observational studies of khat use. Assessment of quality and risk of bias of all included studies was conducted, and the results were synthesised descriptively. Nine eligible cross-sectional studies were identified. All assessed self-reported tobacco among khat users and were carried out in Africa and the Middle East. Eight reported cigarettes and one reported waterpipes as the mode of use. Methods of tobacco use prevalence assessment varied. Prevalence of "current" tobacco use among students and university teachers ranged from 29 to 37%; "lifetime" tobacco use in university teachers was 58% and "undefined" tobacco use in nonspecific adults and students ranged from 17 to 78%. Daily tobacco use among adults was reported as 17% whilst simultaneous tobacco and khat use was reported as between 14 and 30% in students. In conclusion, tobacco prevalence among khat users appears significant. Findings should be interpreted cautiously due to self-reported tobacco use, diversity in questions assessing tobacco use, and type of tobacco consumption. Future research should address the methodological shortcomings identified in this review before appropriate policy interventions can be developed.
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Affiliation(s)
- Saba Kassim
- Barts and The London School of Medicine and Dentistry and Institute of Dentistry, Queen Mary University of London, London E1 2AT, UK
| | - Mohammed Jawad
- Department of Primary Care and Public Health, Imperial College London, London W6 8RP, UK
- Academic Unit of Primary Care and Population Sciences, University of Southampton, Southampton SO16 6YD, UK
| | - Ray Croucher
- Barts and The London School of Medicine and Dentistry and Institute of Dentistry, Queen Mary University of London, London E1 2AT, UK
| | - Elie A. Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
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Kassim S, Rogers N, Leach K. The likelihood of khat chewing serving as a neglected and reverse 'gateway' to tobacco use among UK adult male khat chewers: a cross sectional study. BMC Public Health 2014; 14:448. [PMID: 24885131 PMCID: PMC4039549 DOI: 10.1186/1471-2458-14-448] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 05/01/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chewing khat leaves is often accompanied by tobacco use. We assessed aspects of tobacco use and explored factors associated with tobacco use patterns (frequency of use per week) among khat chewers who used tobacco only when chewing khat ("simultaneous tobacco and khat users", STKU). METHODS A sample of 204 male khat chewers was recruited during random visits to khat outlets. Data collected included socio-demographic items, tobacco use and khat chewing behaviours. Both psychological and physical dependence on khat were assessed using the Severity of Psychological Dependence on Khat (SDS-Khat) Scale, the Diagnostic Statistical Manual IV (DSM-IV) and adapted items from the Fagerström Test for Nicotine Dependence (chewing even when ill, and difficulty in abstaining from khat chewing for an entire week). Descriptive statistics and non-parametric analyses were conducted. RESULTS Of the 204 khat chewers, 35% were khat chewers only, 20% were STKU, and the remainder were daily cigarette smokers. The mean age of STKU was 38.12 (±14.05) years. Fifty seven percent of STKU smoked tobacco and chewed khat for two days per week and 43% smoked and chewed more frequently (three to six days: 33%, daily: 10%). Three quarters (74%) were former daily tobacco users. Khat chewing initiated tobacco smoking among 45% of STKU and 71% reported attempts to quit tobacco smoking during khat chew. Among STKU, smoking tobacco for more than two days per week was significantly associated (p < 0.05) with psychological dependence (increased levels of SDS-Khat), physical dependence (increased levels of DSM-IV symptoms, chewing even when ill, difficulty in abstaining from chewing for an entire week and self-reported health conditions) and behavioural factors (e.g. amount of khat chewed in typical khat session). CONCLUSIONS Khat chewing may promote different patterns of tobacco smoking, initiate and sustain tobacco smoking, and trigger tobacco cessation relapses among STKU. Increased frequency of tobacco smoking among STKU was linked to psycho-physical and behavioural factors. Further investigation within large and representative samples of both sexes of STKU in different contexts should be considered for health research and policy development. Khat chewing should be considered when designing tobacco prevention uptake, cessation interventions and relapse prevention programmes.
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Affiliation(s)
- Saba Kassim
- Institute of Dentistry, Queen Mary, University of London, Barts and The London School of Medicine and Dentistry, 4 Newark Street, London E1 2AT, UK
| | - Nikki Rogers
- Wright State University Boonshoft School of Medicine, Dayton 45420, OH, USA
| | - Kelly Leach
- Wright State University Boonshoft School of Medicine, Dayton 45420, OH, USA
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Reda AA, Kotz D, Biadgilign S. Adult tobacco use practice and its correlates in eastern Ethiopia: a cross-sectional study. Harm Reduct J 2013; 10:28. [PMID: 24171800 PMCID: PMC4175506 DOI: 10.1186/1477-7517-10-28] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2011] [Accepted: 10/27/2013] [Indexed: 11/17/2022] Open
Abstract
Background There is paucity of data on the smoking habits of rural populations in developing countries. This study aimed to explore cigarette smoking practices of a rural community in Ethiopia. Methods A community based cross-sectional study was conducted among 548 individuals from a random sample of households in a rural town and its surrounding rural districts. Descriptive statistics and logistic regression were performed. Results Twenty-eight percent (95% CI: 24.3% - 31.6%) of the respondents were current smokers. A total of 105 (68%) smokers expressed an interest to quit while 37 (34%) had tried to quit previously but without success. There was high exposure to second-hand smoke: 285 (52%) homes allowed indoor smoking, and in 181 (33%) indoor smoking took place daily. Current smoking was strongly associated with male sex (OR = 83.0; 95% CI: 11.5 – 599.0), and being a student was found to be protective of smoking (OR = 0.04; 95% CI: 0.005 – 0.05). Conclusion Cigarette smoking is prevalent among the male rural town population in Ethiopia. In addition, a high level of exposure to indoor second-hand smoke exists. There is a need for investment in rural tobacco control, including educational campaigns and cost-effective smoking cessation services.
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Affiliation(s)
- Ayalu Alex Reda
- Population Studies and Training Center, Brown University, Providence, RI, USA.
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Reda AA, Moges A, Yazew B, Biadgilign S. Determinants of cigarette smoking among school adolescents in eastern Ethiopia: a cross-sectional study. Harm Reduct J 2012; 9:39. [PMID: 23227891 PMCID: PMC3541105 DOI: 10.1186/1477-7517-9-39] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2011] [Accepted: 12/06/2012] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The World Health Organization (WHO) attributes more than 4 million deaths a year to tobacco, and it is expected that this figure will rise to 10 million deaths a year by 2020. Moreover, it is now a growing public health problem in the developing world. OBJECTIVE To assess the prevalence of cigarette use and its determinant factors among high school students in eastern Ethiopia. METHODS A cross-sectional study was conducted using structured self-administered questionnaires among 1,721 school adolescents in Harar town, eastern Ethiopia. Univariate and multivariate logistic regression analyses were performed to examine associations. RESULTS The analysis revealed that prevalence of ever cigarette smoking was 12.2% (95% CI 10.8% - 13.9%). Reasons mentioned for smoking cigarettes were for enjoyment (113, 52.8%), for trial (92, 42.9%), and for other reasons (9, 4.3%). The main predictors of cigarette smoking were sex (OR 4.32; 95% CI 2.59-7.22), age (OR 1.20; 95% CI 1.05-1.38) and having friends who smoke (OR 8.14; 95% CI 5.19-12.70). Living with people who smoke cigarettes was not significantly associated with smoking among adolescents (OR 1.25; 95% CI 0.81-1.92). CONCLUSION This study concluded that high proportion of school adolescents in Harar town smoked cigarettes. Sex, age and peer influence were identified as important determinants of smoking. There is a need for early cost-effective interventions and education campaigns that target secondary school students.
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Affiliation(s)
- Ayalu A Reda
- Department of Public Health, College of Health Sciences, Haramaya University, P.O. Box 235, Harar, Ethiopia
| | - Asmamaw Moges
- Department of Public Health, College of Health Sciences, Haramaya University, P.O. Box 235, Harar, Ethiopia
| | - Berhanu Yazew
- Department of Environmental Health Science, College of Health Sciences, Haramaya University, Harar, Ethiopia
| | - Sibhatu Biadgilign
- Department of Epidemiology and Biostatistics, College of Medical and Health Sciences, Jimma University, Jimma, Ethiopia
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Prevalence and determinants of khat (Catha edulis) chewing among high school students in eastern Ethiopia: a cross-sectional study. PLoS One 2012; 7:e33946. [PMID: 22479484 PMCID: PMC3316517 DOI: 10.1371/journal.pone.0033946] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Accepted: 02/22/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Use of psychoactive drugs such as khat leaves (Catha edulis) alter moods and emotional state and lead to adverse effects on the health and social life of users. Ethiopia is a major producer and exporter of khat in east Africa and the majority of the khat comes from the eastern part of the country, however, no studies have been conducted to investigate the habit in this area. This study was conducted to assess the prevalence and predictors of khat chewing among high school students in Harar, eastern Ethiopia. METHODOLOGY The study was conducted among 1,890 secondary school students in Harar town in April 2010. A structured self-administered questionnaire was used for data collection. Descriptive statistics and logistic regression were performed to examine the prevalence and predictors of khat chewing. RESULT The overall prevalence of khat chewing among the sample was 24.2% (95% CI 22.2%-26.2%). About 28.5% of females and 71.5% of males had chewed khat. Older age (OR 1.31; 95% CI 1.16-1.49), male gender (OR 2.10; 95% CI 1.50-2.93), Muslim religion (OR 1.88; 95% CI 1.17-3.04), having friends who chewed khat (OR 7.93; 95% CI 5.40-11.64), and availability of someone with a similar habit in the family (OR 1.50; 95% CI 1.07-2.11) were found to be independent predictors of chewing. CONCLUSION A significant proportion of students chew khat. The use of khat is significantly associated with age, gender, Muslim religion, peer influence and habit of family and other relatives among students. Measures such as educational campaigns need to be instituted to create awareness among school adolescents and their parents in order to reduce the prevalence of the habit and its adverse social and health consequences.
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Edwards R, Peace J, Stanley J, Atkinson J, Wilson N, Thomson G. Setting a good example? Changes in smoking prevalence among key occupational groups in New Zealand: evidence from the 1981 and 2006 censuses. Nicotine Tob Res 2011; 14:329-37. [PMID: 22140148 DOI: 10.1093/ntr/ntr218] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Role modeling by smokers may influence smoking among children and young adults. Most work on smoking by occupation has focused on health workers. A unique opportunity to explore smoking by occupation is presented in New Zealand (NZ) due to inclusion of a smoking status question in most national censuses since 1976. Our aim was to assess trends in smoking prevalence among potential role model occupational groups in NZ. METHODS Adult smoking status by occupation was obtained from the 1981 census (N = 1,321,323) and 2006 census (N = 1,744,479). Subjects were aggregated into 5 broad groups of potential role-model occupations: teachers, uniformed services, health-related occupations, public figures, and sportspeople/entertainers. Age and sex-standardized current smoking prevalences were calculated using the 2006 NZ employed population as the reference standard. RESULTS Standardized smoking prevalence among the employed population was 34.5% in 1981 and had declined 37% in relative terms and 12.8% in absolute terms to 21.7% in 2006. Relative declines in smoking prevalence between 1981 and 2006 ranged from 35% to 60% among the role model occupational groups and absolute declines from 8.3% to 19.9%. Māori had higher smoking prevalence and lower relative declines in prevalence in each occupational group from 1981 to 2006, compared with non-Māori. Specific occupations mostly had low smoking prevalences--particularly doctors and teachers. But some role model occupations had high crude smoking prevalences in 2006 (up to 47%). CONCLUSIONS Persisting high smoking prevalence among some occupational groups suggest that additional targeted smoking cessation support for role model occupational groups may be justified.
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Affiliation(s)
- Richard Edwards
- Department of Public Health, University of Otago, Wellington, New Zealand.
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Näyhä S, Kivastik J, Kingisepp PH, Heikkinen R. Smoking differences between employees in faculties of the University of Tartu, Estonia, and changes during the country's transition. BMC Public Health 2011; 11:153. [PMID: 21385456 PMCID: PMC3065408 DOI: 10.1186/1471-2458-11-153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Accepted: 03/08/2011] [Indexed: 11/13/2022] Open
Abstract
Background A previous study found marked differences in smoking between employees in various university faculties in Tartu, Estonia, soon after the disruption of communism. The present study was conducted to see whether such differences still exist and how the patterns had changed during the country's first transitional decade. Methods All employees at the University of Tartu (UT) were surveyed for smoking habits by means of a questionnaire in 1992 and 2003. The present paper is based on respondents whose faculty or workplace was known (1390 people in 1992, 1790 in 2003). Smoking differences were assessed in terms of regression-based adjusted figures. Results While 20% of the male employees smoked daily in 1992, 13% did so in 2003, the figures for females being 10% and 7%, respectively. The prevalence of men's daily smoking varied between faculties and other workplaces in the range 4-30% in 1992, and 0-24% in 2003, with corresponding ranges of 3-21% and 0-10% among females. Men in the medical faculty in both surveys, and those in the faculty of philosophy in the second survey showed higher rates than men in most other faculties, as did women in the faculty of law in the first survey and those in the faculty of philosophy in the second. The figures were usually low in the faculties of sports & exercise, physics & chemistry and mathematics. The sex pattern was reversed in the faculty of law and also in that of economics, where the women smoked more than the men. Conclusions Even in this low-smoking academic community, wide smoking differences existed between the faculties and other workplaces. Faculties where physical or mental performance is of prime importance are leading the way towards a smoke-free community, while men in the faculty of philosophy and, paradoxically, men in the medical faculty are lagging behind. The reversed sex ratio in the faculties of law and economics may indicate women's intensified drive for equality in this transitional society. We assume that different professional cultures may introduce variations in smoking patterns, thereby modifying the course of the smoking epidemic.
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Ageely HM. Prevalence of Khat chewing in college and secondary (high) school students of Jazan region, Saudi Arabia. Harm Reduct J 2009; 6:11. [PMID: 19545389 PMCID: PMC2707373 DOI: 10.1186/1477-7517-6-11] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Accepted: 06/20/2009] [Indexed: 01/22/2023] Open
Abstract
Background Khat is widely consumed among the youth of Jazan region of Saudi Arabia. However, its prevalence is not well documented. Objective This study was conducted to assess the prevalence and associated risk factors of khat chewing among college and secondary school students in Jazan region. Methods The study was conducted in May 2006 in the colleges and secondary schools in Jazan region. A sample of 10,000 students aged between 15 and 25 years was randomly selected. Students in each year of study were selected by systematic random sampling technique. Self-administered questionnaire was used for data collection. Results The overall prevalence of khat chewing in all the studied population was 21.4% (colleges 15.2% versus schools 21.5%). There were 3.8% female khat chewers and 37.70% male Khat chewers. Significant differences were found between khat chewers according to age, gender and residence (p < 0.05). The prevalence was different in different colleges and in different provinces of Jazan region. Conclusion The prevalence of Khat chewing seems to be high among male students and not remarkable among female students. The use of Khat is significantly associated with age, gender, residence and school and college education (p < 0.05) among students of Jazan region. Strong measures need to be taken for greater awareness among school and college students to reduce its prevalence.
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Affiliation(s)
- Hussein M Ageely
- Department of internal medicine, Jazan University, Jazan, Kingdom of Saudi Arabia.
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Manghi RA, Broers B, Khan R, Benguettat D, Khazaal Y, Zullino DF. Khat Use: Lifestyle or Addiction? J Psychoactive Drugs 2009; 41:1-10. [DOI: 10.1080/02791072.2009.10400669] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Odenwald M, Lingenfelder B, Schauer M, Neuner F, Rockstroh B, Hinkel H, Elbert T. Screening for posttraumatic stress disorder among Somali ex-combatants: a validation study. Confl Health 2007; 1:10. [PMID: 17822562 PMCID: PMC2020457 DOI: 10.1186/1752-1505-1-10] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2007] [Accepted: 09/06/2007] [Indexed: 11/22/2022] Open
Abstract
Background In Somalia, a large number of active and former combatants are affected by psychological problems such as Posttraumatic Stress Disorder (PTSD). This disorder impairs their ability to re-integrate into civilian life. However, many screening instruments for Posttraumatic Stress Disorder used in post-conflict settings have limited validity. Here we report on development and validation of a screening tool for PTSD in Somali language with a sample of ex-combatants. Methods We adapted the Posttraumatic Diagnostic Scale (PDS) to reflect linguistic and cultural differences within the Somali community so that local interviewers could be trained to administer the scale. For validation purposes, a randomly selected group of 135 Somali ex-combatants was screened by trained local interviewers; 64 of them were then re-assessed by trained clinical psychologists using the Composite International Diagnostic Interview (CIDI) and the Self-Report Questionnaire (SRQ-20). Results The screening instrument showed good internal consistency (Cronbach's α = .86), convergent validity with the CIDI (sensitivity = .90; specificity = .90) as well as concurrent validity: positive cases showed higher SRQ-20 scores, higher prevalence of psychotic symptoms, and higher levels of intake of the local stimulant drug khat. Compared to a single cut-off score, the multi-criteria scoring, in keeping with the DSM-IV, produced more diagnostic specificity. Conclusion The results provide evidence that our screening instrument is a reliable and valid method to detect PTSD among Somali ex-combatants. A future Disarmament, Demobilization and Reintegration Program in Somalia is recommended to screen for PTSD in order to identify ex-combatants with special psycho-social needs.
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Affiliation(s)
- Michael Odenwald
- University of Konstanz, Department of Psychology, Fach D25, 78457 Konstanz, Germany
- vivo international, Ancona, Italy
| | - Birke Lingenfelder
- University of Konstanz, Department of Psychology, Fach D25, 78457 Konstanz, Germany
| | - Maggie Schauer
- University of Konstanz, Department of Psychology, Fach D25, 78457 Konstanz, Germany
- vivo international, Ancona, Italy
| | - Frank Neuner
- University of Konstanz, Department of Psychology, Fach D25, 78457 Konstanz, Germany
- vivo international, Ancona, Italy
| | - Brigitte Rockstroh
- University of Konstanz, Department of Psychology, Fach D25, 78457 Konstanz, Germany
- vivo international, Ancona, Italy
| | - Harald Hinkel
- GTZ International Services, Addis Abbeba, Ethiopia, and The World Bank MDRP (Multi-Country Demobilization and Reintegration Program of the Greater Great Lakes Region in Africa), Goma, Democratic Republic of Congo
| | - Thomas Elbert
- University of Konstanz, Department of Psychology, Fach D25, 78457 Konstanz, Germany
- vivo international, Ancona, Italy
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Abstract
The habit of Catha edulis Forsk (khat) chewing has prevailed for centuries among populations in the horn of Africa and the Arabian peninsula. Fresh leaves of Catha edulis are customarily chewed to attain a state of stimulation. The fact that cathinone has a closer structural similarity with amphetamine, and both share common pharmacodynamic features, led to the conclusion that cathinone is the most important active ingredient of Catha edulis, which causes the major pharmacological effects. Problems associated with repeated consumption of Catha edulis leaves are becoming evident. Literature surveys and clinical diagnostic studies revealed an association with prevalence of psychiatric morbidity. Repeated intermittent oral administration of Catha edulis to laboratory animals lead to development and expression of locomotor sensitisation. Catha edulis also leads to several peripheral effects that include increases in blood pressure and has been associated with the increased incidence of acute coronary vasospasm and myocardial infarction. Catha edulis also accounts for a number of gastrointestinal tract problems, oesophagitis, gastritis and delay intestinal absorption, as well as the development of oral keratotic white lesions at the site of chewing. Administration of Catha edulis extracts showed a deranged systemic capacity to handle oxidative radicals and induces cytotoxic effects in cells of liver and kidney, as well as induction of cell death in various human leukaemia cell lines and in peripheral human blood leukocytes.
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Affiliation(s)
- Molham Al-Habori
- Department of Clinical Biochemistry, Faculty of Medicine and Health Sciences, University of Sana'a, P.O. Box 19065, Sana'a, Republic of Yemen.
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Banjaw MY, Fendt M, Schmidt WJ. Clozapine attenuates the locomotor sensitisation and the prepulse inhibition deficit induced by a repeated oral administration of Catha edulis extract and cathinone in rats. Behav Brain Res 2005; 160:365-73. [PMID: 15863233 DOI: 10.1016/j.bbr.2005.01.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2004] [Revised: 12/21/2004] [Accepted: 01/10/2005] [Indexed: 10/25/2022]
Abstract
Locomotor sensitisation and deficits in prepulse inhibition (PPI) induced by psychostimulants are two paradigms that have been widely studied as animal behavioural models of psychosis. Clozapine is one of the atypical antipsychotic agents which has been widely employed to reverse the aforementioned behavioural changes in these usual models. In this particular study, locomotor sensitisation and prepulse inhibition deficit were induced under the same context by intermittent oral administration of S-(-)-cathinone or Catha edulis extract in rats. The rats were then challenged by administration of the atypical antipsychotic drug, clozapine and were finally challenged with psychostimulants after 2-week of withdrawal. Locomotor activity and PPI were assessed and later analyses of the neurotransmitter levels were made. The results of this experiment show that repeated oral administration of cathinone or C. edulis extract enhanced locomotor and exploratory activity and lead to a gradual deficit in prepulse inhibition. This locomotor sensitisation and PPI deficit could be reversed by administration of clozapine. A challenge with psychostimulant on day 40 (i.e., after 2-week of withdrawal) resulted in a response similar to the initial exposure (day 1). Neurotransmitter level analyses showed a significant increase in the level of dopamine in the prefrontal cortex (p < 0.05). There was also a significant decrease in the level of 5-hydroxytryptamine (5-HT) in the nucleus accumbens (p < 0.05) and its metabolite, 5-hydroxyindole acetic acid (5-HIAA) in the prefrontal cortex (p < 0.01). In the remaining regions (anterior and posterior striatum), there were no significant changes. In conclusion, this is the first study to demonstrate that repeated administration of C. edulis extract, or commercial cathinone, induces prepulse inhibition deficit and clozapine reverses both C. edulis or cathinone-induced sensitised locomotion and prepulse inhibition deficit.
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Affiliation(s)
- Mehret Yerdaw Banjaw
- Department of Neuropharmacology, Zoological Institute, Faculty of Biology, University of Tuebingen, Germany
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Banjaw MY, Schmidt WJ. Behavioural sensitisation following repeated intermittent oral administration of Catha edulis in rats. Behav Brain Res 2005; 156:181-9. [PMID: 15582104 DOI: 10.1016/j.bbr.2004.05.020] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2004] [Revised: 05/15/2004] [Accepted: 05/17/2004] [Indexed: 11/19/2022]
Abstract
A prolonged use of psychostimulants has been suggested to induce long-lasting behavioural sensitisation which plays a role in the acquisition and maintenance of addictive behaviour. A study was conducted to evaluate the effect of repeated oral administration of Catha edulis in rats. Male Sprague-Dawley rats divided into five groups received: saline, S-(-)-cathinone (1.5 mg/kg), D-(+)-amphetamine (1.5 mg/kg) and standardized C. edulis extract (50 or 200 mg/kg) once daily for nine consecutive days and later challenged with the same psychostimulants after five abstinence days. Then, 2 weeks later, rats were decapitated and the level of neurotransmitters were assessed. Behavioural activities were monitored using activity and sniffing boxes. The results demonstrated that the three psychostimulants induced strong behavioural sensitisation in rats. Whereas, neurotransmitters analyses showed no significant changes in the basal level of dopamine in most of the regions except that C. edulis extract (200 mg/kg) significantly reduced the level of DA, DOPAC and HVA in the anterior caudate putamen (P < 0.05). The capacity of C. edulis to elicit a long-lasting behavioural sensitisation support the anecdotal literatures about psychiatric problems associated with C. edulis chewing.
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Affiliation(s)
- Mehret Yerdaw Banjaw
- Department of Neuropharmacology, Zoological Institute, University of Tübingen Auf der Morgenstelle 28E, 72076 Tübingen, Germany.
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