|Year : 2016 | Volume
| Issue : 1 | Page : 105
Tobacco use and substance abuse in students of Karaj Universities
Kourosh Kabir1, Asghar Mohammadpoorasl2, Razie Esmaeelpour3, Fatemeh Aghazamani3, Fatemeh Rostami4
1 Department of Community Medicine, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
2 Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
3 Department of Public Health, School of Health, Alborz University of Medical Sciences, Karaj, Iran
4 Department of Pediatrics, School of Nursing, Baqiyatallah University of Medical Sciences, Tehran, Iran
|Date of Submission||03-Dec-2015|
|Date of Acceptance||26-Jul-2016|
|Date of Web Publication||08-Sep-2016|
Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz
Source of Support: None, Conflict of Interest: None
Background: It is clear that tobacco smoking and substance abuse have negative consequences on adolescent and youth's health. Tobacco smoking especially hookah smoking has increased worldwide especially among university students. This study aimed to determine the prevalence of risk-taking behaviors such as cigarette smoking, hookah smoking, alcohol use, and drug abuse and its predictors in students of Karaj universities.
Methods: This cross-sectional study took place in Karaj in January and February 2014. The randomly selected sample consisted of 1959 college students. A self-administered questionnaire was used to measure risk-taking behaviors as well as demographic and related risk factors. Logistic regression model was performed in data analysis.
Results: The prevalence of cigarette smoking was 9.3%. The prevalence of hookah smoking was 9.3%. 7% of students used illegal drugs and 9.5% of students used alcohol at least once in last 30 days. After adjustment for other factors, being male, living without parents, having smoker friends, and presence any smoker in the family were factors associated with students' risk-taking behaviors. The results showed the co-occurrence of risk-taking behaviors.
Conclusions: The prevalence of tobacco smoking and substance abuse, particular in males, are high. It seems that planning preventive interventions for this part of the population are necessary. This study emphasized the co-occurrence of risky behaviors, so, it is better high-risk behaviors simultaneously targeted at reducing or preventing interventions.
Keywords: Cigarette smoking, college students, risk-taking behaviors, substance abuse, water-pipe
|How to cite this article:|
Kabir K, Mohammadpoorasl A, Esmaeelpour R, Aghazamani F, Rostami F. Tobacco use and substance abuse in students of Karaj Universities. Int J Prev Med 2016;7:105
|How to cite this URL:|
Kabir K, Mohammadpoorasl A, Esmaeelpour R, Aghazamani F, Rostami F. Tobacco use and substance abuse in students of Karaj Universities. Int J Prev Med [serial online] 2016 [cited 2017 Jul 20];7:105. Available from: http://www.ijpvmjournal.net/text.asp?2016/7/1/105/190091
| Introduction|| |
It is clear that tobacco smoking and substance abuse have negative consequences on adolescent and youth's health.  The prevalence of cigarette smoking has been reported as 20.8% in the United States,  as 22% in the United Kingdom, and as 17.5% in Iran.  Due to the influence of early substance dependence on the future of adolescents and young adults, tobacco smoking, and substance abuse among university students remains an important area of research. University students are at high-risk of tobacco smoking and substance abuse as they become exposed to greater availability of these substances and may be subjected to peer pressure. Furthermore, they face social, emotional, and educational challenges when they enter the university. Therefore, tobacco smoking and substance abuse are prevalent in university students. ,,, Numerous studies have shown the negative consequences of risk-taking behaviors associated with health in youth. ,
The number of cigarette smoking among university students has been reported between 8.6% and 28.6% in studies in several countries. ,,,,, This wide range is primarily due to the variety of the definitions of smoking and the location where such studies have taken place. Primack et al.  found that the prevalence of hookah smoking among the United States college students in a lifetime, over the past year, and over the past 30 days were 40.5%, 30.6%, and 9.5%, respectively. The results of Ghoreshi and Shajari study in Zanjan showed that 13% and 4.2% of university students were occasional or regular hookah smokers, respectively.  Mohammadpoorasl et al.  showed that 8.5% of Tabriz universities students used hookah at least once a month. Studies showed that 2.6-7.6% and 8-17% of university students in Iran were drug abusers and used alcohol at least once in the past 30 days, respectively. ,,,
The incidence of high-risk behaviors among Iranian college students has increased. ,,, The aim of the study was to determine the prevalence of risk-taking behaviors such as cigarette smoking, hookah smoking, alcohol use, and drug abuse and its predictors in students of Karaj universities.
| Methods|| |
Study design and participants
A sample of 2084 college students was selected by random proportional cluster sampling by considering student's study fields from seven universities in Karaj, Alborz Province of Iran. The sample size was calculated as 1928 assuming the prevalence of substance abuse of 7.6%  and considering the comparison of two genders and design effect. During January and February 2014, a self-administrated questionnaire was distributed to the students. The survey questionnaire has used in several studies in Iran, and its validity and reliability have approved. , The respondents were free to participating in the study, and there is no need to enter their personal information in the questionnaire. This study and its questionnaire have been approved by the Ethics Committee of Alborz University of Medical Sciences.
The questions were aimed at obtaining information on cigarette smoking, hookah use, drug use, alcohol consumption as well as demographic information.
In this study, the cigarette smoking was measured as a nonsmoker, experimenter (<100 cigarettes in lifetime), occasional user, regular smoker, and ex-smoker. The number of cigarette smokers according to these answers was calculated. However, in evaluating of variables relating to cigarette smoking, the respondents were classified in three categories of cigarette smoking:
For logistic regression analyses, current smokers who had smoked 100 cigarettes or more in their lifetime were considered cigarette smokers.
- Experimenter (experimenter and ex-smoker)
- Regular smoker (occasionally user and regular smoker).
Hookah smoking was measured by a question including the following answers: Nonuser, only tried, occasional user, used once per month, and used once per week. The number of hookah smoking according to these answers was then calculated. However, to consider the factors relating to hookah smoking, the respondents were classified in three statuses of hookah smoking as represented below:
For logistic regression analyses, students who use hookah at least once per month were considered hookah smokers.
- Nonsmoker: Students who have never smoked hookah (even a puff)
- Experimenter: Students who have tried the hookah smoking (even a puff) or have smoked occasionally
- Regular hookah smoker: Students who use hookah at least once per month.
Alcohol use was defined as consuming alcohol in the past 30 days. The use of any illicit drugs such as Ritalin, methamphetamine, ecstasy, cannabis, opium, and heroin was regarded as drug users.
In this study, the method sampling was cluster sampling, and it can affect the confidence intervals. Hence, survey analysis has been used in all analyses. Quantitative and qualitative data in results section have presented as mean ± standard deviation and frequency (percentage), respectively. The Chi-square test, t-test, and one-way ANOVA test were used in univariate analyses. For multiple analyses, the logistic regression model was used. Stata 10 software (StataCorp. 2007. Stata Statistical Software: Release 10. College Station, TX: StataCorp LP) software was used in data analysis.
| Results|| |
Out of 2084 selected students, 1959 students completed the study questionnaire (response rate: 94.0%). The mean age of participants was 22.46 ± 4.55 years (minimum: 17 and maximum: 47). 658 (33.6%) and 1301 (66.4%) of participants were male and female, respectively.
[Table 1] shows the frequency distribution of the substance abuse by gender. As shown in [Table 1], 82% of the students do not smoke cigarettes, 48.8% are nonhookah smoker, 90.5% never consumed alcohol in the past 30 days, and 93% have not experienced of drug use. It is noted that in all categories boys are higher users than girls (P < 0.001).
[Table 2] presents the demographic characteristics of the students by cigarette and hookah smoking. As shown in [Table 2], gender, living status, having job along with education, having smoker friend, presence of a smoker in the family and age had a significant correlation with cigarette and hookah smoking. The results also showed that the hookah smoking, cigarette smoking, alcohol consumption, and drug abuse were co-occurred.
|Table 2: Demographic and key characteristics of the students by cigarette smoking and hookah smoking |
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[Table 3] presents the demographic and key characteristics of the students by alcohol consumption in the past 30 days and drug use. As shown in [Table 3], gender, living status, having a job along with education, having smoker friend, and presence of a smoker in the family had a significant relationship with alcohol consumption in the past 30 days and drug use.
|Table 3: Demographic and key characteristics of the students by alcohol consumption and drug abuse |
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Four logistic models were used to evaluate the relationship of all variables listed in [Table 2] and [Table 3] that significant in 0.2 level with cigarette smoking, hookah smoking, alcohol consumption, and drug abuse. The results of these analyses [Table 4] indicated that being male, living in dormitory in comparison of parental house, having job along with education, having smoker friend, ever drug abuse, alcohol consumption in the past 30 days and hookah smoking increases the risk of cigarette smoking. Living in dormitory in comparison of parental house, having smoker in the family, having smoker friend, alcohol consumption in the past 30 days and cigarette smoking increases the risk of hookah smoking but being married has protective effect for hookah smoking.
|Table 4: Logistic regression analysis of the relationship between cigarette smoking status and hookah smoking status and risk variables |
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The results of [Table 5] indicate that living in single house in comparison of parental house, having smoker in the family, having smoker friend, ever drug abuse, hookah smoking, and cigarette smoking increases the risk of alcohol consumption in the past 30 days but being married has protective effect for alcohol consumption in the past 30 days. Being married, living in dormitory or single house in comparison of parental house, having job along with education, having smoker friend, being regular hookah smoker, and cigarette smoking increases the odds of being drug abuser [Table 5].
|Table 5: Logistic regression analysis of the relationship between alcohol consumption in the past 30 days and drug abuse and risk variables |
Click here to view
| Discussion|| |
In this study, 18% of the students (31.2% of the males and 11.4% of the females) have experienced cigarette smoking, and only 4.8% (11.9% of the males and 1.2% females) have been regular smokers. In addition, 4% of the students (7.1% of the males and 3.2% of the females) were occasional cigarette smokers. These findings are consistent with other national studies and studies in neighboring countries. In a meta-analysis study, entitled "the prevalence of cigarette smoking among students of Iran's universities" by Haghdoost and Moosazadeh in 2013,  22 valid articles were selected. The prevalence of smoking among male students was 13.4-39.9% compared with 0.7-25.5% among female students. The results of meta-analysis demonstrated that prevalence of cigarette smoking among male and female students in Iran's universities was 19.8% (17.7-21.9) and 2.2% (1.4-3.02), respectively. The occurrence of cigarette smoking in university students in other countries was as follows: 18.5% in Turkey,  24% in Pakistan,  and 14.5% in Saudi Arabia.  Hookah smoking was more prevalent than cigarette smoking among Iranian adults and youth. , The prevalence of hookah smoking (at least once per month) in this study was 9.3%. We also realized that 51.1% of the samples had at least tried hookah smoking in some occasions. These values in Mohammadpoorasl et al.  study in Tabriz were 8.5% and 39.4%, respectively. The results of Ghoreshi and Shajari study in Zanjan showed that 13% and 4.2% of university students were occasionally and regular hookah user, respectively.  These results in comparison with studies undertaken in western countries are relatively similar. Primack et al.  found that the prevalence of hookah smoking among the United States college students in a lifetime, over the past year and the past 30 days were 40.5%, 30.6%, and 9.5%, respectively. Thirty-eight percent of the students in Poland had smoked water pipe at least once in their life, and 22% had smoked hookah during the last 30 days.  In this study, 9.5% of students had alcohol consumption in the past 30 days, and 7% had experience of drug abuse. These findings are similar to other national researches and indicated that alcohol consumption and drug abuse among the university students of Karaj city in Iran is generally lower than other countries. Studies showed that 2.6-7.6% and 8-17% of university students in Iran were drug users and used alcohol at least once in the past 30 days. ,,,, Data from the United States revealed that more than 60% of American college students reported past month alcohol use and 14.5% of students reported past 30 days use of marijuana. , Lower rate of alcohol use and drug abuse in Iran can be explained as follow: (1) Legal prohibition of drug abuse and religious and legal prohibition of alcohol use; (2) the society norms about alcohol use and drug abuse; and (3) although survey was anonymous, students still may be reserved about information given.
Findings show that our studied risk-taking behaviors (cigarette smoking, hookah smoking, alcohol use, and drug use) are much more prevalent in males than in females. These results are similar to previous studies results performed in Iran. ,,,,,
According to the findings of the present study, living in dormitory or single house in comparison of parental house was a strong risk factor for cigarette smoking, hookah smoking, alcohol use, and drug abuse. These results are similar to the results of the previous study performed in Iran. ,, The first limitation of the present study is relying on self-report data. Although we tried to increase the validity of answers by ensuring confidentiality and anonymity, we had no way of assessing under-reporting of high-risk behaviors. Finally, due to cross-sectional design of the study, the conclusions about associations between the risk factors and high-risk behaviors are limited.
| Conclusions|| |
The prevalence of tobacco smoking and substance abuse, particular in males, are high. It seems that planning preventive interventions for this part of the population are necessary. Living in dormitory or single house in comparison of parental house was a strong risk factor for cigarette smoking, hookah smoking, alcohol use, and drug use. This study emphasized the co-occurrence of risky behaviors, so, it is better high-risk behaviors simultaneously targeted at reducing or preventing interventions. Future studies should assess the factors affecting smoking initiation, as well as effective techniques for the prevention of smoking initiation and substance abuse in Iranian students.
We would like to thank Deputy of Research and Technology of Alborz University of Medical Sciences for financial support of this study. We also wish to thank all of the students for their valuable collaboration with this study.
Financial support and sponsorship
This work was supported by Alborz University of Medical Sciences.
Conflicts of interest
There are no conflicts of interest.
| References|| |
CDC. The Health Consequences of Smoking: A Report of the Surgeon General. Atlanta, GA: CDC; 2004.
Rock VJ, Malarcher A, Kahende JW, Asman K, Husten C, Caraballo R. Cigarette smoking among adults in United States, 2006. MMWR Morb Mortal Wkly Rep 2007;56:1157-61.
WHO. WHO Report on the Global Tobacco Epidemic, 2009: Implementing Smoke-Free Environments. Geneva: WHO. 2009.
Atwoli L, Mungla PA, Ndung'u MN, Kinoti KC, Ogot EM. Prevalence of substance use among college students in Eldoret, western Kenya. BMC Psychiatry 2011;11:34.
Kenna GA, Wood MD. Substance use by pharmacy and nursing practitioners and students in a northeastern state. Am J Health Syst Pharm 2004;61:921-30.
Heydari ST, Izedi S, Sarikhani Y, Kalani N, Akbary A, Miri A, et al.
The prevalence of substance use and associated risk factors among university students in the city of Jahrom, Southern Iran. Int J High Risk Behav Addict 2015;4:e22381.
Askarian M, Kouchak F, Youssef M, Romito LM. Comparing tobacco use knowledge, attitudes and practices between engineering students at a public and Islamic Azad University in Shiraz, Iran 2011. Int J Prev Med 2013;4:1154-61.
Gonzalez J, Field T, Yando R, Gonzalez K, Lasko D, Bendell D. Adolescents' perceptions of their risk-taking behavior. Adolescence 1994;29:701-9.
Resnick MD, Bearman PS, Blum RW, Bauman KE, Harris KM, Jones J, et al.
Protecting adolescents from harm. Findings from the National Longitudinal Study on Adolescent Health. JAMA 1997 10;278:823-32.
van den Bree MB, Whitmer MD, Pickworth WB. Predictors of smoking development in a population-based sample of adolescents: A prospective study. J Adolesc Health 2004;35:172-81.
Deressa W, Azazh A. Substance use and its predictors among undergraduate medical students of Addis Ababa University in Ethiopia. BMC Public Health 2011 22;11:660.
Saatci E, Inan S, Bozdemir N, Akpinar E, Ergun G. Predictors of smoking behavior of first year university students: Questionnaire survey. Croat Med J 2004;45:76-9.
Koura MR, Al-Dossary AF, Bahnassy AA. Smoking pattern among female college students in Dammam, Saudi Arabia. J Family Community Med 2011;18:63-8.
Haddad LG, Malak MZ. Smoking habits and attitudes towards smoking among university students in Jordan. Int J Nurs Stud 2002;39:793-802.
Haghdoost AA, Moosazadeh M. The prevalence of cigarette smoking among students of Iran's universities: A systematic review and meta-analysis. J Res Med Sci 2013;18:717-25.
Primack BA, Sidani J, Agarwal AA, Shadel WG, Donny EC, Eissenberg TE. Prevalence of and associations with waterpipe tobacco smoking among U.S. university students. Ann Behav Med 2008;36:81-6.
Goreishi A, Shajari Z. Substance abuse among students of Zanjan's Universities (Iran): A knot of today's society. Addict Health 2013;5:66-72.
Mohammadpoorasl A, Abbasi Ghahramanloo A, Allahverdipour H, Modaresi Esfeh J. Prevalence of hookah smoking in relation to religiosity and familial support in college students of Tabriz, northwest of Iran. J Res Health Sci 2014;14:268-71.
Mohammadpoorasl A, Ghahramanloo AA, Allahverdipour H. Risk-taking behaviors and subgrouping of college students: A latent class analysis. Am J Mens Health 2013;7:475-81.
Taremian F, Bolhari J, Pairavi H, Ghazi Tabatabaeii M. The prevalence of drug abuse among university students in Tehran. Iran J Psychiatry Clin Psychol 2008;13:335-42.
Abbasi-Ghahramanloo A, Fotouhi A, Zeraati H, Rahimi-Movaghar A. Prescription drugs, alcohol, and illicit substance use and their correlations among medical sciences students in Iran. Int J High Risk Behav Addict 2015;4:e21945.
Kelishadi R, Ardalan G, Gheiratmand R, Majdzadeh R, Delavari A, Heshmat R, et al.
Smoking behavior and its influencing factors in a national-representative sample of Iranian adolescents: CASPIAN study. Prev Med 2006;42:423-6.
Jalilian F, Karami Matin B, Ahmadpanah M, Ataee M, Ahmadi Jouybari T, Eslami AA, et al.
Socio-demographic characteristics associated with cigarettes smoking, drug abuse and alcohol drinking among male medical university students in Iran. J Res Health Sci 2015;15:42-6.
Mohammadpoorasl A, Nedjat S, Fakhari A, Yazdani K, Foroushani AR, Fotouhi A. Substance abuse in high school students in association with socio-demographic variables in northwest of iran. Iran J Public Health 2012;41:40-6.
Alvur TM, Cinar N, Oncel S, Akduran F, Dede C. Trends in smoking among university students between 2005-2012 in Sakarya, Turkey. Asian Pac J Cancer Prev 2014;15:4575-81.
Rozi S, Butt ZA, Akhtar S. Correlates of cigarette smoking among male college students in Karachi, Pakistan. BMC Public Health 2007;7:312.
Mandil A, BinSaeed A, Dabbagh R, Shaikh SA, AlSaadi M, Khan M. Smoking among Saudi University students: Consumption patterns and risk factors. East Mediterr Health J 2011;17:309-16.
Abdollahifard G, Vakili V, Danaei M, Askarian M, Romito L, Palenik CJ. Are the predictors of hookah smoking differ from those of cigarette smoking? Report of a population-based study in Shiraz, Iran, 2010. Int J Prev Med 2013;4:459-66.
Zielinska-Danch W, Czogala J, Adamczyk R, Danch M. Water pipe smoking and psychoactive substances. Przegl Lek 2012;69:921-3.
Velazquez CE, Pasch KE, Laska MN, Lust K, Story M, Ehlinger EP. Differential prevalence of alcohol use among 2-year and 4-year college students. Addict Behav 2011;36:1353-6.
American College Health Association. American College Health Association-National College Health Assessment Spring 2008 Reference Group Data Report (abridged): The American College Health Association. J Am Coll Health 2009;57:477-88.
Mohammad K, Nourbala AA, Majdzadeh SR, Karimlou M. Trend of smoking prevalence in Iran from 1991 to 1999 based on two national health survey. Hakim 2001;3:290-4.
Sarrafzadegan N, Toghianifar N, Roohafza H, Siadat Z, Mohammadifard N, O'Loughlin J. Lifestyle-related determinants of hookah and cigarette smoking in Iranian adults. J Community Health 2010;35:36-42.
Baheiraei A, Mirghafourvand M, Nedjat S, Mohammadi E, Mohammad-Alizadeh Charandabi S. Prevalence of water pipe use and its correlates in Iranian women of reproductive age in Tehran: A population-based study. Med Princ Pract 2012;21:340-4.
Mohammadpoorasl A, Ghahramanloo AA, Allahverdipour H, Augner C. Substance abuse in relation to religiosity and familial support in Iranian college students. Asian J Psychiatr 2014;9:41-4.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]