Prevalence of Cigarette Smoking Among the Medical Students at Shendi University, Sudan: A Cross-Sectional Study

Background: Smoking is a significant health hazard. It accounted for 100 million deaths in the 20th century. Also, it contributes to morbidity and mortality of many diseases in the heart and lungs. It has been implicated in the causation of different cancers in the body, specifically lung cancer, besides the causation of COPD. In Sudan, cigarette smoking was rare before 1940 and became popular in the 1990s. During the mid-1960s and mid-1970s, Sudan and Somalia were the two countries in Africa to have increased consumption, and the world’s largest airlift of cigarettes took place in Britain. 

Material and methods: A descriptive cross-sectional facility-based study was done among medical students at Shendi University from January to June 2024. It included a total number of 100 participants from the first to the sixth academic year. Data has been collected using an online Google form anonymous questionnaire. 

Results: out of 100 participants, 98% are males, 2% are females. The mean age is (24.5 ± 2.13) years. 95% are smokers.74% tried to quit smoking, .15% tried to quit smoking five times, and 47% smoked 5-10 cigarettes per day. 54% smoked for more than three years. About the reasons for smoking, 35% smoke for stress relief, 19% as a habit, 10% for peer pressure, and 23% perceive smoking as very harmful .19% are very likely to quit smoking in the next year. Of those, 41% mentioned the urgent need for readily available resources to quit smoking in the community, .93% mentioned that smoking affects CVS, and 92% on the respiratory system. Overall, 70% have medical education affected their view of smoking. Conclusion: Cigarette smoking is highly prevalent among medical students in the Faculty of Medicine Medical Students at Shendi University. Contact with smokers, particularly friends, is a significant risk factor for the initiation of the habit. Health and religious considerations are essential motives for not smoking, quitting, or attempting to quit. These findings underscore the urgency for intervention strategies that provide readily available resources for smoking cessation.

Tobacco usage is pervasive worldwide despite its devastating health effects. Up to one billion people will die from tobacco smoking in the twenty-first century if no effective interventions are developed and put into place to combat it [1]. Youth smoking is given special attention. The majority of smokers begin smoking during their youth or shortly after graduating from high school [2]. There is no discernible gender difference in the prevalence of smoking, and youth smoking is a problem in industrial, low-income, and middle-income nations [3,4]. The tobacco epidemic, one of the most significant public health threats facing the world, is responsible for a staggering 6 million deaths annually. More than 5 million of these deaths are the direct result of tobacco use, while over 600,000 are the tragic consequence of nonsmokers being exposed to second‑hand smoke. What's even more alarming is the disproportionate impact of this epidemic on low-and middle-income countries, where nearly 80% of the more than 1 billion smokers worldwide reside. These are the very countries where the burden of tobacco‑related illness and death is heaviest, a stark and unjust reality. A recent study by Mathers and Loncar predicts that more than 80% of the 8.3 million tobacco‑related deaths in 2030 will occur in these same low‑ to middle‑income countries, further highlighting this injustice [5]. By 2030, it is thought that about 70% of deaths due to smoking are expected to occur in developing countries, as the adverse health outcomes of smoking are serious and have been well documented. These outcomes include a range of pulmonary diseases, such as chronic obstructive pulmonary disease (COPD), emphysema, and chronic bronchitis. Cigarette smoke contains over 4,800 chemicals; of them, 69 chemicals cause cancer. Approximately 90% of lung cancer deaths and about 85% of chronic obstructive pulmonary diseases, emphysema, and chronic bronchitis deaths result from cigarette smoking. Death at an earlier age among smokers is more common than among nonsmokers. Reported an average of 10 years earlier death among smokers than among nonsmokers; besides, early smoking initiation increases the lifetime duration of smoking and the burden of smoking-related diseases [6]. It is well known that tobacco addiction can be more severe than alcohol addiction. Your role in addressing this issue is crucial as health professionals and researchers. A light smoker (less than ten cigarettes a day) develops a psychological addiction that includes a habit or a social component. In contrast, heavy smokers (10 or more cigarettes a day) develop both mental and physical addiction. They usually smoke their first cigarette within minutes of arising, and they smoke more than ten cigarettes a day. Therefore, the best way to assess a cigarette smoking addiction is to establish the time of day the first cigarette is smoked, and the number smoked daily [7]. Healthcare professionals, including physicians, are believed to be aware of the adverse effects of smoking on health because they are frequently exposed to the relevant data and research in this field. Therefore, it is essential to determine the prevalence of smoking among medical students, the views of this population on smoking among patients, and the nature of antismoking education provided in medical schools. Medical schools must play a significant role in providing comprehensive antismoking education to their students. This knowledge would be of benefit in preventing future physicians from smoking. Numerous studies have investigated smoking and its associated factors among medical students, including those that address prevalence, smoking within their families, and attitudes toward antismoking measures. One has been done in Sudan, Khartoum, which showed that the prevalence of smoking is estimated to be around 48.8% [8]. It is far more critical to prevent youth from ever smoking by continuously monitoring their risk factors for smoking to modify the modifiable risk factors and target those who have nonmodifiable risk factors with health education and smoking prevention programs [9,10], even though there is a lot of focus on conducting research that involves evaluating smoking cessation interventions [11,12]. The characteristics of the cigarette smoking problem among medical students and the underlying risk factors among the medical students at Shendi University, Sudan, have to be investigated because these students would become future doctors and serve as role models in their communities

Study design

This was a cross-sectional study conducted in Shendi Town. Shendi Town is a city in northern Sudan, situated on the northeast bank of the Nile River, 150 km southwest of Khartoum, and about 45 km southwest of the ancient city of Meroe. The study, performed between May and June 2024, involved a substantial sample size of one hundred (n = 100) randomly collected samples, ensuring the study's representativeness and validity. 

Data collection 

The data collection process was meticulous, involving an online anonymous questionnaire pretested and validated through a pilot study. The questionnaire was comprehensive, covering the status of smoking, frequency and duration of smoking, reasons for smoking, and willingness to quit smoking, in addition to socio-demographic data. The pretesting involved administering the questionnaire to a small group of individuals to identify any potential issues with the questions or the format. The validation process ensured that the questionnaire accurately measured what it was intended to measure.

Data analysis 

Data were analyzed using the Statistical Package for Social Sciences (SPSS) version 28 statistical software. Categorical variables were presented as percentages or proportions, while continuous variables were presented as mean ± standard deviation (SD). Chi-square was used to determine the association between categorical variables. The level of significance was set at p less than 5%.

The total number of participants is 100, with a total response rate of 100%. The minimum age of the participants is 18 years, while the maximum age is 29, with a mean value of (4.5 ± 2.132) 98(98%) of the participants are males, while 2 (2%) are females. 19(19%) of the participants are in the second year, while 25(25%) are in the sixth year (Table 1). About the age of starting smoking, the minimum age is four years, and the maximum age is 25 years, with a mean of (19.9 ± 3.099). 95(95%) of the participants are smokers, while 5 (5%) don’t.74(74%) of the participants tried to quit smoking, while 26(26%) didn’t. The number of trials to quit smoking among the participants15(15%) have tried to quit smoking five times. In comparison, 3 (3%) 11 times (Table 2). 47(47%) of the participants smoked 5-10 cigarettes per day, while 25(25%) smoked less than five cigarettes per day (Table 3). 22(22%) of the participants smoked for 1-3 years, and 54(54%) smoked for more than three years (Table 4).19(19%) of the participants smoked as a habit, while 35(35%) for stress relief (Table 5). 23(23%) of the participants think that smoking is very harmful, while 17(17%) don’t perceive it as dangerous (Table 6).19(19%) of the participants are very likely to quit smoking in the next year. In comparison, 13(13%) are not likely at all to quit smoking (Table 7).71(71%) of the participants are considered role models by people around, while 27(27%) are not. Of those considered role models,42(42%) of the participants is willing to quit smoking, while 38(38%) aren’t .93(93%) of the participants mentioned that smoking affects the CVS. In comparison, 60(60%) mentioned an effect on the reproductive system (Table 8). 70(70%) of the participants mentioned that medical education influenced their view of smoking, while 29(29%) don’t .21(21%) of the participants have resources for smoking cessation easily accessible, while 41(41%) haven’t (Table 9).

Table 1: The year of the study of the participants.

Table 2: The number of trials to quit smoking among the participants.

Table 3: The number of cigarettes smoked per day among the participants.

Table 4: The duration of smoking among the participants.

Table 5: The reasons for smoking among the participants.

Table 6: The degree of participant’s perception about the harmfulness of smoking.

Table 7: The degree of likelihood of quitting smoking in the next year among the participants.

Table 8: The participants mentioned the effect of smoking on the body systems.

Table 9: The degree of availability of resources for smoking cessation.

Although smoking is not a brand-new issue, its widespread prevalence, particularly among young people, and the resulting rise in morbidity and mortality have made it a growing worry [13]. For many years, smoking has been a severe and ongoing social issue with a global impact. This study was conducted to assess the prevalence of cigarette smoking among medical students at Shendi University, contributing to our understanding of this pressing issue. It included a total number of 100 participants, with a total response rate of 100%. The minimum age incorporated in this study is 18 years; the maximum is 29 years, with a mean age of (24.5 ± 2.132) years. Most of the participants are males, with only 2

Despite their knowledge of the health risks associated with tobacco use, this study found that smoking cigarettes was a concern among Shendi University's Faculty of Medicine Medical Students. This issue was caused by sociodemographic and family-related factors, and smoking peers' presence significantly influenced smoking initiation. Essential reasons for not smoking, stopping, or trying to quit include health and religious concerns. These results highlight how urgently intervention programs that offer quickly accessible smoking cessation services are needed.

Recommendations

According to this study, which found that [insert specific statistics on smoking prevalence among medical students], medical schools and universities should encourage medical students to take part in educational initiatives aimed at lowering their risk of smoking and offer free or inexpensive assistance to those who choose to stop—identifying this issue early and at the right moment, as early intervention is critical. Medical and other health colleges should offer educational programs and teach specialized courses on tobacco control to train and equip future health professionals with the knowledge and skills to intervene with smoking effectively.

Consent

The patient’s written consent has been collected. 

Ethical Approval

The Department of Community in the College of Medicine, Shendi University, approved the study. The study matched the ethical review committee. The aims and benefits of this study were explained with the assurance of confidentiality. All protocols in this study were done according to the Declaration of Helsinki (1964).

Sources Of Funding

There was no specific grant for this research from any funding organisation in the public, private, or nonprofit sectors.

Conflict Of Interest

The authors have declared that no competing interests exist.