Tobacco use and its associated factors among Bachelor’s level public health students of Koshi Province

Guragain P. et al. Tobacco use and its associated factors among


INTRODUCTION
Tobacco is a pressing global public health issue, contributing significantly to widespread illness and mortality.All forms of tobacco consumption have adverse effects on well-being, resulting in millions of deaths each year.Whether through smoking, smokeless methods, or exposure to secondhand smoke, it is associated with various health complications, including cardiovascular diseases, respiratory disorders, diverse cancers, non-communicable diseases (NCDs), and more.The WHO Framework Convention on Tobacco Control underscores the pivotal role of healthcare practitioners like doctors, dentists, nurses, pharmacists, and optometrists in aiding individuals to quit or preventing tobacco usage through concise counseling or straightforward advice.Providing cessation training to aspiring health professionals could be a pivotal stride towards advancing tobacco control endeavors.

Material & Methods:
Out of the participants, 14.1% were identified as current smokers.A significant portion (27.6%) had experimented with cigarettes at some point, with the majority initiating cigarette smoking between the ages of 11 and 19 years.In terms of current usage of alternative tobacco products, 8.2% reported ongoing use, while 9.4% had tried them at least once.Male respondents exhibited a 9.05 times higher likelihood of smoking compared to their female counterparts.Furthermore, individuals with friends who engaged in tobacco smoking were 4.02 times more inclined to smoke than those whose friends did not have this habit.
This study employed a descriptive, cross-sectional design to investigate the perspectives of public health students regarding global health issues.Bachelor's level public health students of Koshi Province were administered the Global Health Professional Student Survey (GHPSS), a validated instrument designed to assess prevalence, attitudes, and behaviors related to tobacco use and control.Data collection took place over a specified time frame, with participants providing responses anonymously.Statistical analyses using SPSS 20 employed to derive meaningful insights into the tobacco consumption habits of public health students.

MATERIALS AND METHODS
smoke, has been linked to a range of health problems such as cardiovascular ailments, respiratory conditions, various types of cancers, non-communicable diseases (NCDs), and numerous others. 2 In 2019, tobacco use (including smoking, secondhand exposure, and chewing) was linked to 8.71 million fatalities worldwide. 3The Global Burden of Disease Study ranks tobacco smoking as the third major risk for disability-adjusted life-years attributable to Level 2 risks, despite a slight decrease in incidence from 2010 to 2019 4 More specifically, tobacco smoking resulted in 7.69 million deaths and 200 million DALYs, constituting 13.6% of total human fatalities and 7.89% of all DALYs. 5 2015, tobacco use in the South-East Asian region was highest at 31%, with 49.4% prevalence in males and 12.9% in females. 6The 2019 STEPS survey in Nepal found that 29% of adults aged 15 to 69 used tobacco, with 48% being male and 12% female. 7Recently, there has been a noticeable shift towards preferring smokeless tobacco over traditional smoking in South-East Asia, including Nepal. 8In Nepal specifically, the use of smokeless tobacco is notably more widespread than smoking, with a higher prevalence among males (33%) compared to females (5%). 4e WHO Framework Convention on Tobacco Control (FCTC) advises that the worldwide tobacco crisis should be tracked through population-wide surveys carried out using the Global Tobacco Surveillance System (GTSS) targeting adults, youth, school staff, and student health practitioners. 9The WHO FCTC emphasizes the crucial role of healthcare professionals in providing concise counseling and advice to help individuals quit or prevent tobacco use. 10 11 Offering cessation training to student health professionals could be a highly impactful step in advancing tobacco control initiatives. 12Nevertheless, if health professionals themselves are smokers, they might be hesitant to offer cessation advice and counseling to their patients, as it could be challenging to persuade patients to quit if the providers are smokers themselves. 13Additionally, student health professionals often possess limited knowledge about diseases linked to smoking and typically receive minimal or no instruction on tobacco cessation methods. 14 15ile the impact of tobacco on global health is well-documented, there is a gap in understanding the perspectives of bachelor's level public health students in Koshi province, Nepal.The unique challenges and factors influencing tobacco use among this specific demographic remain underex-A cross-sectional study was carried out among undergraduate public health students in Koshi Province, Nepal.The study spanned from November 25, 2023, to December 25, 2023.All the students enrolled in the undergraduate public health programs in Koshi Province were approached to participate in the study.A total of 170 undergraduate public health students from Koshi Province participated in the study.Sample size was calculated by using the formula of finite population.Corrected sample size (n1) = N* n/N-1+n Where, n = Z 2 pq/d 2 , P: Prevalence of tobacco use among adult which is 29 % as per STEPS survey 2019 q = 1-p d= Absolute error = 5%.N = Total number of public health undergraduate students of Koshi province = 211 After adding 20% non-response rate the sample size fixed was 154.However, we tried to include all the students among whom 170 responded to the study.
A paper-based questionnaire was distributed to all the available students.This study employed the Global Health Professions Student Survey (GHPSS) questionnaire, a validated self-administered tool designed for screening smoking habits among university students. 16The same GHPSS questionnaire was used in Nepal in similar setting. 17The current smokers were defined as those who smoked cigarettes daily or occasionally during the past 30 days preceding the survey.The non-smokers were defined as those who never ever smoked a cigarette in their lifetime.The ever smokers were defined as those who had smoked even a single cigarette in their lifetime.he ethical clearance for the study was obtained from IRC plored.The research aims to shed light on the attitudes and behaviors of this particular group, providing insights that can inform targeted strategies for tobacco control in the region.

RESULTS
Demographic characteristics of participants is shown in table 1.A total of 170 public health students responded for the study.Among the respondent the percentage of male was 36.5% and female was 63.5%.The study included 77 (45.3%) students from lower level of education (first and second year) and 93(54.7)students from higher level (third and fourth year).Among the respondents, higher number of the respondents 73(42.9%)were from Brahmin/Chhetri ethnicity group.Majority of the respondent were from urban areas (62.9%).Higher number of study participants were living without family 129(75.9%).Parental use of tobacco product was 28.2% and friends with habit of tobacco use was 51.2%.Majority of study participants had nuclear family (67.0%).Most of the participants got their education from private school (69.4%).
Among the respondents 14.1% were the current smoker.Almost one third (27.6%) of the respondent had smoked cigarette ever and majority of them had initiated smoking cigarette at the age 11-19 years.Regarding the current use of other tobacco product,8.2% of the respondents currently used it whereas 9.4% had ever tried it.

Table 2. Prevalence of tobacco use n=170
of Birat Medical College Teaching Hospital.All the participants were informed about the aims and objectives of the study.Participants were aware that their participation was voluntary.The confidentiality of the participants was ensured.
Statistical analysis was performed using IBM SPSS version 20.Descriptive analysis was done by calculating frequency and percentages for categorical variables.Association between categorical independent variables and categorical dependent variables was measured by the Chi-square test followed by binary logistic regression analyses

Characteristics Number (%)
Age groups (years) In the bivariate analysis between socio-demographic characteristics and current smoking of the respondents, gender and friends with Tobacco using habits were significantly associated with current cigarette smoking at p-value <0.05.
Among the total respondents, 40.6% had exposed to tobacco smoking at home whereas 49.4% had exposed at public places

RECOMMENDATIONS
Based on the findings of this study, it is evident that there exists a significant association between male gender and smoking behavior.Additionally, a noteworthy correlation was observed between individuals who have friends with a smoking habit and their own smoking behavior.
In light of these results, it is strongly recommended that targeted interventions and educational programs be developed to address smoking habits, particularly among males.Moreover, fostering awareness about the influence of peer groups, especially those with smoking habits, should be a key component of any comprehensive smoking prevention strategy.Furthermore, collaboration between healthcare professionals, educators, and policymakers is essential in creating a supportive environment for individuals looking to quit smoking and for preventing new smokers from initiating this harmful habit.*** = Significant at 99.9% CI *= Significant at 95% CI In this study, multivariate analysis (binary logistic regression) was also conducted to find the significant predictor for current cigarette smoking among the public health students.The important variables like age, gender, friends with the habits of tabaco smoking, current place of residence and study level were run for multivariate analysis.Finally, two variables: gender (Ex.B.=9.05, CI: 2.63-31.17and P<001) and Friends with habit of tobacco smoking (B=4.02,CI: 1.01-16.14and P=0.05) were found significant predictor/determinants for current cigarette smoking status among public health students.Males and students with friends having tobacco smoking habits were significantly associated with current cigarette smoking of the respondents.Male gender is 9.05 time more likely to smoke than female gender and friends with tobacco smoking habits were 4.02 times more likely to smoke than friends without smoking habit.Though others variables were non-significant but expected odds were observed more among ages more than 25 and greater, urban residents and students in higher level of study.

DISCUSSION
In the present study the prevalence of current cigarette smoking was 14.1% which is similar to the Nepal STEPS survey 2019 for Tabacco use among adults (14.5%) 19 .However, the finding was slight lower than the study done among undergraduate public health students of Kathmandu valley (16.8%) 20 and the study conducted among health professional students in Chitwan (16.3%) 17 .The prevalence of ever smoker was 27.6% which is higher than the study done by Shrestha et.al 16 whereas lower than the study done by Chand et.al. 20Majority of the current smokers have initiated their smoking at adolescents (11-19years) period which is supported by the various study conducted in Nepal. 17 18 20Factors like curiosity, need to alleviate stress, and influence from peers could lead to the initiation of smoking at an adolescent age. 18is study further revealed that the prevalence of current other Tabacco product such as chewing tobacco, sniffs, bidis etc. is 8.2% which is lower than the studies conducted in Kathmandu and Chitwan. 17,20and higher than the finding of the study done among Medical Students in a Tertiary Care Teaching Hospital. 16 this study, half of the respondent 49.4% had been exposed to tobacco smoke at public places whereas 40.6% had exposure at home, the finding is supported by various study done in Nepal 16 17 and India 21 which also revealed the higher exposer of tobacco smoke at public places than home indicating ineffective implementation of smoking ban in public places.
The present study showed the significant difference between male and female in smoking, where male were nine times more likely to smoke cigarette in comparison to females, the finding was supported by the study done in Nepal 16 17 .Similarly, the study done among Thai university student showed male were more likely to smoke than female.The reason could be societal acceptability for men to smoke and belief among young males that smoking make them look attractive. 22rther the present study showed significant association between the smoking cigarette and friends with habit of tobacco smoking.The respondent who has friends with habit of tobacco smoking were 4.02 time more likely to be current smoker.The finding is supported by the study done in Finland 23 and Saudi Arabia 24 .There are various methods through which friends can impact the use of cigarettes, including demonstrating risky behaviors and applying social pressures. 20e family type of respondent was not associated with current smoking in the present study which was similar with finding of the study by Chand B et.al 20 whereas the study conducted in Nepal 18 and India 7 .Contrasted the findings.The parental habit of smoking was also not associated with current smoking in the present study which differed with the findings of the study done in China. 25Similarly, the factors like ethnicity, parental habit of tobacco smoking, place of resident, types of school did not show significant association with current smoking of the respondents.
It was developed collaboratively by the World Health Organization (WHO), the US Centers for Disease Control and Prevention (CDC), and the Canadian Public Health Association.