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Volume 2, Issue 2

February 2022

Prevalence of Tobacco Consumption Through Passive Smoking and E-cigarette at Fakeeh College for Medical Sciences

Kausar Ahmed, Sara Alkabli, Reem Alawaji, Abdullah Almutairi, Yaser Albarrak, Abdullah Alammari

DOI: http://dx.doi.org/10.52533/JOHS.2021.2201

Keywords: E-cigarettes, medical students, smoking, passive smoking, tobacco

Background: More than 6 million adults worldwide are lost their lives due to the consumption of cigarettes. Aim of this study is the investigation of tobacco consumption prevalence via both passive smoking and e-cigarette amongst medical students at Fakeeh College for Medical Sciences (FCMS), Jeddah city, Saudi Arabia.

Methods: An epidemiological, cross-sectional study conducted amongst FCMS medical students between July 2020 till November 2020.

Results: Total of 359 participants involved in this study. Females were (87.7%) and males were (12.3%). (48.7%) of the participants were in age group 19-20 years and (30.9%) were 21-22 years. (93.8%) were singles. The majority were in their second and third academic year, 78 (23.1%) and 90 (26.7%), respectively. 293 (81.6%) are not current smokers and 72 (20.1%) are former smokers. Most of the participants agreed that smoking tobacco causes dangerous diseases such as brain thrombosis, heart attacks and lung cancer, 291 (81.1%), 189 (52.6%), 262 (73.0%) and 288 (80.2%); respectively. Using E-cigarette to quit smoking is successful in 53 (14.8%) and 105 (29.2%) recommend E-cigarette for smoking cessation.

Conclusions: Prevalence of E-cigarettes and shisha smoking amongst students of FCMS is not high, yet it is alarming. Most of the participants had good knowledge of tobacco harms. Our results highlight the importance of initiating campaigns to quit smoking cigarettes, E-cigarette, and shisha on-campus. The results obtained from this study show the importance to create, develop and implement tobacco education programs to help in smoking cessation.


Tobacco consumption is available worldwide in the form of cigarettes, pipes, and chewing. It is also a common problem among healthcare students. More than 6 million adults worldwide are killed due to the consumption of cigarettes. Recent study has ratified the correlation between smoking and several ailments e.g., heart disease, lung cancer, bladder cancer, oral cancer, pulmonary emphysema, bronchitis, …. etc (1). One of the important addictive components of tobacco is nicotine, which explains why people who try to stop smoking face difficulties because of nicotine addiction. Even though nicotine is addictive, the majority of tobacco harm use arises from other chemicals. Tobacco consumption considers as one of the leading causes of lung cancer and chronic obstructive lung diseases, which leads to about 8 million annual deaths and 1.2 million of these deaths caused by the passive smoking (2,3). Nowadays, smokers are not only maleficence themselves, but may harm community around them as they are categorized as passive smokers (PS). The PS is defined as tobacco particles inspiration by non-smokers accidentally by having involuntary exposure to tobacco smoke (4). There is a 35% increase in risk among people with tobacco exposure (5). The strength of exposure to periphery tobacco smoke regulated by several parameters e.g., the number of exposure hours/day, the proximity to smokers, the number of active smokers existing in a place, and ventilation capacity where passive smoking exists (6).

Therefore, knowing the real numbers of health care students who consume tobacco through passive smoking or e-cigarette can help the authorities such as the Ministry of Health (MOH) to find a solution to such a problem. From this point, there has been a gap between knowing prevalence of tobacco intake through passive and e-cigarette among health care students at Fakeeh College for Medical Sciences (FCMS).

The aim of this study is to measure prevalence of tobacco usage through passive smoking and E-cigarette amongst FCMS medical students.



The study is an epidemiological, cross-sectional study, executed from July 2020 till November 2020 in Fakeeh College for Medical Sciences (FCMS) among the medical students, Jeddah, Saudi Arabia.


Sample size was 359 medical students from the FCMS enrolled in this study. We measured the sample size by using Raosoft calculator (7). The data has been collected with pre-tested validated questionnaire and it distributed on-line (8,9).

Data Questionnaire

The questionnaire is multidisciplinary composed of 4 different parts. First part included participants sociodemographic characteristics, second part comprised tobacco use prevalence and patterns. Third part based on the comparison between different tobacco use knowledges and fourth part concerned with the characteristics of vaping habits and related data. Data was entered through Microsoft Excel 2021.

Data Analysis

The data obtained were analysed using the SPSS software (version 21). The P-value <0.05 is considered significant statistically at confidence interval (CI) of 95%.


A toatl of 359 participants medical students at FCMS were recruited in this study. Females (87.7%) and males (12.3%). A 48.7% of the participants were in age range 19-20 years, 30.9% were in age range 21-22 years, 14.2% were in age range 23-24 years old, 4.2% were in age range 25-26 years old and 2.1% were in age 27 years old and above. Out of them, 93.8% were singles (unmarried). Most students enrolled in this study were in their second and third academic year (23.1%) and (26.7%); respectively. Most of them lived with family (90.8%). A 5-8 were the number of family members in (62.6%). The majority were non-smokers (80.7%). A 46.0% of them had male smoker in the family (Table 1).

Table 1: Baseline characteristics of participants. Age range, gender, marital status, academic year, families, previous work, and existence of smokers of the participants (n=359).






315 (87.7%)


44 (12.3%)

Age group


175 (48.7%)


111 (30.9%)


51 (14.2%)


15 (4.2%)

27 and above

7 (2.1%)

Marital status







Academic year

First year


Second year


Third year


Fourth year


Fifth year


Sixth year


Personal living

With Family

326 (90.8%)

Personal rented home

26 (7.1%)

Rented home with friends

7 (2.1%)

Previous work


71 (19.9%)


288 (80.1%)

Family characteristics


86 (24.0%)


225 (62.6%)


42 (11.6%)

More than 12

6 (1.8%)

Are you a smoker


69 (19.3%)


290 (80.7%)

Presence of smokers in family

Female smoker

56 (15.7%)

Male smoker

166 (46.0%)


137 (38.3%)

Among participants, 293 (81.6%) are not current smokers and 72 (20.1%) are former smokers. 56 (15.6%) students launched smoking at age between 16-19 years old. The number of cigarettes smoked/day was 1-5 cigarettes in 53 (14.8%) of the students, while 36 (10%) students usually smoked 6-10 cigarettes per day. 95 (26.5%) students used to smoke shisha. 72 (20.1%) students tried occasionally to quit smoking. The duration of smoking shisha (hours) was in 68 (18.95%) students and the favourable place to smoke shisha significantly found p<0.035 to be in home for 68 (18.9%) students (Table 2).

Table 2. Smoking habits among the participants





Current smoker?

66 (18.4%)

293 (81.6%)


Former smoker?

72 (20.1%)

287 (79.9%)


Current smoker of smokeless tobacco

64 (17.8%)

295 (82.2%)


Using snuff by mouth/day

57 (15.9%)

302 (84.1%)


Smoking shisha

95 (26.5%)

264 (73.5%)


Age starting smoking (years)




20 and more

Never smoked


N (%)

10 (2.8%)

29 (8.1%)

56 (15.6%)

23 (6.4%)

241 (67.1%)

Number Cigarettes smoked/day




Never smoked


N (%)

53 (14.8%)

36 (10.0%)

12 (3.3%)

258 (71.9%)

Time of starting smoking

after awakening

Within 5 min

6-60 min

>60 min

Never smoked


N (%)

43 (12.0%)

29 (8.1%)

32 (8.9%)

255 (71.0%)

Trying to quit smoking?



Never smoked


N (%)

72 (20.1%)

34 (9.5%)

253 (70.5%)

Causes for trying to quit



Family advice

Health problem

Never smoked


N (%)

71 (19.8%)

18 (5.0%)

23 (6.4%)

247 (68.8%)

Duration of smoking shisha



Never smoked


N (%)

48 (13.4%)

68 (18.9%)

243 (67.7%)

Place of smoking shisha


Coffee shop


Never smoked


* P-value <0.05 statistically significant

The student's knowledge and attitude concerning the tobacco usage are shown in Table 3. Most participants agreed that, smoking tobacco causes dangerous disease, brain thrombosis, heart attack and lung cancer 291 (81.1%), 189 (52.6%), 262 (73.0%) and 288 (80.2%), respectively. On the other hand, 87 (24,2%) students thought that smokeless tobacco is significantly less dangerous, p< 0.009. 124 (34.5%) and 64 (17.8%) did not know if smokeless tobacco and shisha smoking is less dangerous respectively. The majority 257 (71.6%) and 226 (63.0%) agreed that smoking and smoking shisha are significantly considered as type of addiction; respectively; p<0.003; p<0.00005. Most of the students 232 (64.6%) agreed significantly that all cigarette advertisings should be banned, p< 0.03 (Table 3).

Table 3: The participants knowledge and attitude about tobacco




Do not know

P value

Smoking tobacco causes dangerous diseases

291 (81.1%)

14 (3.9%)

54 (15.0%)


Smoking tobacco causes brain thrombosis

189 (52.6%)

27 (7.5%)

143 (39.8%)


Smoking tobacco causes heart attack

262 (73.0%)

30 (8.4%)

67 (18.7%)


Tobacco smoking causes lung cancer

288 (80.2%)

25 (7.0%)

46 (12.8%)


Smokeless tobacco is less dangerous

87 (24.2)

148 (41.2%)

124 (34.5%)


Shisha smoking is less dangerous

60 (16.7%)

235 (65.5%)

64 (17.8%)


Smoking is a type of addiction

257 (71.6%)

41 (11.4%)

61 (17.0%)


Smoking shisha is a type of addiction

226 (63.0%)

59 (16.4%)

74 (20.6%)


Islam forbids smoking

213 (59.3%)

58 (16.2%)

88 (24.5%)


Tobacco products taxes should be increased

190 (52.9%)

86 (24.0%)

83 (23.1%)


All cigarettes advertising should be banned

232 (64.6%)

40 (11.1%)

87 (24.2%)


* P-value <0.05 statistically significant

Most of the students didn’t smoke vape 272 (75.8%). Using the E-cigarette to cease smoking was recommended by 105 (29.2%) students as a gadget for smoking cessation. 53 (14.8%) students were usefully able to stop smoking via the E-cigarette. 209 (58.2%) students did not realized that E-cigarette smoking is more felled than ordinary cigarette. 175 participants (48.7%) notarized that E-cigarette is less harmful than the conventional cigarettes (Table 4).

Table 4: Characteristics of vaping habits and related data among participants (n=359)



N (%)


Vaping pattern


50 (13.9%)


Regular vaping

37 (10.3%)

Do not vape

272 (75.8%)

Reason behind vaping

Peer effect

18 (5.0%)


Sadness and depression

14 (3.9%)

Anxiety and stress relief

23 (6.4%)


21 (5.8%)

Quit conventional cigarette

21 (5.8%)

Do not vape

262 (73.0%)

Smoking cessation via E- cigarette


53 (14.8%)



32 (8.9%)

Never smoked

274 (76.3%)

Recommend E-cigarette for smoking cessation


105 (29.2%)



254 (70.8%)

Vaping cessation


54 (15.0%)



39 (10.9%)

Do not vape

266 (74.1%)

Tried vaping


141 (39.3%)


Never tried

218 (60.7%)

E-cigarette flavors


61 (17.0%)



27 (7.5%)

Do not use E-cigarette

271 (75.5%

E-cigarette usage frequency


44 (12.3%)



39 (10.9%)

Used E-cigarette for reason of quitting smoking?


84 (23.4%)



275 (76.6%)

E-cigarette smoking is more harmful?


150 (41.8%)



209 (58.2%)

Conventional smoking is more addictive?


201 (56.0%)



158 (44.0%)

Believe that E-cigarette has adverse health effects

More harm

184 (51.3%)


Less harm

175 (48.7%)


The prevalence of tobacco use among youth is crucial to assess tobacco as a risk factor for health complications and to implement control guidelines for the prevention of tobacco-related maladies. Prevalence of tobacco users amongst students in this study (18.4%) was similar to those found in preceding Saudi studies, which spanned from 14 to 21.6% (10,12).

Other than cigarettes, Shisha smoking is one of the most ubiquitous smoking practices globally, including Saudi Arabia. The incidence of shisha smokers (26.5%) in our study were consistent with previous findings (8,10,12,13). Majority of the population consider that shisha smoking is less harmful or do not know the amount of harm shisha could make than cigarettes because they believe that the water filters out harmful substances. In our study, 16.7% and 17.8% agreed and did not know if shisha is less dangerous than cigarettes, respectively. In addition, the level of plasma nicotine generated by smoking single shisha was observed to be 20% higher than the nicotine bloodstream level generated from cigarettes, which is much more harmful (14). As just a consequence, it poses significant risk with one's health. These findings demonstrate the importance of tobacco control initiatives all forms of tobacco addiction, not just to cigarette smoking

In this study, most of FCMS students had good knowledge that cigarette smoking is affiliated with medical problems. Numerous previous studies showed that cigarette smoking was prevalent among health-related college students despite their knowledge and realization of its harmful effects on the human bodies (8,12,15,16).

According to a study performed by Kawakami, medical students' comprehension of harmful impacts of smoking and their willingness in accomplishing tobacco cessation in the prospect seemed underwhelming (17). In fact, medical students have a superior hope of understanding out about risks of smoking throughout their undergraduate studies. As just a consequence, all health colleges' curricula should include a more comprehensive approach to tobacco dependence education, emphasizing medical skill and practice for students in counselling their patients in giving up smoking (18,19). It should be noted that policymakers should promote the implementation of tobacco prevention and treatment programs and enable undergraduate students to engage actively in these programs.

Despite the reality that e-cigarettes have hardly become available in Saudi Arabia, our findings shows that it has become a widespread practice amongst young undergrads daily (12.3%) and occasionally E-cigarette consumers were found (10.9%). Students from King Saud University in Riyadh (20) reported a similar percentage (25.6%), whereas students from health science colleges at King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz University, and Jeddah University reported 27.7% (9).

We believe that the principal cause for the E-cigarette's popularity is the implementation of a massive advertising blitz appealing to young individuals, like that utilized by conventional cigarette smokers (21, 22). Our study's prevalence is considerably larger than that of a study performed among medical students in Poland; nevertheless, it is equivalent to those from USA, where the prevalence was 3.5% and 24.2%, correspondingly (3, 24).


We finale that, popularity of E-cigarettes and shisha smoking in FCMS as a health college is not high, yet it is alarming. Most of the participants had good knowledge of tobacco harms. Our results highlight the importance of initiating campaigns to quit smoking cigarettes, E-cigarette, and shisha on-campus. Finally, the data gathered from this study showed the necessity to implement tobacco awareness programs and techniques to aid in smoking cessation.


Authors acknowledge the sincere help of Prof. Hesham El-Beshbishy for advising and revising the manuscript.



No conflict of interest.


No fund

Ethical Consideration

This study was approved by Dr. Soliman Fakeeh Hospital (DSFH) Scientific Research Review Committee (DSFH IRB approval # 105/IRB/2020; Date: 27 July 2020).

Data availability

Data that support the findings of this study are embedded within the manuscript

Author Contribution

All authors contributed to conceptualizing, data drafting, collection, analysis and final writing of the manuscript.