INTRODUCTION

Tobacco smoking among young adults has become a global health concern¹ as it affects different physiological systems and increases the risk of different forms of cancers². Research shows that it reduces the life expectancy of male smokers by about 12 years and that of females by 11 years³. The ill health effects of smoking, particularly lung cancer, are most prevalent among people who start smoking at an early age and continue smoking into adulthood⁴. Smoking causes many deaths among smokers, and also among non-smokers who frequently are exposed to smoke¹.

There are about 1.07 billion smokers worldwide, of whom 908 million are men and 162 million are women, with the majority from low- and middle-income countries¹. In the USA, nearly 8 in100 adults aged 18–24 years smoke cigarettes⁵. In England, about 14% of adults smoke, which is the main risk to their health⁶. The smoking prevalence among Bangladeshi adults is about 19%¹. A recent study among university students of Jahangirnagar University, Bangladesh, shows that 60% of the students smoke⁷. In another study conducted on university students of Sylhet division found that the prevalence of smoking is 37%, while about half of the male students were smokers⁸.

From the literature, the majority of university students start smoking due to the influence of friends. Students who have more smoker friends are more likely to become smokers^7-9. They also start smoking by imitating their smoker family members⁷ and through curiosity^7-9. The prevalence of cigarette smoking was found higher in students who live away from home and have higher living expenditures⁸. Very few students report that a feeling of maturity, symbol of manliness and unhappy family environment as reasons for smoking⁹. In the case of resident students, prevalence is higher than in non-resident students as they are away from their family and home and may receive different influences than students who live with their families. The objectives of this study were to explore the prevalence and risk factors associated with cigarette smoking among resident students of a university in Bangladesh.

METHODS

RESULTS

Table 1 shows the descriptive statistics of the study participants. The average age of the students was 21.5 years (SD=1.7) and the majority of the participants were male. The cigarette smoking prevalence for the 355 participants was 32.6%. As seen in Table 1, almost half of the male students were smokers (49.1%) while only 2.4% of females were smokers with the prevalence higher for those aged 21–23 years (36%). Smoking prevalence was also higher among the students from the engineering faculty (46.4%) and 4th year students (42.6%). There was no association found between the parental educational status and smoking behavior of the students. More than half of the students (54.7%) that spent more (>5000 BDT; exchange rate 1000 BDT about 12 US$) money on living expenses were found to be smokers compared with others. The analysis also shows that smoking behavior was significantly associated with parental smoking, peer smoking status, and living with smokers.

Results from the regression analysis showed that there was a significant association between mother’s occupation and cigarette smoking of the students. Students whose mothers were employed had higher odds of using cigarettes than students whose mothers were housewives (crude OR=2.3; 95% CI: 1.4–3.8). It remained higher after adjusting for covariables (AOR=3.4; 95% CI: 1.7–6.8). Respondents who spent >5000 BDT per month for living expenses had a higher risk of being a smoker (crude OR=25.3; 95% CI: 5.8–110.2) and it remained higher after adjusting for the variables (AOR=34.1; 95% CI: 7.1–163.1). The association was highly significant in both cases. The analysis also showed that students who are currently sharing their room with a smoker had a higher risk of being a smoker (crude OR=12.5; 95% CI: 7.0–22.2) and the odds of being a smoker remained higher after adjusting for the variables (AOR=9.7; 95% CI: 4.9–19.0), both associations were statistically significant (Table 2).

DISCUSSION

In our present survey on cigarette smoking behavior among the resident university students in Bangladesh, the overall prevalence of cigarette smoking was 32.7%, lower than in previous studies conducted among the university students in Sylhet division¹⁰ and medical students in Bangladesh¹¹. However, the prevalence was lower than given in the Global Adult Tobacco Survey (GATS) report, where the overall prevalence of tobacco smoking in Bangladesh was 23.0%¹², suggesting a higher prevalence of smoking among university students in Bangladesh than among young adults in general. This study also reported that nearly half of the male students smoke, in line with the GATS¹² and the study done in Sylhet¹⁰. The prevalence was higher than that reported in nearby countries such as India (20.4%)¹³, Pakistan (26.1%)¹⁴, Nepal (33.6%)¹⁵ and Malaysia (42.1%)¹⁶. The present study found that the prevalence of cigarette smoking among students who come from an urban area is higher than for those who come from a rural area. The most important independent factor associated with cigarette smoking was having smoking friends and/or smoking roommates; similar results were reported from different regions of the world¹⁷. We also found that smoking among university students was correlated with parental smoking and this finding is consistent with other studies¹⁷. The prevalence of smoking by mother’s profession as well as by monthly expenditure was significantly different, which may be related to higher levels of family income as students may have more money available¹⁰. This study also found that the risk of being a smoker is 9.7 times higher for those who have a smoker roommate compared with those with a non-smoker roommate – without excluding the likelihood that smokers may select each other as roommates. The risk of becoming a smoker was found to be 3.4 times higher among students whose mothers worked outside the home than those whose mothers were housewives. Respondents whose parents were smokers were more likely to be smokers.

CONCLUSIONS

The findings of our study show that cigarette smoking prevalence is higher among resident university students than in the general population and identified a number of parameters associated with higher odds of being a smoker. Our findings will contribute to knowledge of cigarette use among Bangladeshi university students. These findings may also be useful for policymaking and for the tobacco-free campus movement.