Exploring Cognitive and Behavioral Dynamics of Smoking among Medical Students: A National Cross-sectional Study

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Aljunaid, Haneen Saud Bukhari, Rafal Hussain Alsharif, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4415248/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Assessment of smoking behaviors and their dynamics is a crucial domain, particularly among medical students who serve as future healthcare providers. However, the association between smoking behaviors and academic progression remains understudied in Jeddah, Saudi Arabia. Objectives This study aims to determine smoking patterns, prevalence, and associated factors among medical students in Jeddah, focusing on experimentation, daily smoking, cessation efforts, awareness of health risks, and attitudes towards quitting. Methods A cross-sectional study was conducted in Jeddah, Saudi Arabia, from September to November 2023. Male and female medical students from the second to sixth year, enrolled in specific universities, were included. Data collection utilized a comprehensive questionnaire, adapted from the World Health Organization's questionnaire and enhanced with additional relevant items by the researchers. The questionnaire, comprising of eight sections, was administered online over a three-month period. Descriptive statistics were used for analysis. Results About 30.8% reported ever smoking, with 21.6% currently smoking. Among ever-smokers, 43.1% began smoking during college, mostly in the second year. Stress, exploration, and peer influence were frequent reasons for initiating smoking during college years. About 32.3% never considered quitting, while 67.7% thought about it. Regarding quit attempts, 46.2% did not try, 53.8% attempted seriously, and 5.3% quit in the last year. Protective factors against smoking included health concerns and setting a good example. Most participants recognized smoking-related health hazards, with strong consensus on the effectiveness of anti-smoking measures. Notably, many participants expressed proactive attitudes towards smoking cessation interventions. Conclusion Smoking is prevalent among Saudi medical students, often starting in college due to stress, new experiences, and peer influence. Many consider quitting, probably supported by the educational environment and a sense of responsibility towards personal and public health. Strengthened educational frameworks, including stress management training, are crucial for fostering a health-focused professional identity. Introduction Smoking poses a significant health risk, contributing to cardiovascular diseases, cerebrovascular accidents, and various cancers, notably lung cancer [ 1 ]. Given their pivotal role as future healthcare providers, medical students serve as influential figures, setting examples for patients and communities [ 2 ]. Research focused on medical students' smoking habits is essential, particularly considering the stress they encounter during their academic progression, stemming from peer comparison, demanding curricula, and licensure exam. Such stressors may lead to smoking as a coping mechanism, potentially exacerbating existing smoking habits exams [ 3 – 6 ]. As the next generation of physicians, medical students will play a crucial role in community education, smoking prevention, and cessation initiatives, spanning across various age demographics. Studies have shown varying prevalence rates of smoking among medical students in Saudi Arabia, with several associations with psychosocial and academic determinants. A cross-sectional study conducted at King Fahad Medical City in Riyadh revealed that 39.8% of the participating students had smoked before, with 17.6% being current smokers. The mean age of smoking initiation was 15.8 (± 3.3) years, with a significantly higher proportion of males being smokers than females. Primary reasons for smoking included leisure, imitation, and stress relief, while health and religious concerns motivated non-smokers [ 7 ]. A cross-sectional survey at Prince Sultan Military College of Health Sciences in Dammam demonstrated that smokers had lower grade point averages, increased absences, and more academic warnings, with a negative correlation between cigarette consumption and grade point averages [ 8 ]. Another study at the College of Medicine, Jazan University, found the highest smoking prevalence among third-year students (15.1%), contrasting with the lowest rates among second-year students (8.6%) [ 9 ]. However, the association between smoking habits and academic progression among medical students in Jeddah remains understudied, necessitating further investigation. To address this gap, this study aims to determine the patterns and prevalence of smoking and smoking-related behaviors and their association with academic progression among medical students enrolled in prestigious institutions such as the University of Jeddah, King Abdulaziz University, Ibn Sina University, Batterjee Medical College, King Saud University, and Fakeeh College of Medical Sciences in Jeddah, Saudi Arabia. By elucidating this relationship, we seek to provide insights into potential interventions and educational programs tailored to mitigate smoking habits among medical students and future healthcare professionals. The study aimed to achieve the following objectives: To determine the prevalence of smoking among medical students, including experimentation, daily smoking, and initiation during college years. To explore the psychological, social, and educational factors influencing smoking habits among medical students. To assess the prevalence of quit attempts among current smokers and factors influencing cessation efforts. To investigate medical students' awareness of smoking-related health risks and perceptions towards anti-smoking measures. To examine the attitudes towards quitting smoking and the role of proactive health professional interventions among medical students. Such data provide insights into the cognitive and behavioral dynamics surrounding smoking among medical students and emphasize the role of medical education in smoking cessation and prevention. Methods Design The cross-sectional study was conducted in Jeddah, Saudi Arabia, between September 2023 to November 2023. Ethical approval was obtained from Bioethics Committee of Scientific & Medical Research, University of Jeddah, Saudi Arabia ( Ref# UJ-REC-146). Participants Inclusion criteria encompassed female and male medical students from the second to sixth year enrolled in specific universities: University of Jeddah, King Abdulaziz University, King Saud University, Ibn Sina National College for Medical Studies, Fakeeh College for Medical Science, and Batterjee Medical College. Exclusion criteria included interns and medical students from other universities. Data collection Data collection used an adapted version of the World Health Organization questionnaire on tobacco-smoking survey among healthcare professionals [ 10 ]. Items were selected as adapted based on relevance with regards to the study objectives. Other questions were added by authors, notably to explore the dynamics of smoking during the college years and other relevant dimensions. Thus, the administered questionnaire was organized into eight sections: 1) Demographic and academic data, including age, sex, nationality, academic year, etc. 2) Smoking experiences and behavior, including ever smoking, ever smoking daily for at least six months, current smoking frequency (no smoking, occasional, daily), and smoking methods. 3) Smoking during medical college years, including whether smoking started during college years, year of start, intention for a one-time experience, smoking amount compared to the past year, quit attempts and duration of quitting, and forecasted smoking habits in the future. 4) Reasons for smoking initiation during college years, such as academic stress, peer influence, etc. (six reasons). Answering options were "no association," "associated," "contributing cause," or "major cause." 5) Protective cognitive factors against smoking, such as the occurrence of health symptoms, protecting health, self-discipline, etc. Each item was introduced with the question "to what extent the following constitute a valid reason for not smoking?" Answering options were: not a reason, low, moderate, and high extent. 6) Knowledge about smoking-related health hazards, including a list of 11 health conditions such as bladder cancer, coronary artery disease, lung cancer, etc. Each hazard is categorized by respondents' responses: "Don't know," "No association," "Contributing cause," "Associated with," and "Major cause." 7) Perceived effectiveness of different antismoking measures. This section assessed participants' opinions on the effectiveness of four anti-smoking measures, including health warnings on cigarette packages, smoking restrictions in closed public places, increased tobacco product prices, and restrictions on smoking in hospitals. Responses ranged from "Strongly disagree" to "Strongly agree." 8) Attitudes towards second-hand smoke and smoking cessation and opinions regarding the role of doctors in addressing smoking (five items). This section assessed the agreement level from "Strongly disagree" to "Strongly agree". Procedure Data collection was conducted online via Google Forms. The survey link was distributed through students’ most popular social media platforms and WhatsApp groups with respect of the targeted universities and faculties. The link was active for a duration of three months. Participants were able to access and complete the survey using the provided link within this timeframe. Statistical methods The survey data was extracted as Excel file from the Google Forms platform. It was then transferred for statistical analysis on the Statistical analysis used the Statistical Package of Social Sciences (SPSS), version 21. Descriptive statistics were used to compute frequencies and percentages of categorical variables and means and standard deviations on continuous variables. Results Demographic and academic data A total of 213 individuals reached the link but two individuals refused to participate and 211 have completed the questionnaire. The mean (SD) age of the participants was 22.57 (2.20) years, and 125 (59.2%) were female. The majority of students were in 5th (28.9%) and 6th (38.4%) year. Jeddah University (29.4%), King Abdulaziz University (20.9%), and King Saud University in Jeddah (12.8%) were the most represented institutions (Table 1 ). Table 1 Demographic and academic data (N = 211) Parameter Level Mean SD Age (years) 22.57 2.20 Parameter Level Frequency Percentage Sex Male 86 40.8 Female 125 59.2 Nationality Saudi 191 90.5 Non-Saudi 20 9.5 Academic year 2nd 20 9.5 3rd 22 10.4 4th 27 12.8 5th 61 28.9 6th 81 38.4 Place of living Villa 100 47.4 Apartment 97 46.0 Hut 5 2.4 University Campus/dormitory 9 4.3 College Jeddah University 62 29.4 King Abdulaziz University 44 20.9 King Saud University 27 12.8 Other 78 36.9 Marital status Single 201 95.3 Married 9 4.3 Divorced 1 0.5 Ever smoking No 146 69.2 Yes 65 30.8 Ever smoking and current smoking status Of the total participants, 65 (30.8%) reported having ever smoked; among these, 31 (47.7%) indicated they had smoked daily for at least six months. Currently, 25 (38.5%) of the 65 identify as daily smokers, 19 (29.2%) no longer smoke, and 21 (32.3%) consider themselves occasional smokers. Thus, the rate of current smoking is 21.6%. The most frequently reported smoking methods were e-cigarette and manufactured cigarettes, used by 13 (20.0%) and 19 (29.2%) students, respectively. However, 40 (61.5%) have not declared their smoking method (Table 2 ). Table 2 Smoking patterns and behaviors among ever smokers (N = 65) Characteristics n % from ever smokers % from relevant subgroup Smoking experiences Ever smoked daily for at least 6 months No 34 52.3 Yes 31 47.7 Current smoking frequency Not at all 19 29.2 Occasionally 21 32.3 Daily 25 38.5 Smoking method a Not reported 40 61.5 Reported 25 38.5 Manufactured cigarettes 13 20.0 e-cigarette 19 29.2 Hand rolled tobacco 2 3.1 Hookah 2 3.1 Cigar 3 4.6 Pipefuls 1 1.5 Smoking dynamics during college years Started during medical college years No 37 56.9 Yes 28 43.1 Is yes, what year? Preparatory / 1st year 4 6.2 14.3 b 2nd year 13 20.0 46.4 3rd year 5 7.7 17.9 4th year 4 6.2 14.3 5th year 2 3.1 7.1 Intended to be a one-time experience No 9 13.8 32.1 b Yes 19 29.2 67.9 Smoking compared to last year Has quitted 2 3.1 Smokes less 4 6.2 Smokes same amount 12 18.5 Smokes more 7 10.8 Not answered 40 61.5 Ever thought of quitting smoking No 21 32.3 Yes 44 67.7 Ever made a serious quit attempt No 30 46.2 Yes 35 53.8 Duration of quitting smoking Days 6 9.2 17.1 c Weeks 8 12.3 22.9 Months 18 27.7 51.4 Years 3 4.6 8.6 Smoking habits in the future Will most certainly not smoke daily 36 55.4 Will probably smoke daily 17 26.2 Will most certainly smoke daily 12 18.5 a A participant may report more than one smoking method b Percentages calculated among participants who started smoking during college years (n = 28) c Percentages calculated among participants who declared having made serious quit attempts (n = 35) Smoking dynamics during the college years Smoking dynamics during the college years are presented in Table 2 . Among the 65 individuals who reported ever smoking, 28 (43.1%) began during their college years, most commonly in the second year (13, 20.0%). This implies that 13.3% of students start smoking during their medical college years. In most of these instances (19/28, or 67.9%), the initiation of smoking was intended as a one-time experience. Furthermore, 32.3% (n = 21) have never considered quitting smoking, while 67.7% (n = 44) have thought about it. Regarding serious quit attempts, 46.2% (n = 30) have not made one, whereas 53.8% (n = 35) have attempted to quit smoking seriously resulting in varying abstinence duration. Compared to last year, a small proportion (3.1%) have quit smoking, 6.2% smoke less, 18.5% maintain the same smoking level, 10.8% smoke more, and 61.5% did not respond to the question on changes in their smoking habits. Regarding future smoking habits, 55.4% (n = 36) of participants are certain they will not smoke daily, 26.2% (n = 17) believe they will probably smoke daily, and 18.5% (n = 12) are certain they will smoke daily. Reasons for smoking initiation during college years Stress related to study/exams, exploring new experiences/trends, and family stress were identified as the primary reasons for initiating smoking during college years, reported by 50%, 35.7%, and 21.4% of participants, respectively. When these factors were not cited as primary causes, they were considered contributing factors, noted by 10.7%, 14.3%, and 28.6% of participants, respectively. On the other hand, peer pressure towards smoking and grieving a loved one were acknowledged as major causes by 17.9% and 14.3% and contributing factors by 10.7% each, respectively (Table 3 ). Table 3 Reasons for smoking initiation during college years (N = 28) Factor No association Associated with Contributing cause Major cause Not answered n % N % n % n % N % Stress related to study/exams 6 21.4 4 14.3 3 10.7 14 50.0 1 0.5 Family stress 10 35.7 4 14.3 8 28.6 6 21.4 0 0.0 Peer pressure 13 46.4 6 21.4 3 10.7 5 17.9 1 0.5 Exploring new experience/ Trend 6 21.4 6 21.4 4 14.3 10 35.7 2 7.1 Grieving a loved one 16 57.1 3 10.7 3 10.7 4 14.3 2 7.1 Other 11 5.2 3 1.4 1 0.5 4 1.9 9 4.3 Protective cognitive factors against smoking In assessing protective cognitive factors against smoking among 211 participants, the study found that the most compelling reasons for not smoking were related to health protection (90% high importance), setting a good example for children (69.2% high importance), and self-discipline (68.7% high importance). The occurrence of certain symptoms also played a significant role, with 57.8% of participants rating it as a highly protective factor against smoking. Factors such as saving money and the influence of professional colleagues not to smoke were deemed important by over half of the respondents. Detailed percentages across different levels of importance (low, moderate, high) and the categorization of other factors are presented in Table 4 . Table 4 Protective cognitive factors against smoking (N = 211) Factor Not a reason Low Moderate High n % n % n % n % Occurrence of certain symptoms 26 12.3 14 6.6 49 23.2 122 57.8 To protect your heath 3 1.4 6 2.8 12 5.7 190 90.0 To save money 24 11.4 33 15.6 44 20.9 110 52.1 Self-discipline 5 2.4 20 9.5 41 19.4 145 68.7 To comply with pressure from professional colleagues not to smoke 71 33.6 56 26.5 21 10 63 29.9 Not to create discomfort in nearby people 33 15.6 28 13.3 44 20.9 106 50.2 To set a good example for patients 21 10 34 16.1 31 14.7 125 59.2 To set good example for health workers 28 13.3 36 17.1 26 12.3 121 57.3 To set good example for children 17 8.1 23 10.9 25 11.8 146 69.2 To set good example for adults in your social environment 26 12.3 32 15.2 30 14.2 123 58.3 Item presented in this table explored the level of perceived importance of the given reason / factor for not smoking; items were introduced by the question “to what extent the following constitute a valid reason for not smoking?” Knowledge about health hazards related to smoking In exploring the perceptions regarding smoking-related health hazards, lung cancer was recognized as a major cause by the highest percentage of participants (91.5%), followed closely by chronic bronchitis (84.4%), laryngeal cancer (77.3%), coronary artery disease (72.5%) and oral cancer (72.0%). Peripheral vascular disease, leukoplakia, neonatal death, and any soft tissue lesion in the mouth or lip were less frequently identified as majorly caused by smoking, yet recognized as associated or major cause by over half of the respondents (Table 5 ). Overall, majority (92.4%) strongly agreed that smoking is harmful to health, with 63.0% expressing very high concern and 24.2% fairly high concern about the detrimental effects of smoking on their health. Table 5 Knowledge about smoking related health hazards (N = 211) Health hazard Don’t know No association Contributing cause Associated with Major cause n % n % n % n % N % Bladder cancer 13 6.2 25 11.8 78 37.0 38 18.0 57 27.0 Coronary artery disease 2 0.9 3 1.4 45 21.3 8 3.8 153 72.5 Lung cancer 0 0 1 0.5 12 5.7 5 2.4 193 91.5 Chronic bronchitis 1 0.5 2 0.9 24 11.4 6 2.8 178 84.4 Oral cancer 5 2.4 1 0.5 43 20.4 10 4.7 152 72.0 Pulmonary emphysema 6 2.8 4 1.9 43 20.4 14 6.6 144 68.2 Laryngeal cancer 2 0.9 1 0.5 38 18.0 7 3.3 163 77.3 Peripheral vascular disease 7 3.3 7 3.3 65 30.8 24 11.4 108 51.2 Leukoplakia 21 10 12 5.7 62 29.4 32 15.2 84 39.8 Any soft tissue lesion (mouth/lip) 10 4.7 7 3.3 61 28.9 34 16.1 99 46.9 Neonatal death 20 9.5 15 7.1 42 19.9 34 16.1 100 47.4 Perceived effectiveness of different antismoking measures Participants' perceptions of the effectiveness of various anti-smoking measures reveal a strong consensus on their potential impact (Table 6 ). Majority of the participants strongly agreed that health warnings on cigarette packages (55.0%), restrictions on smoking in closed public places (63.0%), and sharp increases in tobacco product prices (68.7%) are effective strategies for smoking cessation. Additionally, the restriction of smoking in hospitals to designated smoking areas was also viewed favorably, with 60.2% expressing strong agreement on its effectiveness. Additionally, between 15.6% and 21.3% expressed moderate agreement with the effectiveness of these measures, whereas only a minority expressed disagreement. Table 6 Perceived effectiveness of different antismoking measures (N = 211) Measure Strongly disagree Somewhat disagree Neither agree nor disagree Somewhat agree Strongly agree N % n % n % n % n % The health warning on cigarette packages 12 5.7 18 8.5 20 9.5 45 21.3 116 55.0 Smoking in closed public places being restricted 10 4.7 7 3.3 21 10.0 40 19.0 133 63.0 The sharply increase in price of tobacco products 10 4.7 9 4.3 14 6.6 33 15.6 145 68.7 Smoking in hospitals being restricted to special smoking area. 17 8.1 11 5.2 23 10.9 33 15.6 127 60.2 Participants rated their level of agreement with the effectiveness of each of the above smoking cessation measures. Various perceptions and attitudes towards smoking cessation and exposure One-third of the participants (35.1%) strongly believed that most smokers can quit if they truly wish to, and 40.3% somewhat agreed with this statement. Notably, 70.6% find it bothersome to be around someone smoking. Despite medical advice, 54.5% strongly agree that most individuals will not cease smoking, reflecting skepticism about the efficacy of health professional interventions. Regarding their capability to counsel patients on quitting smoking, 42.2% feel their current knowledge is adequate. Moreover, 60.7% advocate for seizing every appropriate patient interaction as an opportunity to discourage smoking, underscoring a proactive stance on part of healthcare professionals (Table 7 ). Table 7 Attitudes and opinions regarding the role of doctors in addressing smoking (N = 211) Measure Strongly disagree Neither agree nor disagree Somewhat agree Strongly agree n % n % n % n % Most smokers can stop if they wanted to 22 10.4 30 14.2 85 40.3 74 35.1 It’s annoying to be around someone who is smoking 4 1.9 20 9.5 38 18 149 70.6 Most people will not give up smoking even if their doctor tells them 2 0.9 23 10.9 71 33.6 115 54.5 Your current knowledge is sufficient as a basis for counseling patients who want to stop smoking 8 3.8 41 19.4 73 34.6 89 42.2 At every contact with a patient where it would be natural to do so, you should dissuade him from smoking 8 3.8 24 11.4 51 24.2 128 60.7 Discussion Summary of findings The current national study offers an in-depth exploration of smoking habits, attitudes, and perceptions among medical students, particularly focusing on the dynamics of smoking behavior during their medical college years. This investigation seeks to establish a comprehensive framework that integrates psychological, social, and educational factors influencing smoking habits. Key findings reveal that 30.8% of participants have experimented with smoking, with nearly half of these individuals having smoked daily for at least six months. Notably, 43.1% of ever smokers commenced smoking during their college years, primarily driven by stress related to studies, the allure of new experiences, and family pressures. Concurrently, a significant proportion of smokers have contemplated quitting, with over half having attempted serious quit efforts. Current smoking status showed that 46 (21.6%) were active smokers, of whom 25 (11.8%) were daily smokers. On the other hand, health protection, exemplary behavior, and self-discipline serve as potent disincentives against smoking. Furthermore, the participants demonstrated a high level of awareness regarding smoking-related health risks, along with quite favorable perceptions towards the effectiveness of anti-smoking measures. The diverse attitudes towards the feasibility of quitting and the importance of proactive health professional interventions highlight a nuanced understanding of the smoking dilemma within the medical student community. These findings not only reflect the cognitive and behavioral dynamics surrounding smoking but also emphasize the critical role of medical education in fostering a deeper understanding and proactive approach towards smoking cessation and prevention among future physicians. Smoking experiences Assessment of smoking experiences showed that 30.8% of the participating medical students had ever experienced smoking while the rate of active smoking was 21.6%. This concords with the figures of smoking prevalence among Saudi adolescents and undergraduate students, ranging between 2.4–39.6% as shown by a systematic review [ 11 ]. More specifically, studies involving medical students showed disparate figures ranging from 2.9%, in a national study from 2012 [ 12 ], to 29.8% in male medical students from Riyadh in 2016 [ 13 ]. However, daily smokers accounted for 54.3% of current smokers, while the remainder described themselves as occasional smokers. These high figures of smoking among medical students may indicate an adverse health lifestyle and should be prioritized in health promotion interventions. A study from Jeddah showed that smoking among medical students was associated with lower levels of health responsibility, physical activity, nutrition, and interpersonal relationships. The authors suggested that planning and prioritizing health-promoting activities for medical students is crucial, not only to improve their lifestyles and health but also to potentially support population health promotion programs, given their future roles of healthcare providers [ 2 ]. Smoking initiation and dynamics during college years Smoking was initiated during college years in 43% of ever smokers, with academic stress being the most common factor. Due to the demanding nature of the medical curriculum, medical students are more exposed to continuous stress compared to other specialties [ 6 ]. Other sources of stress include psychosocial stress such as family pressure, financial concerns, and emotional relationships, all contribute in the stress load [ 5 ]. This stress load significantly impacts the student’s physical and psychological wellbeing, besides their academic performance [ 3 ]. Among the deleterious consequences of continuous academic stress is smoking. A qualitative study from Riyadh, Saudi Arabia, explored the role of smoking in stress management among medical students, revealing a complex and paradoxical relationship between stress and smoking behaviors. The study showed that while medical students are aware of the ineffectiveness of smoking as a stress relief tool, many continue to use it as a temporary escape from stress. This behavior is supported by a combination of habituation, social dynamics, and the intense pressure of their studies, rather than a belief in its efficacy as a stress management technique [ 4 ]. The high levels of stress endured during medical college years highlight the need to modernize medical education by implementing curricular reforms to improve the mental health of medical students [ 14 ]. Among the non-stress-related reasons for smoking initiation during college years are the exploration of new experiences and trends, and peer pressure towards smoking. These were reported as major or contributing factors by 50.0% and 28.6% of the concerned subgroup, respectively. The influence of peers is a well-established factor in smoking initiation, as documented extensively in the literature [ 15 ]. With regards to smoking dynamics, we observed an interesting trend where most smoking initiation cases occurred during the second year of college. Subsequently, the number of new smokers significantly dropped in the third year and the following years. Additionally, two-thirds of the smokers have contemplated quitting, 53.8% have made serious attempts to quit, and 55.4% predict they will not smoke daily in the future. The observed trends in smoking behavior during medical college years carry significant implications for intervention strategies. The peak in initiation during the second year suggests that this period may be particularly stressful or associated with other factors conducive to smoking initiation. Understanding the specific causes—whether academic pressures, social changes, or others is crucial for targeted interventions. Nonetheless, these trends appear to contradict data from both local and international studies. A study from Jazan, Saudi Arabia, showed that second-year medical students had the lowest smoking rates compared to their peers [ 9 ]. Similarly, a study from China demonstrated that susceptibility to smoking followed a U-shaped curve with age, indicating an initial decrease followed by an increase as students aged [ 16 ]. The high rates of contemplation and quit attempts among students highlight a clear need for smoking cessation support. This need presents an opportunity for health promotion programs to offer structured cessation support during medical education. Peer education is an effective method tailored for medical students. Establishing support or mentorship groups within medical schools, utilizing peers and faculty who have successfully quit, can be highly effective. These programs not only provide educational and emotional support but also reinforce positive behavior changes and self-efficacy [ 15 ]. By fostering a supportive community and highlighting successful role models, medical schools can improve smoking cessation rates, promoting healthier lifestyles and better role models for future clinicians. Protective factors against smoking Health protection, exemplary behavior for children and patients, and self-discipline were shown to be potent disincentives against smoking among the study participants. Furthermore, students showed high levels of awareness about health hazards of smoking, despite some diseases where awareness was relatively low. These levels of awareness are probably shaped by knowledge gained during the medical college years. Likewise, a study among medical students in Egypt showed high levels of awareness about smoking hazards and their future role in fighting against smoking in the community training [ 17 ]. Arguably, the effectiveness of awareness about smoking health hazards in combating smoking is questionable. Krosnick et al. suggest that public awareness of the relative risk of smoking, rather than the absolute risk, would elicit more behavioral change and provide better protection against smoking. This concept relates to the extent to which smoking increases the probability of adverse health outcomes [ 18 ]. Evaluating the perceived effectiveness of anti-smoking measures, the study finds strong support for all explored measures as effective cessation strategies, notably restrictions in public places, price increases, and the restriction of smoking areas in hospitals. This is consistent with data from Egypt [ 17 ]. On the other hand, health warnings on cigarette packaging have shown mixed perceptions of effectiveness. Findings from an Australian study suggest that such warnings are relatively more effective on non-smokers, as they prevent smoking initiation. However, adolescents appear to be desensitized to these warnings [ 19 ]. Interestingly, the present study showed that smoking is not socially encouraged among peers; even friends who smoke are reluctant to offer cigarettes, acknowledging the harmful implications of smoking. This indicates a higher level of awareness about the negative aspects of smoking, even among smokers themselves [ 4 ]. This indicates that awareness, attitudes, and cognitive protection against smoking are dynamic constructs shaped by the students’ medical knowledge, experiences, and progressive embodiment of their future roles as doctors. Another protective dimension against smoking is the attitude towards doctors’ roles in addressing smoking. Although only 42.2% of the participants declared being sufficiently knowledgeable to conduct smoking cessation counseling, 60.7% stated they would engage in smoking-related discussions with their patients. Consistently, the previous study from Egypt showed that medical students have high levels of commitment to the role of physicians in smoking cessation, coupled with a recognition of the need for specialized training [ 17 ]. The endorsement of a future doctor’s role represents a critical dimension in the cognitive and behavioral determinants of smoking among medical students. However, tole model endorsement, adequate formal training in smoking cessation, and promoting a healthy lifestyle and positive behavioral changes are all interconnected dimensions [ 2 , 17 , 20 , 21 ]. Therefore, enhancing medical curricula to include comprehensive smoking cessation training could significantly improve public health outcomes. Equipping future physicians with these skills not only prepares them to better address smoking behaviors but also strengthens their role as health advocates. Additionally, promoting physicians as role models for healthy behaviors can increase their impact on patient and community health, ultimately contributing to lower smoking rates and improved public health. Implications for action Findings from the present study indicate that the unique pressures, stressors, and health education opportunities of medical education significantly shape students' attitudes towards smoking, potentially influencing their initiation, continuation, or cessation of smoking, besides their attitudes and perceptions towards smoking and smoking cessation. These findings provide valuable insights guidance towards the development of targeted interventions for smoking prevention and cessation within the medical student population. Based on these insights, several implications for action emerge: Develop targeted educational programs and create support networks : Institutions should integrate tailored health and wellbeing education programs into the medical curriculum. Establishing support groups or mentorship programs within medical schools would help address smoking cessation, notably by leveraging peers and faculty members who have successfully quit smoking. Incorporate stress management training : Since medical training can be highly stressful, providing students with effective stress management techniques could reduce the likelihood of smoking as a stress relief measure. Promote smoke-free policies : Strengthen smoke-free campus policies in medical schools to reduce environmental triggers for smoking and normalize non-smoking behaviors. Facilitate access to cessation resources : Ensure that medical students have easy access to smoking cessation resources, such as nicotine replacement therapy, counseling services, and digital health tools like apps designed to support quitting efforts. Leverage role modeling : Encourage faculty and senior medical professionals to model non-smoking behavior and actively participate in anti-smoking advocacy, reinforcing the anti-smoking message within the medical community. Conduct regular surveys and assessments : Periodically assess medical students' smoking habits and attitudes towards smoking. Use this data to identify trends, at-risk individuals, and the effectiveness of current educational strategies. Limitations The present study has some limitations that hinder the validity and generalizability of the findings. The cross-sectional design and self-assessment methods pose a high risk for information bias. Additionally, the small sample size and the limited representativeness of faculties outside Jeddah restrict the generalization of the findings to the national level. Conclusion Smoking is highly prevalent among Saudi medical students, with a notable initiation of smoking habits during the college years linked to academic stress, new experiences, and peer influences. Remarkably, a substantial number of students have considered quitting, highlighting a recognition of the health risks associated with smoking. Despite the challenges, there is a robust inclination towards cessation, facilitated by the educational environment that enhances awareness of smoking's health risks and promotes anti-smoking attitudes. This environment not only educates students about the dangers but also fosters a sense of responsibility towards personal and public health. Overall, the findings advocate for strengthened educational frameworks that integrate comprehensive smoking cessation training, promote health-conscious role models, and support the development of medical students into health professionals who can advocate effectively against smoking and influence public health positively. Additionally, considering the integration of stress management training within these curricula is crucial, as it can enhance the mental well-being of students, enabling them to manage the high levels of stress often associated with medical education. This approach not only addresses immediate health behaviors but also fosters a more sustainable, health-focused professional identity. Abbreviations N/A Declarations Ethical approval and consent to participate: This study was conducted in accordance with the Declaration of Helsinki and local ethical principles. Ethical approval was obtained from Bioethics Committee of Scientific & Medical Research, University of Jeddah, Saudi Arabia ( Ref# UJ-REC-146). All participants provided their informed consent prior to participation. The consent statement was embedded in the study questionnaire. Consent for publication: Not applicable. Competing Interest: The authors declare that they have no competing interests. Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Authors’ contributions : Conceptualization, M.A.A.; methodology, H.S.B.; software, R.H.A.; validation, H.S.B.; formal analysis, M.A.A.; investigation, R.A.; resources, S.A.; data curation, S.A.M.; writing—original draft preparation, M.A.A.; writing—review and editing, M.A.A.; visualization, R.A.; supervision, M.A.A.; project administration, S.A.M.; funding acquisition, R.H.A. All authors have read and agreed to the published version of the manuscript. Acknowledgments: Not applicable. References Reitsma MB, Fullman N, Ng M, Salama JS, Abajobir A, Abate KH, et al. Smoking prevalence and attributable disease burden in 195 countries and territories, 1990–2015: a systematic analysis from the Global Burden of Disease Study 2015. Lancet. 2017;389:1885–906. Alzahrani SH, Malik AA, Bashawri J, Shaheen SA, Shaheen MM, Alsaib AA, et al. Health-promoting lifestyle profile and associated factors among medical students in a Saudi university. SAGE Open Med. 2019;7:205031211983842. Ribeiro ÍJS, Pereira R, Freire I V., de Oliveira BG, Casotti CA, Boery EN. Stress and quality of life among university students: A systematic literature review. Health Professions Education. 2018;4:70–7. Abouammoh N, Irfan F, AlFaris E. Stress coping strategies among medical students and trainees in Saudi Arabia: a qualitative study. BMC Med Educ. 2020;20:124. Ragab EA, Dafallah MA, Salih MH, Osman WN, Osman M, Miskeen E, et al. Stress and its correlates among medical students in six medical colleges: an attempt to understand the current situation. Middle East Current Psychiatry. 2021;28:75. Bamuhair SS, Al Farhan AI, Althubaiti A, Agha S, Rahman S ur, Ibrahim NO. Sources of stress and coping strategies among undergraduate medical students enrolled in a problem-based learning curriculum. J Biomed Educ. 2015;2015:1–8. Al-Kaabba A, Saeed A, Abdalla A, Hassan H, Mustafa A. Prevalence and associated factors of cigarette smoking among medical students at King Fahad Medical City in Riyadh of Saudi Arabia. J Family Community Med. 2011;18:8. Alqahtani JS, Aldhahir AM, Alanazi Z, Alsulami EZ, Alsulaimani MA, Alqarni AA, et al. Impact of smoking status and nicotine dependence on academic performance of health sciences students. Subst Abuse Rehabil. 2023;:13–24. Alkhalaf M, Suwyadi A, AlShamakhi E, Oribi H, Theyab Z, Sumayli I, et al. Determinants and Prevalence of Tobacco Smoking among Medical Students at Jazan University, Saudi Arabia. J Smok Cessat. 2021;2021:e20. World Health Organization. Guidelines for the conduct of tobacco-smoking surveys among health professionals. Winnipeg; 1983. Alasqah I, Mahmud I, East L, Usher K. A systematic review of the prevalence and risk factors of smoking among Saudi adolescents. Saudi Med J. 2019;40:867–78. Al-Bedah AM, Basahi JA, Ahmed SS, Mohamed NA. Saudi Arabia Global Health Professional Students Tobacco Survey 2010–2011. Life Sci J. 2012;9:5241–3. Almutairi KM. Predicting relationship of smoking behavior among male Saudi Arabian college students related to their religious practice. J Relig Health. 2016;55:469–79. Slavin SJ, Schindler DL, Chibnall JT. Medical student mental health 3.0. Academic Medicine. 2014;89:573–7. Leshargie CT, Alebel A, Kibret GD, Birhanu MY, Mulugeta H, Malloy P, et al. The impact of peer pressure on cigarette smoking among high school and university students in Ethiopia: A systemic review and meta-analysis. PLoS One. 2019;14:e0222572. Peng S, Yu L, Yang T, Wu D, Bottorff J, Barnett R, et al. Susceptibility to smoking and determinants among medical students: A representative nationwide study in China. Tob Induc Dis. 2019;17:36. Shalaby SF, Soliman MA. Knowledge, attitude, and practice of medical students regarding smoking and substance abuse, Cairo University, Egypt. J Egypt Public Health Assoc. 2019;94:11. Krosnick JA, Malhotra N, Mo CH, Bruera EF, Chang L, Pasek J, et al. Perceptions of health risks of cigarette smoking: A new measure reveals widespread misunderstanding. PLoS One. 2017;12:e0182063. Drovandi A, Teague P-A, Glass B, Malau-Aduli B. Australian school student perceptions of effective anti-tobacco health warnings. Front Public Health. 2018;6:297. Bilgiç N, Günay T. Evaluation of effectiveness of peer education on smoking behavior among high school students. Saudi Med J. 2018;39:74–80. Orsal O, Ergun A. The effect of peer education on decision-making, smoking-promoting factors, self-efficacy, addiction, and behavior change in the process of quitting smoking of young people. Risk Manag Healthc Policy. 2021;14:925–45. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4415248","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":307238370,"identity":"009dfb96-b310-41cf-b887-b43d3151817a","order_by":0,"name":"Mohammed A. Aljunaid","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6ElEQVRIiWNgGAWjYHACxgMSQJKNIfkAA5DB2ECMHqiWtAQStECoHAOwnQS16LYffnDAsu2OPB97zjcJCwYb2Q0H2B9+wKfF7EyawQHJtmeGbTxvt0lIMKQZbzjAYyyBV8uBBJCWw4xtErkgLYcTgVoY8Gs5//wDSIt9m0TOM6CW/0At7I9/4NVyIwdsSyJQCxtQywGgFgYz/LbceFNwQOLc4eQ2nmfGFhIGycYzD/OYWeB3WPrGxxJlh23ntyc/vC1RYSfbd7z98Q18WkCAWQLOAEUNMyH1QMD4AZ0xCkbBKBgFowAZAABOWk7csKiKlwAAAABJRU5ErkJggg==","orcid":"","institution":"University of Jeddah","correspondingAuthor":true,"prefix":"","firstName":"Mohammed","middleName":"A.","lastName":"Aljunaid","suffix":""},{"id":307238371,"identity":"05f18c13-c844-4dc7-ab08-a6bf3428c5bc","order_by":1,"name":"Haneen Saud Bukhari","email":"","orcid":"","institution":"University of Jeddah","correspondingAuthor":false,"prefix":"","firstName":"Haneen","middleName":"Saud","lastName":"Bukhari","suffix":""},{"id":307238372,"identity":"2fa240ee-1475-41f1-a3e0-cb62946af96c","order_by":2,"name":"Rafal Hussain Alsharif","email":"","orcid":"","institution":"University of Jeddah","correspondingAuthor":false,"prefix":"","firstName":"Rafal","middleName":"Hussain","lastName":"Alsharif","suffix":""},{"id":307238373,"identity":"0d6ab36d-b9a1-48d5-84f8-01392e632461","order_by":3,"name":"Shahad Alharbi","email":"","orcid":"","institution":"University of Jeddah","correspondingAuthor":false,"prefix":"","firstName":"Shahad","middleName":"","lastName":"Alharbi","suffix":""},{"id":307238374,"identity":"7eb1b1e2-556a-4267-adde-2e0fe2a864db","order_by":4,"name":"Rawaf Hussain Alsharif","email":"","orcid":"","institution":"University of Jeddah","correspondingAuthor":false,"prefix":"","firstName":"Rawaf","middleName":"Hussain","lastName":"Alsharif","suffix":""},{"id":307238375,"identity":"39887505-fecf-4682-bef9-cb36193a6b42","order_by":5,"name":"Safaa A. Mehdar","email":"","orcid":"","institution":"University of Jeddah","correspondingAuthor":false,"prefix":"","firstName":"Safaa","middleName":"A.","lastName":"Mehdar","suffix":""}],"badges":[],"createdAt":"2024-05-13 20:53:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4415248/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4415248/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":64303166,"identity":"b343cd9a-17b8-459d-a693-9134aeb2fdac","added_by":"auto","created_at":"2024-09-11 12:10:37","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1190614,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4415248/v1/db1f48d1-3c41-4d29-a99e-f02ca8b3b10b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Exploring Cognitive and Behavioral Dynamics of Smoking among Medical Students: A National Cross-sectional Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSmoking poses a significant health risk, contributing to cardiovascular diseases, cerebrovascular accidents, and various cancers, notably lung cancer [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Given their pivotal role as future healthcare providers, medical students serve as influential figures, setting examples for patients and communities [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Research focused on medical students' smoking habits is essential, particularly considering the stress they encounter during their academic progression, stemming from peer comparison, demanding curricula, and licensure exam. Such stressors may lead to smoking as a coping mechanism, potentially exacerbating existing smoking habits exams [\u003cspan additionalcitationids=\"CR4 CR5\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. As the next generation of physicians, medical students will play a crucial role in community education, smoking prevention, and cessation initiatives, spanning across various age demographics.\u003c/p\u003e \u003cp\u003eStudies have shown varying prevalence rates of smoking among medical students in Saudi Arabia, with several associations with psychosocial and academic determinants. A cross-sectional study conducted at King Fahad Medical City in Riyadh revealed that 39.8% of the participating students had smoked before, with 17.6% being current smokers. The mean age of smoking initiation was 15.8 (\u0026plusmn;\u0026thinsp;3.3) years, with a significantly higher proportion of males being smokers than females. Primary reasons for smoking included leisure, imitation, and stress relief, while health and religious concerns motivated non-smokers [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. A cross-sectional survey at Prince Sultan Military College of Health Sciences in Dammam demonstrated that smokers had lower grade point averages, increased absences, and more academic warnings, with a negative correlation between cigarette consumption and grade point averages [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Another study at the College of Medicine, Jazan University, found the highest smoking prevalence among third-year students (15.1%), contrasting with the lowest rates among second-year students (8.6%) [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. However, the association between smoking habits and academic progression among medical students in Jeddah remains understudied, necessitating further investigation.\u003c/p\u003e \u003cp\u003eTo address this gap, this study aims to determine the patterns and prevalence of smoking and smoking-related behaviors and their association with academic progression among medical students enrolled in prestigious institutions such as the University of Jeddah, King Abdulaziz University, Ibn Sina University, Batterjee Medical College, King Saud University, and Fakeeh College of Medical Sciences in Jeddah, Saudi Arabia. By elucidating this relationship, we seek to provide insights into potential interventions and educational programs tailored to mitigate smoking habits among medical students and future healthcare professionals. The study aimed to achieve the following objectives:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eTo determine the prevalence of smoking among medical students, including experimentation, daily smoking, and initiation during college years.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eTo explore the psychological, social, and educational factors influencing smoking habits among medical students.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eTo assess the prevalence of quit attempts among current smokers and factors influencing cessation efforts.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eTo investigate medical students' awareness of smoking-related health risks and perceptions towards anti-smoking measures.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eTo examine the attitudes towards quitting smoking and the role of proactive health professional interventions among medical students.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eSuch data provide insights into the cognitive and behavioral dynamics surrounding smoking among medical students and emphasize the role of medical education in smoking cessation and prevention.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eDesign\u003c/h2\u003e \u003cp\u003eThe cross-sectional study was conducted in Jeddah, Saudi Arabia, between September 2023 to November 2023. Ethical approval was obtained from Bioethics Committee of Scientific \u0026amp; Medical Research, University of Jeddah, Saudi Arabia ( Ref# UJ-REC-146).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003e Inclusion criteria encompassed female and male medical students from the second to sixth year enrolled in specific universities: University of Jeddah, King Abdulaziz University, King Saud University, Ibn Sina National College for Medical Studies, Fakeeh College for Medical Science, and Batterjee Medical College. Exclusion criteria included interns and medical students from other universities.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eData collection\u003c/h2\u003e \u003cp\u003eData collection used an adapted version of the World Health Organization questionnaire on tobacco-smoking survey among healthcare professionals [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Items were selected as adapted based on relevance with regards to the study objectives. Other questions were added by authors, notably to explore the dynamics of smoking during the college years and other relevant dimensions. Thus, the administered questionnaire was organized into eight sections:\u003c/p\u003e \u003cp\u003e1) Demographic and academic data, including age, sex, nationality, academic year, etc.\u003c/p\u003e \u003cp\u003e2) Smoking experiences and behavior, including ever smoking, ever smoking daily for at least six months, current smoking frequency (no smoking, occasional, daily), and smoking methods.\u003c/p\u003e \u003cp\u003e3) Smoking during medical college years, including whether smoking started during college years, year of start, intention for a one-time experience, smoking amount compared to the past year, quit attempts and duration of quitting, and forecasted smoking habits in the future.\u003c/p\u003e \u003cp\u003e4) Reasons for smoking initiation during college years, such as academic stress, peer influence, etc. (six reasons). Answering options were \"no association,\" \"associated,\" \"contributing cause,\" or \"major cause.\"\u003c/p\u003e \u003cp\u003e5) Protective cognitive factors against smoking, such as the occurrence of health symptoms, protecting health, self-discipline, etc. Each item was introduced with the question \"to what extent the following constitute a valid reason for not smoking?\" Answering options were: not a reason, low, moderate, and high extent.\u003c/p\u003e \u003cp\u003e6) Knowledge about smoking-related health hazards, including a list of 11 health conditions such as bladder cancer, coronary artery disease, lung cancer, etc. Each hazard is categorized by respondents' responses: \"Don't know,\" \"No association,\" \"Contributing cause,\" \"Associated with,\" and \"Major cause.\"\u003c/p\u003e \u003cp\u003e7) Perceived effectiveness of different antismoking measures. This section assessed participants' opinions on the effectiveness of four anti-smoking measures, including health warnings on cigarette packages, smoking restrictions in closed public places, increased tobacco product prices, and restrictions on smoking in hospitals. Responses ranged from \"Strongly disagree\" to \"Strongly agree.\"\u003c/p\u003e \u003cp\u003e8) Attitudes towards second-hand smoke and smoking cessation and opinions regarding the role of doctors in addressing smoking (five items). This section assessed the agreement level from \"Strongly disagree\" to \"Strongly agree\".\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eProcedure\u003c/h2\u003e \u003cp\u003eData collection was conducted online via Google Forms. The survey link was distributed through students\u0026rsquo; most popular social media platforms and WhatsApp groups with respect of the targeted universities and faculties. The link was active for a duration of three months. Participants were able to access and complete the survey using the provided link within this timeframe.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical methods\u003c/h2\u003e \u003cp\u003eThe survey data was extracted as Excel file from the Google Forms platform. It was then transferred for statistical analysis on the Statistical analysis used the Statistical Package of Social Sciences (SPSS), version 21. Descriptive statistics were used to compute frequencies and percentages of categorical variables and means and standard deviations on continuous variables.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eDemographic and academic data\u003c/h2\u003e \u003cp\u003eA total of 213 individuals reached the link but two individuals refused to participate and 211 have completed the questionnaire. The mean (SD) age of the participants was 22.57 (2.20) years, and 125 (59.2%) were female. The majority of students were in 5th (28.9%) and 6th (38.4%) year. Jeddah University (29.4%), King Abdulaziz University (20.9%), and King Saud University in Jeddah (12.8%) were the most represented institutions (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic and academic data (N\u0026thinsp;=\u0026thinsp;211)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLevel\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eParameter\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eLevel\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eFrequency\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003ePercentage\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNationality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSaudi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e191\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e90.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-Saudi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eAcademic year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2nd\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3rd\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4th\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5th\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6th\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003ePlace of living\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVilla\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eApartment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHut\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUniversity Campus/dormitory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eCollege\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJeddah University\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKing Abdulaziz University\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKing Saud University\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e201\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEver smoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e146\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e69.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eEver smoking and current smoking status\u003c/h2\u003e \u003cp\u003eOf the total participants, 65 (30.8%) reported having ever smoked; among these, 31 (47.7%) indicated they had smoked daily for at least six months. Currently, 25 (38.5%) of the 65 identify as daily smokers, 19 (29.2%) no longer smoke, and 21 (32.3%) consider themselves occasional smokers. Thus, the rate of current smoking is 21.6%. The most frequently reported smoking methods were e-cigarette and manufactured cigarettes, used by 13 (20.0%) and 19 (29.2%) students, respectively. However, 40 (61.5%) have not declared their smoking method (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSmoking patterns and behaviors among ever smokers (N\u0026thinsp;=\u0026thinsp;65)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e% from ever smokers\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e% from relevant subgroup\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eSmoking experiences\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEver smoked daily for at least 6 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eCurrent smoking frequency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot at all\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOccasionally\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDaily\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003eSmoking method \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot reported\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e61.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReported\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eManufactured cigarettes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ee-cigarette\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHand rolled tobacco\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHookah\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCigar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePipefuls\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSmoking dynamics during college years\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eStarted during medical college years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIs yes, what year?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePreparatory / 1st year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14.3 \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2nd year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e46.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3rd year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4th year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5th year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eIntended to be a one-time experience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e32.1\u003csup\u003e\u003cem\u003eb\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e67.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eSmoking compared to last year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHas quitted\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSmokes less\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSmokes same amount\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSmokes more\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot answered\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e61.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEver thought of quitting smoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e67.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEver made a serious quit attempt\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e53.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eDuration of quitting smoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDays\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17.1 \u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWeeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMonths\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e51.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYears\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eSmoking habits in the future\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWill most certainly not smoke daily\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWill probably smoke daily\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWill most certainly smoke daily\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003ea\u003c/sup\u003e A participant may report more than one smoking method\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003eb\u003c/sup\u003e Percentages calculated among participants who started smoking during college years (n\u0026thinsp;=\u0026thinsp;28)\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003ec\u003c/sup\u003e Percentages calculated among participants who declared having made serious quit attempts (n\u0026thinsp;=\u0026thinsp;35)\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eSmoking dynamics during the college years\u003c/h2\u003e \u003cp\u003eSmoking dynamics during the college years are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Among the 65 individuals who reported ever smoking, 28 (43.1%) began during their college years, most commonly in the second year (13, 20.0%). This implies that 13.3% of students start smoking during their medical college years. In most of these instances (19/28, or 67.9%), the initiation of smoking was intended as a one-time experience.\u003c/p\u003e \u003cp\u003eFurthermore, 32.3% (n\u0026thinsp;=\u0026thinsp;21) have never considered quitting smoking, while 67.7% (n\u0026thinsp;=\u0026thinsp;44) have thought about it. Regarding serious quit attempts, 46.2% (n\u0026thinsp;=\u0026thinsp;30) have not made one, whereas 53.8% (n\u0026thinsp;=\u0026thinsp;35) have attempted to quit smoking seriously resulting in varying abstinence duration.\u003c/p\u003e \u003cp\u003eCompared to last year, a small proportion (3.1%) have quit smoking, 6.2% smoke less, 18.5% maintain the same smoking level, 10.8% smoke more, and 61.5% did not respond to the question on changes in their smoking habits. Regarding future smoking habits, 55.4% (n\u0026thinsp;=\u0026thinsp;36) of participants are certain they will not smoke daily, 26.2% (n\u0026thinsp;=\u0026thinsp;17) believe they will probably smoke daily, and 18.5% (n\u0026thinsp;=\u0026thinsp;12) are certain they will smoke daily.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eReasons for smoking initiation during college years\u003c/h2\u003e \u003cp\u003eStress related to study/exams, exploring new experiences/trends, and family stress were identified as the primary reasons for initiating smoking during college years, reported by 50%, 35.7%, and 21.4% of participants, respectively. When these factors were not cited as primary causes, they were considered contributing factors, noted by 10.7%, 14.3%, and 28.6% of participants, respectively. On the other hand, peer pressure towards smoking and grieving a loved one were acknowledged as major causes by 17.9% and 14.3% and contributing factors by 10.7% each, respectively (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eReasons for smoking initiation during college years (N\u0026thinsp;=\u0026thinsp;28)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFactor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eNo association\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eAssociated with\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eContributing cause\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003eMajor cause\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003eNot answered\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStress related to study/exams\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e14.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e10.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e50.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily stress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e14.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e28.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e21.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeer pressure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e21.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e10.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e17.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExploring new experience/ Trend\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e21.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e14.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e35.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e7.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrieving a loved one\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e57.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e10.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e10.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e14.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e7.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e1.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e4.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eProtective cognitive factors against smoking\u003c/h2\u003e \u003cp\u003eIn assessing protective cognitive factors against smoking among 211 participants, the study found that the most compelling reasons for not smoking were related to health protection (90% high importance), setting a good example for children (69.2% high importance), and self-discipline (68.7% high importance). The occurrence of certain symptoms also played a significant role, with 57.8% of participants rating it as a highly protective factor against smoking. Factors such as saving money and the influence of professional colleagues not to smoke were deemed important by over half of the respondents. Detailed percentages across different levels of importance (low, moderate, high) and the categorization of other factors are presented in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eProtective cognitive factors against smoking (N\u0026thinsp;=\u0026thinsp;211)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFactor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eNot a reason\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOccurrence of certain symptoms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e23.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e122\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e57.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTo protect your heath\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e190\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e90.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTo save money\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e15.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e20.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e52.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-discipline\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e9.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e19.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e145\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e68.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTo comply with pressure from professional colleagues not to smoke\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e26.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e29.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot to create discomfort in nearby people\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e13.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e20.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e50.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTo set a good example for patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e16.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e14.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e59.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTo set good example for health workers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e17.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e12.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e121\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e57.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTo set good example for children\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e10.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e11.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e146\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e69.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTo set good example for adults in your social environment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e15.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e14.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e58.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eItem presented in this table explored the level of perceived importance of the given reason / factor for not smoking; items were introduced by the question \u0026ldquo;to what extent the following constitute a valid reason for not smoking?\u0026rdquo;\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eKnowledge about health hazards related to smoking\u003c/h2\u003e \u003cp\u003eIn exploring the perceptions regarding smoking-related health hazards, lung cancer was recognized as a major cause by the highest percentage of participants (91.5%), followed closely by chronic bronchitis (84.4%), laryngeal cancer (77.3%), coronary artery disease (72.5%) and oral cancer (72.0%). Peripheral vascular disease, leukoplakia, neonatal death, and any soft tissue lesion in the mouth or lip were less frequently identified as majorly caused by smoking, yet recognized as associated or major cause by over half of the respondents (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). Overall, majority (92.4%) strongly agreed that smoking is harmful to health, with 63.0% expressing very high concern and 24.2% fairly high concern about the detrimental effects of smoking on their health.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eKnowledge about smoking related health hazards (N\u0026thinsp;=\u0026thinsp;211)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHealth hazard\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eDon\u0026rsquo;t know\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eNo association\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eContributing cause\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003eAssociated with\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003eMajor cause\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBladder cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e11.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e37.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e18.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e27.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCoronary artery disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e21.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e3.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e153\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e72.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLung cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e5.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e2.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e193\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e91.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChronic bronchitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e11.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e2.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e178\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e84.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOral cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e20.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e4.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e152\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e72.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePulmonary emphysema\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e20.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e6.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e144\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e68.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLaryngeal cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e18.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e163\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e77.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeripheral vascular disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e30.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e11.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e51.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeukoplakia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e29.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e15.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e39.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAny soft tissue lesion (mouth/lip)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e28.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e16.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e46.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeonatal death\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e7.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e19.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e16.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e47.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003ePerceived effectiveness of different antismoking measures\u003c/h2\u003e \u003cp\u003eParticipants' perceptions of the effectiveness of various anti-smoking measures reveal a strong consensus on their potential impact (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e). Majority of the participants strongly agreed that health warnings on cigarette packages (55.0%), restrictions on smoking in closed public places (63.0%), and sharp increases in tobacco product prices (68.7%) are effective strategies for smoking cessation. Additionally, the restriction of smoking in hospitals to designated smoking areas was also viewed favorably, with 60.2% expressing strong agreement on its effectiveness. Additionally, between 15.6% and 21.3% expressed moderate agreement with the effectiveness of these measures, whereas only a minority expressed disagreement.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePerceived effectiveness of different antismoking measures (N\u0026thinsp;=\u0026thinsp;211)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMeasure\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eStrongly disagree\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eSomewhat disagree\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eNeither agree nor disagree\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003eSomewhat agree\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003eStrongly agree\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe health warning on cigarette packages\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e9.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e21.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e55.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking in closed public places being restricted\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e10.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e19.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e133\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e63.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe sharply increase in price of tobacco products\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e6.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e15.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e145\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e68.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking in hospitals being restricted to special smoking area.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e10.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e15.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e127\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e60.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eParticipants rated their level of agreement with the effectiveness of each of the above smoking cessation measures.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eVarious perceptions and attitudes towards smoking cessation and exposure\u003c/h2\u003e \u003cp\u003eOne-third of the participants (35.1%) strongly believed that most smokers can quit if they truly wish to, and 40.3% somewhat agreed with this statement. Notably, 70.6% find it bothersome to be around someone smoking. Despite medical advice, 54.5% strongly agree that most individuals will not cease smoking, reflecting skepticism about the efficacy of health professional interventions. Regarding their capability to counsel patients on quitting smoking, 42.2% feel their current knowledge is adequate. Moreover, 60.7% advocate for seizing every appropriate patient interaction as an opportunity to discourage smoking, underscoring a proactive stance on part of healthcare professionals (Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAttitudes and opinions regarding the role of doctors in addressing smoking (N\u0026thinsp;=\u0026thinsp;211)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMeasure\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eStrongly disagree\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eNeither agree nor disagree\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eSomewhat agree\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003eStrongly agree\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMost smokers can stop if they wanted to\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e14.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e40.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e35.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIt\u0026rsquo;s annoying to be around someone who is smoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e9.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e149\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e70.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMost people will not give up smoking even if their doctor tells them\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e10.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e33.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e54.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYour current knowledge is sufficient as a basis for counseling patients who want to stop smoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e19.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e34.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e42.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAt every contact with a patient where it would be natural to do so, you should dissuade him from smoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e11.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e24.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e128\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e60.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eSummary of findings\u003c/h2\u003e \u003cp\u003eThe current national study offers an in-depth exploration of smoking habits, attitudes, and perceptions among medical students, particularly focusing on the dynamics of smoking behavior during their medical college years. This investigation seeks to establish a comprehensive framework that integrates psychological, social, and educational factors influencing smoking habits. Key findings reveal that 30.8% of participants have experimented with smoking, with nearly half of these individuals having smoked daily for at least six months. Notably, 43.1% of ever smokers commenced smoking during their college years, primarily driven by stress related to studies, the allure of new experiences, and family pressures. Concurrently, a significant proportion of smokers have contemplated quitting, with over half having attempted serious quit efforts. Current smoking status showed that 46 (21.6%) were active smokers, of whom 25 (11.8%) were daily smokers. On the other hand, health protection, exemplary behavior, and self-discipline serve as potent disincentives against smoking. Furthermore, the participants demonstrated a high level of awareness regarding smoking-related health risks, along with quite favorable perceptions towards the effectiveness of anti-smoking measures. The diverse attitudes towards the feasibility of quitting and the importance of proactive health professional interventions highlight a nuanced understanding of the smoking dilemma within the medical student community. These findings not only reflect the cognitive and behavioral dynamics surrounding smoking but also emphasize the critical role of medical education in fostering a deeper understanding and proactive approach towards smoking cessation and prevention among future physicians.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eSmoking experiences\u003c/h2\u003e \u003cp\u003eAssessment of smoking experiences showed that 30.8% of the participating medical students had ever experienced smoking while the rate of active smoking was 21.6%. This concords with the figures of smoking prevalence among Saudi adolescents and undergraduate students, ranging between 2.4\u0026ndash;39.6% as shown by a systematic review [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. More specifically, studies involving medical students showed disparate figures ranging from 2.9%, in a national study from 2012 [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], to 29.8% in male medical students from Riyadh in 2016 [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. However, daily smokers accounted for 54.3% of current smokers, while the remainder described themselves as occasional smokers. These high figures of smoking among medical students may indicate an adverse health lifestyle and should be prioritized in health promotion interventions. A study from Jeddah showed that smoking among medical students was associated with lower levels of health responsibility, physical activity, nutrition, and interpersonal relationships. The authors suggested that planning and prioritizing health-promoting activities for medical students is crucial, not only to improve their lifestyles and health but also to potentially support population health promotion programs, given their future roles of healthcare providers [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eSmoking initiation and dynamics during college years\u003c/h2\u003e \u003cp\u003eSmoking was initiated during college years in 43% of ever smokers, with academic stress being the most common factor. Due to the demanding nature of the medical curriculum, medical students are more exposed to continuous stress compared to other specialties [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Other sources of stress include psychosocial stress such as family pressure, financial concerns, and emotional relationships, all contribute in the stress load [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. This stress load significantly impacts the student\u0026rsquo;s physical and psychological wellbeing, besides their academic performance [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Among the deleterious consequences of continuous academic stress is smoking. A qualitative study from Riyadh, Saudi Arabia, explored the role of smoking in stress management among medical students, revealing a complex and paradoxical relationship between stress and smoking behaviors. The study showed that while medical students are aware of the ineffectiveness of smoking as a stress relief tool, many continue to use it as a temporary escape from stress. This behavior is supported by a combination of habituation, social dynamics, and the intense pressure of their studies, rather than a belief in its efficacy as a stress management technique [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The high levels of stress endured during medical college years highlight the need to modernize medical education by implementing curricular reforms to improve the mental health of medical students [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAmong the non-stress-related reasons for smoking initiation during college years are the exploration of new experiences and trends, and peer pressure towards smoking. These were reported as major or contributing factors by 50.0% and 28.6% of the concerned subgroup, respectively. The influence of peers is a well-established factor in smoking initiation, as documented extensively in the literature [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWith regards to smoking dynamics, we observed an interesting trend where most smoking initiation cases occurred during the second year of college. Subsequently, the number of new smokers significantly dropped in the third year and the following years. Additionally, two-thirds of the smokers have contemplated quitting, 53.8% have made serious attempts to quit, and 55.4% predict they will not smoke daily in the future. The observed trends in smoking behavior during medical college years carry significant implications for intervention strategies. The peak in initiation during the second year suggests that this period may be particularly stressful or associated with other factors conducive to smoking initiation. Understanding the specific causes\u0026mdash;whether academic pressures, social changes, or others is crucial for targeted interventions. Nonetheless, these trends appear to contradict data from both local and international studies. A study from Jazan, Saudi Arabia, showed that second-year medical students had the lowest smoking rates compared to their peers [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Similarly, a study from China demonstrated that susceptibility to smoking followed a U-shaped curve with age, indicating an initial decrease followed by an increase as students aged [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe high rates of contemplation and quit attempts among students highlight a clear need for smoking cessation support. This need presents an opportunity for health promotion programs to offer structured cessation support during medical education. Peer education is an effective method tailored for medical students. Establishing support or mentorship groups within medical schools, utilizing peers and faculty who have successfully quit, can be highly effective. These programs not only provide educational and emotional support but also reinforce positive behavior changes and self-efficacy [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. By fostering a supportive community and highlighting successful role models, medical schools can improve smoking cessation rates, promoting healthier lifestyles and better role models for future clinicians.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eProtective factors against smoking\u003c/h2\u003e \u003cp\u003eHealth protection, exemplary behavior for children and patients, and self-discipline were shown to be potent disincentives against smoking among the study participants. Furthermore, students showed high levels of awareness about health hazards of smoking, despite some diseases where awareness was relatively low. These levels of awareness are probably shaped by knowledge gained during the medical college years. Likewise, a study among medical students in Egypt showed high levels of awareness about smoking hazards and their future role in fighting against smoking in the community training [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Arguably, the effectiveness of awareness about smoking health hazards in combating smoking is questionable. Krosnick et al. suggest that public awareness of the relative risk of smoking, rather than the absolute risk, would elicit more behavioral change and provide better protection against smoking. This concept relates to the extent to which smoking increases the probability of adverse health outcomes [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEvaluating the perceived effectiveness of anti-smoking measures, the study finds strong support for all explored measures as effective cessation strategies, notably restrictions in public places, price increases, and the restriction of smoking areas in hospitals. This is consistent with data from Egypt [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. On the other hand, health warnings on cigarette packaging have shown mixed perceptions of effectiveness. Findings from an Australian study suggest that such warnings are relatively more effective on non-smokers, as they prevent smoking initiation. However, adolescents appear to be desensitized to these warnings [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eInterestingly, the present study showed that smoking is not socially encouraged among peers; even friends who smoke are reluctant to offer cigarettes, acknowledging the harmful implications of smoking. This indicates a higher level of awareness about the negative aspects of smoking, even among smokers themselves [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. This indicates that awareness, attitudes, and cognitive protection against smoking are dynamic constructs shaped by the students\u0026rsquo; medical knowledge, experiences, and progressive embodiment of their future roles as doctors.\u003c/p\u003e \u003cp\u003eAnother protective dimension against smoking is the attitude towards doctors\u0026rsquo; roles in addressing smoking. Although only 42.2% of the participants declared being sufficiently knowledgeable to conduct smoking cessation counseling, 60.7% stated they would engage in smoking-related discussions with their patients. Consistently, the previous study from Egypt showed that medical students have high levels of commitment to the role of physicians in smoking cessation, coupled with a recognition of the need for specialized training [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe endorsement of a future doctor\u0026rsquo;s role represents a critical dimension in the cognitive and behavioral determinants of smoking among medical students. However, tole model endorsement, adequate formal training in smoking cessation, and promoting a healthy lifestyle and positive behavioral changes are all interconnected dimensions [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Therefore, enhancing medical curricula to include comprehensive smoking cessation training could significantly improve public health outcomes. Equipping future physicians with these skills not only prepares them to better address smoking behaviors but also strengthens their role as health advocates. Additionally, promoting physicians as role models for healthy behaviors can increase their impact on patient and community health, ultimately contributing to lower smoking rates and improved public health.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eImplications for action\u003c/h2\u003e \u003cp\u003eFindings from the present study indicate that the unique pressures, stressors, and health education opportunities of medical education significantly shape students' attitudes towards smoking, potentially influencing their initiation, continuation, or cessation of smoking, besides their attitudes and perceptions towards smoking and smoking cessation. These findings provide valuable insights guidance towards the development of targeted interventions for smoking prevention and cessation within the medical student population. Based on these insights, several implications for action emerge:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eDevelop targeted educational programs and create support networks\u003c/b\u003e: Institutions should integrate tailored health and wellbeing education programs into the medical curriculum. Establishing support groups or mentorship programs within medical schools would help address smoking cessation, notably by leveraging peers and faculty members who have successfully quit smoking.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eIncorporate stress management training\u003c/b\u003e: Since medical training can be highly stressful, providing students with effective stress management techniques could reduce the likelihood of smoking as a stress relief measure.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003ePromote smoke-free policies\u003c/b\u003e: Strengthen smoke-free campus policies in medical schools to reduce environmental triggers for smoking and normalize non-smoking behaviors.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eFacilitate access to cessation resources\u003c/b\u003e: Ensure that medical students have easy access to smoking cessation resources, such as nicotine replacement therapy, counseling services, and digital health tools like apps designed to support quitting efforts.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eLeverage role modeling\u003c/b\u003e: Encourage faculty and senior medical professionals to model non-smoking behavior and actively participate in anti-smoking advocacy, reinforcing the anti-smoking message within the medical community.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eConduct regular surveys and assessments\u003c/b\u003e: Periodically assess medical students' smoking habits and attitudes towards smoking. Use this data to identify trends, at-risk individuals, and the effectiveness of current educational strategies.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThe present study has some limitations that hinder the validity and generalizability of the findings. The cross-sectional design and self-assessment methods pose a high risk for information bias. Additionally, the small sample size and the limited representativeness of faculties outside Jeddah restrict the generalization of the findings to the national level.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eSmoking is highly prevalent among Saudi medical students, with a notable initiation of smoking habits during the college years linked to academic stress, new experiences, and peer influences. Remarkably, a substantial number of students have considered quitting, highlighting a recognition of the health risks associated with smoking.\u003c/p\u003e \u003cp\u003eDespite the challenges, there is a robust inclination towards cessation, facilitated by the educational environment that enhances awareness of smoking's health risks and promotes anti-smoking attitudes. This environment not only educates students about the dangers but also fosters a sense of responsibility towards personal and public health.\u003c/p\u003e \u003cp\u003eOverall, the findings advocate for strengthened educational frameworks that integrate comprehensive smoking cessation training, promote health-conscious role models, and support the development of medical students into health professionals who can advocate effectively against smoking and influence public health positively. Additionally, considering the integration of stress management training within these curricula is crucial, as it can enhance the mental well-being of students, enabling them to manage the high levels of stress often associated with medical education. This approach not only addresses immediate health behaviors but also fosters a more sustainable, health-focused professional identity.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eN/A\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the Declaration of Helsinki and local ethical principles.\u0026nbsp;Ethical approval was obtained from Bioethics Committee of Scientific \u0026amp; Medical Research, University of Jeddah, Saudi Arabia ( Ref#\u0026nbsp;UJ-REC-146).\u0026nbsp;All participants provided their informed consent prior to participation. The consent statement was embedded in the study questionnaire.\u003cbr\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Not applicable.\u003cbr\u003e\u003cstrong\u003eCompeting Interest:\u003c/strong\u003e\u003cbr\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003cbr\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization, M.A.A.; methodology, H.S.B.; software, R.H.A.; validation,\u003c/p\u003e\n\u003cp\u003eH.S.B.; formal analysis, M.A.A.; investigation, R.A.; resources, S.A.; data curation, S.A.M.;\u003c/p\u003e\n\u003cp\u003ewriting\u0026mdash;original draft preparation, M.A.A.; writing\u0026mdash;review and editing, M.A.A.; visualization,\u003c/p\u003e\n\u003cp\u003eR.A.; supervision, M.A.A.; project administration, S.A.M.; funding acquisition, R.H.A. All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eReitsma MB, Fullman N, Ng M, Salama JS, Abajobir A, Abate KH, et al. Smoking prevalence and attributable disease burden in 195 countries and territories, 1990\u0026ndash;2015: a systematic analysis from the Global Burden of Disease Study 2015. Lancet. 2017;389:1885\u0026ndash;906.\u003c/li\u003e\n\u003cli\u003eAlzahrani SH, Malik AA, Bashawri J, Shaheen SA, Shaheen MM, Alsaib AA, et al. Health-promoting lifestyle profile and associated factors among medical students in a Saudi university. SAGE Open Med. 2019;7:205031211983842.\u003c/li\u003e\n\u003cli\u003eRibeiro \u0026Iacute;JS, Pereira R, Freire I V., de Oliveira BG, Casotti CA, Boery EN. Stress and quality of life among university students: A systematic literature review. Health Professions Education. 2018;4:70\u0026ndash;7.\u003c/li\u003e\n\u003cli\u003eAbouammoh N, Irfan F, AlFaris E. Stress coping strategies among medical students and trainees in Saudi Arabia: a qualitative study. BMC Med Educ. 2020;20:124.\u003c/li\u003e\n\u003cli\u003eRagab EA, Dafallah MA, Salih MH, Osman WN, Osman M, Miskeen E, et al. Stress and its correlates among medical students in six medical colleges: an attempt to understand the current situation. Middle East Current Psychiatry. 2021;28:75.\u003c/li\u003e\n\u003cli\u003eBamuhair SS, Al Farhan AI, Althubaiti A, Agha S, Rahman S ur, Ibrahim NO. Sources of stress and coping strategies among undergraduate medical students enrolled in a problem-based learning curriculum. J Biomed Educ. 2015;2015:1\u0026ndash;8.\u003c/li\u003e\n\u003cli\u003eAl-Kaabba A, Saeed A, Abdalla A, Hassan H, Mustafa A. Prevalence and associated factors of cigarette smoking among medical students at King Fahad Medical City in Riyadh of Saudi Arabia. J Family Community Med. 2011;18:8.\u003c/li\u003e\n\u003cli\u003eAlqahtani JS, Aldhahir AM, Alanazi Z, Alsulami EZ, Alsulaimani MA, Alqarni AA, et al. Impact of smoking status and nicotine dependence on academic performance of health sciences students. Subst Abuse Rehabil. 2023;:13\u0026ndash;24.\u003c/li\u003e\n\u003cli\u003eAlkhalaf M, Suwyadi A, AlShamakhi E, Oribi H, Theyab Z, Sumayli I, et al. Determinants and Prevalence of Tobacco Smoking among Medical Students at Jazan University, Saudi Arabia. J Smok Cessat. 2021;2021:e20.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. Guidelines for the conduct of tobacco-smoking surveys among health professionals. Winnipeg; 1983.\u003c/li\u003e\n\u003cli\u003eAlasqah I, Mahmud I, East L, Usher K. A systematic review of the prevalence and risk factors of smoking among Saudi adolescents. Saudi Med J. 2019;40:867\u0026ndash;78.\u003c/li\u003e\n\u003cli\u003eAl-Bedah AM, Basahi JA, Ahmed SS, Mohamed NA. Saudi Arabia Global Health Professional Students Tobacco Survey 2010\u0026ndash;2011. Life Sci J. 2012;9:5241\u0026ndash;3.\u003c/li\u003e\n\u003cli\u003eAlmutairi KM. Predicting relationship of smoking behavior among male Saudi Arabian college students related to their religious practice. J Relig Health. 2016;55:469\u0026ndash;79.\u003c/li\u003e\n\u003cli\u003eSlavin SJ, Schindler DL, Chibnall JT. Medical student mental health 3.0. Academic Medicine. 2014;89:573\u0026ndash;7.\u003c/li\u003e\n\u003cli\u003eLeshargie CT, Alebel A, Kibret GD, Birhanu MY, Mulugeta H, Malloy P, et al. The impact of peer pressure on cigarette smoking among high school and university students in Ethiopia: A systemic review and meta-analysis. PLoS One. 2019;14:e0222572.\u003c/li\u003e\n\u003cli\u003ePeng S, Yu L, Yang T, Wu D, Bottorff J, Barnett R, et al. Susceptibility to smoking and determinants among medical students: A representative nationwide study in China. Tob Induc Dis. 2019;17:36.\u003c/li\u003e\n\u003cli\u003eShalaby SF, Soliman MA. Knowledge, attitude, and practice of medical students regarding smoking and substance abuse, Cairo University, Egypt. J Egypt Public Health Assoc. 2019;94:11.\u003c/li\u003e\n\u003cli\u003eKrosnick JA, Malhotra N, Mo CH, Bruera EF, Chang L, Pasek J, et al. Perceptions of health risks of cigarette smoking: A new measure reveals widespread misunderstanding. PLoS One. 2017;12:e0182063.\u003c/li\u003e\n\u003cli\u003eDrovandi A, Teague P-A, Glass B, Malau-Aduli B. Australian school student perceptions of effective anti-tobacco health warnings. Front Public Health. 2018;6:297.\u003c/li\u003e\n\u003cli\u003eBilgi\u0026ccedil; N, G\u0026uuml;nay T. Evaluation of effectiveness of peer education on smoking behavior among high school students. Saudi Med J. 2018;39:74\u0026ndash;80.\u003c/li\u003e\n\u003cli\u003eOrsal O, Ergun A. The effect of peer education on decision-making, smoking-promoting factors, self-efficacy, addiction, and behavior change in the process of quitting smoking of young people. Risk Manag Healthc Policy. 2021;14:925\u0026ndash;45.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-4415248/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4415248/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eAssessment of smoking behaviors and their dynamics is a crucial domain, particularly among medical students who serve as future healthcare providers. However, the association between smoking behaviors and academic progression remains understudied in Jeddah, Saudi Arabia.\u003c/p\u003e\u003ch2\u003eObjectives\u003c/h2\u003e \u003cp\u003eThis study aims to determine smoking patterns, prevalence, and associated factors among medical students in Jeddah, focusing on experimentation, daily smoking, cessation efforts, awareness of health risks, and attitudes towards quitting.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cross-sectional study was conducted in Jeddah, Saudi Arabia, from September to November 2023. Male and female medical students from the second to sixth year, enrolled in specific universities, were included. Data collection utilized a comprehensive questionnaire, adapted from the World Health Organization's questionnaire and enhanced with additional relevant items by the researchers. The questionnaire, comprising of eight sections, was administered online over a three-month period. Descriptive statistics were used for analysis.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAbout 30.8% reported ever smoking, with 21.6% currently smoking. Among ever-smokers, 43.1% began smoking during college, mostly in the second year. Stress, exploration, and peer influence were frequent reasons for initiating smoking during college years. About 32.3% never considered quitting, while 67.7% thought about it. Regarding quit attempts, 46.2% did not try, 53.8% attempted seriously, and 5.3% quit in the last year. Protective factors against smoking included health concerns and setting a good example. Most participants recognized smoking-related health hazards, with strong consensus on the effectiveness of anti-smoking measures. Notably, many participants expressed proactive attitudes towards smoking cessation interventions.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eSmoking is prevalent among Saudi medical students, often starting in college due to stress, new experiences, and peer influence. Many consider quitting, probably supported by the educational environment and a sense of responsibility towards personal and public health. Strengthened educational frameworks, including stress management training, are crucial for fostering a health-focused professional identity.\u003c/p\u003e","manuscriptTitle":"Exploring Cognitive and Behavioral Dynamics of Smoking among Medical Students: A National Cross-sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-31 09:41:31","doi":"10.21203/rs.3.rs-4415248/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"229a1bca-5d61-4506-91d3-87733fa09ca4","owner":[],"postedDate":"May 31st, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-09-11T12:02:30+00:00","versionOfRecord":[],"versionCreatedAt":"2024-05-31 09:41:31","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4415248","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4415248","identity":"rs-4415248","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}