Prevalence and correlates of tobacco smoking among adult males of Kabul city, Afghanistan

Date of Award


Document Type


Degree Name

Master of Science in Epidemiology & Biostatistics (MSc Epidemiology & Biostats)


Community Health Sciences


Introduction — Tobacco smoking causes 5 million deaths worldwide each year. Unless immediate steps are taken to reduce smoking rates, the number of deaths due to tobacco smoking will rise to 10 million per year by 2030, and 70% of these deaths will occur in developing countries. Few studies are conducted to estimate the prevalence of smoking in Afghanistan among youths and to our knowledge no study has explored tobacco smoking among adult population. This study estimated the prevalence and determined the correlates of cigarette smoking among adult males of age 8 years residing in Kabul city, Afghanistan. In addition, the study determined the knowledge and attitudes towards smoking. Methodology — A cross sectional survey was conducted between July-October 2007 in Kabul city, Afghanistan to collect data through a multi-stage cluster sampling from 54 randomly selected Guzars of Kabul city. A total of 773 adult males aged 18 years and older participated in the study. Data was collected through a well defined questionnaire translated into Dan in a face-to-face interview. We analyzed the data in SAS for windows version 9.1. We used PROC SURVEYFREQ and PROC SURVEYLOGISTIC commands to estimate adjusted prevalence and 95% Cis and correlates of smoking. We built two models for assessment of correlates of smoking, one for smokers and the other for current smokers. We compared knowledge and attitude of non-smokers with smokers and current smokers using chi-square and fisher-exact tests. Results — The prevalence of cigarette smoking was 37.1% (95% CI = 33.8% to 40.4%) and the prevalence of current smokers were 22.1% (95% CI = 19.2% - 25.0%) among males aged 18 years and older in Kabul city. Most (86%) of the current smokers started smoking before age 20. Naswar (moist snuff) was the other common form of tobacco used by adult males with overall prevalence of 12.9% (95% CI = 10.3% to 15.6%). Among smokers the Naswar use was higher 10.5% (95% CI = 8.1% to 12.9%) compared to non-smokers 2.5% (95% CI = 1.3% to 3.6%). Those whom most of their friends smoke were 5.3 times (95% CI = 2.8 to 9.9) more likely to be current smokers compared to those whom none of their friends smoke, when adjusted for other variables. We found that in both models, the strongest associated social factor with adult cigarette smoking was friends' smoking followed by use of Naswar and being married. Conclusion — Peer pressure was a strong social factor associated with smoking status. Majority of smokers started smoking before age 20. The results of this study indicate a need to develop an educational curriculum in secondary schools and colleges to teach young adults about the negative immediate and long-term consequences of smoking cigarettes. In developing such a curriculum, it is crucial to consider empowerment of young adults with the necessary life skills to overcome the pressure of peers and friends who may encourage them to acquire risky behaviors such as smoking cigarettes.

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