Smoking Prevention and Cessation in Saudi Youth - Research Paper Example

Smoking prevalence and smoking prevention and cessation in Saudi Youth: A concept analysis Table of Contents Introduction 2 Background 4 Methodological Justification for the Practice Project 6 Literature Review 12 Introduction 12 Peer Influence in Smoking Prevalence, Cessation, and Prevention 13 Gender Influence 13 Family Influence 14 Influence of Perceived Norms 16 Influence of Positive Beliefs about Smoking 17 Religious Influence 18 Influence of Perceived Negative Consequences of Smoking 19 Conclusion 20 References 21 Appendix 28 Introduction In a large majority of the developing nations, the challenge of cigarette smoking has been a persistent cause of concern for health care practitioners. Statistics indicate that cigarette smoking has been attributed to be a cause of one out every six deaths globally (Fida & Abdelmoneim 2013). Further, 1.2 billion smokers hail from the developing nations and out of this population, 50% of these smokers are in the Asian continent. Moreover, in Saudi Arabia, approximately 6 million children aged less than 18 years end up dying in their youthful age due to initiation into smoking during their adolescent years (Huang et al. 2011). Therefore, inasmuch as smoking-related deaths are preventable, the reality is that cigarette smoking is still a leading cause of high morbidity rate (Al-haqwi, Tamim, & Asery 2010). Moreover, tobacco-related deaths have a negative impact on the society as a whole. An integrated analysis of the extent to which the prevalence of cigarette smoking has penetrated into the Saudi Arabia adolescents, and the relevant measures that can be undertaken to ensure that cigarette cessation and prevention is enhanced remains an area with scant research as most studies have focused on these issues independently (Al-malki, FitzGerald, & Clark 2011, p. 307). There are evident patterns indicating that smoking is an age-related addiction; and those who begin smoking in their adolescent years carry on with the habit later on as adults. Similarly, those who do not smoke as adolescents are equally unlikely to smoke as adults (Koechl, Unger, & Fischer 2012, p. 542). Adolescence is perceived as a transitional phase between childhood and adulthood. During this period, a lot of social, psychological, and biological changes take place. Moreover, there is a tendency that during this stage, individuals are more self-aware and open to experimentation, exploration, and are keen to understand the environmental processes that shape their surroundings (Gaffar, Alsanosy, & Mahfouz 2013, p. 383). This stage is also marked by a characteristic increase of engaging in risk intensive activities (Al-moamary et al. 2012). Moreover, the influence of peers is highest at this stage during the adolescence years and, thus, a large majority of social habits are picked from peer social circles. Additionally, Al-zabani & Kasim (2015) intimate that there is a trend indicating that tobacco consumption has been on the increase among college and university students – and the youth in general. Essentially, the aim of this study is to present an objective analysis of the prevalence of smoking in the kingdom of Saudi Arabia. The study will further integrate the smoking cessation and prevention that should be incorporated by the nursing fraternity to alleviate the prevalence. As such, this paper provides a framework review- incorporating a concept analysis on smoking prevalence, prevention, and cessation within Saudi Arabia. Background Despite the common use of the terms prevention, prevalence and cessation, there is a need to develop a more contextual definition of these terms in order to bring a more succinct and objective understanding of these terms and related literature with reference to tobacco smoking. Therefore, a concept analysis research approach was adopted in order to operationalize these terms and the literature with relevance to the nursing context (Penrod & Hupcey 2005). Fundamentally, a concept analysis approach is a research methodology that elaborates on the key attributes of a concept through clarifying on the relationship between the characteristics and the concepts elicited (Risjord 2009). In this regard, the focus was on developing a theoretical framework that would clarify on the smoking cessation, prevalence, and prevention with regards to the realities in Saudi Arabia and the existing literature on tobacco smoking. Smoking prevalence is understood as the extent to which smoking affects a particular geographical region and basically involves the number addicts, active smokers, and occasional smokers (Fida & Abdelmoneim 2013). The understanding derived from this terminology brings to focus a rather ignored section of youthful smokers who are hardly captured in most researches – the occasional smokers. As will be discussed later in this analysis, there are a wide variety of reasons as to why youths start smoking. This means that the progression from an occasional smoker to an active smoker and finally an addict is a gradual process that should be very keenly evaluated when examining smoking prevalence. Smoking cessation refers to the strategies and mechanisms that can be put in place to entirely bar smoking among the affected members (Subaie et al. 2011). Ideally, the concept of smoking cessation involves use of pharmacological and non-pharmacological treatment services to smokers. Evaluation of the smoking cessation programs is easily determined by the number of participants in the program who are able to stick to a certain program. Most of the youths who engage in cigarette smoking are well aware of the hazardous health effects of smoking and are willing to stop (Sreedharan 2010). However, they need to be engaged in cessation programs that provide them with a platform and motivation to reduce tobacco intake and eventually cease from the habit. As such, the analysis of cessation focuses entirely on the group of youths who are already engaged in the smoking. Unlike smoking cessation, the idea of smoking prevention evaluates on the approaches that can effectively alienate the non-smokers from getting involved in smoking of tobacco and related products (Mahabee-Gittens, Ding, & Huan 2010). Peer pressure, ignorance by some of the youths, and a genera laxity among the family and educational institutions to educate the youths on the dangers of smoking has been a major contributor to the increased prevalence in tobacco smoking. Therefore, prevention programs aim at enlightening the youths on the potential dangers associated with smoking. It also involves developing ad enforcing tobacco control measures to alienate smoking from the public and thus reduce prevalence. The use of a concept analysis approach made it possible to develop a candid theoretical framework of the key concepts on cessation, prevention and prevalence with regards to tobacco smoking. Essentially, this approach builds a better conceptual and terminological clarity in the use of concepts within the nursing context (Coker et al. 2013). Consequently, with a clear operationalization of the key research terms used in this study, the literature review developed was more accurate to the context that was being examined. Methodological Justification for the Practice Project The Walker and Avant (2011) concept analysis was applied in developing the literature and theories that were used in this research (Risjord 2009). Through this technique, it was possible to clarify the key definitions and terms in the literature and also expound on the role of health practitioners in intervening to alleviate smoking prevalence among the youths in Saudi Arabia (Jradi and Al-shehri 2014). Within the nursing research, there are various approaches that can be adopted in coming up with a study using the concept analysis approach. This research was founded on the enquiry and the endeavor to understand the extent to which tobacco smoking had affected a selected cohort within Saudi Arabia. The results would have yielded varying results for different age brackets and if the investigation had been carried out to examine different aspects of smoking. Therefore, in selecting the most appropriate concept analysis approach to use, the key considerations were on the semantic representation of terminologies and a research approach that could integrate a series of research concepts and the key research questions (Penrod & Hupcey 2005). With regards to these considerations, the Walker and Avant (2011) analysis technique proved to be the most appropriate ad applicable for the study. According to Walker and Avant, the research process should be carried out systematically through analyzing the key facts available and the data that is presented for evaluation (Beckwith, Dickson, and Kendall 2008). This gives the Walker and Avant (2011) model a more in-depth approach to research inquiry. In the eight step process, the model gives the procedure through which the concept analysis process is carried out. Essentially, the steps in the model are represented as: 1. Concept selection – The selected concept for analysis has already been identified. 2. Identifying the aim of the concept analysis – According to walker and Avant (2011), the approach to identifying the aim of a concept analysis is through clarifying the definition of terminologies used. Therefore, this step entails operationalization of the definitions used in the concept. As such, the scientific and ordinary language usage with regards to the concept is clearly distinguished in this step. 3. Identifying the uses of the concept – In continuation with the operationalization of concept, this step explores additional use of the concept from dictionaries, and medical or nursing literature. 4. Determining the defining attributes – According to Walker and Avant (2011), the defining attributes are the characteristics associated with the concept that are repeated severally in the study. Therefore, this step involves identifying the repeat patterns and incorporating these traits as critical attributes for the concept analysis. For this case, the defining attributes examined if the attributes adopted to reduce or prevent smoking prevalence in various institutions were worked and the associated effects. 5. Identifying a model case – The use of a model case is to present a scenario- based analysis of a real life example whereby the practical application of the defining attributes is analyzed. Consequently, a model case incorporates all the attributes that are applicable to the research concept (Risjord 2009). For this analysis, the model case will involve the role of a nurse in facilitating a rehabilitation of a Saudi youth addicted to smoking. 6. Identifying additional cases – According to Walker and Avant (2011), identification of identical cases facilitates the judgment on which attributes are best fitted to the case under consideration. As such the cases identified could be contrary or similar to the model case (Coker et al. 2013, p. 6). For the concept analysis on smoking prevalence, the additional cases will consider a borderline and a contrary case. 7. Identifying antecedents and consequences – The Walker and Avant (2011) model explains antecedents as being the events that take place prior to the existence of the concept. In light of this concept analysis, the antecedents capture the key prior incidents that must occur with respect to smoking prevalence, cessation and prevention. On the other hand, the consequences refer to the events that follow the occurrence or adoption if the research concept. Thefore, the consequences will cover the factors that are evidenced as a result of alleviation of smoking prevalence and subsequent cessation and prevention of tobacco smoking among the youths under consideration (Aveyard & Raw 2012 p.255). 8. Defining the empirical referents – This is the last step of this model and it involves elaboration of how the concept under analysis can be conceptualized through a measurable criteria. This step will involve demonstrating actual phenomena that validate the literature and findings on smoking prevalence among Saudi youths An alternative model that is used in concept analysis is Rodgers model (1989). This concept analysis model uses an evolutionary approach which acknowledges the changes in perspectives and contextual use of language. One of the key defining features of Rodgers’ model is that it emphasizes mainly on using the concept boundaries in guiding the analysis process. This bears much semblance with Morse et al. (1996) framework. Inasmuch as Rodgers’ model has the benefit of identifying the more contemporary use of language in the literature review, the key challenge is that it uses a randomized criteria in its search strategy. This is in contrast with Walker & Avant’s (2011) model which has a more systematic approach in its search strategy. Similar to Wilson and Walker & Avant approaches, this model includes the development of a model case, identifying attributes, antecedents, and consequences. However, Rodgers approach is particularly difficult to adopt in the concept analysis as its analysis is more descriptive than scientific and, therefore, does not present an interpretation and evaluation of the main features in the analysis. Comparatively, Wilson provides an iterative research process that also examines the subjectivity of concepts within the confines of the contexts they are applied (Risjod 2009). In essence, Walker and Avant (2011) model is a simplification of Wilson’s concept analysis model as it reduces the number of steps from eleven to eight. However, unlike Walker and Avant approach, Wilson research methodology does not provide a rigorous theoretical framework that can expound on the concept under consideration (Beckwith, Dickinson, and Kendall 2008). Additionally, the fact that the Walker and Avant (2011) approach analyzes of concepts and theories from a neutral perspective makes the model appropriate when examining a research area that is bound to present new evidence. Wilson’s model has also been critiqued severally for having a reductionist framework, which implies that contextual influences are not put into consideration in his research (Beckwith, Dickinson, & Kendall 2008, p. 6). Morse et al.’s (1996) model is an alternative approach that could have been used in conducting a concept analysis for the selected participants. However, Morse et al.’s (1996) approach does not have a definitive preliminary framework which an essential component for this concept analysis (Tofthagen & Fagerstrom 2010). Moreover, the fact that this research relied on secondary data (due to limitation in time) in the development of theories and concepts presented a unique challenge in adopting the Walker and Avant approach fully. This was due to the fact that their research approach is partially dependent on observation of the trends and repetitive characteristics in order to ascertain the defining attributes in the research. However, the methodological modification was only applied to determining the defining attributes. This was done through eliciting data from a wide variety of previous independent researches. In this way, then a cluster of attributes were effectively gathered and it was eventually possible to identify the characteristics that were more repeated than others. From the wide variety of sources, it was also possible to draw substantial data that was consistent with the literature gathered on smoking in Saudi Arabia. Literature Review Introduction This review presents an evaluation of the key researches and existing literature on smoking prevalence within the context of Saudi Arabia. It also incorporates an analysis of the key research articles and journals used in the review (see Appendix 1). The review provides an objective assessment of the principal motivators to smoking prevalence among Saudi youths, and put particular emphasis to evaluate the factors that have propagated the culture of cigarette smoking among the youths in Saudi Arabia. Key among them has been the high susceptibility to experimentation (Abdalla et al. 2011). The smoking rates have been on a consistent increase among the youths. The existent linkage between experimentation and susceptibility to smoking is considered as the initial trigger to engage in tobacco smoking among the youths. (Al-malki, FitzGerald, & Clark 2011). Peer Influence in Smoking Prevalence, Cessation, and Prevention According to Brown (2010, p. 267), youths were more likely to engage in smoking due to peer influence after having engaged in the act voluntarily as a result of experimentation. Therefore, despite the existent of peer influence, it only acted as a facilitator to tobacco smoking in the event that the participant had offered to be allowed to smoke out of their own volition and agreed. Consequently, after experimentation, there was a tendency among the youths to believe that smoking was much more common and this mindset rationalizes their smoking habits. Qureshi and Al-bedah (2011) explain that 7 out of every 10 smokers are intent to quit smoking. This, therefore, raises the question on why with the high number of youths still intent to quit smoking, youth smokers is still on an increase. This can be deduced to mean that there withough deliberate efforts to ensure that smoking prevention and cessation programs are put in place, the prevalence of tobacco smoking might increase to uncontrollable levels in the near future. Gender Influence In spite of the influence of peers, Saudi Arabia faces a more pertinent challenge in addressing tobacco smoking among the youths. Particularly, gender influence plays a critical role in determining the probability that a youth will be susceptible to tobacco smoking. According to Al-moamary et al. (2012), males were more exposed to tobacco smoking compared to their female counterparts. This assertion is shared by a large number of nursing scholars who argue that as a result of experimentation and the cultural complacency regarding tobacco use, males find it easier to engage in smoking without feeling culturally alienated. Al-zalabani and Kasim (2015) intimate that males are 27 times more likely to engage in tobacco smoking. While the common argument raised is that the discrepancies in statistical figures are influenced by the social stigma that females face if they openly admitted to tobacco smoking, it is still widely believed and accepted that males are more likely to engage in smoking. Further, Al-zalabani and Kasim (2015) record that the major observable differences between the males and females who engaged in smoking was observed mainly when it came to critical factors such as attitudes towards smoking, intensity of smoking, knowledge regarding the expose to tobacco addiction and the places where they would engage in smoking. However, when it came to exposure to tobacco smoking and awareness of the associated health hazards, both males and females were well aware. These findings provide insights into why there is a probable underreporting of females who engage in smoking. Family Influence It should also be noted that the family setting has had a tremendous impact on the smoking patterns. Ideally, youths spend a substantial amount of time with their family member, and this in return has an impact on their behavioral pattern and social practices. According to Bello et al. (2012, p. 956), in a family where the father smokes, the probability of the children to also engage in smoking was significantly higher than in those where the father did not smoke. From a more critical viewpoint, the influence of a family member who smoked has a negative influence on any efforts to dissuade another member of the family from being a potential smoker. Conversely, in a family where none of the family members engaged in smoking, it was highly unlikely that the youths would engage in tobacco smoking even when faced with the externalities of peer pressure. However, depending on the level of education of the youth, it is still possible to turn around such negative family influence. As Vohra (2009) espouses, the influence of a family member who smokes attributed to 65% likelihood that a youth in the same family would likely to smoke. This was much higher than if the same influence came from peers (35%). Essentially, this points that most of the efforts in smoking prevention programs should be channeled toward discouraging the culture of smoking from the family level. There are inherent challenges in approaching smoking prevention from the family level. As Brown & Rinelli (2010) argue, a family is a close-knit institution where the values shared go beyond culture. There is a high tendency to imitate members of the family, especially if those members have impacted on the youth’s upbringing. However, despite this challenge, Mahabee-Gittens, Ding, and Huan (2010) opine that learning institutions play a critical role in countering such negative family influence. In this regard, a more tacit integration between health practitioners and the schools in order to enlighten leaners on the detrimental effects of smoking should be engaged at the elementary levels. In their research on the influence of a parent on the youth’s vulnerability to tobacco smoking, Brown and Rinelli (2010) highlight that parental behavior and attitude had a profound effect on propagating smoking habits among the youth. They further conclude that for there to be significant reduction in smoking prevalence and a consequent cessation and alleviation of instances where youths imitate parental behaviors, there should be deliberate efforts by parents to discourage tobacco smoking from an early age. Certainly, initiating prevention at an early age would be the most feasible approach but the challenges involved in reaching out to individual parents faces insurmountable logistical challenges. Influence of Perceived Norms Norms refer to the practices and beliefs within a particular social system. Fundamentally, norms are a reflection of what is perceived to be socially acceptable and, thus, is considered normal. Youths are very sensitive to the opinions and views of their peers. As Hoda and Al-shehri (2014) point out, perceived norms are a not a true reflection of what the society believes to socially correct but rather an ideal created by a group of people and adopted with the same enthusiasm as a norm would be. In most learning institutions, youths actively influence each other’s approaches in problem solving, decision making, and other day-to-day activities. This develops a close-knit association that over time has a great influence on their behavior. Therefore, norms play a critical part in triggering the start of smoking tendencies as much as it influences smoking cessation. In the former, norms push youths to engage in smoking as a way of seeking approval from their peers and will invariably smoke with the intent to feel part of the perceived sociocultural association. In the latter, perceived norms act as a positive influence in smoking cessation by creating the impression that smoking is wrong and unacceptable. This viewpoint is supported by Nowatzki, Schultz and Griffith (2010, p. 79) who point out that smoking prevalence is significantly low in the southern region of Saudi Arabia and very high in the Eastern region of Saudi Arabia. In comparing the two geographical regions, the most evident difference is in the norms shared. In the Eastern part of the country, there is a significantly high influence of smoking in learning institution and this has adversely affected any efforts to alleviate smoking prevalence in the region. On the other hand, the southern region has an equally low prevalence level, a factor that has been largely been attributed to the shunning of smoking in the families and learning institutions Moreover, the religious institutions have also played a major role as will be discussed in this analysis. Influence of Positive Beliefs about Smoking The inaccuracies in the information shared among youths create one of the biggest challenges in effectively coming up with long-term strategies to counter the high smoking prevalence. In the literature on drug and substance abuse, the motivations for engaging in drugs include the perception that drug use creates a good feeling. Ideally, youths undergo tremendous biological and social changes during theses year and in the conflicts self-identity, they are likely to indulge themselves in the use of drugs with the expectation that the blissful feeling will have a positive effect on them. On the contrary, continuous use of drugs brings about dependency on them and eventually leads addiction. Lewis’ et al. (2011) study on a group of students who engaged in cigarette smoking indicated that positive beliefs about cigarette smoking impacted on the participant’s use of drugs and consequently influenced peers to engage in smoking. Beliefs such as tobacco smoking will assist an individual to relax, reduce stress, or eliminate boredom are some of the reasons for the tendency for youths to engage in smoking. Since a large a majority of youths are not vigilant to ascertain the truth in such claims, they end up getting carried away by the fallacies associated with such beliefs. In learning institutions, however, there are no elaborate subjects in the curriculum that substantiate that such short-term effects after tobacco use have damaging effects to the users. Religious Influence Religion plays a critical role in designing the conduct in most societies. While there is scant research in the nursing literature that points out to religious influence in smoking, the case of Saudi Arabia presents a very unique study on how religious influences are intertwined with the medical profession to influence smoking cessation and prevention among the youths. According to Al-haqwi, Tamim, & Asery (2010), youths are generally oblivious to the information passed to them in the classroom settings and through the mainstream medical care practitioners. The high exposure to tobacco and it is high availability presents a challenge in coming up with prevention and cessation approaches. However, as Menezes, Hussain, & Madadin (2015, p. 314) note, if the same message is passed on to the youths through the religion, the effects are profound – the youths were less adamant. Therefore, as a smoking cessation and prevention strategy, religious influences are pivotal in influencing the youth’s opinions and outlook on the effects of tobacco smoking. Religious and cultural influences are closely intertwined as Saudi Arabia is a Muslim nation and as such, the Muslim culture is advocated for. The religious influence was in this case found to curb susceptibility of youths to use of drugs. Smoking prevalence is found to be particularly low in areas where there is a high religiosity as evidenced in cases in Israel, and the United States of America. In Saudi Arabia, religion could also partner with the health sector to bring more awareness on the negative effects of smoking as well as contribute towards impacting the youths to desist from tobacco smoking. Influence of Perceived Negative Consequences of Smoking Prolonged tobacco use leads to a myriad of health related complications. This is the principal reason as to why the use of tobacco is discouraged especially among the youths. While not all youths are cognizant of the negative effects of smoking in Saudi Arabia, they still have certain preconceived notions about the possible negative effects of smoking. As Abdalla et al. 2011 argue, the fact that a youth understands that smoking will lead to yellowing of their teeth should discourage them from engaging in the vice. For instance, having the knowledge that smokers have a shorter lifespan compared to non-smokers or that tobacco smoking leaves the users with a foul mouth creates the perception that smoking has negative consequences. Health institutions are faced with the arduous task of demystifying the truths regarding actual consequences of tobacco smoking. Such clarification is critical to developing an environment whereby youths are in a position to understand the extent of health damage that smoking can have on their bodies (Whitehead 2004). An understanding of the negative effects of smoking is bound to have a profound effect on alleviating the susceptibility of youths to engage in smoking. Conclusion This analysis approach literature review offers significant contribution to the existing literature on tobacco use and prevention among youths. The conceptualization of smoking among young adults in Saudi Arabia provides the necessary associations between smoking prevalence and the actions that should be taken to ensure cessation of smoking among the youths. The literature review further provides a clarification on the underlying differences in the conceptions of smoking prevention and cessation with relation to the young Saudi adults. In a more practical perspective, this analysis points out to prevalent cigarette smoking has spread in Saudi Arabia among the youths and provides the key literature to explain the reasons for the existing prevalence. It also indicates how with an understanding of the triggers of smoking prevalence, it is possible to come up with effective smoking cessation and prevention approaches. This knowledge can certainly be applied by learning institutions to increase the overall effectiveness in implementing cessation and prevention interventions that will see a significant reduction in the number of young Saudi adults engaging in tobacco smoking. Ultimately, this will lead to a positive effect through not only reducing the smoking prevalence but also lowering the associated high mortality rates among the youths. References Abdalla, A, Hassan, H, Mustafa, A, Al-kaabba, A & Saeed, A 2011, Prevalence and associated factors of cigarette smoking among medical students at King Fahad Medical City in Riyadh of Saudi Arabia. Journal of Family and Community Medicine, vol. 18 no. 1, p.8. Abdulghani H,M, Alrowais N,A, Alhaqwi A,I, Alrasheedi A, Al-Zahir M, Al-Madani A, & Ahmad F 2013, Cigarette smoking among female students in five medical and nonmedical colleges. International Journal of General Medicine, vol. 6, no. 1, pp. 719–727. 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Journal of Advanced Nursing, vol. 47, no. 3, pp.311-320 Appendix Author Year of Publication Title/ Journal Identified Health Approach Country and Setting Research Aim Method Sample Findings/ Outcomes Al-Zalabani & Kasim 2015 Prevalence and predictors of adolescents’ cigarette smoking in Madinah, Saudi Arabia: A school-based cross-sectional study. BMC Public Health Behavioral, lifestyle, and preventive Saudi Arabia – School The aim was to determine the extent of the prevalence of cigarette smoking among adolescents A school-based cross-sectional study Self-administered questionnaires on 3400 students in 34 secondary schools 1. Family and friends were played a critical role in influencing smoking prevalence among adolescents. Al-haqwi, Tamim, and Asery 2010 Knowledge, attitude and practice of tobacco smoking by medical students in Riyadh, Saudi Arabia. Annals of Thoracic Medicine Behavioral, lifestyle, and preventive Saudi Arabia –School To evaluate smoking prevalence among medical students. To also evaluate the practices, attitude, and knowledge regarding associate risk factors of smoking. A cross-sectional questionnaire-based study. 215 students from two colleges participated in the study 1. The students continued smoking despite awareness of the hazardous effects of smoking. 2. Smoking was strongly linked to stress among the students. Mahabee-Gittens, Ding, and Huan 2010 Agreement between parents and youth on measures of anti-smoking socialization. Journal of Child and Adolescent Substance Abuse Behavioral, lifestyle, and preventive Saudi Arabia - Community To analyze the role played by parents in alleviating smoking prevalence among the youths through selective socialization Descriptive, use of self-administered questionnaires A parent and a 16 year old youth From the study, there was an evidently poor engagement between the parent and the youth regarding anti-smoking socialization. The study viewed that parents need to communicate to the youths on the risk of smoking. Koechl, Unger, & Fischer 2012 Age-Related Aspects of Addiction, Gerontology. Behavioral, lifestyle, and preventive Saudi Arabia - Community The research aim was to elaborate the relationship between addictive tendencies and impact on physical health Descriptive, correlational design The research showed that individuals facing addiction challenges were more vulnerable to psychological, physical, and psychiatric problems. The research suggested the use of non-pharmacological interventions to help in cessation of cigarette addiction Jradi & Al-Shehri Knowledge about Tobacco Smoking among Medical Students in Saudi Arabia: Findings from Three Medical Schools. Epidemiology: Open Access Behavioral, lifestyle, and preventive Saudi Arabia -School The aim of the research was to assess amicable training and educational strategies that can in cessation and prevention of smoking among youths in schools A school-based cross-sectional study 237 medical students from three different medical schools in Saudi Arabia were engaged 1.Majority of students do not know about the health hazards associated with tobacco smoking 2. There is need to incorporate and prioritize education on effects of smoking into the curriculum. Gaffar, Alsanosy, & Mahfouz 2013 Socio-demographic Factors Associated With Tobacco Smoking Among Intermediate and Secondary School Students in Jazan Region of Saudi Arabia. Substance Abuse Behavioral, lifestyle, and preventive Saudi Arabia -School The aim of the research was to identify the predictors that promoted cigarette smoking among the youths A cross sectional study was carried out A group of 3923 students from the Jazan region participated in survey questionnaires It was found that the use cigarette triggered use of other drugs. Friends played a major role in smoking prevalence, and so did high stress levels. smoking prevention and cessation measures could best be implemented at school level since the highest level of influence was for youths was in learning institutions. Fida & Abdelmoneim 2013 Prevalence of smoking among secondary school male students in Jeddah, Saudi Arabia: a survey study. BMC Public Health, Behavioral, lifestyle, and preventive Saudi Arabia -School The aim of the study was to examine the extent of smoking prevalence among youths in school and to evaluate their knowledge on effects of smoking A cross-sectional study with a to-stage cluster sample was conducted. A group of 695 students from 85 secondary schools were interviewed. They were between 16-22 years. 1. The scant knowledge held by students regarding effects of passive smoking meant there was a need to enlighten the youths on the dangers of smoking. 2. The fact that student who were smokers were intent to quit indicated that schools should come up with prevention and cessation programs for students Brown 2010 Family structure, family processes, and adolescent smoking and drinking. Journal of Research on Adolescence Behavioral, lifestyle, and preventive Saudi Arabia – Community To determine the association between the family structure and adolescent risk behaviors such as smoking A longitudinal research design A sample of 90,000 adolescents between grades 7 to 12 1. Adolescents who hailed from low socio-economic class were more likely to engage in smoking. 2. There was high smoking prevalence among adolescents who came from single-mother families Bello et al. 2012 Smokers and marriage: Attitude of youth in the United Arab Emirates. Asian Pacific Journal of Cancer Prevention lifestyle, and preventive Saudi Arabia – Community To determine the impact of adolescent relationship on attitudes and prevalence of smoking A cross-sectional research design 415 students from five different universities 1. Control activities should be taken at the community level to facilitate smoking cessation and prevention. Abdalla et al. 2011 Prevalence and associated factors of cigarette smoking among medical students at King Fahad Medical City in Riyadh of Saudi Arabia. Journal of Family and Community Medicine Behavioral, lifestyle, and preventive Saudi Arabia – School To examine smoking prevalence among students and the association between smoking and socio-demographical factors such as gender, religion, and stress A cross-sectional research design comprising of self-administered questionnaires. A total of 153 first year and second year students at King Fahad Medical City 1. Religion and health are key motivators for not smoking and quitting among the youths. 2. The influence of friends negatively affected cessation and prevention efforts. Read More