Factors (Risk) Contributing to Tobacco use among Undergraduate University Students (18-25 Years) in Khyber Pakhtunkhwa (KP), Pakistan

Amir Abdullah *, Tazeen Saeed Ali**, Kashmira Nanji***, Saleema Allana****, Hizbullah Khan*****, Bilal Ahmed******
* Shaukat Khanam Memorial Cancer Hospital and Research Center, Peshawar, Pakistan.
** Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
*** Department of Family Medicine, Aga Khan University, Karachi, Pakistan.
**** School of Nursing and Midwifery & Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
***** Bacha Khan Medical College, Mardan, Pakistan.
****** Planning & Monitoring Specialist - MNTE, UNICEF, USA.
Periodicity:August - October'2020
DOI : https://doi.org/10.26634/jnur.10.3.17109


Tobacco use is considered as one of the leading causes of lung cancer and Chronic Obstructive Pulmonary Disease (COPD). The use of tobacco is dependent upon many factors, such as age, sex, social class, education and income. Therefore, the trend of tobacco consumption is shifting from the developed to the developing countries. The purpose of this study was to identify the contributing factors which lead to tobacco use among undergraduate university students (18-25 years). A retrospective Case-Control study was carried out on 560 (280 Cases and 280 Controls) undergraduate students in three universities of Khyber Pukhtunkhwa (KP), Pakistan. Data was collected through a self-filled structured questionnaire, which was analyzed using descriptive and inferential Odd Ratio (OR) statistics, via SPSS Version 19. The data revealed that tobacco use is significantly associated with brothers (OR: 1.81), and other family members (father in law, grandfather, nephew, relatives) (OR: 3.62) who are addicted to tobacco use. Tobacco using friends (OR: 15.39), use of tobacco in university (OR: 4.37), hostel (OR: 3.79), and public places (OR: 1.49) are also significantly associated with tobacco use. Staying in social gatherings (OR: 2.23) where people use tobacco and offer it to others (OR: 7.43) is also linked with tobacco use. Getting impressed by media promotion advertisements (OR: 1.81), and beliefs about the beneficial effects of tobacco use (OR: 2.19) are also significantly related to tobacco use. Furthermore, having personal problems (OR: 1.78), physical / medical diseases (OR: 1.78), and financial problems (OR: 1.57) were also found significantly associated with tobacco use. The study concluded that there are many factors like tobacco using family members, peer pressure, social gatherings where tobacco is used and offered freely, and promotion of tobacco by media, etc., are positively associated with tobacco use among undergraduate university students (18-25 years) in KP, Pakistan.


Tobacco Use, University Students, Peer Pressure, Media Promotion, Social Factor, Stress.

How to Cite this Article?

Abdullah, A., Ali, T. S., Nanji, K., Allana, S., Khan, H., and Ahmed, B. (2020). Factors (Risk) Contributing to Tobacco use among Undergraduate University Students (18-25 Years) in Khyber Pakhtunkhwa (KP), Pakistan. i-manager's Journal on Nursing, 10(3), 22-40. https://doi.org/10.26634/jnur.10.3.17109


[1]. Ahmed, R., Rizwan-ur-Rashid, P. W., & Ahmed, S. W. (2008). Prevalence of cigarette smoking among young adults in Pakistan. Journal of Pakistan Medical Association, 58(11), 597-601.
[2]. Al-Haqwi, A. I., Tamim, H., & Asery, A. (2010). Knowledge, attitude and practice of tobacco smoking by medical students in Riyadh, Saudi Arabia. Annals of Thoracic Medicine, 5(3), 145-148.
[3]. Al-Naggar, R. A., Al-Dubai, S. A. R., Hamoud, T., Al- Naggar, R. C., & Al-Jashamy, K. (2011). Prevalence and associated factors of smoking among Malaysian university students. Asian Pacific Journal of Cancer Prevention, 12, 619-624.
[4]. Bandura, A. (2011). Social cognitive theory. Handbook of Social Psychological Theories, 349-373.
[5]. Blas, E., & Kurup, A. S. (Eds.). (2010). Equity, social determinants and public health programmes. World Health Organization.
[6]. Centers for Disease Control and Prevention, (2010). Any tobacco use in 13 States behavioral risk factor surveillance system. MMWR- Morbidity and Mortality Weekly Report, 59(30), 946-950.
[7]. Dhanani, R., Jafferani, A., Bhulani, N., Azam, S. I., & Khuwaja, A. K. (2011). Predictors of oral tobacco use among young adult patients visiting family medicine clinics in Karachi, Pakistan. Asian Pacific Journal of Cancer Prevention, 12(1), 43-47.
[8]. Ertas, N. (2007). Factors associated with stages of cigarette smoking among Turkish youth. The European Journal of Public Health, 17(2), 155-161.
[9]. Gupta, P. C., & Ray, C. S. (2003). Smokeless tobacco and health in India and South Asia. Respirology, 8(4), 419- 431. https://doi.org/10.1046/j.1440-1843.2003.00507.x
[10]. Imam, S. Z., Nawaz, H., Sepah, Y. J., Pabaney, A. H., Ilyas, M., & Ghaffar, S. (2007). Use of smokeless tobacco among groups of Pakistani medical students - A cross sectional study. BMC Public Health, 7(1), 1-6. https://doi.org /10.1186/1471-2458-7-231
[11]. Jamil, A., Khan, U. A., Atta, M. A., Shahzada, G., & Younis, M. (2012). Attitude of adolescents for smoking. Journal of Educational and Social Research, 2(3), 369- 376. https://doi.org/10.5901/jesr.2012.v2n3p369
[12]. Kakde, S., Bhopal, R. S., & Jones, C. M. (2012). A systematic review on the social context of smokeless tobacco use in the South Asian population: Implications for public health. Public Health, 126(8), 635-645. https://doi.or g/10.1016/j.puhe.2012.05.002
[13]. Kazmi, S. S., & Hashim, M. (2014). Attitudes & practices of smoking in high school students. International Journal of Recent Research in Social Sciences and Humanities, 1 (1), 1-5.
[14]. Kelkar, D. S., Patwardhan, M., & Joshi, V. D. (2013). Prevalence and causalities of tobacco consumption (TC) among adolescents: A cross sectional study at Pune. The Journal of the Association of Physicians of India, 61(3), 174-178.
[15]. Khader, Y. S., & Alsadi, A. A. (2008). Smoking habits among university students in Jordan: Prevalence and associated factors. EMHJ-Eastern Mediterranean Health Journal, 14 (4), 897-904.
[16]. LeMaster, P. L., Connell, C. M., Mitchell, C. M., & Manson, S. M. (2002). Tobacco use among American Indian adolescents: Protective and risk factors. Journal of Adolescent Health, 30(6), 426-432.
[17]. Maula, F., Adil, M., Zaman, S., Nadeem, M., Zeb, A., Nawaz, K., & Ali, S. (2012). The trends of tobacco use among medical and non-medical students in District Bannu. Gomal Journal of Medical Sciences, 9(2).
[18]. Park, H. K., Al Agili, D. E., & Bartolucci, A. (2012). Factors affecting tobacco use among middle school students in Saudi Arabia. Maternal and Child Health Journal, 16(9), 1828-1836. https://doi.org/10.1007/s10995- 011-0929-z
[19]. Parslow, R. A., & Jorm, A. F. (2006). Tobacco use after experiencing a major natural disaster: Analysis of a longitudinal study of 2063 young adults. Addiction, 101(7), 1044-1050.
[20]. Polit, D. F., & Beck, C. T. (2010). Nursing Research: Generating and Assessing Evidence for Nursing Practice (9th ed.). Philadephia: Lippincott Williams &Wilkins.
[21]. Pradhan, P. M. S., Niraula, S. R., Ghimire, A., Singh, S. B., & Pokharel, P. K. (2013). Tobacco use and associated factors among adolescent students in Dharan, Eastern Nepal: A cross-sectional questionnaire survey. BMJ Open, 3(2), 1-7.
[22]. Reda, A. A., Moges, A., Yazew, B., & Biadgilign, S. (2012). Determinants of cigarette smoking among school adolescents in eastern Ethiopia: A cross-sectional study. Harm Reduction Journal, 9(1), 1-6. https://doi.org/10.118 6/1477-7517-9-39
[23]. Rozi, S., & Akhtar, S. (2007). Prevalence and predictors of smokeless tobacco use among high-school males in Karachi, Pakistan. Eastern Mediterranean Health Journal, 13(4), 916-924.
[24]. Sajwani, R. A., Shoukat, S., Raza, R., Shiekh, M. M., Rashid, Q., Siddique, M. S., & Kadir, M. (2009). Knowledge and practice of healthy lifestyle and dietary habits in medical and non-medical students of Karachi, Pakistan. Journal of Pakistan Medical Association, 59(9), 650-655.
[25]. Shah, I. A., & Baporikar, N. (2013). Gender discrimination: Who is responsible? Evidence from Pakistan. Women's Studies, 42(1), 78-95. https://doi.org/10.1080/00 497878.2013.736284
[26]. Sinha, D. N., Gupta, P. C., Ray, C. S., & Singh, P. K. (2012). Prevalence of smokeless tobacco use among adults in WHO South-East Asia. Indian Journal of Cancer, 49(4), 342-345.
[27]. Thankappan, K. R., & Thresia, C. U. (2007). Tobacco use & social status in Kerala. Indian Journal of Medical Research, 126(4), 300-308.
[28]. Valliani, A., Ahmed, B., Nanji, K., Valliani, S., Zulfiqar, B., Fakih, M., & Arjan, S. (2012). Use of smoke-less tobacco amongst the staff of tertiary care hospitals in the largest city of Pakistan. Asian Pacific Journal of Cancer Prevention, 13(5), 2315-7.
[29]. Warren, C. W., Riley, L., Asma, S., Eriksen, M. P., Green, L., Blanton, C., & Yach, D. (2000). Tobacco use by youth: A surveillance report from the Global Youth Tobacco Survey project. Bulletin of the World Health Organization, 78(7), 868-876.
[30]. Zaman, M., Irfan, U., & Irshad, E. (2002). Prevalence of cigarette smoking among Peshawar University students. Pakistan Journal of Chest Medicine, 8, 9-18.
If you have access to this article please login to view the article or kindly login to purchase the article

Purchase Instant Access

Single Article

North Americas,UK,
Middle East,Europe
India Rest of world
Pdf 35 35 200 20
Online 35 35 200 15
Pdf & Online 35 35 400 25

Options for accessing this content:
  • If you would like institutional access to this content, please recommend the title to your librarian.
    Library Recommendation Form
  • If you already have i-manager's user account: Login above and proceed to purchase the article.
  • New Users: Please register, then proceed to purchase the article.