الفهرس 
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Abstract
Smoking is one of the greatest causes of preventable morbidity and mortality globally, where it contains over 4,800 chemicals. At least sixty-nine chemicals cause cancer. Prevalence of smoking among medical students varies internationally. Various factors contribute and motivate medical students to smoke. There is no doubt that medical advice helps smokers quit, in addition, health care professionals have a major role to struggle against cigarettes, provide protection and enhance of personal health. Measures of WHO to control cigarette use include recommending the permanent and regular monitoring of smoking by some professional groups due to their professional responsibilities and social roles.
The aim of the present study was to study smoking among male biomedical students in Tobruk, Libya and with following specific objectives:
1. To estimate the prevalence of smoking among male biomedical sciences students
2. To identify the possible determinants of smoking use among male biomedical sciences students.
3. To assess the knowledge of male biomedical sciences students regarding the effect of smoking on health.
A cross-sectional design study was conducted among all (499) male students from the different medical faculties in Tobruk including; faculty of nursing, faculty of medicine, faculty of pharmacy, and faculty of medical technology.
Data collection was done by using a pre-designed self-administered questionnaire including; socio-demographic data, smoking history, smoking history among other family members, smoking data, knowledge about the hazardous effect of smoking on health. Data entry and statistical analysis were done by using the software Statistical Package for Social Sciences (SPSS) version 23. Statistical analysis were performed in both descriptive and inferential forms.
The study revealed the following main results:
A) Socio-demographic data
Age of students ranged from 18 to 26 years with mean ± SD age (20.21 ± 1.98) years.
About three-quarters (76.6%) of the students live inside the city.
Most students (90.2%) were unmarried, compared to 9.8% who were married.
More than two-thirds (66.7%, 61.9%) of students’ fathers and mothers have secondary ,university degree or more, respectively.
More than half (51.3%) of the total students reported that their family size ranging from 5-9 members. while more than one- quarter (27.3%) mentioned that family size ranging from 1- 4.
Monthly income revealed that the median family income for all students was 1000.
More than two-fifths (43.29%) of the total students were in the faculty of medicine, about one third (32.46%) of them were in the faculty of medical technology while those from the faculty of pharmacy and faculty of nursing represented by 13.23% and 11.02%.
Almost one-half (46.7%) of the total students live with non- smoker family members while about 30% and 16% live with a smoking father or a brother, respectively. Among those who live with non-smoking family members 56.1% were non-smokers, while 36.9% were smokers.
More than one-half (59.6%) of non-smoker students have non-smoker friends compared to 24.2% of the smoker students. While 29.9% of the smokers and 11.0% of the non-smokers have 10 or more smoker friends.
In logistic regression analysis: the number of smokerss among friends were significantly associated with smoking.
B) Prevalence of smoking among biomedical sciences faculties’ students
More than one-half (51.1%) of the total students never smoke, 29.7% occasionally smoke, and 19.2% are current smokers.
The highest percent of occasionally smokers was among students at faculty of pharmacy, followed by faculty of medicine (34.8% vs 29.6%, respectively). While, the highest percent of the current smokers was among students at faculty of nursing, followed by faculty of medicine (21.8% vs 21.3%, respectively).
C) Causes of smoking among the smokers students.
The main reported causes of smoking among male biomedical students in the present study appear to be smoking exploration (36.1%), stress relief (27.9%), simulation of friends, and general appearance (18.4%).
D) Smoking data
More than two-thirds (62.3%) started smoking at the age of 15-19 years. 23.8% aged less than 15 years.
About half (50.4%) of the smoker students received their first cigarette from friends, 30.7% received it from the coffee shop.
The majority of the smokers (70.9%) smoke daily for years, while only29.1% smoke daily occasionally.
More than half (52.5%) of the smoker students smoke cigarettes only, 17.2% smoke shisha while 29.5% smoke both cigarettes and shisha.
About two thirds (60.9%) smoke 6-10 cigarettes/day, 27.3% smoke 1-5 cigarettes per day.
71.5% reported to have 6-10 shisha sessions daily, 19.0% have 1-5 shisha sessions daily.
About one-third (31.1%) of smoker students prefer smoking in the coffee shops compared to 31% who do not prefer place for smoking.
E) Knowledge of biomedical sciences faculties students regarding the effect of smoking on health
a. Knowledge regarding the effect of active smoking on health.
Most of the students (85.2%) stated that smoking could cause cancer.
Three-quarters or more of the total students stated that smoking could cause CVDs (79.2%,), respiratory diseases(73.5%) , and mortality (78.0%).
Almost two-thirds of the students mentioned that smoking would cause infertility (59.7%), sexual disability (64.1%), congenital anomalies (62.5%), and anxiety& tiredness (64.9%).
Less than one half of the students reported that smoking cause osteoporosis(48.1%) , and lack of concentration(48.5%)
b. Knowledge of the biomedical sciences students regarding passive smoking and its effect on health.
About three-quarters (75.6%) of the total students stated that they knew passive smoking.
More than three-quarters (79.8%) mentioned that the exposure to nicotine could affect non-smokers.
Two thirds or more of the total students reported that passive smoking could result in lung cancer (79.6%), and asthma(72.1%). Whereas, almost two thirds of them reported that passive smoking could result in cardiac emboli (60.6%), and cerebral emboli (56.0%).
c. Knowledge regarding effect of nicotine on children’s health.
The majority (81.6%) of the total students reported that nicotine could affect the health of exposed children.
Different proportions of the total students stated that nicotine might result in recurrent cough episodes )57.0%( , asthma )73.6%(,, and otitis media (38.0%) among exposed children.
d. Knowledge about chemical composition of tobacco.
The majority of the total students mentioned that nicotine (84.2%) and tar (80.8%), are among the main components of cigarettes.
Thirty one of the total students reported that cigarettes are composed of acetone and 39.5% stated that carbon monoxide is one the components of cigarettes. Furthermore, more than one- fifth (23.6%) of them mentioned that ammonia is one of the contents of cigarettes.
F) Health complaints experienced by biomedical sciences faculties’ students
Almost one-half (48.3%) of the total students mentioned that they do not have any health complaint, compared to one third (31.3%) of them who suffer from more than one health complaint. Moreover, minority (3.8%, 4.8%, 4.2%) of total students complain of tooth black spots (3.8%), dental caries (4.8%), malnutrition(4.2%). Based on the results of the current study, the following can be concluded:
Prevalence of current smoking among male biomedical students in Tobruk, Libya, was 19.2%.
Smoking exploration is considered as the main cause of smoking among male biomedical students in the present study (36.1%), followed by stress relief (27.9%), simulation of friends, and general appearance (18.4%).
Biomedical students had good level of knowledge regarding cancer, cardiovascular diseases, risk of mortality, and effect of passive smoking on health. Meanwhile, they have fair level of knowledge regarding respiratory diseases, infertility, sexual disability, congenital anomalies, and anxiety& tiredness. On the other hand, they have poor level of knowledge only regarding osteoporosis, and lack of concentration.
Smoking is determined mainly by the higher number of smokers among the biomedical students which implies the role that is played by peers.
The majority (81.6%) of the students reported that nicotine could affect the health of exposed children, where 57.0%, 73.6%, 38.0% of the students stated that nicotine might result in recurrent cough episodes, asthma, and otitis media among exposed children, respectively.
The main recommendations of the study are:
Launching smoking cessation campaigns that adopt peer education as a main method of transmitting information.
Establishing an adolescent clinic, where mental health services (for stressed students) are provided in addition to counselling on smoking, its effects and quitting.
Promoting for the negative image of smokers and smoking and its harmful effects through different activities carried out by youth including plays and short videos.
Enforcing the laws banning smoking inside university campus.
Results of this study must be used as a basis for enhancing the capacity to develop and implement tobacco education programs and training in smoking cessation techniques into the curricula of health.
The mass media must play a major role in increase public awareness about health dangers of smoking, and help in the control of smoking habit through the explanation of the bad effects of smoking. In addition posters, magazines, personal interviews and educational advices.