1. Prevalence of smoking in Saudi Arabia Yousef Abdullah Al Turki MBBS,DPHC,ABFM Associate Professor Family Medicine College of Medicine King Saud University

2. Content  Introduction  Prevalence of smoking in the world  Prevalence of smoking in Saudi Arabia  Prevalence of smoking among health care professionals  Prevalence of smoking among health care students  How to help smokers to quit smoking?  discussion

3. scenario  Khalid 54 years old diabetic patient followed in primary care clinic at king Khalid University hospital.  He is smoker for the last 35 years, and had difficulty to stop smoking.  How you can help Khalid to quit smoking?

4. Why we are concern about smoking!?  Smoking represents the most readily preventable risk factor for morbidity and mortality.  Smoking related disease will kill one in 10 adults globally.  By 2030, if current trends continue, smoking will kill one in 6 people.* *( world health organization. Smoking statistics, fact sheet 2002. WHO, Regional office for western pacific 2005. available from URL: http;//www.who.int/en/)

5. Prevalence of smoking  In the world:  Smoking is on the rise in the developing world but falling in developed nations.  Among American, smoking rate shrunk by nearly half in 3 decades (from the mid 1960 to mid 1990) falling to 23% of adults by 1997.  In the developing world, tobacco consumption is rising by 3.4% per year. (World Health organization, smoking statistic, http://www.who.int/en/)

6. Smoking prevalence U.S  Smoking prevalence among U.S adults: Center for disease control (CDC):  http://www.cdc.gov/ blackwhitefemalemaleOveralYear 45.842.133.951.942.41965 21.521.918.123.920.92005

7. Smoking prevalence UK http://www.who.int/en/

8. Smoking prevalence among jewes

9. Smoking prevalence in Greece

10. Smoking prevalence in Netherland

11. continue  In Saudi Arabia:  In a community based study, during 5 year period between 1995 and 2000, cigarette smoking was shown to be significantly associated with coronary artery diseases among Saudi patients.* *(Al-Nozha M, Arafah M, Al-mazrou Y, Al-Maatouq M, khan N, Khalil M, etal. Coronary artery disease in Saudi Arabia. Saudi Med J 2004;25:1165-71.)

12. continue  In Saudi Arabia’ family health survey in 1996, an estimate of 9% of those aged 15 years or more was current cigarette smokers: 18% of men and less than one percent of women.* *(khoja T, Farid S. Saudi Arabia family health survey. Council of Health Ministries of GCC states;2000.

13. Prevalence of smoking among health care professionals  Different studies showed that smoking prevalence is quite high among health care workers even though they know the harmful effects of active and passive smoking*. - *Siddiqui S, Ogbeide D. Profile of smoking amongst health staff in a primary care unit at a general hospital in Riyadh, Saudi Arabia. Saudi Med J 2001; 22:1101-04. - *Al- shahri M, Al Almaie S. promotion of non-smoking: The role of primary health care physicians. Ann Saudi Med 1997;17:515-17 - *Behbehani N, Hamadeh R, Macklali N. Knowledge and attitude towards tobacco control among smoking and non smoking physicians in 2 Gulf Arab States. Saudi Med J 2004;25:585-91.

14. continue  Local study was carried out among health staffs in a primary care unit at a general hospital in Riyadh region, which showed that there were 19% smokers, 14% ex- smokers.* - *Siddiqui S, Ogbeide D. Profile of smoking amongst health staff in a primary care unit at a general hospital in Riyadh, Saudi Arabia. Saudi Med J 2001; 22:1101-04.

15. continue  Another local study showed that 17% of primary health care physicians in Riyadh city were current smokers, 20% ex- smoker.* *Al- shahri M, Al Almaie S. promotion of non-smoking: The role of primary health care physicians. Ann Saudi Med 1997;17:515-17

16. continue  In Gulf countries:  One study showed that the prevalence of smoking is high among male physicians in both Kuwait and Bahrain. In Kuwait, current smokers were 18.4% and ex- smoker were 15.8%. In Bahrain, current smokers were 14.6% and ex-smokers were 14.3%.* - *Behbehani N, Hamadeh R, Macklali N. Knowledge and attitude towards tobacco control among smoking and non smoking physicians in 2 Gulf Arab States. Saudi Med J 2004;25:585-91.

17. Prevalence of smoking among health care students  Cigarette smoking is prevalent among students of health care professionals, one study showed that 29% were current smokers among students of the college of applied medical science in Riyadh, Saudi Arabia.* * - Hashim T. Smoking habits of students in college of applied medical science, Saudi Arabia. Saudi Med J 2000;21:76-80.

18. continue  Another study showed that regular smoking has a prevalence rate of 13.6% among medical students at college of medicine in Abha, Saudi Arabia.* *- Abol Fotouh M, Abdel Aziz M, Alakija w, Al-Safy A, Khattab M, Mirdad S, etal. Smoking habits of King Saud university students in Abha, Saudi Arabia. Ann Saudi Med 1998;18:212-16

19. continue  smoking habits among male medical students, college of medicine.ksu.(Saudi Med J 2006)

20. continue  The study showed that 13% of male medical students were currently active smokers, 5.3% were ex- smokers, and 38.2% were passive smokers.  The types of smoking included sheesha 44.1%, cigarette 32.2%, and both 23.7%

21. continue  The common reason given for the smoking behavior was the influence of friends.  The study showed that 57.1% of current smokers were motivated to stop smoking* *Al Turki Y. Smoking habits among medical students in central Saudi Arabia. Saudi Med J 2006;27(5):700-703.

23. How to help smoker to quit smoking?  convince smoker to think and try to stop smoking?  Increase the motivation  Start from now to plan to stop smoking  Give him good news and the benefit of stop smoking  Give him real examples.

24. continue  Discuss with smoker different ways to help him to quit smoking.  guide him to Anti smoking clinic  Do not blame even if he did not try and always motivate and support him.  If he can not stop smoking, educate him to keep the his family, friend, and community away from passive smoking.

25. conclusion  There is an urgent need to promote multi- disciplinary health education activities at different age groups in order to prevent adolescent and younger age from smoking, and to help smokers to quit.

26. Home work  Can we build up new strategy to succeed in smoking cessation?

27.  Thanks