Kassim Saba, Rogers Nikki, Leach Kelly
Institute of Dentistry, Queen Mary, University of London, Barts and The London School of Medicine and Dentistry, 4 Newark Street, London E1 2AT, UK.
BMC Public Health. 2014 May 13;14:448. doi: 10.1186/1471-2458-14-448.
Chewing khat leaves is often accompanied by tobacco use. We assessed aspects of tobacco use and explored factors associated with tobacco use patterns (frequency of use per week) among khat chewers who used tobacco only when chewing khat ("simultaneous tobacco and khat users", STKU).
A sample of 204 male khat chewers was recruited during random visits to khat outlets. Data collected included socio-demographic items, tobacco use and khat chewing behaviours. Both psychological and physical dependence on khat were assessed using the Severity of Psychological Dependence on Khat (SDS-Khat) Scale, the Diagnostic Statistical Manual IV (DSM-IV) and adapted items from the Fagerström Test for Nicotine Dependence (chewing even when ill, and difficulty in abstaining from khat chewing for an entire week). Descriptive statistics and non-parametric analyses were conducted.
Of the 204 khat chewers, 35% were khat chewers only, 20% were STKU, and the remainder were daily cigarette smokers. The mean age of STKU was 38.12 (±14.05) years. Fifty seven percent of STKU smoked tobacco and chewed khat for two days per week and 43% smoked and chewed more frequently (three to six days: 33%, daily: 10%). Three quarters (74%) were former daily tobacco users. Khat chewing initiated tobacco smoking among 45% of STKU and 71% reported attempts to quit tobacco smoking during khat chew. Among STKU, smoking tobacco for more than two days per week was significantly associated (p < 0.05) with psychological dependence (increased levels of SDS-Khat), physical dependence (increased levels of DSM-IV symptoms, chewing even when ill, difficulty in abstaining from chewing for an entire week and self-reported health conditions) and behavioural factors (e.g. amount of khat chewed in typical khat session).
Khat chewing may promote different patterns of tobacco smoking, initiate and sustain tobacco smoking, and trigger tobacco cessation relapses among STKU. Increased frequency of tobacco smoking among STKU was linked to psycho-physical and behavioural factors. Further investigation within large and representative samples of both sexes of STKU in different contexts should be considered for health research and policy development. Khat chewing should be considered when designing tobacco prevention uptake, cessation interventions and relapse prevention programmes.
嚼恰特草叶的行为通常伴随着烟草使用。我们评估了烟草使用的各个方面，并探讨了仅在嚼恰特草时使用烟草的恰特草咀嚼者（“烟草与恰特草同时使用者”，STKU）中与烟草使用模式（每周使用频率）相关的因素。
在对恰特草销售点进行随机走访期间，招募了204名男性恰特草咀嚼者作为样本。收集的数据包括社会人口学项目、烟草使用和恰特草咀嚼行为。使用恰特草心理依赖严重程度量表（SDS - 恰特草）、《精神疾病诊断与统计手册》第四版（DSM - IV）以及尼古丁依赖的法格斯特龙测试改编项目（即使生病时也咀嚼，以及难以整周戒除恰特草咀嚼）对恰特草的心理和生理依赖进行评估。进行了描述性统计和非参数分析。
在204名恰特草咀嚼者中，35%仅为恰特草咀嚼者，20%为STKU，其余为每日吸烟者。STKU的平均年龄为38.12（±14.05）岁。57%的STKU每周两天既吸烟又嚼恰特草，43%的人吸烟和嚼恰特草更频繁（三至六天：33%，每日：10%）。四分之三（74%）曾是每日烟草使用者。45%的STKU在嚼恰特草时开始吸烟，71%的人报告在嚼恰特草期间曾试图戒烟。在STKU中，每周吸烟超过两天与心理依赖（SDS - 恰特草水平升高）、生理依赖（DSM - IV症状水平升高、即使生病时也咀嚼、难以整周戒除咀嚼以及自我报告的健康状况）和行为因素（例如在典型的恰特草咀嚼时段嚼恰特草的量）显著相关（p < 0.05）。
嚼恰特草可能促进不同的吸烟模式，引发并维持吸烟行为，并在STKU中引发戒烟复吸。STKU中吸烟频率增加与心理 - 生理和行为因素有关。为了健康研究和政策制定，应考虑在不同背景下对STKU的大量且具有代表性的男女样本进行进一步调查。在设计烟草预防、戒烟干预和复吸预防项目时应考虑嚼恰特草这一因素。
