Social factors associated with tobacco smoking among medical students of Maseno university, Kenya

Tobacco smoking is a major health concern among healthcare professionals globally; it kills and sickens millions of people annually. In the US and UK, tobacco is responsible for about one in five and one in eight deaths annually respectively. It is projected that about 10 million people would die annually by 2030 since tobacco related diseases take time to become evident. A global commitment by World Health Organization to reversing the tobacco epidemic was done in 2003 by member states adopting WHO-FCTC which laid out specific evidence based action to reduce the demand for tobacco by at least 30%. Prevalence rate among medical students globally ranges from 2 to 58% despite the interventions put in place. Smoking among medical students may impact negatively on their health, future professional conduct and consequently safety of patients. Protecting medical students from tobacco smoke is essential to help them survive and thrive. Medical students are future doctors and role models in the society. Subsequently, their smoking habits have a direct impact on the cessation rate. In Kenya, the magnitude of tobacco smoking among medical students is unclear since the data is scanty. The main objective of the study was to establish the social factors associated with smoking among medical students of Maseno University, Kenya. The specific objectives were to: examine the socio-demographic characteristics associated with smoking habits of medical students of Maseno University, establish the relationship between social referent groups and smoking habits of medical students of Maseno University and assess the association between attitude of medical students and smoking habits. The study was guided by the theory of planned behaviour by Icek Ajzen (1991) since it is best used to predict behaviour guided by its three constructs; behavioural control, subjective norm and perceived behavioural control. The study was carried out in Maseno University in both Schools of Medicine and School of Nursing which had a total of 712 medical students enrolled in the schools. For quantitative data collection, 264 students were sampled using stratified random sampling using Yamane (1967) formula. Qualitative data was collected from purposively selected medical and nursing students to participate in the four focus group discussion (FGDs) of eight students each. In addition, deans of School of Medicine, School of Nursing and one officer from NACADA were purposively selected as key Informants. Quantitative data was analyzed through descriptive and inferential statistics using SPSS software 20.0 version while qualitative data was coded and organized in themes and sub-themes for generalization purposes using NVivo software. Chi-square was used to test the association with 5% level of significance. The findings revealed that the main influence on students to start smoking was peer pressure which may be direct or normative to take up certain habits such as initiating tobacco use. Mass media has greater influence in shaping minds of medical students who are in the social transition to adulthood. There was also demonstrable evidence that parental smoking influence smoking habits of young adults. The study also revealed that health and religious considerations are important motives for not smoking. The study also exhibited that attitude played a role in smoking habits of medical students. The study concluded and recommended that there should be targeted cessation interventions by the stakeholders to mitigate smoking among medical students; prevention programmes should be broad based with priorities to target peer effect and parents for effective results