Smoking between Young Workers in Healthy Field, Trigger Factors and Reasons of Cessation

Background: Smoking is an important factor correlates with morbidity and mortality all over the world and it still a real challenge according to the promotion of tobacco companies and war conditions. It correlates well with emphysema and cancers of lung and bladder in elderly adults. Materials and Methods: A cross-sectional questionnaire-based study was applied to workers on healthy eld and medical students in age (15-45) in Aleppo University Hospital. They were divided into 2 groups (smokers and non-smokers). This study aims to dene the relationship between smoking and different variants in young ages. Results: The study included 169 healthy workers (93 males, 76 females). Smokers were 88 (52.07%), 62.5% active and 37.5% passive. Most of them classied as lighter smokers, whereas13.6% were heavy smokers. 37 of smokers (42.53%) smoke shisha. 68 smokers want to stop smoking (77.27%), and 61 of them (69.31%) try that. Only 4 smokers try drugs or electronic cigarette. Promotion is the most common trigger factor for smoking 38.27% followed by war 30.86%. Genders, living with a smoker and awareness of the correlation between shisha and tuberculosis, have a statically signicant between the two groups of study (p =0.009, <0.0001, 0.041) respectively. Weight and regular sporting have no signicance. Conclusions: Promotion is still the rst reason for smoking between young ages. Awareness by the risk of tuberculosis by shisha, living with smoker people and gender correlates well with the smoking and plays a role in this eld.

People who work in healthy eld are more likely to work under pressure, and to suffer from many pressures in work and out of work. Smoking spreads between university students, young students and professionals in healthy eld.
This study aims to de ne the relationship between smoking and different variants in young age's people in healthy eld.

Methods:
Population: Control case study was applied to workers on healthy eld and medical students in age  in Aleppo University Hospital. They were divided into 2 groups (smokers and non-smokers). This study aims to de ne the relationship between smoking and different variants in young ages.

Data collection:
A questionnaire was applied to all the participants, and only participants who gave his or her consent for the collection and use of their data were included.
The variants were collected included: gender, age, the educational level, weight, regular sport, living with smoker in the same home, time of beginning smoking, trigger factors, classi cation of smoking, willing to stop, trying to stop, ways to cessation and the awareness of risk that correlates with shisha smoking.
They were divided to: smokers and non-smokers. Smokers are 2 sub-groups, active smokers, who are smoking cigarettes or shisha or both, and passive smokers who live or work with smokers Classi cation of smoking was suspected according to the number of cigarettes that a person smokes on one day as: I. Light smokers: less than 10 cigarettes II. Middle smoker: less than 20 cigarettes III. Heavy smoker: less than 40 cigarettes Statistical analysis: Demographic characteristics and variables of interest were summarized by smoking status (smoker vs. non-smoker) using descriptive statistics: mean (SD) for continuous variables and frequency (proportion) for categorical variables.
To assess the risk factors, logistic regression was used, and the results are reported as an odds ratio, with a 95% con dence interval. A p-value of less than 0.05 was used to detect the statistical signi cance. χ 2 (chi square) is used as a test for statistical signi cance. Analysis was performed using IBM SPSS statistical software 23.
Studying the pattern of smoking (active or passive) was then performed.

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Analysis was performed using IBM SPSS statistical software 24.

Results:
169 worker and medical student were included. 88 of them were smokers (52.1%) and 81 were none (47.9%). 64.77% of smokers were men. The rst trigger factor to smoke was promotion of tobacco companies and between friends (38.27%), whereas the studying failure was in the last list of factors (7.41%). 40% of smokers were light smokers, medium 39% and only 19% were heavy smokers ( gure1) . (37 of smokers were smoking shisha (42.05%), we suppose that 15 minutes from smoking of shisha (water pipe) is equivalent 10 cigarettes. Gender, living with smoker, and awareness of the relationship between shisha and tuberculosis have a signi cant between the two groups of study (p =0.009, <0.001, 0.041) respectively. Weight and regular sporting have no signi cance (table 1). Studying the risk estimate for the variants (table2) By studying the 2 subgroups of smokers, (active and passive), we nd: there's important statically signi cant for; gender, weight smoking shisha, (p= <0.001, 0.03, 0.014) respectively (table3). Studying the risk estimate of variants also summarize in (table4).
Figure2 shows the lines of trigger factors for the two patterns of smokers. 68 smokers want to stop smoking (77.27%), and 61 of them (69.31%) try that. Only 4 smokers try drugs or electronic cigarette.

Discussion:
The important ndings in this study were: Smoking is still challenge and promotion is the rst trigger factor even though all the awareness campaigns of the harmful effects of smoking, which re ects the role of tobacco companies. This nding accepts with the study performed by Krugman, Dean M., et al [5] and also accepted with Cauchi, Daniel, and Julian Mamo [6] who recommended banning of tobacco sales to adolescents. Study shows war as a trigger factor for smoking between young workers and students in healthy eld that supports the study performed by Kakaje, A., et al. in Syria [7] and Haddad, Chadia, et al in Lebanon after civil war, which refers to high prevelance rates of smoking after war according to the WHO records [8]. Family problems were important trigger factor for beginning of smoking or severe the case of smoker in 24% of cases in the study, and that is closed to results of Banzer, Raphaela, et al. [9].
Studying failure was the less important factor between the factors we study, and that looks to be closed to Azevedo, Renata Cruz Soares de study that suggests the higher education as a risk factor correlated with failure to quit smoking among smokers [10]. Men smokes more than women, and there is a high signi cance for gender in the study (P=0.009). Living with smoker is a risk factor to be an active smoker, and passive smokers on risk of heart disease by inspiriting other's smoke, even they didn't smoke. A Chinese study suggests living with smoker as an important factor against smoking cessation [11], which supports our study result that nd an important statically signi cance (p<0.001) between the 2 groups of study (smokers, non-smokers).
The healthy awareness about risks of smoking in general, and the risk between shisha and tuberculosis [12], was important factor in our study and has a signi cance (p=0.041) which is so closed to the study [13] This study suggests weight as a risk factor for smoking. More weight, more smoke. There's many studies suggests smoking as a reason of overweight in younger ages, which is so close to many studies [14,15,16], even though, from the opposite side, there are many studies suggests weight gain after smoking cessation [17,18] Risk estimate for the 2 subgroups of smokers were summarize in table4.
One of the important outcomes of this study, smoking shisha has a high prevalence between younger smokers, and that is a risk factor, closing to the result of Nelson, R. [19]. Another study was performed in KSA [20] showed a high prevalence of shisha smoking between male students of medical colleges, which is accepted with our result. Hookah or shisha is another face of cigarettes, and tobacco companies try to produce it as an alternative of cigarettes. Many participants when you ask them, do you smoke, they answer no but when you ask about shisha, then yes! By comparing this result with study performed in USA [21] that clears most of shisha smokers think that isn't harmful to their health, and that is also bright the result of the role of awareness of shisha harmful effects on health in general, and pulmonary diseases in specialty.
The most important limitations of this study are the ability to de ne the real dose of tobacco between people who smokes shisha, the time of smoking was closed to suspect in our study.
Other limitation was in responding; most of women weren't responding well, so they were excluded, smoking in some regions is sensitive subject to girls, so we need more information regarding this point.

Conclusions:
Smoking still a challenge faces doctors and health professional all over the world. Social relations, family problems and promotion are risk factor for smoking between Youngers. Shisha smoking is a new challenge which needs more awareness of the harmful effects of this tobacco product.
Healthy awareness is the most important factor that can help to ght this bad habit between Youngers.
We need more studies about the real prevalence of smoking between workers in healthy eld.

Declarations:
Consent: Each participant gave his or her written consent for the collection and use of their clinical data.

Funding:
The author received no nancial support for the research, authorship, and/or publication of this article.

Declaration of Interests:
There's no potential con ict of interest to report Tables: Table1-Demographics and other Figure 1 Classi cation of smokers Figure 2