Epidemiology of smoking in the male population in Tunisia. HSHS Study 6

Abstract

Objectives: To determine the prevalence of smoking in the male population of Hammam Sousse (Tunisia), to describe its modalities and to analyse its
determining factors.

Methods: This was a “community-based” study, carried out on a random sample of households, including a population of males aged 20 or over. The data
were collected, at home, using a specific support consisting of a lifestyle questionnaire, a physical examination, and a biological assessment, oriented
towards cardiovascular risk factors. Smoking behaviour covered both forms of cigarettes and Narghile. “Current smokers” included all men declaring
that they smoked at the time of the survey, including “regular smokers”, who smoked daily at the time of the survey, and “occasional smokers”, less than
once a day. The group of “non-smokers” at the time of the survey was the sum of “ex-smokers” and those “who had never smoked”. The prevalences
were calculated after their weighting according to age and the adjusted odds ratios were measured following a multivariate study by logistic regression.

Results: The study population was composed of 481 men with an average age of 49.6±16.35 years and a median of 49 years. Mean body mass index and systolic
blood pressure were 26.9 kg/m2 ±4.20 and 151.9 mmHg±24.36, respectively. After adjusting for age, the proportions of current users, former users and subjects who
had never used tobacco (all forms combined) were respectively 50.4% (95% CI [49.49-51.3]), 17.4% (95% CI [16.71-18.08]) and 30.9% (95% CI [30.06-31.73]). Daily
cigarette consumption was characterized by an average onset at age 20.1±6.91 years, an average duration of 27.0±15.22 years and an average amount of 17.6±9.8
cigarettes smoked per day. After adjusting for age, level of education, and socioeconomic level, smoking behaviour was attributed to a single independent risk factor:
the presence of a smoker in the family, with an adjusted OR of 45.17 (p<10-3) for regular cigarette smokers, and 29.66 for regular tobacco users of all forms.

Conclusion: Smoking would be a real endemic in Tunisia, threatening the cardiovascular health of the country. The national health system is called upon
to strengthen its action plan for the prevention and control of smoking, in all living environments: family, school, work, health centre, etc.