Predictors of smoking relapse in a cohort of adolescents and young adults in Monastir (Tunisia)
More details
Hide details
Smoking Cessation Center of Monastir University Hospital, Monastir, Tunisia
Submission date: 2013-01-16
Acceptance date: 2013-05-15
Publication date: 2013-05-25
Corresponding author
Sana El Mhamdi   

Smoking Cessation Center of Monastir University Hospital, Monastir, Tunisia
Tobacco Induced Diseases 2013;11(May):12
Smoking prevalence in adolescents and young adults is substantially elevated in Tunisia. Moreover, there is a lack of knowledge regarding the effectiveness and associated factors in smoking cessation interventions among adolescents and young adults. This study aims at identifying the major factors leading to smoking relapse among adolescents and young adults in the region of Monastir, Tunisia.

We carried out a prospective cohort study at the smoking cessation center of the University hospital of Monastir, Tunisia. The population study consisted of all adolescents and young adults (15–30 years) consulted during a period of two years (2009 – 2010). A questionnaire was used to explore the patient’s sociodemographic characteristics, smoking history, nicotine dependence (Fagerstrom test) and anxiety / depression (Hospital Anxiety and Depression Scale). A telephone survey was conducted in July 2011 to assess smoking cessation results. A multivariate Cox regression was used to identify predictors of smoking relapses.

A total of 221 adolescents and young adults were included in this study with a mean age of 25.5 ± 3.9 years. At follow up, 59 study participants (26.7%) were abstinent and the overall median abstinence was 2 months. In the multivariate analysis smoking relapse was associated with being an adolescent patient (HR 2.16; 95% CI: 1.54-3.05), medium or higher nicotine dependence at baseline (HR 2.66, 95% CI: 1.06-7.05 and HR 3.12, 95% CI: 1.20-8.12 respectively), not receiving treatment (HR 1.70, 95% CI: 1.25-2.33) and have friend who is a smoker (HR 1.63; 95% CI: 0.96-2.79).

The results of this study provide important information about beneficial effect of smoking cessation support for adolescent and young adults. More efforts must be deployed to deal with contributing factors to smoking relapse.

Idrees M, Koniski ML, Taright S: Smoking habits in the Middle East and North Africa: results of the BREATHE study. Respir Med. 2012, 106 (Suppl 2): S33-44.
Fakhfakh R, Hsairi M, Achour N: Epidemiology and prevention of tobacco use in Tunisia: a review. Prev Med. 2005, 40: 652-7. 10.1016/j.ypmed.2004.09.002.
El Mhamdi S, Wolfcarius-Khiari G, Mhalla S, Ben Salem K, Soltani MS: Prevalence and predictors of smoking among adolescent schoolchildren in Monastir, Tunisia. East Mediterr Health J. 2011, 17: 523-8.
Osinubi OY, Slade J: Tobacco in the workplace. Occup Med. 2002, 17: 137-58.
Brown J: A review of the evidence on technology-based interventions for the treatment of tobacco dependence in college health. Worldviews Evid Based Nurs. 2013, 19: In press.
Zhou X, Nonnemaker J, Sherrill B, Gilsenan AW, Coste F, West R: Attempts to quit smoking and relapse: factors associated with success or failure from the ATTEMPT cohort study. Addict Behav. 2009, 34: 365-73. 10.1016/j.addbeh.2008.11.013.
Etter JF: A comparison of the content-, construct- and predictive validity of the cigarette dependence scale and the Fagerström test for nicotine dependence. Drug Alcohol Depend. 2005, 77: 259-68. 10.1016/j.drugalcdep.2004.08.015.
Bjelland I, Dahl AA, Haug TT, Neckelmann D: The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res. 2002, 52: 69-77. 10.1016/S0022-3999(01)00296-3.
Moore D, Aveyard P, Connock M, Wang D, Fry-Smith A, Barton P: Effectiveness and safety of nicotine replacement therapy assisted reduction to stop smoking: systematic review and meta-analysis. BMJ. 2009, 338: B1024-10.1136/bmj.b1024.
El-Sharkawy GF: Cigarette smoking among University students: family related and personal risk factors. J Am Science. 2011, 7: 260-8.
Ayo-Yusuf OA, Szymanski B: Factors associated with smoking cessation in South Africa. S Afr Med J. 2010, 100: 175-179.
Audrain-McGovern J, Halbert CH, Rodriguez D, Epstein LH, Tercyak KP: Predictors of participation in a smoking cessation program among young adult smokers. Cancer Epidemiol Biomarkers Prev. 2007, 16: 617-619. 10.1158/1055-9965.EPI-06-0791.
Breslau N, Peterson EL: Smoking cessation in young adults: age at initiation of cigarette smoking and other suspected influences. Am J Public Health. 1996, 86: 214-20. 10.2105/AJPH.86.2.214.
Van De Ven MO, Greenwood PA, Engels RC, Olsson CA, Patton GC: Patterns of adolescent smoking and later nicotine dependence in young adults: a 10-year prospective study. Public Health. 2010, 124: 65-70. 10.1016/j.puhe.2009.11.009.
Cengelli S, O’Loughlin J, Lauzon B, Cornuz J: A systematic review of longitudinal population-based studies on the predictors of smoking cessation in adolescent and young adult smokers. Tob Control. 2012, 21: 355-62. 10.1136/tc.2011.044149.
Klatt C, Berg CJ, Thomas JL: The role of peer E-mail support as part of a College smoking-cessation website. Am J Prev Med. 2008, 35 (6 Suppl): S471-8.
Islam SM, Johnson CA: Influence of known psychosocial smoking risk factors on Egyptian adolescents’ cigarette smoking behavior. Health Promot Int. 2005, 20: 135-45.
Grimshaw GM, Stanton A: Tobacco cessation interventions for young people. Cochrane Database Syst Rev. 2006, 18: CD003289.
Kralikova E, Kozak JT, Rasmussen T, Gustavsson G, Le Houezec J: Smoking cessation or reduction with nicotine replacement therapy: a placebo-controlled double blind trial with nicotine gum and inhaler. BMC Publ Health. 2009, 9: 433-10.1186/1471-2458-9-433.
Toljamo T, Hamari A, Nieminen P, Kinnula VL: Young male daily smokers are nicotine dependent and experience several unsuccessful quit attempts. Scand J Prim Health Care. 2012, 30: 183-8. 10.3109/02813432.2012.704809.
Rath JM, Villanti AC, Abrams DB, Vallone DM: Patterns of tobacco use and dual use in US young adults: the missing link between youth prevention and adult cessation. J Environ Public Health. 2012, 2012: 679134.
West R, McNeill A, Raw M: Smoking cessation guidelines for health professionals: anupdate. Health Education Authority. Thorax. 2000, 55: 987-99. 10.1136/thorax.55.12.987.
Avila-Tang E, Apelberg BJ, Yamaguchi N, Katanoda K, Sobue T, Samet JM: Modelling the health benefits of smoking cessation in Japan. Tob Control. 2009, 18: 10-7. 10.1136/tc.2007.024620.
Madkour AS, Ledford EC, Andersen L, Johnson CC: Tobacco advertising/promotions and adolescents’ smoking risk in Northern Africa. Tob Control. 2013, 8: Article in press.
Florescu A, Ferrence R, Einarson T, Selby P, Soldin O, Koren G: Methods for quantification of exposure to cigarette smoking and environmental tobacco smoke: focus on developmental toxicology. Ther Drug Monit. 2009, 31: 14-30. 10.1097/FTD.0b013e3181957a3b.
Longitudinal Examination of Predictors of Smoking Cessation in a National Sample of U.S. Adolescent and Young Adult Smokers
J. F. Walker, P. D. Loprinzi
Nicotine & Tobacco Research
Additional follow-up telephone counselling and initial smoking relapse: a longitudinal, controlled study
Lei Wu, Yao He, Bin Jiang, Fang Zuo, Qinghui Liu, Li Zhang, Changxi Zhou
BMJ Open
Exposure to community and collective violence during childhood and tobacco use patterns among young adults in Tunisia
Sana El Mhamdi, Andrine Lemieux, Arwa Ben Salah, Ines Bouanene, Kamel Ben Salem, Mustafa al'Absi
Health & Social Care in the Community
The smoking spectrum: review of the existing evidence and future directions
Garbis A. Meshefedjian
Journal of Public Health
Effectiveness of a School-Based Tobacco Prevention Program for Middle School Students in Saudi Arabia: A Quasi-Experimental Controlled Trial
Agili Al, Hamisu Salihu
Tobacco Use Insights
The association between heated tobacco product use and cigarette cessation outcomes among youth smokers: A prospective cohort study
Wei Xia, William Li, Yuan Luo, Ting Liang, Laurie Ho, Ankie Cheung, Peige Song
Journal of Substance Abuse Treatment
Factors related to the smoking relapse of out-of-school adolescents
Ji Bae, Chul-Woung Kim, Seung Lee, Hyo-Bin Im, In Kim, Tae-Yong Lee, Sang-Yi Lee, Myungwha Jang
Korean Journal of Health Education and Promotion
Cancer in the Arab World
Nesrine Mejri, Haifa Rachdi, Lotfi Kochbati, Hamouda Boussen
Factors associated with long-term smoking relapse in those who succeeded in smoking cessation using regional smoking cessation programs
Seung Lee, Yu Yi, Young Lee, Hyo Lee, Kyoung-Min Lim
Journals System - logo
Scroll to top