Prevalence of Smoking among the Students resided at Dormitories in Golestan University of Medical Sciences ,

Introduction: Smoking is considered a major preventable cause of morbidity and mortality, causing over four million deaths a year1. This figure is forecast to increase to 10 million deaths per annum by 2030; 70 % of which will be in developing countries2. Cigarette smoking is well known as risk factor for many of health problems such as lung cancer, cardiovascular diseases, intrauterine growth retardation, spontaneous abortion, antepartum hemorrahage, female infertility, peptic ulcer disease, chronic obstructive lung disease, sexual dysfunction in men, and so on. Passive smokers can also acquire diseases associated with cigarette smoking3-7. Beside harmful physical and emotional problems, smoking is a predispose factor

for the addiction.When people want to quit, they also have a psychological habit to break.That is why we must emphasis on prevention and preventive measure 8 .The World Health Organization estimates that 1.3 billion people smoke and more than 80 percent of these people live in countries with low or middle income levels 9 .Numerous studies indicated that both in developed and developing countries the prevalence of smoking is increasing in youths, while the age of smoking initiation is decreasing 10 .One of the main reasons that young people smoke is to be like their friends and gain excitement.This may become very soon a part of their behaviors 11 .Twenty eghit point seven percent of smokers are between the ages 18-24 years 12 .Studentship is a period that many of behavioral patterns are forming and establishing, so smoking among the students should be considered carefully 13 .The youth including medical students are the main part of Iran's population.Therefore we cannot ignore their influence on health system of the country.Medical students may be considered as a role model for other young people.The students studied in governmental university while pay no cost, then the society expects to have healthy educated doctors and nurses for a healthy community.The aim of this study was to estimate the prevalence and causes of smoking among Golestan University of Medical Sciences students.

Material & Methods:
A cross-sectional analytical study conducted among the students residing in dormitories of Golestan University of medical sciences, Gorgan, located in Northern Iran, in 2010.The sample size consisted all of the university dormitories' students.A 25-item self-administered questionnaire incuding demographic characteristics and needed factors was designed and validated in a pilot study.The content validity was verified by a panel of experts, and the reliability was confirmed with a Cronbach alpha reliability coefficient of 80 percent obtained in a pilot study on 15 cases.A team of expert students, especially trained for this study distributed the anonymous questionnaires among the participants, while giving adequate explanation and reassurance.Of 669 male and female residents in four dormitories, 538(80.4%)participants filled out the questionnaires confidentially.The obtained data were analyzed by SPSS software package version 16.0 using t-test for comparison of mean values and Chi square test for comparing the frequencies between smokers and non-smokers.Logistic regression analysis was fitted to the data to calculate odds ratio and 95% confidence interval (95% CI) were employed to evaluate the gender-specific associations of starting to smoke with possible associated factors such as socioeconomic factors, smoking of relatives and friends, parents' marital status.The P-Value less than 0.05 was considered as statically significant.

Results:
Of 538 students, 67.3% (362 subjects) were female and 92.4% (497) single.The mean age of smokers were 22.18 ±2.35 years (age range: 18 to 39) (Table 1).17.3 % of them had smoker fathers, 1.3% smoker mothers and 9.5% had smoker siblings.The average starting age of smoking was 20.65± 1.98 years.47.8% of the students stated at least once a day exposed to someone else's smoke.Prevalence of smoking was 6.1% while, 83.5% of student had experiences of cigarette smoking atleast for once.The reasons for starting smoking show that the three most common causes were "having a smoker friend, personal interest and hobby".The average number cigarette smoked per day was 5.2.The average time to become addicted to smoking was two years.The average cigarettes costing was 3480 Rials (Amlost 1$) per week.
For 48.5% of the students, dormitory was the place that smoked their first trial (48.5).30% of the smokers at least for once time tried to quit smoking.
Tables 2 and 3 show relation between cigarette smoking, ethnicity, sex, age and years of education.
We couldn't find any significant relationships among major and marital status with cigarette smoking (P>0.05).Although the prevalence of smoking in our study was lower than the above mentioned studies, however 83.5% of the participants had an experience of smoking.In two similar studies only 13.9 and 31% of the students had smoking experience 16,24 .
In Iran smoking is strongly disapprove by the families.It is not only bane in high schools but also culturally unacceptable among teenagers.Some of the authors believe the cultural issues possibly explain the lower rate of adolescence smoking in our study population 25 .However, in our country the price of cigarette is not high and everyone can buy it.Then, one of the strategies that may be effective particularly for young people is increasing the price of cigarette.Limit distribution, ban advertising and not easy access to the smokes may be helpful too 26  Finally, it should be emphasizes that the university students are vulnerable and at high risk for smoking since they are away of their parents, residents in dormitories feel more, home sickness 38 .

Limitations
There are two aspects of the study design to be taken into account.First, the conclusions of this study are based on a cross-sectional sample.This design only allows for measures of association.Second, the selfreported nature of the data also needs to be taken into account.The validity of the responses will therefore depend on the responder's perception of the social disapproval of smoking.As the questionnaire was presented as confidential and anonymous, and since smoking is not illegal at the ages considered in this study, the probability of a response bias is minimized.

Conclusion:
Smoking behaviors of medical and nursing students may have a profound effect on the implementation of smoking-prevention activities in the future, as they are the role models.In this study cigarette smoking prevalence rate was relatively low in comparison with similar studies.However, psychosocial issues should be addressed to prevent future epidemics.According to the participants views friends' approval and friends' smoking prevalence were associated with their tendency to smoking.Appropriate interventions such as parental control and monitoring from early childhood may be useful as preventive measure.We can't underestimate a holistic approach to the students' education about smoking prevention as well.

Table 1 : Demographic characteristics of the subjects studied
Table 4 shows the relationship among smoking with age, gender and friends using multivariate logistic regression analysis.

Table 2 : Characteristics of the subjects studied in the smoking and nonsmoking students
ers" 33 .Having fun and joy was the important factor for smoking among the students of two medical universities 19,34 .Molavi reported depression as an important factor for smoking tendency 35 however; we couldn't find depression as reported factor for