Study settings and participants

A descriptive cross-sectional study among Saudi residents was conducted using convenience sampling. The study was conducted from December 2022 to February 2023. Volunteers aged ≥18 years who live in Saudi Arabia participated in the study, while children and those residing in other countries were excluded. Taif University Ethical Committee approved the study protocol (Approval # 44-126). The survey link was distributed on several social media platforms, such as Telegram, Twitter, and WhatsApp groups, with a brief description of the study’s aim, and the participation was voluntary. Consent to participate in the study and that the participant is aged ≥18 years was obtained online at the beginning of the survey. Responses were limited to one by a single individual in the Google form settings. The data obtained were collected from foreigners and citizens, including men and women. A total of 1358 participants successfully submitted the online survey, and the responses were kept on a password-protected Google Drive.

Study tool and measures

The study tool was a self-administered online questionnaire designed after consulting previously published literature. The questionnaire contained demographic data in addition to 28 questions that assessed the knowledge, attitudes, and general perceptions of smokers in Saudi Arabia about the harms of smoking and different ways to quit it. The questionnaire was prepared in English and translated into Arabic for upload on a Google form for implementation. The questionnaire consisted of the following four sections:

Section 1: Participants were asked to indicate their demographics, such as gender, age, residency city/area, education level, marital status, employment, presence of chronic diseases, monthly salary, and smoking status.

Section 2: This section contained 13 questions determining the participants’ perception of smoking.

Section 3: This section consisted of 10 questions to assess the participants’ perception of quitting smoking.

Section 4: This section contained five questions to identify methods used to quit smoking.

Statistical analysis

Descriptive statistics were generated for the responses and correlation coefficients to describe relationships between continuous variables. For independent variables, the chi-squared test was applied to compare categorical variables, and a p<0.05 was considered significant. Statistical analyses for the gathered data were performed using the Statistical Package for Social Sciences software, version 25 (SPSS, IBM Corporation, NY, USA).

Demographic characteristics of the study participants

The 1358 respondents’ demographic characteristics are summarized in Table 1. Most participants were males (n=984; 72.5%). The data show that those who live in Taif were 595 (43.9%), Makkah 155 (11.4%), and Jeddah 321 (23.7%). Regarding education, the percentage of participants whose education level was university student or degree was 878 (74.6%), while that of illiteracy was 16 (1.2%). In general, the economic level of the respondents is relatively high, as it was found that 57.5% had an income of more than 3000 Saudi Riyals. The data showed that 941 (69.3%) participants do not suffer from any chronic disease. Regarding smoking status, 860 (63.3%) of the sample were smokers, of whom 86.7% were males.

Assessment of the smokers’ perception of smoking

The attitude of the smokers who participated in the study is shown in Table 2. Nearly half (52.6%; n=452) of the 860 smokers started smoking when they were aged between 18 and 30 years, and this was significantly associated with male gender (p=0.028). About 38.1% (n=328) of smokers consumed between 11 to 20 cigarettes per day. As shown in Table 2, approximately 61% (n=524) of the 860 smokers reported that one of their family members smoked, while 71.2% (n=612) of smokers did not like that someone in their family smokes. Moreover, 66.3% (n=570) of the smokers strongly agreed/agreed that having friends who smoke is the primary cause of smoking. Furthermore, 57.7% (n=496) of smokers strongly disagreed/disagreed that family is the primary cause of smoking. About 77% of the smokers did not take any chronic disease medications.

Smokers’ perception of quitting smoking

Table 3 presents the smokers’ perceptions of quitting smoking, where 74% (n=636) of the 860 smokers reported that a smoking cessation service was available in their location. Also, 74.3% (n=639) of the smokers admitted that schools, universities, or other governmental entities prohibit smoking on their campus. In addition, around 88% (n=756) of the smokers supported obligating strict anti-smoking regulations.

As shown in Table 3, approximately 45% (n=389) of the smokers strongly agreed/agreed that it is difficult to stop smoking in public places where it is forbidden, such as in malls, while only 30.1% (n=259) of the participants strongly disagreed/disagreed with this statement. On the other hand, about 81% (n=697) of the smokers wanted to quit smoking. Also, 66.6% (n=573) of the smokers have tried to quit smoking before.

Assessment of methods used to quit smoking

The responses of the smoking participants toward the methods used to quit smoking are shown in Table 4. As shown, 40% (n=229) of the 860 participants were enrolled in a smoking cessation program at some point. In addition, 15.7% (n=90) of the participants used nicotine patches that helped them quit smoking, while 7.2% (n=41) of the participants had ever used nicotine lozenges. Overall, 35% (n=200) and 26.7% (n=152) of the participants used one and two to three methods to quit smoking, respectively. As shown in Table 4, about two-thirds of the smokers in the study (62%) tried at least one method to quit smoking.

Strengths and limitations

One of the study’s strengths is its relatively large sample size, another is that it covered the entire country and did not focus on a specific region. One of the limitations is the cross-sectional design which does not allow for causal inferences, while the most important limitation is that the convenience sampling method via social media was non-probability sampling that could lead to selection bias, and thus the results of this study cannot be generalized to the entire population of Saudi smokers. Additionally, as no further statistical analyses were performed on the data, we cannot rule out other factors that may have influenced the perceptions of smokers.