Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Aug 2;18(1):88.
doi: 10.1186/s12889-017-4606-z.

Socio-cognitive correlates of intention to use Toombak: a cross-sectional study among students (13-16 years) in Khartoum State, Sudan

Affiliations

Socio-cognitive correlates of intention to use Toombak: a cross-sectional study among students (13-16 years) in Khartoum State, Sudan

Hatim Mohammed Almahdi et al. BMC Public Health. .

Erratum in

  • Erratum to: BMC Public Health, Vol. 18.
    [No authors listed] [No authors listed] BMC Public Health. 2017 Sep 22;17(1):736. doi: 10.1186/s12889-017-4709-6. BMC Public Health. 2017. PMID: 28938882 Free PMC article. No abstract available.

Abstract

Background: Toombak is a form of smokeless tobacco, locally made and consumed in Sudan. It is associated with a number of health hazards, particularly oral cancer. This study was set out to assess the prevalence and socio-demographic distribution of its use, and to explore the socio-cognitive factors affecting the intention to use Toombak among secondary school students in Khartoum State, Sudan.

Methods: A cross-sectional school-based study was conducted in 2013-2014 where schools were randomly selected using a one-stage stratified sampling procedure. The sample size was calculated to consist of 1526 students. Data were collected through a self-administered questionnaire, which contained some cognitive constructs; information received, social image, attitudes, normative social influence, accessibility to Toombak, socio-demographics and Toombak use related variables.

Results: A total of 1670 secondary school students participated in the study. More than half of them 53.4% were <15-years-old and 53.6% were females. Only 5.3% of the students reported intention to use Toombak. Among the students 10.9% were ever Toombak users, 81.6% reported a positive attitude towards its use and 60.7% had received information about its harmful effects. A total of 72.6% reported normative social influence towards using Toombak and 62.5% perceived a negative social image attached to its use. Most of the students, 70.8% reported exposure to anti-Toombak information, 41.8% confirmed exposure to Toombak advertisement and 87.5% reported indirect access to its sale. Younger students reported ever use of Toombak less frequently than their older counterparts (38.4% versus 61.6%), p < 0.001. Males reported ever use of Toombak more frequently than did females (74.3% versus 25.7%), p < 0.001. According to the regression model, individuals who perceived a positive social image of Toombak users and had past experience were more likely to intend to its use.

Conclusions: The present study suggested that the prevalence of Toombak use among Sudanese secondary school students is low and that male and older students are more frequent users. Students' decision to use Toombak was based upon past experience with Toombak use and the social image attached to its use. Easy access to Toombak and encouragement from friends and classmates were among the factors which support intention to use Toombak but only in the unadjusted analyses.

Keywords: Ever tobacco use; Intention to use tobacco; Smokeless tobacco; Social cognitive; Social image; Social normative influence; Sudan; Toombak.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

Ethics approval of Ethical Committee of the Faculty of Dentistry, University of Science and Technology, Ministry of Health and Ministry of Education was obtained and the committee’s reference number was No. WKH/WS/AA/AB.18.09.2013.

Written informed consent was requested from the participating students and their parents through the schools’ administration, and the participation was voluntary and anonymous.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Frequency and percentage distribution of normative social influence factors and intention to use Toombak

References

    1. National Cancer Institute and Centers for Disease Control and Prevention . Smokeless tobacco and public health: a global perspective. Bethesda: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Institutes of Health, National Cancer Institute. NIH Publication No. 14-7983; 2014.
    1. WHO . Adolescents: health risks and solutions. 2016. http://www.who.int/mediacentre/factsheets/fs345/en/. Accessed 9 Apr 2017.
    1. Agaku IT, Ayo-Yusuf OA, Vardavas CI, Connolly G. Predictors and patterns of cigarette and smokeless tobacco use among adolescents in 32 countries, 2007–2011. J Adolesc Health. 2014;54(1):47–53. doi: 10.1016/j.jadohealth.2013.07.037. - DOI - PMC - PubMed
    1. WHO. Global Youth Tobacco Survey fact sheets and country reports. http://www.emro.who.int/tobacco/gtss-youth-survey/gyts-factsheets-report.... Accessed 9 Apr 2017.
    1. Ahmed HG. Aetiology of oral cancer in the Sudan. J Oral Maxillofac Res. 2013;4(2):e3. doi: 10.5037/jomr.2013.4203. - DOI - PMC - PubMed