Prevalence and determinants of smoking and secondhand smoke exposure in a rural population of central Greece: a cross-sectional study

Introduction: Smoking is one of the most important risk factors for heart and lung disease and is also responsible for many forms of cancer. The resulting morbidity and mortality weigh heavily upon countries with high prevalence, such as Greece. According to the Global Adult Tobacco Survey (GATS) Greece, 38.2% of Greeks aged ≥15 years old, namely 51.2% of men and 25.7% of women, are smokers.Smoking is also common among the young and persons of high education. Despite laws prohibiting smoking at indoor places, exposure to environmental tobacco is very high both in private and public places. Our goal was to estimate the prevalence and characteristics of smoking, the level of tobacco exposure and the factors that affect both in a rural population.

Methods: A cross-sectional household study was conducted using the GATS questionnaire in a rural borough of Thessaly, Greece. Eligible participants were permanent residents of the selected villages, aged 18 years or older and they were selected by a combination of stratified sampling with probability proportional to size (PPS), random sampling and convenience sampling. Population demographics, current smoking status and tobacco use patterns, exposure to second hand smoke, attitudes and knowledge on smoking were recorded. Analyses were performed accordingly to the GATS manuals using the SPSS complex samples module.

Results: 330 adults participated in the study (168 men, 162 women). The mean age of the sample was 54.2 ± 17.75 years (range 18.5 – 86.1 years). Smoking prevalence was 32.4%; 46.4% (95%CI 37.8 – 55.3) of men and 17.9% (95%CI 12.0 – 25.9) of women were smokers. Smoking was also common among the young, persons with secondary education and high school graduates. The manufactured cigarette was the most preferred tobacco product. Daily smokers consumed on average 20.6 (95%CI 17.67 – 23.52) cigarettes per day. Men smoked more cigarettes and started at an earlier age than women. Overall exposure to environmental tobacco smoke was high among the population. Men, individuals aged 18-24 and 40-54 were more exposed than their counterparts. Places where high exposure was recorded included restaurants (80.0%, 95% CI 76.0-83.5), bars (87.8%, 95% CI 75.7-94.3) and coffee shops (82.6%, 95% CI 68.4-91.3). Six out of ten (62.1%, 95% CI 51.7-71.5) workers were exposed at their workplace and nearly the half were exposed on a daily basis. Prevalence of home exposure was 40.4% (95% CI 32.0 – 49.5). The multivariate analysis showed that gender and age were independent predictors of current smoking status, while only gender was independently associated with exposure to secondhand smoke.

Conclusions: There are very few studies studying the characteristics of smoking and tobacco exposure exclusively in rural populations in Greece, such as the present study.Both the high prevalence of smoking and the high levels of exposure to tobacco show a population at increased risk for tobacco-related disease. These call for immediate action to reduce smoking prevalence, help smokers quit and protect the health of non-smokers. Our conclusions provide the basis for designing local prevention programs and the baseline for monitoring of future trends in the area.