|Year : 2020 | Volume
| Issue : 1 | Page : 33-37
Awareness on the association between skin aging and smoking: Impact on smoking quitting
Arwa Z Fatani, Hussein M Alshamrani, Khalid A Alshehri, Abdullah Y Almaghrabi, Yahya A Alzahrani, Mohammed H Abduljabbar
Department of Dermatology, King Abdulaziz University, Jeddah, Saudi Arabia
|Date of Submission||10-Aug-2019|
|Date of Acceptance||27-Sep-2019|
|Date of Web Publication||30-Dec-2019|
Dr. Hussein M Alshamrani
Faculty of Medicine, King Abdulaziz University, Jeddah
Source of Support: None, Conflict of Interest: None
Aim: This study aims to evaluate the public's knowledge and awareness of the association between cigarette smoking and skin aging in Jeddah, Saudi Arabia.
Methods: This is a cross-sectional study conducted by distributing a questionnaire to the general population of Jeddah across different age groups in 2018. Data were organized using a frequency distribution table, and analysis was done using Chi-square test.
Results: Among 2443 participants, 68.2% were female and 12.6% were current smokers. More than half (64%) of the participants answered correctly that smoking increases facial aging. Slightly higher number of nonsmokers responded correctly than current and former smokers. There was a statistically significant difference between gender and the response to the association of smoking and skin aging, with majority of the females (71%) responding correctly (P < 0.0001). A considerable number of younger participants and college graduates knew that smoking increases wrinkles. Among the current smokers, 25% said that most/some smokers would quit if they learned that smoking increases facial aging. However, among the current smokers, there was no statistically significant association between their awareness of the relationship between smoking and skin aging and their motivation to quit (P = 0.032).
Conclusion: The society's lack of knowledge about the association between cigarette smoking and skin aging needs more attention. Knowledge needs to be spread by prompting health campaigns and by the participation of health authorities to make more effective public health policies against smoking.
Keywords: Skin aging, smoking, wrinkles
|How to cite this article:|
Fatani AZ, Alshamrani HM, Alshehri KA, Almaghrabi AY, Alzahrani YA, Abduljabbar MH. Awareness on the association between skin aging and smoking: Impact on smoking quitting. Imam J Appl Sci 2020;5:33-7
|How to cite this URL:|
Fatani AZ, Alshamrani HM, Alshehri KA, Almaghrabi AY, Alzahrani YA, Abduljabbar MH. Awareness on the association between skin aging and smoking: Impact on smoking quitting. Imam J Appl Sci [serial online] 2020 [cited 2020 Jun 1];5:33-7. Available from: http://www.e-ijas.org/text.asp?2020/5/1/33/274293
| Introduction|| |
Cigarette smoking is one of the leading causes of mortality and morbidity. Every year, about 5.4 million people die due to smoking-related problems, more than that of tuberculosis-, HIV/AIDS-, and malaria-related deaths combined. In addition to its strong association with serious diseases, many dermatological conditions are influenced by tobacco smoking, including poor wound healing, early skin aging, squamous cell carcinoma, melanoma, oral cancer, acne, psoriasis, eczema, and hair loss.
Precocious skin aging is the most common dermatological manifestation of smoking and at the same time the most socially distressing condition. A “smoker's face” is characterized by noticeable wrinkles and gaunt features with prominent bony contours. The connection between smoking and early skin aging was first described 150 years ago, and since then, a lot of studies have confirmed this association. It has been reported that the skin of a 40-year-old smoker is comparable to the skin of a 70-year-old nonsmoker., A cross-sectional study conducted in the USA aimed to examine the facial wrinkles of smokers. Their results supported the earlier findings; smokers had significantly more facial wrinkles than people who have never smoked. Another study assessed the relationship between the appearance of premature facial wrinkles and cigarette smoking., They proved that cigarette smoking is an independent risk factor for the development of premature wrinkles.,
Knowledge of the connection between smoking and particular diseases is critically important, which can lead to smoking cessation. A study conducted in the USA assessed the public's awareness of the link between skin aging and cigarette smoking. They concluded that smokers were less likely to know this association compared to nonsmokers. Some of the nonsmokers believed that most smokers might consider quitting if they knew this information. Furthermore, a study in Poland suggested that most smokers do not pay attention to the harmful effects of tobacco to their bodies.
Informing the public on the association between cigarette smoking and skin aging could prompt people to quit smoking and could help avoid any complications brought about by smoking. This cross-sectional study aims to evaluate the public's knowledge and awareness of the association between cigarette smoking and skin aging in Jeddah, Saudi Arabia. We will also estimate the awareness campaigns and commercial interventions needed to deliver information on the fatal effects of smoking.
| Methods|| |
This cross-sectional, survey-based study was conducted by distributing a questionnaire to the general population of Jeddah in 2018. Jeddah, one of the biggest cities in Saudi Arabia, is located in the western region of the country and has a population of approximately 3.5 million. We interviewed and distributed the questionnaire to the general population, across different age groups and genders, in multiple locations including malls, coffee shops, and universities. This study was approved by the Institutional Review Board of King Abdulaziz University Hospital.
The survey included four main questions, namely, (1) if they have smoked 100 cigarettes in their life; (2) whether they are a current smoker, a former smoker, or a nonsmoker; (3) if they think that smoking increases wrinkles, decreases wrinkles, does not have an effect on skin aging, or if they do not know; and (4) if they believe that knowing how smoking cigarettes increases facial aging and wrinkles would motivate smokers to quit. For analysis purposes, answers to the last question were dichotomized into either most/some people would quit or few/none would quit. Demographic variables included gender, age group (18–34, 35–49, or 50 years or older), and level of educational attainment (high school graduate or less, undergraduate student, or college graduate). Distribution of these variables was expressed as percentages. Microsoft Office Excel 2007 and Statistical Package for the Social Sciences software version 21 (IBM Corp., Armonk, NY, USA) for Windows were used for the data analysis. Chi-square test was used, and P < 0.05 was considered statistically significant.
| Results|| |
This study included 2443 participants, 31.8% of males and 68.2% of females. Almost 73.6% of the participants were in the age range of 18–34 years, 16.1% were in the age range of 35–49 years, and 10.4% were older than 50 years. Only 13.8% were high school graduates or less and the rest have higher educational attainment. Nearly 15.4% have smoked at least 100 cigarettes in their lifetime and the current smokers were 12.6%. More than half (64%) of the participants answered correctly that smoking increases facial aging and wrinkles [Table 1]. Slightly higher number of nonsmokers than current and former smokers responded that smoking increases facial aging and wrinkles, with the current smokers having the least belief about the relationship.
|Table 1: Distribution of participants' opinions on the effect of smoking on facial aging and wrinkles by smoking status|
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There was a significant difference to the response of males and females to the association of smoking and increased facial aging and wrinkles. Nearly 70.9% of the females responded that smoking increases facial aging and wrinkles (P < 0.0001) [Table 2]. Among the current smokers, one-quarter reported that they thought most/some smokers would quit if they learned that smoking increases facial aging and wrinkles. Almost 25.8% of former smokers and 21.3% of nonsmokers responded the same to that question. Compared to other demographics, a considerable number of younger participants and college graduates knew that smoking increases facial aging and wrinkles. [Table 3] shows the differences in the knowledge of the association and other demographic data confined only to the current smokers. Current smokers who were aware of the relationship between smoking and skin aging were not more likely to quit than people unaware of the relationship (P = 0.032) [Table 3].
|Table 2: Distribution of participants' awareness of the association between smoking and increase in facial aging and wrinkles and belief that most or some smokers would quit if they knew about this association|
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|Table 3: Distribution of the current smokers' awareness of the association between smoking and increased facial aging and wrinkles and belief that most or some smokers would quit if they knew about this association|
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| Discussion|| |
In this study, we describe the public's knowledge and awareness of the association between cigarette smoking and skin aging. More than half of the participants were knowledgeable about this relationship, with more nonsmokers responding correctly than current and former smokers. Current smokers were the least informed on this relationship and on the effects of smoking to the body. This could explain why current smokers still smoke despite efforts of the Saudi Ministry of Health. Educating these uninformed people of this relationship is a public health responsibility of dermatologists and other doctors. A study conducted in the USA in 1994 to assess the general population's knowledge on the association between smoking and skin aging showed that 54% were aware of the ill effects of smoking. This is slightly lower than our findings. Therefore, there is no significant change in the level of knowledge about the relationship of smoking and skin aging since the 1990s. This suggests a lack in effective ways of spreading awareness and knowledge and calls for better action because the relationship between skin aging and cigarette smoking has been confirmed in laboratories with mechanical evidence and epidemiological studies.,
Almost 12.6% of our participants were smokers, nearly similar to the 12.2% smokers in the nationally representative multistage sampling study conducted in 2013 that assessed tobacco consumption status in the Kingdom of Saudi Arabia. Another cross-sectional, nationwide survey conducted in 2018 across the 13 regions of Saudi Arabia showed that the prevalence of cigarette smoking was 22.78% in the Makkah region that includes Jeddah. This shows that the number of smokers is still high, and we are in need of an intervention to decrease this number. This intervention could be implemented by increasing cigarettes price, which the government did recently.
Majority of the participants were between the ages of 18 and 34 years, whereas 10.4% were 50 years or older. We targeted not only the younger people who are more likely to care for their skin, but also older age groups. Knowledge of older age groups is more important because they could teach, protect, and motivate younger people to avoid or quit smoking. Population aged 18 years and younger must be enrolled in future researches because education on the relationship between smoking and skin aging might be most effective in this age group.
Among current smokers who were aware of the relationship between smoking and skin aging, there was no significant association with their motivation to quit. This demonstrates some of the difficulties to smoking cessation such as the challenging and difficult quitting process that necessitates several targeted messages and efforts. A previous study conducted among young adults showed that the lack of a way to cope with stress and pressure (60%) and cravings (52%) are obstacles in stopping smoking. One must consider health gain as a motivation, which may be deficient in our sample, to change their smoking behavior. Smoking cessation, especially in the younger age groups, can be driven by the public's understanding of its effects on skin aging and overall health. A study conducted in Poland on motivations for quitting smoking concluded that awareness on tobacco-related diseases and health problems is a significant motivator for smokers to quit. Facial aging is a better motivator for younger age groups who may be more worried with their appearance because a beautiful and youthful appearance could affect their social behavior and reproductive status positively.
Higher number of younger participants and college graduates believed that smoking increases facial aging and wrinkles. This highlights the significance of education as highly educated individuals were more aware of the health-related problems brought about by smoking.
| Conclusion|| |
More than the half of the participants were aware of the relationship between smoking and facial aging, with more nonsmokers responding correctly than current and former smokers. There was no significant association with the motivation to quit among current smokers and their awareness of the relationship between smoking and skin aging. The society's lack of knowledge about the association between cigarette smoking and aging calls for more attention. Knowledge should be spread by prompting health campaigns, putting smoking cessation steps in the cigarette packets, creating a smoking cessation application or using other artificial intelligence as a cognitive behavioral therapy, and participation of health authorities to make more effective public health policies against smoking. Further researches with younger population are needed.
The authors would like to thank Talah Magadmi, Esraa Basalem, Mohammad Assaggaf, Abdullah Sultan, Abdulrahman Aboalola, and Khadijah Aljahdali for their contribution in data collection.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Metelitsa AI, Lauzon GJ. Tobacco and the skin. Clin Dermatol 2010;28:384-90.
Morita A. Tobacco smoke causes premature skin aging. J Dermatol Sci 2007;48:169-75.
Ortiz A, Grando SA. Smoking and the skin. Int J Dermatol 2012;51:250-62.
Urbańska M, Nowak G, Florek E. Cigarette smoking and its influence on skin aging. Przegl Lek 2012;69:1111-4.
Ernster VL, Grady D, Miike R, Black D, Selby J, Kerlikowske K, et al.
Facial wrinkling in men and women, by smoking status. Am J Public Health 1995;85:78-82.
Kadunce DP, Burr R, Gress R, Kanner R, Lyon JL, Zone JJ, et al.
Cigarette smoking: Risk factor for premature facial wrinkling. Ann Intern Med 1991;114:840-4.
Koh JS, Kang H, Choi SW, Kim HO. Cigarette smoking associated with premature facial wrinkling: Image analysis of facial skin replicas. Int J Dermatol 2002;41:21-7.
Demierre MF, Brooks D, Koh HK, Geller AC. Public knowledge, awareness, and perceptions of the association between skin aging and smoking. J Am Acad Dermatol 1999;41:27-30.
Urbańska M, Ratajczak L, Witkowska-Nagiewicz A. Analysis of knowledge about tobacco smoking influence on skin condition. Przegl Lek 2012;69:1055-9.
Morita A, Torii K, Maeda A, Yamaguchi Y. Molecular basis of tobacco smoke-induced premature skin aging. J Investig Dermatol Symp Proc 2009;14:53-5.
Moradi-Lakeh M, El Bcheraoui C, Tuffaha M, Daoud F, Al Saeedi M, Basulaiman M, et al.
Tobacco consumption in the Kingdom of Saudi Arabia, 2013: Findings from a national survey. BMC Public Health 2015;15:611.
Algabbani AM, Almubark R, Althumiri N, Alqahtani A, BinDhim N. The Prevalence of Cigarette Smoking in Saudi Arabia in 2018. Food and Drug Regulatory Science Journal 2018;1:1.
Silvis GL, Perry CL. Understanding and deterring tobacco use among adolescents. Pediatr Clin North Am 1987;34:363-79.
Villanti AC, Bover Manderski MT, Gundersen DA, Steinberg MB, Delnevo CD. Reasons to quit and barriers to quitting smoking in US young adults. Fam Pract 2016;33:133-9.
Sieminska A, Buczkowski K, Jassem E, Lewandowska K, Ucinska R, Chelminska M, et al.
Patterns of motivations and ways of quitting smoking among Polish smokers: A questionnaire study. BMC Public Health 2008;8:274.
[Table 1], [Table 2], [Table 3]