INTRODUCTION

A substance is burned during the practice of smoking, and the resulting smoke is typically inhaled so that it can be tasted and absorbed into the bloodstream [1]. The World Health Organization (WHO) estimates that tobacco use kills 6 million people annually, with secondhand smoke killing an additional 600,000 people [2].

 More than 80% of smokers live in low-and middle-income countries, where there are approximately 1.3 billion smokers worldwide [3]. Recent statistics show a decline in the prevalence of smokers worldwide, with the majority of the decline taking place in North American and Scandinavian countries. But over the same time period, smoking frequency has rapidly increased in both high-income and low-income countries, including Cote d'Ivoire, Kazakhstan, Serbia, and Mauritania [4]. According to recent estimates, roughly 20% of Saudi Arabian residents use tobacco, with comparable proportions recorded among teenagers [5, 6]. According to the WHO, smoking was prevalent among Saudi Arabian teenagers in 2016, with 21.2% of men and 9.1% of girls smoking. Males smoked 23.7% of the time, whereas females smoked 1.5% of the time [7]. Published reports indicate that between 2007 and 2018, the prevalence of tobacco use among Saudi Arabian adolescents ranged from 2.4% to 39.6% [8].

In addition to cancers of the mouth, throat, lungs, kidneys, cervix, and pancreas, smoking has also been linked to an increased risk of stroke, chronic respiratory and cardiovascular diseases, and cancers of the cervix and kidneys [9, 10]. Around 20% of adult deaths worldwide are attributed to smoking. Smoking is predicted to cause 8 million annual deaths by 2030, with 80 percent of these deaths taking place in low and middle-income countries [11, 12]. Smoking is linked to a variety of ailments, including respiratory, cardiovascular, and cancer. Furthermore, some research has found a substantial link between smoking and eye illnesses such age-related macular degeneration, cataracts, Graves' ophthalmopathy, and glaucoma [13]. Despite this association, compared to other more well-known illnesses such as lung cancer, oral cancer, stroke, and heart attack, a large portion of the general population is ignorant of it [14]. Only 5% of the 260 adolescents (aged between 11- 18 years old) in a study conducted in England, people were aware that it caused blindness. The teens, on the other hand, were much more afraid of blindness than of lung cancer, heart disease, or stroke [15, 16]. Furthermore, when compared to early indicators of lung cancer, heart disease, or stroke, more teens stated they would quit smoking if they saw early signs of blindness. As a result, it's critical to increase awareness about the link between smoking and blindness and to encourage people to quit smoking [17, 18].

The majority of Greek smokers agreed that smoking causes lung cancer (95.4%), heart disease (94.4%), throat cancer (87.9%), bronchitis (87.7%), and mouth cancer (84.8%), but 51.7% disagreed that smoking causes blindness (37.8%), tuberculosis (38.%), impotence (33.8%), stroke (24%) and heart attacks in non-smokers (27.3 percent) according to Ioanna Petroulia, et al. In smokers who reported having significant difficulties quitting, the proportions who were aware of blindness and stroke were lower. Smokers also claimed they found it difficult to stop and were not aware that smoking could result in TB and bronchitis. Smokers who stated they wanted to quit "a lot" had higher levels of awareness of all health risks [19].

Understanding the harmful effects of active and passive smoking is the first step toward behavior change, but it is not enough to help people quit. Twyman et al. published a comprehensive assessment of the perceived barriers to smoking cessation in vulnerable populations. Individual and lifestyle issues; physical addiction, low confidence, behavioral habits, low motivation, failed previous attempts, relaxation, stress and mood management, perceived mental health benefits, enjoyment, low health related knowledge, social and community barriers; lack of support from a health professional, socializing, lack of social support, high prevalence and acceptability of smoking in social and community barriers as cultural norms, maintaining identity [20].

Study Rationale

Smoking related health disorders are on the rise due to increase in the number of smokers. Smoking acts as an etiological factor for various diseases affecting oral and general health. Up to our knowledge, there is lack of studies assessing Saudi population awareness of negative effects of smoking on general health.

Research Hypothesis

Null Hypothesis

Saudi general population in have no knowledge regarding effects of smoking on the general health.

Alternative Hypothesis

Saudi general population, have enough knowledge regarding effects of smoking on the general health.

Research Question

Dose Saudi general population have enough knowledge regarding effects of smoking on the general health?

Study Objective

The objective of this Integrative Literature Review (ILR) is to consider the knowledge on injurious possessions of smoking amongst Saudi general population.

MATERIALS AND METHODS

Type of the Study

Integrative Literature Review (ILR).

ILR is a technique for compiling previously published studies with the aim of synthesizing evidence on a topic; it is frequently used in the health sciences to identify innovations and discover new approaches to healthcare, enabling the use of evidence-based services, guaranteeing quality, and enhancing patient safety. There are six steps that must be carried out in that order: The study problem is explained, the inclusion and exclusion criteria are applied, the included studies are evaluated, the results are interpreted, and the ILR synthesis is presented.

The research question was developed using the PICO (Patient, Intervention, Comparison, and Outcome) technique, which is frequently used in evidence-based practice. According to the PICO strategy, issues should be broken down into the following four categories: patient, intervention, and treatment outcome, comparison, and (PICO). Because of how these pieces are made, it is possible to create designs that are more flexible and effective in solving the current issue.

The papers that answered the research question were reviewed in depth after searching and defining the sample. Following data collection, the information was grouped in a table, allowing the profile of the articles to be described and the main points were highlighted.

Topics concerning knowledge on harmful effects of smoking among Saudi general population were used in the making of the article. The titles and abstracts of the established papers were scrutinized. These articles were picked for inclusion based on their applicability to the project, which had to address one of the following issues: overall Saudi community awareness of the negative consequences of smoking.

Exclusion Criteria

All additional papers, repeated studies, and reviews of research that do not have one of these themes as their major end were disregarded.

Statistical Analysis

There was no software used in the data analysis. The publication's title, author's name, objective, executive summary, outcomes, and results were all taken from a predetermined form. The outcomes of each participant were double-revised to ensure validity and minimize errors.

In order to ensure that the research we enrolled is relevant to the goal of our study and to prevent or reduce mistakes in the results; studies were double-reviewed during the article selection process.

RESULTS AND DISCUSSION

The choice and designation of research are shown in Figure 1. A number of 105 studies were identified after searching the aforementioned databases, which were then used for title filtering. 32 of them were excluded after 63 of them were comprised for summary screening. The entire texts of the remaining 31 publications were examined. 21 papers were excluded as a result of the full-text review, and 10 remained enrolled for the final data extraction (Table 1).

The included studies had different study designs.

Marzo (2016) reported that, greatest smoking prevalence was observed in those aged 25 to 44. A higher percentage of smokers than of non-smokers (90.9%) were aware that cigarette cartons contain health warnings regarding smoking. Smokers and non-smokers both chose the graphic depiction of lung cancer the most frequently (32.3%). The voters' preferred option was frightening imagery [21].

Shanmugasundaram & Sitaraman (2019) revealed that 83% of the study population were aware of the ill – effects of tobacco use. Majority of the participants were aware that smoking causes lung cancer. 88% of the study population were aware of the risks of passive smoking. About 16 % were unaware of the complications of passive smoking. 78% of respondents were aware that tobacco chewing can cause oral cancer [22].

Salgado et al. (2017) studied 1659 participants, 453 of whom (27.3 %) were current smokers. Only 52 % of participants agreed that 30.9% of respondents said that medical guidance had little impact on patients' quitting behavior, while 19.4% supposed that clinicians might refuse to treat smoldering cases that were unable to quit. Physicians ought customary an instance intended for their clients thru evading smoking [23].

Pascal & Collins (2017) found that, there was 95.6%, 92.8%, and 65.2% understanding the overall health consequences of indirect smoking on individuals, kids, and expectant women, respectfully. Lung cancer (95.6%), the onset of asthma (92.8%), and the birth of tiny infants (65.2%) constituted the most frequent particular health impacts of which the responses were informed for individuals. Radio accounted for 93.6% of all sources of information awareness. There was a significant relationship between exposure status and knowledge of the overall health consequences of contact to passive smoke on individuals (P = 0.041), children (P = 0.031), and pregnant women (P = 0.02) [24].

Dawood et al. (2016) revealed that smokers had limited knowledge of certain of the risks associated with smoking, including lung cancer in nonsmokers (30.1%), impotence in smokers (52.6%), accelerated ageing (64%), and stroke (66.3%). Additionally, there was a strong correlation between the intention to stop and having good knowledge and perception scores [25].

Park et al. (2018) found that, positive attitudes to quitting smoking were substantially linked to a greater degree of tobacco-related information. It's interesting to note that among present smokers, just those who correctly answered 9 out of 12 items relating to nicotine had a meaningful connection for their attitude about quitting smoking [26].

The fewest often detected health hazards, according to Alzahrani (2020), were cognitive deficiency (47.8%), heart attack in children (37.5%), and ear infection in children (28.1%). In comparison to their counterparts, 57.5% of the participants had enough knowledge, which was greater among women and lower among those living with friends (p 0.05). There was no correlation between level of comprehension and the SHS sensitivity measures or the degree of discomfort felt [27].

94% of the research group, according to Al-Haqwi et al. (2010), said that smoking might lead to significant diseases. In the future, around 90% of the students said they would encourage their patients to stop smoking, and 88% agreed that smoking should be prohibited in public places. A total of 44 students (20%) believed that smoking has some positive impacts, mostly as a stress-reduction technique [28].

According to research by Minh et al. (2013), most people had a solid understanding of the health hazards associated with both active smoking and secondhand smoke exposure (90% and 83%, respectively). Stroke, heart attack, and lung cancer-related knowledge, on the other hand, seems to be less common (51.5%). Smokers were substantially less likely than non-smokers to show that they knew more about the health concerns associated with AS (OR 1.6) and SHS (OR 1.7). Adults with secondary school, college education, or higher levels of education also knew substantially more about the health hazards associated with AS/SHS than adults with only elementary education. Growing older was positively correlated with awareness of the health effects of SHS, and information availability was strongly correlated with knowledge of the health hazards connected with AS/SHS [29].

According to Owusu-Dabo et al. (2011), women had lower levels of health knowledge than men did. Traditionalists showed higher levels of health awareness than Christians, the relatively well-educated, and people living in rural regions [30].