Abstract
Khat, an “amphetamine-like green leaf,” may influence the consumption of tobacco. This study reviews the epidemiology of tobacco use among khat users. Electronic database searches using appropriate keywords/terms were conducted to identify observational studies of khat use. Assessment of quality and risk of bias of all included studies was conducted, and the results were synthesised descriptively. Nine eligible cross-sectional studies were identified. All assessed self-reported tobacco among khat users and were carried out in Africa and the Middle East. Eight reported cigarettes and one reported waterpipes as the mode of use. Methods of tobacco use prevalence assessment varied. Prevalence of “current” tobacco use among students and university teachers ranged from 29 to 37%; “lifetime” tobacco use in university teachers was 58% and “undefined” tobacco use in nonspecific adults and students ranged from 17 to 78%. Daily tobacco use among adults was reported as 17% whilst simultaneous tobacco and khat use was reported as between 14 and 30% in students. In conclusion, tobacco prevalence among khat users appears significant. Findings should be interpreted cautiously due to self-reported tobacco use, diversity in questions assessing tobacco use, and type of tobacco consumption. Future research should address the methodological shortcomings identified in this review before appropriate policy interventions can be developed.
Highlights
Tobacco smoking is a significant cause of preventable death and ill health worldwide [1]
This review evaluated the epidemiology of tobacco use among khat users
Was a significant level of tobacco use reported among university teachers [44] and health care providers who used khat [40], and high income was associated with dual use [40]
Summary
Tobacco smoking is a significant cause of preventable death and ill health worldwide [1]. Khat use has become a national and international public health concern, with many countries such as the United Kingdom banning its use [27, 28]. We seek in this review to inform the scientific debate about the neglected public health issue that khat use is often associated with tobacco. Our primary aim is to systematically identify, appraise, synthesise, and summarise the best available evidence on the epidemiological association between khat use as the exposure and tobacco use (prevalence, pattern, and mode of tobacco) as the outcome. The review question is as follows: What is the best available evidence on the epidemiology of tobacco among khat users?
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