Exposure to tobacco smoke, concurrent short-term symptoms of respiratory, allergic, cardiovascular morbidities and health-services use among young adults in Kuwait.
Akhtar S, Almutairi S, et al. • BMC health services research • 2026
Although tobacco exposure (first and/or secondhand) itself was not directly associated with health-services use at least once in the past year, smoking-related symptoms and ill-health conditions were significantly associated with health-care use at least once during the past year among young adults in Kuwait.
Key Findings
Results
The overall prevalence of exposure to tobacco smoke among Kuwait University undergraduate students was 55.9%.
740 of 1,323 participants reported exposure to tobacco smoke overall.
First-hand tobacco smoke exposure prevalence was 13.4% (177/1,323).
Second-hand tobacco smoke exposure at home was reported by 50.8% (672/1,323) of participants.
The study was cross-sectional, conducted in October 2022 using a structured electronic questionnaire with a convenience sample.
The majority of participants were Kuwaiti (87.5%) and female (75.8%).
Results
Respiratory symptoms were highly prevalent among study participants, with shortness of breath being the most commonly reported.
Shortness of breath was reported by 59.1% of participants.
Cough was reported by 46.3% of participants.
Chest pain was reported by 26.9% of participants.
Difficulty during exercise was reported by 21.6% of participants.
Results
Physician-diagnosed morbidities including asthma and eczema were prevalent among the study population.
Asthma was reported by 16.8% of participants.
Eczema was reported by 11.2% of participants.
Chronic obstructive pulmonary disease (COPD) was reported by 1.4% of participants.
These were all self-reported physician-diagnosed conditions.
Results
Nearly half of participants used health services at least once during the past year.
44.6% (590/1,323) of participants used health services at least once during the past year.
Health-services use was defined as one or more visits versus none during the past one-year period.
Health-services use was the primary outcome evaluated in the multivariable logistic regression model.
Results
Cough was significantly associated with increased odds of health-services use at least once during the past year.
Adjusted OR = 2.10; 95% CI: 1.66–2.64; p < 0.001.
This was the strongest respiratory symptom predictor of health-services use in the multivariable model.
The model adjusted for effects of age and sex.
Results
Nausea/vomiting was associated with the highest odds of health-services use among all symptoms examined.
Adjusted OR = 2.52; 95% CI: 1.79–3.54; p < 0.001.
This was the largest odds ratio among all symptom predictors in the multivariable model.
The association remained significant after adjusting for age and sex.
Results
Shortness of breath was significantly associated with increased odds of health-services use in the past year.
Adjusted OR = 1.30; 95% CI: 1.01–1.67; p = 0.044.
This was the weakest but still statistically significant symptom predictor of health-services use.
The association was adjusted for age and sex in the multivariable model.
Results
A physician diagnosis of asthma was significantly associated with increased health-services use during the past year.
Adjusted OR = 1.95; 95% CI: 1.43–2.65; p < 0.001.
Asthma was the only physician-diagnosed condition explicitly reported as significantly associated with health-services use in the multivariable model.
The model adjusted for age and sex.
Results
Active and/or secondhand tobacco smoking was not significantly associated with health-services use at least once during the past year.
Tobacco smoking (active and/or secondhand) was included as a variable in the multivariable logistic regression model.
The association between tobacco exposure and health-services use did not reach statistical significance.
The authors note that smoking-related symptoms and conditions, rather than tobacco exposure itself, drove health-services use.
What This Means
This research suggests that tobacco smoke exposure is extremely common among university students in Kuwait, with more than half of participants (55.9%) exposed to either first-hand or second-hand tobacco smoke. Notably, second-hand smoke exposure at home was far more common (50.8%) than active smoking (13.4%), pointing to the household environment as a major source of exposure. Alongside this high exposure burden, large proportions of students reported respiratory symptoms like shortness of breath and cough, and significant percentages had been diagnosed by a physician with conditions such as asthma and eczema.
This research suggests that while tobacco smoke exposure itself was not directly linked to whether students visited a healthcare provider in the past year, the symptoms and diseases associated with smoking — particularly cough, shortness of breath, nausea/vomiting, and asthma — were strongly linked to healthcare use. Students with these conditions were roughly 1.3 to 2.5 times more likely to have sought health services compared to those without them. This means the health burden of tobacco smoke may be showing up indirectly through the illnesses it causes rather than through a straightforward exposure-to-healthcare-use pathway.
This research suggests that public health efforts targeting tobacco smoke reduction — especially secondhand smoke in homes — could help reduce the high rates of respiratory and allergic disease seen in this young population, potentially reducing the downstream demand on health services. The findings highlight the need for smoke-free home environments and educational campaigns aimed at young adults in Kuwait and similar settings.
Akhtar S, Almutairi S, Alhajri W, Alrashidi S, Almutairi N, Almutairi G, et al.. (2026). Exposure to tobacco smoke, concurrent short-term symptoms of respiratory, allergic, cardiovascular morbidities and health-services use among young adults in Kuwait.. BMC health services research. https://doi.org/10.1186/s12913-026-15530-x