Tobacco smoking and the risk of eating behaviors and depression among Palestinian female university students.

Background: Tobacco smoking and eating disorders are often connected to concerns about body image and can be indicative of underlying mental health conditions, such as depression. In Palestinian society, females have a cultural belief that smoking can aid in weight loss. Societal pressure on body image may drive females to such risky behaviors. However, few studies have examined the link between smoking and eating disorder behaviors. We researched the prevalence of tobacco smoking among Palestinian female university students and its association with binge/purge behaviors and depression.

Method: A cross-sectional research study was carried out at An-Najah National University. Female students [N = 642] completed anonymous surveys, sharing information about tobacco smoking and other substance use habits, answering questions from the Eating Attitude Test-26, the Sick (EAT-26), Control, One, Fat, and Food (SCOF) screening tests, and the Beck Depression Inventory.

Results: The study reported a high prevalence of waterpipe smoking (24.4%) among Palestinian university female students, which exceeded the prevalence of cigarette smoking (4%). For the SCOF scale, 36.3% scored ≥ 2 points, indicating a screened positive for anorexia or bulimia nervosa; 40% struggled with binge-eating behavior, while only 7.8% had sought treatment for eating disorders. Additionally, 34.7% of the students experienced depression. The adjusted binary logistic regression model of risk factors for cigarette smoking has shown that cigarette smoking is significantly associated with self-induced vomiting (aOR = 6.075, p-value = 0.027), history for eating disorder treatment (aOR = 3.438, p-value = 0.047), e-cigarettes (aOR = 10.070, p-value = 0.001), waterpipe (aOR = 3.299, p-value = 0.022), energy drinks (aOR = 5.163, p-value = 0.003), moderate depression (aOR = 11.499, p-value = 0.010), and mild depression (aOR = 12.963, p-value = 0.003).

Conclusion: The study revealed concerning results of tobacco smoking linked to depression, binge/purge behaviors, obesity, and various weight-control methods. These findings highlight the urgent need for targeted interventions through awareness campaigns, culturally tailored health education, implementation of mental health support for students, and provide accessible medical and psychological assistance to at-risk Palestinian female students.