Validity of the Fagerstrom Test for Cigarette Dependence in UK-resident Yemeni Khat Chewers

Cigarette smoking remains a leading cause of preventable disease (cancer, heart disease) and premature death in the United States and other countries (Surgeon General’s report, 2004, 2010). The prevalence of tobacco smoking in the developed world has decreased dramatically in the last decades whilst the trend for the increase in the developing countries is growing. It is estimated that by 2030, 80% of all tobacco-related deaths will occur in developing countries (Mathers & Loncar, 2006). In the Arabic speaking countries in the Middle East the consumption of cigarette smoking has increased by 24% between 1990-1997 and the prevalence is higher amongst males with the Yemen having the highest rate (75%) of male prevalence of smoking followed by Jordan, Tunisia, Syria, Lebanon and Palestine at 40% (Shafey, 2007). The use of khat chewing amongst the Yemeni in homeland and diaspora to facilitate social interaction is often associated with tobacco smoking. Khat is an established drug of dependence resembling amphetamine chemically and in mode of action (Kalix, 1992). High prevalence of regular cigarette smoking amongst khat chewers has been reported recently (Kassim & Croucher, 2011). According to the Surgeon General’s report (1988),