{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T17:15:16Z","timestamp":1784308516460,"version":"3.55.0"},"reference-count":40,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2024,8,22]],"date-time":"2024-08-22T00:00:00Z","timestamp":1724284800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Princess Nourah bint Abdulrahman University: Researchers Supporting Project","award":["PNURSP2024R563"],"award-info":[{"award-number":["PNURSP2024R563"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Numerous studies have examined substance use and smoking behavior among adolescents and university students. However, little is known about these behaviors among students undergoing university entrance tests, a critical transition period from adolescence to adulthood. The entrance test can significantly affect students\u2019 mental health, potentially leading to substance use. This study aims to investigate the prevalence of cigarette smoking and substance use among students taking these exams and the associated factors.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>A cross-sectional survey was carried out on September 4th and 11th, 2022 to collect data from 1,480 university entrance test-taking students using a convenience sampling technique. Chi-square tests and logistic regression were conducted using SPSS software. Besides, GIS mapping was used to visualize the distribution of substance use and smoking behavior across districts via ArcGIS.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>The study found a 10% prevalence of current tobacco smoking and 4% substance use. Females (OR = 1.98; 95% CI: 1.38\u20132.85), urban residence (OR = 2.03; 95% CI: 1.42\u20132.88), repeater (OR = 1.45; 95% CI: 1.02\u20132.06), anxiety (OR = 1.55, 95% CI: 1.10\u20132.19), burnout (OR = 1.51, 95% CI: 1.00\u20132.12), and suicidal behavior (OR = 1.57; 95% CI: 1.03\u20132.40) were the significant factors for cigarette use. Whereas the urban residence (OR = 1.91; 95% CI: 1.11\u20133.31), anxiety (OR = 2.47, 95% CI: 1.45\u20134.20), and suicidal behavior (OR = 2.76; 95% CI: 1.55\u20134.92) significantly increased the risk of substance use. GIS analysis revealed males varied in substance use and females in tobacco smoking by district. Repeat test-takers were associated with district variations in both smoking and substance use.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Educational institutions, public health authorities, and policymakers must implement mental health support and substance use prevention programs for students. Integrating mental health education, providing resources, and enforcing regulations can promote healthier coping strategies and reduce substance use risks among students.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0308697","type":"journal-article","created":{"date-parts":[[2024,8,22]],"date-time":"2024-08-22T19:08:21Z","timestamp":1724353701000},"page":"e0308697","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":13,"title":["Prevalence and associated factors of cigarette smoking and substance use among university entrance test-taking students: A GIS-based study"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1728-8966","authenticated-orcid":true,"given":"Mohammed A.","family":"Mamun","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8454-6128","authenticated-orcid":true,"given":"Nitai","family":"Roy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Gozal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moneerah Mohammad","family":"Almerab","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Md. Shakhaoat","family":"Hossain","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4611-9624","authenticated-orcid":true,"given":"Firoj","family":"Al Mamun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,8,22]]},"reference":[{"key":"pone.0308697.ref001","doi-asserted-by":"crossref","first-page":"e885","DOI":"10.1002\/hsr2.885","article-title":"Prevalence of substance use among Iranian male adolescents: Systematic review and meta\u2010analysis.","volume":"5","author":"J Hosseini","year":"2022","journal-title":"Health Sci Rep"},{"key":"pone.0308697.ref002","doi-asserted-by":"crossref","first-page":"1795","DOI":"10.3109\/10826084.2014.933240","article-title":"Predictors of substance use among young adults transitioning away from high school: A narrative review.","volume":"49","author":"M Kirst","year":"2014","journal-title":"Subst Use Misuse"},{"key":"pone.0308697.ref003","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/BF03391702","article-title":"Substance use and associated health conditions throughout the lifespan.","volume":"35","author":"MT Schulte","year":"2013","journal-title":"Public Health Rev."},{"key":"pone.0308697.ref004","author":"United Nations","year":"2022","journal-title":"World Drug Report 2022."},{"key":"pone.0308697.ref005","article-title":"Control the alarming drug problem before it\u2019s too late","author":"MM Rashid","year":"2022","journal-title":"In: The Independent [Internet]."},{"key":"pone.0308697.ref006","author":"Addiction Center","year":"2023","journal-title":"Addiction Statistics"},{"key":"pone.0308697.ref007","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1016\/j.jsat.2018.08.005","article-title":"Substance use consequences, mental health problems, and readiness to change among Veterans seeking substance use treatment.","volume":"94","author":"DH Morris","year":"2018","journal-title":"J Subst Abuse Treat"},{"key":"pone.0308697.ref008","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.drugalcdep.2013.12.011","article-title":"Early adolescent patterns of alcohol, cigarettes, and marijuana polysubstance use and young adult substance use outcomes in a nationally representative sample.","volume":"136","author":"HB Moss","year":"2014","journal-title":"Drug Alcohol Depend."},{"key":"pone.0308697.ref009","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1111\/josh.12723","article-title":"Substance use, academic performance, and academic engagement among high school seniors","volume":"89","author":"BA Bugbee","year":"2019","journal-title":"Journal of School Health"},{"key":"pone.0308697.ref010","doi-asserted-by":"crossref","first-page":"149509","DOI":"10.1155\/2015\/149509","article-title":"Stress among medical students and its association with substance use and academic performance.","volume":"2015","author":"L Melaku","year":"2015","journal-title":"J Biomed Educ"},{"key":"pone.0308697.ref011","doi-asserted-by":"crossref","first-page":"e0258100","DOI":"10.1371\/journal.pone.0258100","article-title":"Burnout, does the university entrance test failing attribute? A Bangladeshi exploratory study","volume":"16","author":"MA Mamun","year":"2021","journal-title":"PLoS One."},{"key":"pone.0308697.ref012","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1111\/ppc.12783","article-title":"Suicidal behaviors and university entrance test-related factors: A Bangladeshi exploratory study.","volume":"58","author":"MA Mamun","year":"2022","journal-title":"Perspect Psychiatr Care"},{"key":"pone.0308697.ref013","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1093\/inthealth\/ihy091","article-title":"Prevalence and predictors of tobacco smoking among university students in Sylhet Division, Bangladesh.","volume":"11","author":"MS Hassan","year":"2019","journal-title":"Int Health"},{"key":"pone.0308697.ref014","doi-asserted-by":"crossref","first-page":"e0244335","DOI":"10.1371\/journal.pone.0244335","article-title":"Determinants of cigarette\/bidi smoking among youth male in rural Mymensingh of Bangladesh: A cross-sectional study.","volume":"15","author":"KMM Rahman","year":"2021","journal-title":"PLoS One."},{"key":"pone.0308697.ref015","doi-asserted-by":"crossref","first-page":"e101934","DOI":"10.1371\/journal.pone.0101934","article-title":"Patterns and predictors of smokeless tobacco use among adults in Bangladesh: Findings from the International Tobacco Control (ITC) Bangladesh Survey.","volume":"9","author":"AS Abdullah","year":"2014","journal-title":"PLoS One."},{"key":"pone.0308697.ref016","doi-asserted-by":"crossref","first-page":"e012765","DOI":"10.1136\/bmjopen-2016-012765","article-title":"Prevalence, pattern and sociodemographic differentials in smokeless tobacco consumption in Bangladesh: evidence from a population-based cross-sectional study in Chakaria.","volume":"7","author":"MN Mia","year":"2017","journal-title":"BMJ Open"},{"key":"pone.0308697.ref017","doi-asserted-by":"crossref","first-page":"129","DOI":"10.2147\/RMHP.S282965","article-title":"Suicidal Behavior and Flood Effects in Bangladesh: A Two-Site Interview Study.","volume":"14","author":"MA Mamun","year":"2021","journal-title":"Risk Manag Healthc Policy."},{"key":"pone.0308697.ref018","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1046\/j.1525-1497.2001.016009606.x","article-title":"The PHQ-9: Validity of a brief depression severity measure","volume":"16","author":"K Kroenke","year":"2001","journal-title":"J Gen Intern Med"},{"key":"pone.0308697.ref019","doi-asserted-by":"crossref","first-page":"e129","DOI":"10.1192\/bjo.2023.526","article-title":"Prevalence and factors associated with suicidal ideation among students taking university entrance tests: revisited and a study based on Geographic Information System data.","volume":"9","author":"R Nahrin","year":"2023","journal-title":"BJPsych Open."},{"key":"pone.0308697.ref020","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.1001\/archinte.166.10.1092","article-title":"A brief measure for assessing generalized anxiety disorder: The GAD-7","volume":"166","author":"RL Spitzer","year":"2006","journal-title":"Arch Intern Med"},{"key":"pone.0308697.ref021","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1177\/0022022102033005003","article-title":"Burnout and engagement in university students: A cross-national study.","volume":"33","author":"WB Schaufeli","year":"2002","journal-title":"J Cross Cult Psychol"},{"key":"pone.0308697.ref022","doi-asserted-by":"crossref","first-page":"e0191746","DOI":"10.1371\/journal.pone.0191746","article-title":"Burnout among medical students during the first years of undergraduate school: Prevalence and associated factors.","volume":"13","author":"S Boni RA dos","year":"2018","journal-title":"PLoS One."},{"key":"pone.0308697.ref023","doi-asserted-by":"crossref","first-page":"e0254926","DOI":"10.1371\/journal.pone.0254926","article-title":"Substance use behavior and its lifestyle-related risk factors in Bangladeshi high school-going adolescents: An exploratory study.","volume":"16","author":"MS Moonajilin","year":"2021","journal-title":"PLoS One."},{"key":"pone.0308697.ref024","article-title":"Tobacco use and substance abuse in students of Karaj Universities.","volume":"7","author":"K Kabir","year":"2016","journal-title":"Int J Prev Med."},{"key":"pone.0308697.ref025","doi-asserted-by":"crossref","first-page":"969837","DOI":"10.1155\/2014\/969837","article-title":"Substance Use and Associated Factors among University Students in Ethiopia: A Cross-Sectional Study.","volume":"2014","author":"G Tesfaye","year":"2014","journal-title":"J Addict."},{"key":"pone.0308697.ref026","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1177\/0272684X17749570","article-title":"Prevalence, Trends, and Consequences of Substance Use Among University Students: Implication for Intervention.","volume":"38","author":"M Ayalew","year":"2018","journal-title":"Int Q Community Health Educ"},{"key":"pone.0308697.ref027","doi-asserted-by":"crossref","first-page":"186","DOI":"10.4103\/2278-330X.195339","article-title":"Prevalence of tobacco use and its contributing factors among adolescents in Bangladesh: results from a population-based study","volume":"5","author":"SMS Islam","year":"2016","journal-title":"South Asian J Cancer"},{"key":"pone.0308697.ref028","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1177\/1010539509350495","article-title":"Sociopsychological correlates of smoking among male university students in Bangladesh.","volume":"23","author":"SMM Kamal","year":"2011","journal-title":"Asia Pacific Journal of Public Health"},{"key":"pone.0308697.ref029","first-page":"244","article-title":"Prevalence of Tobacco Smoking and Factors Associated with the Initiation of Smoking among University Students in Dhaka, Bangladesh.","volume":"6","author":"S Hossain","year":"2017","journal-title":"Cent Asian J Glob Health."},{"key":"pone.0308697.ref030","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1007\/s11920-009-0019-8","article-title":"Gender differences in adolescent substance abuse.","volume":"11","author":"A Kloos","year":"2009","journal-title":"Curr Psychiatry Rep"},{"key":"pone.0308697.ref031","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13034-019-0281-4","article-title":"Gender-specific substance use patterns and associations with individual, family, peer, and school factors in 15-year-old Portuguese adolescents: a latent class regression analysis.","volume":"13","author":"J Picoito","year":"2019","journal-title":"Child Adolesc Psychiatry Ment Health"},{"key":"pone.0308697.ref032","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1080\/00952990.2017.1341903","article-title":"Rural and urban substance use differences: effects of the transition to college","volume":"44","author":"KJ Derefinko","year":"2018","journal-title":"Am J Drug Alcohol Abuse"},{"key":"pone.0308697.ref033","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1080\/1067828X.2016.1210550","article-title":"Recent alcohol, tobacco, and substance use variations between rural and urban middle and high school students.","volume":"26","author":"JC Warren","year":"2017","journal-title":"J Child Adolesc Subst Abuse."},{"key":"pone.0308697.ref034","doi-asserted-by":"crossref","first-page":"772","DOI":"10.15288\/jsad.2012.73.772","article-title":"Socioeconomic status and substance use among young adults: a comparison across constructs and drugs","volume":"73","author":"ME Patrick","year":"2012","journal-title":"J Stud Alcohol Drugs"},{"key":"pone.0308697.ref035","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1016\/j.addbeh.2008.09.004","article-title":"Substance use behaviors, mental health problems, and use of mental health services in a probability sample of college students.","volume":"34","author":"JA Cranford","year":"2009","journal-title":"Addictive behaviors."},{"key":"pone.0308697.ref036","doi-asserted-by":"crossref","first-page":"1117","DOI":"10.1111\/j.1360-0443.2010.02902.x","article-title":"Mental disorders as risk factors for substance use, abuse and dependence: results from the 10\u2010year follow\u2010up of the National Comorbidity Survey.","volume":"105","author":"J Swendsen","year":"2010","journal-title":"Addiction"},{"key":"pone.0308697.ref037","doi-asserted-by":"crossref","first-page":"807","DOI":"10.1001\/archpsyc.61.8.807","article-title":"Prevalence and co-occurrence of substance use disorders and independentmood and anxiety disorders: Results from the national epidemiologic survey on alcohol and relatedconditions","volume":"61","author":"BF Grant","year":"2004","journal-title":"Arch Gen Psychiatry"},{"key":"pone.0308697.ref038","doi-asserted-by":"crossref","first-page":"598","DOI":"10.1111\/j.1521-0391.2014.12150.x","article-title":"Cannabis and related impairment: The unique roles of cannabis use to cope with social anxiety and social avoidance.","volume":"23","author":"JD Buckner","year":"2014","journal-title":"Am J Addict"},{"key":"pone.0308697.ref039","first-page":"414","article-title":"Anxiety and alcohol use disorders: comorbidity and treatment considerations","volume":"34","author":"JP Smith","year":"2012","journal-title":"Alcohol Res"},{"key":"pone.0308697.ref040","doi-asserted-by":"crossref","first-page":"S11","DOI":"10.1016\/j.drugalcdep.2004.08.003","article-title":"Association of alcohol and drug use disorders and completed suicide: an empirical review of cohort studies","volume":"76","author":"HC Wilcox","year":"2004","journal-title":"Drug Alcohol Depend"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0308697","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,22]],"date-time":"2024-08-22T19:09:08Z","timestamp":1724353748000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0308697"}},"subtitle":[],"editor":[{"given":"Palash Chandra","family":"Banik","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2024,8,22]]},"references-count":40,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2024,8,22]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0308697","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,22]]}}}