Awareness of the Saudi population regarding the effects of smoking on fracture healing

Smoking tobacco negatively affects fracture healing, increasing the risk of delayed union, malunion, and nonunion, as well as healthcare expenses. Although smoking is common in Saudi Arabia, the literature on public awareness of the negative impact of smoking on fractures is limited. Our study aimed to address this gap and assess the population's knowledge on the effects of smoking on fracture healing.

An analytical cross-sectional study, involving 1033 Saudi adults, was conducted between June and September 2024 in Saudi Arabia. A validated and reliable self-created Smoking and Fracture Knowledge Assessment tool (SFKAT) was used in an online questionnaire to collect the participants' responses. Participants were categorized into good- or poor-knowledge groups based on the median SFKAT score. Binary logistic regression was used to adjust for confounding variables.

The participants included 54.4% men. The median age of the participants was 39 years and 24.1% of them were smokers. Most smokers were men (87%). The median SFKAT score was 16 (interquartile range, IQR=12-19) and 53% of the respondents demonstrated good knowledge on the effects of smoking on fracture healing. The likelihood of good-knowledge scoring was considerably lower for men than women (adjusted odds ratio, AOR=0.48: 95% CI: 0.36-0.65; p<0.001). Healthcare workers were more likely to have a good-knowledge scoring (AOR=2.78; 95% CI: 1.90-4.08; p<0.001). Smokers had lower odds of having a good-knowledge scoring (AOR=0.54; 95% CI: 0.38-0.75; p<0.001).

The awareness of the detrimental effects of smoking on fracture healing is suboptimal, particularly among men and smokers. Sex, healthcare work, and smoking were significantly associated with knowledge levels after adjusting for confounders. These findings may encourage educational strategies and direct counseling for populations with an observed knowledge gap to help lower the burden and treatment costs.