The Growing Trend of Filter Khaini Smokeless Tobacco Use among Male University Students in Aden, Yemen: A Cross-Sectional Survey

Background: Smokeless tobacco products, particularly Filter Khaini (locally known as AL-HOT), are increasingly popular in Yemen, especially among young adults.


Objective: This study aimed to estimate the prevalence of AL-HOT use among male university students in Aden and explore its associations with demographic factors, concurrent risk behaviors, and health perceptions.


Methods: A cross-sectional survey was conducted between February and April 2025 among 1,000 male undergraduate students aged 18–30 years from public and private universities in Aden. Data were collected using a culturally adapted, self-administered questionnaire based on the WHO Global Adult Tobacco Survey. Descriptive statistics summarized participant characteristics, and chi-square tests (p < 0.05) assessed associations between AL-HOT use and independent variables.


Results: Overall, 82.9% of participants were aware of AL-HOT, and 27.1% reported ever using it. Among users, 68.3% reported daily use and 31.7% less frequent use. AL-HOT use was significantly associated with cigarette smoking, e-cigarette use, qat chewing, and energy drink consumption (all p = 0.001), but not related to demographic factors. Daily users were more likely to perceive AL-HOT as less harmful than cigarettes (81.8%), consider it socially acceptable (84.8%), and report higher dependence and gastrointestinal symptoms. While most users acknowledged its addictiveness and supported awareness campaigns, daily users were less supportive of campus bans.


Conclusion: AL-HOT use among male university students in Aden is common and closely linked to other risky behaviors, shaped by misconceptions of reduced harm and social acceptance. Culturally tailored prevention and policy interventions are urgently needed to curb smokeless tobacco use in this population.