Table 1 A summary of thematized PBS employed by khat chewers
| Â | PBS employed | Targeted risk |
|---|---|---|
General PBS | Limiting the amount of use Buying khat when it is cheap or buying a cheaper type Chewing while also working Avoiding the need to chew khat for mirkana Obtaining khat from friends or retailers for free | Economic impacts |
Slow reduction Taking a break from chewing for a while (khat holiday) Engagement in other activities instead of chewing Limiting the amount of use Using khat only in the afternoon | Dependence and tolerance | |
Distracting activities such as going for a walk, busying oneself with activities, visiting relatives/friends, consuming caffeinated drinks and sleeping at their usual khat chewing time Acknowledging the withdrawal symptoms and not doing anything about them (denial) Chewing a small amount of khat (limited access) | Withdrawal symptoms | |
Chewing while also working, if the nature of the work allows Chewing quickly (making lulu) before work or chewing after work or only during free time, if the nature of the work does not allow, and chewing while also working if the nature of the work allows Limiting the amount of khat chewed Avoiding chewing at night so that it does not disturb their sleeping pattern and they will be able to get up on time for work Avoiding the need to chew in the morning and dedicating the time wholly to work Chewing with friends who have a positive attitude towards work | Work | |
Avoiding the use of other substances | Health | |
Not chewing before a date | Sexual performance | |
PBS before the chewing session | Eating well, selecting the khat type convenient to their taste and health, avoiding buying chemically sprayed khat | Physical health |
Avoiding to buy a khat type thought to reduce sexual performance | Sexual performance | |
PBS during the chewing session | Selecting the right place for chewing Chewing in company to strengthen social bonds | Social impacts |
Avoiding additives like sugar and peanuts, using adequate water, limiting the amount of khat chewed, avoiding drinking alcohol or smoking cannabis as this increases the desire to chew and there may be related health effects | Physical health | |
Stopping chewing ahead of time if they plan sexual intercourse | Sexual performance | |
Limiting the amount of khat, stopping chewing earlier and avoiding the consumption of caffeinated drinks | Sleeplessness | |
Avoiding mixing different khat types, chewing with others, avoiding stressful thoughts while chewing through listening to music or controlling their thoughts, avoiding exposure to noise or too much talk during mirkana | Mental health | |
PBS after the chewing session | Carrying out household chores to induce tiredness, taking a bath, reading, watching movies, drinking milk, non-caffeinated soft drinks or soup, eating a substantial meal and drinking alcohol | Sleeplessness |
Drinking alcohol, eating well | Sexual performance | |
Taking an adequate break after ‘spitting khat’ and using juicy and simple foods to overcome appetite loss | Appetite loss | |
Drinking milk, fenugreek juice or flax seeds juice to avoid impacts on the gastrointestinal system Mouth rinsing or brushing teeth to avoid dental health effects | Physical health |