Introduction: The WHO expert committee on drug dependence noted in its 2006 review of khat that excessive use of khat leads to adverse social and health consequences, and recommended drawing attention to such use patterns. Similarly, several of the studies reporting the association between khat and health problems emphasized the role of ‘heavy use patterns.’ Such findings and recommendations indicate the need to understand factors shaping khat-chewing topography, which is defined as the study of how one chews khat and the contextual factors shaping such behaviours.
Methods: The study relied on a qualitative method in which 102 khat-chewers were recruited from the general community in Jimma, Ethiopia using a snowball sampling from May 2021 to February 2022.
Results: Our findings reveal that khat-chewing topography constitutes the amount, the duration of a chewing session, the frequency, the rate, and the timing of chewing. The khat chewing topography is shaped through a complex interplay of multiple variables, which we categorized into six themes: perceived harms, the pre-chewing state, the khat variety, norms of khat chewing rate, the khat rhythm factor, and the context of chewing.
Conclusion: The typical khat-chewing topography identified in this study shows that khat-chewers regulate their chewing behaviour by considering multiple factors, including the social norms of khat consumption and the possible harm to their health, social life, and budgets. As a result, most of the chewers were able to build a consumption topography that can be described as ‘harm reduction from below.’