Int J Adolesc Med Health 2015; 27(3): 357–360
Short Communication AbdulKarim S. Al-Makadma, Melissa Moynihan*, Sarah Dobson and Elizabeth Saewyc
Tobacco use among adolescents in Riyadh Saudi Arabia Abstract Background: Initiation of smoking behavior during adolescence is associated with negative health outcomes. Understanding initiation of smoking behavior in adolescents in relation to other behavioral, health, and environmental factors is essential for effective behavioral modification. Objective: The aim of this study was to describe tobacco use behaviors among adolescents in Riyadh, Saudi Arabia, and related demographic and social factors. Subjects: A total of 1430 students aged 14–19 from high schools across the city of Riyadh participated in the study. Methods: A comprehensive adolescent health survey was administered to students in high school classrooms across Riyadh. Data were analyzed primarily via contingency tables with χ2-tests. Results: One in five students reported having ever smoked cigarettes, with a significantly higher proportion of boys than girls reporting tobacco use. Students who smoked had significantly lower school connectedness compared with those who never smoked. Tobacco use by family members was common, and students with at least one family member who smoked were significantly more likely to use tobacco themselves. Conclusion: Improving school connectedness among students by fostering supportive and safe school environments could be a potential strategy for reducing *Corresponding author: Melissa Moynihan, MSN, RN, Stigma and Resilience Among Vulnerable Youth Centre, The University of British Columbia School of Nursing, T201-2211 Wesbrook Mall, Vancouver, BC, Canada V6T 2B5, E-mail: [email protected] AbdulKarim S. Al-Makadma: General Pediatrics and Adolescent Medicine Department, King Fahad Medical City–Specialized Children Hospital, Riyadh, Saudi Arabia Sarah Dobson: Stigma and Resilience Among Vulnerable Youth Centre, The University of British Columbia School of Nursing, Vancouver, BC, Canada Elizabeth Saewyc: Stigma and Resilience Among Vulnerable Youth Centre, The University of British Columbia School of Nursing, Vancouver, BC, Canada; and Division of Adolescent Health and Medicine, The University of British Columbia Faculty of Medicine, Vancouver, BC, Canada
adolescent smoking. Reducing smoking in the general population and educating families about being better role models for youth are also critical. Keywords: adolescents; Saudi Arabia; tobacco use. DOI 10.1515/ijamh-2014-0023 Received April 11, 2014; accepted June 6, 2014; previously published online August 15, 2014
Background Initiation of smoking behavior during adolescence is associated with negative health outcomes. Adolescent smokers are at greater risk of becoming adult smokers, and earlier onset of adolescent smoking increases the risk of adult smoking (1). In Saudi Arabia, the prevalence of teen smoking has only recently begun to be monitored. The 2013 World Health Organization Report on the Global Tobacco Epidemic (2) indicates that the prevalence of daily tobacco smoking among adults is 22% (men: 35%, women: 6%), while the prevalence of current cigarette use among youth aged 13–15 from the 2010 Global Youth Tobacco Survey (3) was 8.9% (boys: 13%, girls: 5%). Studies examining adolescent tobacco use in Saudi Arabia have found significantly higher prevalence of ever smoked and current smokers among boys compared with girls (4, 5). Understanding initiation of smoking behavior in adolescents in relation to other behavioral, health, and environmental factors is essential for effective behavioral modification. This research brief presents data from a study of adolescent health developed for Saudi youth in Riyadh.
Objective The purpose of this analysis was to describe the tobacco use behaviors of adolescent boys and girls aged 14–19 in Riyadh, Saudi Arabia, and the association between tobacco use and demographic and social factors.
Brought to you by | New York University Bobst Library Technical Services Authenticated Download Date | 12/9/16 7:15 AM
358 Al-Makadma et al.: Adolescent tobacco use in Riyadh
A total of 1430 students from 12 schools participated in the study, of which 54.8% were male. Students ranged in age from 14 to 19 and were in grades 7–12. Fifty-eight percent of participants were 14–16 years old. Students were distributed across three types of educational institutions, with 41% attending government, 36.1% private, and 22.9% international schools. The majority of students self-identified as Saudi Arabian nationals (65.3%).
Methods A comprehensive adolescent health survey was developed for Saudi youth based on an extensive literature review of adolescent health. The survey focused on adolescents’ behaviors and attitudes and included questions about smoking and tobacco use, general health, perceptions of school and family, use of technology, school activities, and activities outside of school. The study was conducted in high schools in Riyadh, the largest city in Saudi Arabia. Schools were selected based on geographical location and type of institution. Riyadh was divided into three geographical areas for sampling purposes (North, South, Middle). In each geographical area, the two largest public schools, one private school, and one international school were selected. Public schools were single-gender institutions, while private and international schools were coeducational. Classrooms were selected at random, and the investigators worked with school administrators to include all classes who had a free period. Prior to administering the survey, a committee visited each school to explain the purpose of the study to students, and an informational letter and consent form were sent home to parents. Students were informed that participation in the study was completely voluntary. A research team returned to schools at a later date to administer the survey in classrooms. Four research teams composed of health professionals (nurses, health coordinators, and paramedicals) collected the data from November 2010 to February 2012. Ethical approval for the study was obtained from the King Fahad Medical City Institutional Review Board, and the Ministry of Education gave permission to administer the survey in schools. The survey collected demographic information about students, including type of school, current grade, age, gender, and ethnicity. Age was categorized as middle adolescence (14–16 years) and later adolescence (17–19 years) based on developmental stages of adolescence and school groupings. Seven items specifically addressed students’ smoking and tobacco use. These questions asked adolescents to report the following: how old they were when they first smoked a whole cigarette, their smoking behaviors in the past 30 days, if they had ever tried to quit smoking, why they like smoking, where they smoke, and if any family members smoke cigarettes. A school-connectedness measure included in the survey was psychometrically evaluated before being included in analyses that examine the link between smoking and students’ relationships with school. The school connectedness scale included seven Likert-type response items (strongly agree to strongly disagree) that asked participants about teacher support, feeling safe at school, and caring about their school. A higher score indicates stronger school connectedness.
This measure was included because studies have found that lower levels of school connectedness have been linked to smoking (6). Univariate descriptive statistics were examined, and data were analyzed primarily via contingency tables with χ2-tests; the link between school connectedness and smoking was assessed with a t-test. Analyses were conducted using SPSS Statistics (Version 21.0) software (IBM Corp., Armonk, NY, USA). Alpha was set at 0.05, so p-values
Short Communication AbdulKarim S. Al-Makadma, Melissa Moynihan*, Sarah Dobson and Elizabeth Saewyc
Tobacco use among adolescents in Riyadh Saudi Arabia Abstract Background: Initiation of smoking behavior during adolescence is associated with negative health outcomes. Understanding initiation of smoking behavior in adolescents in relation to other behavioral, health, and environmental factors is essential for effective behavioral modification. Objective: The aim of this study was to describe tobacco use behaviors among adolescents in Riyadh, Saudi Arabia, and related demographic and social factors. Subjects: A total of 1430 students aged 14–19 from high schools across the city of Riyadh participated in the study. Methods: A comprehensive adolescent health survey was administered to students in high school classrooms across Riyadh. Data were analyzed primarily via contingency tables with χ2-tests. Results: One in five students reported having ever smoked cigarettes, with a significantly higher proportion of boys than girls reporting tobacco use. Students who smoked had significantly lower school connectedness compared with those who never smoked. Tobacco use by family members was common, and students with at least one family member who smoked were significantly more likely to use tobacco themselves. Conclusion: Improving school connectedness among students by fostering supportive and safe school environments could be a potential strategy for reducing *Corresponding author: Melissa Moynihan, MSN, RN, Stigma and Resilience Among Vulnerable Youth Centre, The University of British Columbia School of Nursing, T201-2211 Wesbrook Mall, Vancouver, BC, Canada V6T 2B5, E-mail: [email protected] AbdulKarim S. Al-Makadma: General Pediatrics and Adolescent Medicine Department, King Fahad Medical City–Specialized Children Hospital, Riyadh, Saudi Arabia Sarah Dobson: Stigma and Resilience Among Vulnerable Youth Centre, The University of British Columbia School of Nursing, Vancouver, BC, Canada Elizabeth Saewyc: Stigma and Resilience Among Vulnerable Youth Centre, The University of British Columbia School of Nursing, Vancouver, BC, Canada; and Division of Adolescent Health and Medicine, The University of British Columbia Faculty of Medicine, Vancouver, BC, Canada
adolescent smoking. Reducing smoking in the general population and educating families about being better role models for youth are also critical. Keywords: adolescents; Saudi Arabia; tobacco use. DOI 10.1515/ijamh-2014-0023 Received April 11, 2014; accepted June 6, 2014; previously published online August 15, 2014
Background Initiation of smoking behavior during adolescence is associated with negative health outcomes. Adolescent smokers are at greater risk of becoming adult smokers, and earlier onset of adolescent smoking increases the risk of adult smoking (1). In Saudi Arabia, the prevalence of teen smoking has only recently begun to be monitored. The 2013 World Health Organization Report on the Global Tobacco Epidemic (2) indicates that the prevalence of daily tobacco smoking among adults is 22% (men: 35%, women: 6%), while the prevalence of current cigarette use among youth aged 13–15 from the 2010 Global Youth Tobacco Survey (3) was 8.9% (boys: 13%, girls: 5%). Studies examining adolescent tobacco use in Saudi Arabia have found significantly higher prevalence of ever smoked and current smokers among boys compared with girls (4, 5). Understanding initiation of smoking behavior in adolescents in relation to other behavioral, health, and environmental factors is essential for effective behavioral modification. This research brief presents data from a study of adolescent health developed for Saudi youth in Riyadh.
Objective The purpose of this analysis was to describe the tobacco use behaviors of adolescent boys and girls aged 14–19 in Riyadh, Saudi Arabia, and the association between tobacco use and demographic and social factors.
Brought to you by | New York University Bobst Library Technical Services Authenticated Download Date | 12/9/16 7:15 AM
358 Al-Makadma et al.: Adolescent tobacco use in Riyadh
A total of 1430 students from 12 schools participated in the study, of which 54.8% were male. Students ranged in age from 14 to 19 and were in grades 7–12. Fifty-eight percent of participants were 14–16 years old. Students were distributed across three types of educational institutions, with 41% attending government, 36.1% private, and 22.9% international schools. The majority of students self-identified as Saudi Arabian nationals (65.3%).
Methods A comprehensive adolescent health survey was developed for Saudi youth based on an extensive literature review of adolescent health. The survey focused on adolescents’ behaviors and attitudes and included questions about smoking and tobacco use, general health, perceptions of school and family, use of technology, school activities, and activities outside of school. The study was conducted in high schools in Riyadh, the largest city in Saudi Arabia. Schools were selected based on geographical location and type of institution. Riyadh was divided into three geographical areas for sampling purposes (North, South, Middle). In each geographical area, the two largest public schools, one private school, and one international school were selected. Public schools were single-gender institutions, while private and international schools were coeducational. Classrooms were selected at random, and the investigators worked with school administrators to include all classes who had a free period. Prior to administering the survey, a committee visited each school to explain the purpose of the study to students, and an informational letter and consent form were sent home to parents. Students were informed that participation in the study was completely voluntary. A research team returned to schools at a later date to administer the survey in classrooms. Four research teams composed of health professionals (nurses, health coordinators, and paramedicals) collected the data from November 2010 to February 2012. Ethical approval for the study was obtained from the King Fahad Medical City Institutional Review Board, and the Ministry of Education gave permission to administer the survey in schools. The survey collected demographic information about students, including type of school, current grade, age, gender, and ethnicity. Age was categorized as middle adolescence (14–16 years) and later adolescence (17–19 years) based on developmental stages of adolescence and school groupings. Seven items specifically addressed students’ smoking and tobacco use. These questions asked adolescents to report the following: how old they were when they first smoked a whole cigarette, their smoking behaviors in the past 30 days, if they had ever tried to quit smoking, why they like smoking, where they smoke, and if any family members smoke cigarettes. A school-connectedness measure included in the survey was psychometrically evaluated before being included in analyses that examine the link between smoking and students’ relationships with school. The school connectedness scale included seven Likert-type response items (strongly agree to strongly disagree) that asked participants about teacher support, feeling safe at school, and caring about their school. A higher score indicates stronger school connectedness.
This measure was included because studies have found that lower levels of school connectedness have been linked to smoking (6). Univariate descriptive statistics were examined, and data were analyzed primarily via contingency tables with χ2-tests; the link between school connectedness and smoking was assessed with a t-test. Analyses were conducted using SPSS Statistics (Version 21.0) software (IBM Corp., Armonk, NY, USA). Alpha was set at 0.05, so p-values
