J. Maatoug

School-based intervention to promote healthy lifestyles in Sousse, Tunisia.

Background: Integrated actions against selected risk factors (i.e. smoking, physical inactivity, and unhealthy diet) can lead to the reduction of major chronic diseases. Objective: To implement and evaluate a school-based intervention program to prevent cardiovascular risk factors among children. Materials and Methods: Design: Pre- test post-test quasi experimental design with a control group. Setting: Four secondary schools in Sousse, Tunisia. Intervention: The overall intervention program lasted for a school year and incorporated educative actions concerning tobacco use, physical activity, and healthy diet. Results: Globally, knowledge, behaviors, and intentions concerning smoking improved in both groups between baseline and the end of the study, particularly in the intervention group. Nutrition knowledge, behaviors, and intentions improved in both groups between baseline and final stage, particularly in the intervention group. At the final stage, there was an increase in the proportion of children walking to and from school in the intervention group. There was also an increase in the percentage of children with intention of practicing sport in the future particularly in the intervention group. There were no significant differences in BMI after the intervention neither in intervention nor in control groups. At the end of the study, the incidence of overweight and obesity was similar to that at baseline. Conclusions: This pilot study has demonstrated the potential of school as a suitable setting for the promotion of healthy lifestyles in children. The study resulted in substantial improvements concerning knowledge, behaviors, and intentions in the intervention group.

Three-Year Intervention Program to Prevent Hypertension in Workplaces in Tunisia: A Pre-Post Quasi-Experimental Design with Control Group

Objectives: to evaluate the effectiveness of a three-year workplace intervention for healthy lifestyle promotion in the prevention of hypertension among employees. Methods: A quasi-experimental study design was employed to assess the effectiveness of a health promotion intervention program for corporate employees, which mainly consisted of educational videos and interactive teaching sessions with occupational physicians, healthy eating and smoking cessation workshops, free physical activity sessions for employees and free smoking cessation consultation in workplace. There were three workplace sites in the intervention and control groups, respectively. Results: The prevalence of screened hypertension decreased significantly in the intervention arm from 16.2% to 12.8% (p=0.02), but increased significantly in the control arm from 13.3% to 23.3% (p<0.001). Of note, obesity increased both in intervention and control arms. Assessment of hypertension prevalence according to weight status demonstrated a significant decrease in the intervention group among normal weight participants from 11.5% to 6.6% (p=0.009), but an increase in the control group albeit not statistically significant. Among overweight participants, hypertension decreased in intervention group from 18.9% to 13.5% (p=0.058), but increased significantly in control group from 13.1% to 23.1% (p=0.001). Among obese participants, the decrease in the prevalence of hypertension was not significant in intervention group (27.8% to 24.4%, p=0.48), however, it increased significantly in the control group from 22.4% to 34.3% (p=0.009). Determinants of hypertension were age > 35 years, male sex, overweight and obesity in the two groups. Overall, the intervention was negatively associated with hypertension in intervention group (OR= 0.61, CI 95% [0.47-0.8]). Conclusion: The intervention program was effective in decreasing the prevalence of hypertension among normal weight workers. However, additional strategies and/or time are need to combat hypertension among overweight and obese individuals.

Effectiveness of a Community-Based Intervention Program to Reduce Hypertension Prevalence Among Adults : Results of a Quasiexperimental Study With Control Group in the Region of Sousse, Tunisia

BACKGROUND High blood pressure is preventable and is directly related to lifestyle habits such as an unbalanced diet, low levels of physical activity, and tobacco use. OBJECTIVES This quasiexperimental study aimed to assess the effectiveness of a 3-year community intervention targeting healthy lifestyle promotion in reducing hypertension prevalence among adults. METHODS A quasiexperimental design was used to evaluate the effectiveness of a 3-year intervention for healthy lifestyle that was implemented between 2010 and 2013 in a community of adults in the region of Sousse in Tunisia. The population study was randomly selected in both intervention and control groups at pre-assessment and post-assessment. After considering a type 1 error α of 5%, a type 2 error β of 20%, and a change in the prevalence of various risk factors of 6% between pre-intervention and post-intervention, the sample size was fixed to 2,000 adults in intervention and control areas. RESULTS The intervention group was composed of 940 and 1,001 adults, and the control group was composed of 940 and 976, respectively, at pre-assessment and post-assessment. The prevalence of hypertension decreased in the intervention group globally from 37.3% to 33.7% but not significantly (p = 0.1). In the control group, this proportion increased from 31.1% to 33.4% without significant difference (p = 0.28). In the intervention group, after stratification for age, a significant decrease (p = 0.007) in the prevalence of hypertension was observed for participants younger than 40 years old: it decreased from 22.8% to 16.2%. In the control group, it increased from 14% to 15.4% (p = 0.52). In intervention group, a significant decrease of the hypertension from 31.4% to 26% (p = 0.03) was observed among nonobese participants after stratification for weight status. No significant change was observed in the control group. CONCLUSIONS This study showed the feasibility and effectiveness of a community-based intervention to reduce the prevalence of hypertension in the context of a developing country.

School-Based Intervention as a Component of a Comprehensive Community Program for Overweight and Obesity Prevention, Sousse, Tunisia, 2009-2014.

Introduction Combating obesity at an early age, by improving physical activity and nutrition-related behaviors, is vital to the prevention of more critical health concerns in adulthood. This intervention study evaluated the effectiveness of a school-based component of a community behavioral intervention on overweight and obesity rates of adolescents in Sousse, Tunisia. Methods A quasi-experimental school-based intervention was conducted with an intervention group (in Sousse Jawhara and Sousse Riadh) and a control group (in Sousse Msaken). The intervention (which was a physical activity and nutrition program) lasted 3 years, with data at preintervention collected during the 2009–2010 school year and at postintervention collected during the 2013–2014 school year. Descriptive statistics and multivariate analysis were used to determine the effect of the intervention on risk of excess weight. Results Results showed a significant increase in fruit and vegetable intake by the intervention group (P = .04). The intervention group had an increase in students in the normal weight category (P = .03) and a decrease in students in the overweight category (P = .03).The intervention effect was a protective factor against excess weight for the participating schoolchildren (OR, 0.84; P = .02). Conclusion This study showed that a school-based intervention is successful in increasing healthy dietary habits and in reducing risk of excess weight. It also showed the importance of a multisectoral approach to provide an environment conducive to healthy behaviors for adolescents.

A 3-Year Workplace-Based Intervention Program to Control Noncommunicable Disease Risk Factors in Sousse, Tunisia

Objective: To assess the effectiveness of a 3-year workplace-based intervention program on the control of the main noncommunicable disease risk factors (poor nutrition, physical inactivity, and tobacco use) among the employees of Sousse, Tunisia. Methods: We conducted a quasi-experimental study (pre- and postassessments with intervention and control groups) in six companies of the governorate of Sousse in Tunisia. The intervention program consisted of health education programs (eg, workshops, films and open sensitization days). We also scheduled free physical activity sessions and free smoking cessation consultations. Results: Our intervention program showed meaningful improvement among the employees toward dietary and physical activity behaviors but not for tobacco use. Conclusions: Workplace is a crucial setting for health promotion, and future programs should consider a multisectoral approach to control the main noncommunicable disease risk factors.

Assessment of the validity of self-reported smoking status among schoolchildren in Sousse, Tunisia.

Abstract Introduction: Tobacco use, which begins in adolescence and childhood and continues in later life, is the major avoidable risk for non-communicable diseases and death in the world. Self-reports have frequently been used to estimate smoking prevalence and health consequences. This study explores the validity of self-reports of smoking behavior among schoolchildren in Tunisia. Materials and methods: This study was conducted in March 2014 among a sample of 147 schoolchildren randomly selected. Data concerning the smoking habit were collected by a questionnaire designed for the purposes of this work. Then, exhaled CO, a biochemical marker of smoke exposure, was measured using piCO+ Smokerlyzer® breath CO monitor among participants. Sensitivity and specificity of self-reports were calculated. Results: The prevalence of reported smoking was 9.5% with 16.7% and 1.7% respectively among boys and girls. Their mean age was 14.5±1.28 years old. When considering 4 ppm as the cut-off level of breath CO, sensitivity and specificity of self-reports were 100% and 93.7%, respectively. But at a breath CO cut-off of 3 ppm, self-reporting was 62.5% sensitive and 93.5% specific. Conclusion: According to our findings, we suggest that self-reports can be considered as a good tool to be used with a reasonable confidence to assess the smoking status.

School-based intervention to promote healthy nutrition in Sousse, Tunisia.

Abstract Introduction: Obesity among children is a major risk factor for chronic diseases. School interventions programs can represent a mean to implement healthy nutrition attitudes at early ages. Our objective was to evaluate the effects of a school intervention program to promote healthy nutrition among adolescents, in terms of knowledge, behaviors and intention. Methods: Quasi experimental study among urban students in Sousse, Tunisia with 2 groups, intervention and control. The intervention group had an interactive program integrated with school courses that promoted healthy nutrition habits. Both groups had a pre post evaluation. Results: 2200 students aged from 12 to 16 participated to the pre post evaluation. In the intervention group, there were significant changes form pre to post test in knowledge, intentions, and behaviors. In the control group, almost no significant changes were observed. Conclusion: School intervention programs can represent an interesting approach to promote healthy nutrition habits among adolescents.

Clustering of Risk Factors With Smoking Habits Among Adults, Sousse, Tunisia

Introduction In Tunisia, few studies have assessed the association between tobacco use and other lifestyle risk factors for chronic disease (eg, unhealthy diet, physical inactivity). We studied 1,880 adults to determine the association between tobacco use and other lifestyle risk factors in Tunisia. Methods This study was part of an assessment of the prevalence of chronic disease risk factors in a community-based trial conducted in 2009 to implement a chronic disease prevention program. The study population was randomly selected from 3 districts of the region of Sousse. The questionnaires were administered by personal interview and included the assessment of tobacco use and other chronic disease risk factors such as unhealthful diet habits and physical inactivity. Results Of the 1,880 study participants, 64% were women. The mean age of the participants was 37.9 (standard deviation, 13.5 y). The prevalence of tobacco use in our population was 50.4% for men and 3.1% for women. Among men, the proportion of alcohol consumption was significantly higher among smokers (25.3% vs 5.7% [P <.001]). Smokers consumed fewer fruits and vegetables and more high-fat, high-salt, and high-sugar foods than did nonsmokers. There was no significant difference between male smokers and nonsmokers regarding physical activity (P = .36). Conclusion Physical activity and dietary characteristics may be important areas for physicians to assess during smoking-cessation interventions.

Advising Obese Adults about Diet and Physical Activity in Sousse, Tunisia

Background. To our knowledge no study has been conducted in Tunisia to describe practice of health care providers towards chronic disease risk factors, particularly among obese adults. Aim. This study is aimed at assessing the level of giving advice on diet and physical activity by health care providers for obese adults comparing to nonobese adults in Tunisia. Methods. A cross-sectional survey was carried out in 2010 for adults aged from18 to 65 years living in the region of Sousse. The questionnaires were administered by an interview made by trained data collectors to standardize the administration of the questionnaire. Anthropometric measurements of height and weight were obtained using a standardized protocol from each participant. Results. The findings from this study indicate that obesity is frequent among adults essentially among women and aged categories. It also shows that obese adults are not adequately diagnosed with few proportion of anthropometric measure evaluation among all the participants. Even if obese participants were significantly more advised than nonobese participants with, respectively, 28.5% to lose weight and 23.8% to increase physical activity, this proportion remains low.

Sustainability of the results of a non communicable diseases prevention program among youth in the region of Sousse, Tunisia.

Abstract Introduction: Implementation of a healthy lifestyle at an early age is described as a successful intervention to prevent non communicable diseases. However, successful programs are not necessarily sustainable. The purpose of this study was to evaluate a 1-year sustainability of a 3-year comprehensive intervention conducted to promote a healthy lifestyle among schoolchildren. Materials and methods: A cohort study of 204 schoolchildren enrolled in middle schools was conducted after a quasi-experimental study in the region of Sousse, Tunisia. The survey lasted 1 year. An exposed group (n=105) was selected from the intervention group and the not-exposed group (n=99) was selected from the control group. The exposition was the intervention. The same questionnaire used at pre-intervention and post-intervention was self-administered to collect data about tobacco use, physical activity and eating habits. The biometric measurements were taken by trained medical doctors at schools. Results: After 1 year of follow-up, none of participants became smokers in the exposed group. However, in the not-exposed group five (5.1%) participants became smokers. The proportion of schoolchildren who experimented with tobacco for the first time increased insignificantly by 2.9% (p=0.77) in the exposed group versus a significant increase by 11.1% (p=0.001) in the not-exposed group. Concerning the recommended physical activity practice, fast food and fried food consumption and overweight, there were no significant changes in the two groups. Conclusion: A 3-year non communicable diseases prevention program has limited sustainable effects among schoolchildren in the short-term. Its repetition or a continued program through multisectoral actions is required.