Lilian A. Ghandour

Promoting healthy eating and physical activity among school children: findings from Health-E-PALS, the first pilot intervention from Lebanon

BackgroundIn Lebanon, childhood obesity doubled during the past decade. Preventive measures should start early in life and Schools are considered an important environment to promote energy balance health behaviours. School-based programmes promoting healthy lifestyles are lacking. The purpose of this study was to evaluate the feasibility and effectiveness of a multicomponent school-based intervention to promote healthy eating and physical activity (and prevent obesity) with school children aged 9–11 years in Lebanon.MethodsThe intervention was developed based on the constructs of the Social Cognitive Theory and adapted to the culture of Lebanese and Arab populations. It consisted of three components: class curriculum, family involvement and food service. Eight schools were purposively selected from two communities of different socioeconomic status (SES) in Beirut and, within each school type, were matched on SES, religious sect profile, and then randomly assigned to either the intervention or control group. Anthropometric measurements and questionnaires on determinants of behavioural change, eating and physical activity habits were completed by the students in both groups at baseline and post intervention. Focus group interviews were conducted in intervention schools at the end of the study. Challenges encountered during the programme implementation were also identified, since Lebanon is considered a country with political unrest and no similar research projects were conducted in the area.ResultsStudents in the intervention group reported purchasing and consuming less chips and sweetened drinks post-intervention compared with controls (86% & 88% less respectively p < 0.001). Knowledge and self-efficacy scores increased for the intervention (+2.8 & +1.7 points respectively p < 0.001) but not for the control group. There was no difference in physical activity and screen time habits and no changes in BMI between groups at post intervention. Interview data from focus groups showed that the programme was generally well accepted. Limitations for better outcomes include the length of the programme and the school environment.Conclusion“Health-E-PALS” intervention is a promising innovative, theory-based, culturally sensitive intervention to promote healthy eating habits and physical activity in Lebanese school children with a potential to be scaled up, replicated and sustained.

Prescription opioid use disorder and heroin use among 12-34 year-olds in the United States from 2002 to 2014

a Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th St., New York, NY 10032, USA b Rutgers University, Institute for Health, 112 Paterson St., New Brunswick, NJ 08901, USA c New York State Psychiatric Institute and the Department of Psychiatry, Columbia University, Harkness Pavilion, 180 Ft. Washington Ave., New York, NY 10032, USA d Department of Emergency Medicine, University of California at Davis, 4150 V St., Patient Support Services Bldg., Suite 2100, Sacramento, CA 95817, USA e Department of Family and Community Health, University of Maryland School of Nursing, 655 West Lombard St., Baltimore, MD 21201, USA f Department of Epidemiology and Population Health, American University of Beirut, Van Dyck Hall, PO Box 11-0236, Riad El-Solh, Beirut 1107 2020, Lebanon

Understanding the patterns and distribution of opioid analgesic dependence symptoms using a latent empirical approach

Prevalence of extramedical opioid analgesic use in the US is rising, yet little is known about the nature and extent of problems of dependence related to the use of these drugs. This study uses Latent Class Analysis to empirically define classes of past‐year extramedical opioid analgesic users based on observed clustering of DSM‐IV defined clinical dependence features; multinomial logistic regression is used to describe differences across these groups. The 2002–2003 public data‐files of the National Survey on Drug Use and Health were used to identify 7810 extramedical opioid analgesic users in the past‐year. The best‐fitting four‐class model identified classes that differed quantitatively and qualitatively, with 2% of the users in Class 4 (most severe) and 84% in Class 1 (least severe). Classes 2 and 3 had parallel symptom profiles, but those in Class 3 reported additional problems. Adolescents (12–17 year olds) were at higher odds of being in Class 3 versus older age groups; females were two times as likely to be in Classes 2 and 4, and those with mental health problems were at higher odds of belonging to the more severe classes. Differences by type of past year opioid users were also detected. This study sheds light on the classification and distribution of extramedical opioid analgesic dependence symptoms in the US general population, identifying subgroups that warrant immediate attention. Copyright

Cell Phone and Face-to-face Interview Responses in Population-based Surveys How Do They Compare?

Findings on the reliability and cost-effectiveness of the use of cellular phones vis-à-vis face-to-face interviews in investigating health behaviors and conditions are presented for a national epidemiological sample from Lebanon. Using self-reported responses on identical questions, percentage agreement, κ statistics, and McNemar’s test were used to make the comparisons. Concordance was almost perfect (κ statistics, κ > .8) for measures including age, health insurance, cigarette smoking (ever and current), and diabetes; and substantial (0.6 ≤ κ ≤ 0.8) for other measures such as education, water pipe smoking, alcohol consumption, and hypertension. Moreover, cell phone interviewing saved approximately US

Alcohol and illegal drug use behaviors and prescription opioids use: how do nonmedical and medical users compare, and does motive to use really matter?

14 per person interviewed. Future research on their use for health research purposes in Lebanon and the region should address their use alone or in combination with landlines in obtaining nationally representative samples.

Double trouble: Exploring the association between waterpipe tobacco smoking and the nonmedical use of psychoactive prescription drugs among adolescents.

Background/Aims: This study compares illegal drug and alcohol use behaviors between medical and nonmedical users of prescription opioids (PO) and nonmedical users with distinct motives to use. Method: An ethically approved cross-sectional study (2010) was conducted on a representative sample of private university students (n = 570), using a self-filled anonymous questionnaire. Results: About 25% reported using PO only medically and 15% nonmedically. The prevalence of alcohol and illegal drug use was consistently higher among nonmedical than medical PO users. Adjusting for age and gender, lifetime medical users of PO were more likely to use marijuana only (OR = 1.8, 95% CI: 1.1, 2.8), while nonmedical users were at higher odds of using marijuana, ecstasy, cocaine/crack, and alcohol problematically. Compared to nonusers, students who took PO nonmedically for nontherapeutic reasons were more likely to use various illegal drugs, but nonmedical users who took PO to relieve pain/help in sleep were only more likely to use marijuana (OR = 2.5, 95% CI: 1.1, 5.4) and alcohol (e.g. alcohol abuse; OR = 3.8, 95% CI: = 1.4, 10.1). Conclusion: Youth who use PO nonmedically to self-treat have a different alcohol and illegal drug-using profile than those who take it for nontherapeutic reasons.

Gambling behavior subtypes among respondents with gambling-related problems in a population-based sample

BACKGROUND In youth, both waterpipe tobacco smoking (WTS) and nonmedical use of prescription drugs (NMUPD) are globally growing concerns. This study assesses for the first time the lifetime and past-year associations between WTS and four classes of psychoactive prescription drugs. METHODS Cross-sectional data (2011) on 986 high school students attending public and private high schools in Beirut (Lebanon) was analyzed. Schools were selected using proportionate random cluster sampling from a comprehensive list of schools provided by the Ministry of Education. RESULTS Almost half (46%) had tried WTS compared to 25% who had ever tried cigarettes. Lifetime prevalence estimates of NMUPD were: pain relievers (8.2%), sedatives/tranquilizers (5.6%), stimulants (3.5%), antidepressants (2.5%), and sleeping pills (2.3%). WTS was associated with increased odds of sedatives/tranquilizer use (OR = 3.22, 95% CI: 1.25, 8.25), pain reliever use (OR = 4.31, 95% CI: 2.02, 9.17), and sleeping medication use (OR = 8.31, 95% CI: 2.37, 29.20), controlling for sex, age, school type, and other substance use. For cigarettes, the associations were consistently either weaker or non-existent, except with stimulant use (OR = 5.29, 95% CI: 1.55, 18.05). CONCLUSIONS While public health professionals have watched with caution the global prevalence of youth cigarette use-worldwide, an insidious alternative form of tobacco use has grown. Further research is needed to understand the unique risk factors and motives associated with WTS and how these relate to NMUPD in order to inform the development of effective intervention programs and policies that support youth positive health decisions.

Sociodemographic and Substance Use Correlates of Gambling Behavior in the Canadian General Population

ABSTRACT Latent class analysis was used to delineate distinctive subgroups of gamblers and examine whether they differed by demographics and gambling severity. Data from three Canadian provinces focused on respondents who reported at least some risk of problem gambling in the past year (N= 1,071). Three latent classes were distinguished: a low on most items group (class 1), a behaviorally conditioned/substance abusing impulsive/emotionally vulnerable (or all types) group (class 2), and a familial-genetic/behaviorally conditioned group (class 3). Gamblers in classes 2 and 3 were most likely to be moderate-risk and problem gamblers. Community-based prevention efforts may need to address each subgroup differently but also according to their characteristics.

Gambling behaviors among university youth: Does one's religious affiliation and level of religiosity play a role?

ABSTRACT This study describes sociodemographic and substance use correlates of gambling behaviors, measured among 9,481 past-year gamblers from the Canadian general population. Compared to non-problem gamblers in this study (N = 8,035), the 98 problem gamblers who scored 8 or more points on the Canadian Problem Gambling Research Index were more likely to report being “drunk or high” while gambling (adjusted odds ratio [AOR]: 8.92; 95% confidence interval [CI]: 5.46,14.55; p < .001), to admit to having an alcohol or drug problem (AOR: 3.80; 95% CI:2.21,6.52; p < .001), and to use electronic gambling devices (AOR: 4.85; 95% CI: 3.08-7.66; p< .001).

Nonmedical use of prescription drugs in adolescents and young adults: not just a Western phenomenon

This study investigated the association between religion, religiosity, and gambling using a cross-sectional sample of 570 American University of Beirut students, who self-filled an anonymous English questionnaire. About half (55%) were lifetime gamblers, of which 12% screened as problem/pathological gamblers. Controlling for other demographics and lifetime substance use, Christian students (vs. Muslims) had higher odds of lifetime gambling [6.6 (3.6, 12.2)], any strategic gambling [2.7 (1.2, 5.9)], social nonproblem gambling (SNPG) [7.6 (4.6, 12.3)], and problem/pathological gambling (PG) [6.8(1.8, 26.5)]. Students who never/rarely practiced their faith were 3.6 times as likely [95% CI: 1.5, 8.7] to report lifetime gambling, 3.7 times as likely to report SNPG (vs. NG) [95% CI: 1.3, 10.6], and 7 times as likely to screen for PG (vs. NG) [95% CI: 1.8, 27.4]. Decreased religious importance was associated with greater odds of lifetime gambling, SNPG and PG (vs. nongambling). Stronger associations were observed among Muslims. Religion and religiosity seem to play a protective role, particularly among Muslims whose faith strictly prohibits gambling.