Majid A. Al-Eissa

Adverse childhood experiences, chronic diseases, and risky health behaviors in Saudi Arabian adults: A pilot study

Adverse childhood experiences (ACEs) have been linked with risky health behaviors and the development of chronic diseases in adulthood. This study examined associations between ACEs, chronic diseases, and risky behaviors in adults living in Riyadh, Saudi Arabia in 2012 using the ACE International Questionnaire (ACE-IQ). A cross-sectional design was used, and adults who were at least 18 years of age were eligible to participate. ACEs event scores were measured for neglect, household dysfunction, abuse (physical, sexual, and emotional), and peer and community violence. The ACE-IQ was supplemented with questions on risky health behaviors, chronic diseases, and mood. A total of 931 subjects completed the questionnaire (a completion rate of 88%); 57% of the sample was female, 90% was younger than 45 years, 86% had at least a college education, 80% were Saudi nationals, and 58% were married. One-third of the participants (32%) had been exposed to 4 or more ACEs, and 10%, 17%, and 23% had been exposed to 3, 2, or 1 ACEs respectively. Only 18% did not have an ACE. The prevalence of risky health behaviors ranged between 4% and 22%. The prevalence of self-reported chronic diseases ranged between 6% and 17%. Being exposed to 4 or more ACEs increased the risk of having chronic diseases by 2-11 fold, and increased risky health behaviors by 8-21 fold. The findings of this study will contribute to the planning and development of programs to prevent child maltreatment and to alleviate the burden of chronic diseases in adults.

Self Reported Awareness of Child Maltreatment among School Professionals in Saudi Arabia: Impact of CRC Ratification.

OBJECTIVES The Convention on the Rights of the Child (CRC) was ratified by Saudi Arabia 15 years ago; yet addressing the issue of child maltreatment only began in more recent years. School professionals play a significant role in childrens lives, as they spend a great deal of time with them and are hence essential to protecting and identifying those in danger or at risk. The objective of this study is to identify school professionals awareness of child maltreatment and the existing national policies and procedures to examine the extent of efforts made in Saudi Arabia and to activate the roles of schools and school professionals in protecting children from violence and implementation of Article 19 of the CRC. METHODS This was a cross-sectional study, where school professionals from randomly selected schools throughout the country were invited to participate in a self-administered questionnaire. RESULTS A total of 3,777 school professionals participated in the study. Fifty-five percent of professionals had at least 10 years of work experience. A low-level of awareness of child maltreatment was found in about 1/3 of school professionals. Only 1.9% of school professionals had ever attended any sort of specific training on child maltreatment, though 69.3% of those who had not, were willing to attend future training. With regards to awareness of CRC Article 19 or policies and procedures addressing child maltreatment, only 22% reported being aware of it. CONCLUSION The majority of school professionals in Saudi Arabia have a low-intermediate level of awareness of child maltreatment, ratification of CRC, and related national policies and procedures, yet most are willing to attend training programs on this subject matter. Efforts need to be made in the country to fill this gap.

A commentary on national child maltreatment surveillance systems: Examples of progress

a Medical and Social Affairs, The National Family Safety Program, Saudi Arabia b Child Protection Research Center, American Humane Association, USA c PICU and Pediatric Emergencies, Hotel-Dieu Hospital, Beirut, Lebanon d Department of Child and Adolescent Psychiatry/Psychotherapy, University, Ulm, Germany e Department of Children, Schools and Families, England, United Kingdom f Child and Youth Welfare Unit, Australian Institute of Health and Welfare, Australia g Child Protection Unit Department of Pediatrics, University of the Philippines, Philippines h Kind & Gezin, Belgium i Child, Youth and Family, New Zealand j Surveillance and Epidemiology Division, Public Health Agency of Canada, Canada

Preventing child abuse and neglect in Saudi Arabia: are we ready?

Although child abuse and neglect (CAN) have been recognized by medical professionals for the last 20 years, child protection services and child maltreatment prevention programs are still emerging in Saudi Arabia. This paper will review the progress made in the country in terms of recognition and implementation of child protection services. Furthermore, it will draw attention to the essential steps required to start child maltreatment prevention programs, as CAN prevention is currently viewed as a global healthcare priority with an emphasis on evidence-based interventions. In addition, this paper will assess Saudi Arabia′s readiness to prevent CAN and the challenges that will be faced by the professionals in implementing evidence-based CAN prevention programs.

Determining prevalence of maltreatment among children in the Kingdom of Saudi Arabia

PURPOSE The aim of this study is to find out the overall prevalence rates for the major forms of abuse among adolescents in the Kingdom of Saudi Arabia and the differences in prevalence by age, gender and living arrangement. METHODS The cross-sectional study was conducted in secondary high schools in five of the 13 main regions of Kingdom of Saudi Arabia during 2012. Through a multistage stratified sampling technique, a sample (n = 16 939) of adolescents (15-19 years) were identified and invited to participate. The ISPCAN Child Abuse Screening Tool - Child was used for data collection. The previous years occurrence of violence exposure, psychological, physical and sexual abuse, and neglect were assessed. RESULTS Nearly 90% of the adolescents were between 16 and 18 years of age, and over 80% were cared for by both of their biological parents. Annual prevalence of various forms of abuse in the year before the 2012 assessment ranged between 0.10 and 0.65, with the lowest rate for sexual abuse and the highest for psychological abuse. Significantly, greater rates of all forms of abuse/exposure were found when participants lived with their mother or father only (versus with both), and even greater rates for all when they lived with their biological parent and a step-parent. Rates for violence exposure, psychological abuse and neglect were significantly greater for girls, and rate of sexual abuse was greater for boys. CONCLUSIONS More attention should be given to the effect of adolescent maltreatment particularly among girls. In addition, sexual abuse prevention programme should be targeted among boys.

Gender-based disparities in the impact of adverse childhood experiences on adult health: findings from a national study in the Kingdom of Saudi Arabia

BackgroundAdverse Childhood Experiences (ACEs) have been linked to an increased risk of health and social problems throughout life. Studies on gender differences from developing countries are scarce. In this paper, we will examine gender variations in the types of reported ACEs and gender-specific relationships between cumulative ACEs and physical and mental health, and Risky Health Behaviors (RHB) in adulthood in the Kingdom of Saudi Arabia (KSA).MethodsA cross sectional national study was conducted in all of the 13 regions in KSA in 2013 using the ACE- International Questionnaire (ACE-IQ). We used multivariate logistic regression to examine the relationship between 4 + ACEs and physical, mental health and RHBs for both men and women separately after adjusting for age, education, marital status and current employment.ResultsThe total number of participants was 10,156 and women comprised 48% of the sample. The majority of respondents (80%) reported at least one ACE. Women had higher percentages of < =2 ACEs (65% vs 55%; p <0.05) while men were more likely to have 4+ ACEs (33% vs 25%; p < 0.05). When compared to participants with 0 ACE, men who reported 4+ ACEs were associated with the highest likelihood of using drugs (OR = 9.7; 95% CI: 6.4-14.5) and drinking alcohol (OR = 9.2; 95% CI: 6.3-13.6). On the other hand, women who experienced 4+ ACEs were associated with the highest likelihood of depression (OR = 7.0; 95% CI: 5.2-9.4), anxiety (OR = 6.4; 95% CI: 5.0-8.2) and other mental illnesses (OR = 7.4; 95% CI: 5.2-10.6). As for chronic diseases, abused men and women in childhood showed similarly a twofold increased risk of developing diabetes, hypertension, coronary heart disease and obesity when compared to non-abused participants.ConclusionFindings highlight the need to consider gender specific differences in the development of preventive strategies to address ACEs in KSA.

Adverse childhood experiences and association with health, mental health, and risky behavior in the kingdom of Saudi Arabia

BACKGROUND The aim of this study is to determine if ACEs impact the health and risk behavior burden among Kingdom of Saudi Arabia (KSA) adults. METHODS In 2013, a cross-sectional study was conducted across KSA to identify the retrospective prevalence of ACEs and their association with high risk behaviors and chronic diseases. Surveys from 10,156 adults in all 13 Saudi regions were obtained using an Arabic version of the WHO ACE-IQ (KSA ACE-IQ). RESULTS Compared to respondents reporting no ACEs, even just one ACE contributed significantly to the odds of experiencing diabetes mellitus (OR=1.3), depression (OR=1.32), or anxiety (OR=1.79) outcomes. Two ACEs were necessary for statistically significant, higher odds to emerge for hypertension (OR=1.46), mental illness (OR=1.93), smoking (OR=1.17), alcohol use (OR=1.75), and drug use (OR=1.45). Respondents who reported four or more ACEs had greater odds of coronary heart disease (OR=1.94), and obesity (OR=2.25). Compared to those reporting no ACEs, respondents reporting four or more ACEs had over four times the odds of Alcohol or Drug Use, Mental Illness, Depression, and/or Anxiety outcomes and more than twice the odds of diabetes, hypertension, obesity, and/or smoking outcomes. CONCLUSION Findings from this analysis underscore the potential benefit of providing focused preventative approaches to mitigating ACEs in KSA in relation to both the specific and cumulative burden of health and risky behavior outcomes.

Relationship between childhood bullying and addictive and anti-social behaviors among adults in Saudi Arabia: a cross-sectional national study

Abstract Background Bullying is a widespread public health problem among youth with potentially far reaching negative implications. Objective To determine the prevalence of childhood bullying and its association with addictive and anti-social behaviors among adults. Subjects Adults (n = 10,156) aged ≥18 years were invited to participate. Methods A cross-sectional, national study utilizing Adverse Childhood Experiences International Questionnaire (ACE-IQ) was conducted in Saudi Arabia (SA). Odds ratios (OR) and 95% confidence intervals (CIs) were calculated for bullying in relation to the outcome. Results Participant’s mean age was 34.3 ± 11.3 years and 52% were male. Thirty-nine percent of the participants reported being bullied. Significant gender differences were found in terms of prevalence of different types of bullying. Men reported higher prevalence of physical (40% vs. 33%, p < 0.01) and sexual (19% vs. 10%, p < 0.01) types of bullying. In contrast, women tend to report higher prevalence of psychological (16% vs. 9%, p < 0.01) and social (14% vs. 10%, p < 0.01) types of bullying. Bullying victims were 1.8 (95% CI 1.6–2.1) times more likely to smoke, 2.3 (95% CI 1.9–2.7) times more likely to drink alcohol, 2.9 (95% CI 2.4–3.4) times more likely to use drugs, 2.1 (95% CI 1.8–2.4) times more likely to have ever had out of wedlock sexual relations, and 2.5 (95% CI 2.1–3.0) times more likely to have suicidal thoughts compared to those who were not bullied. Conclusion Childhood bullying increases the chances of risky behaviors among adults in SA. Prevention of bullying should be in the national agenda of the Ministry of Education.

The impact of adverse childhood experiences on social determinants among Saudi adults

Background Early exposure to violence has deleterious effect on the childs brain development. The aims for this project were to assess the prevalence of Adverse Childhood Experiences (ACEs) and their impact on social determinants in Saudi Arabia (SA). Methods A cross-sectional, national study conducted in all regions of SA using the World Health Organization-ACE-International Questionnaire to determine the association between ACEs and socioeconomic outcomes. Results A total of 10 156 participants completed the questionnaire with five main ACE categories (abuse, neglect, family dysfunction, peer and community violence). Over half of the sample (52%) experienced emotional abuse, followed by physical abuse (42%), bullying (39%), neglect (29%) and sexual abuse (21%). The most common family dysfunction was witnessing domestic violence against any household member (57%) and the least prevalent was living with a substance abuser (9%). Low educational attainment, disruption in marital life and substance abuse were significantly affected by all ACE categories. However, unemployment was marginally affected only by neglect and household dysfunction. Conclusions ACEs are highly prevalent in SA and have significant negative impact on life opportunities. National preventive programs should be implemented to reduce ACE and their deleterious outcomes.

Child maltreatment prevention strategies: Saudi youth perspectives

Background and Objectives Child maltreatment (CM) is a global problem that has long-term negative outcomes. The objective of this study is to explore the knowledge and perceptions of youth regarding CM prevention. Methods The study was conducted in Saudi Arabia using International Child Abuse Screening Tool (ICAST). Answers to open-ended questions were analyzed and a list of CM prevention strategies was generated. Results Participants identified a range of preventive strategies that were grouped into three main themes: 1) collective preventive efforts; 2) recognizing and responding to CM; 3) gaining closure. For each overarching theme, a list of subthemes were derived. Subthemes included raising awareness through the mass media; school professionals’ capacity building and curriculum advancement; strengthening family relationships; enact CM preventive legislations and policies; monitoring media content and video games and limiting access to firearms for the first theme. The second theme comprised the subthemes reporting services and protective services. As for the third theme it included rehabilitation; punishment for CM crimes and connection to spirituality. Conclusion Gathering youth perspectives on CM prevention will help us in designing future prevention strategies.