Nihaya A. Al-sheyab

Peer-led education for adolescents with asthma in Jordan: A cluster-randomized controlled trial

Objectives: To determine the impact of a peer-led education program, developed in Australia, on health-related outcomes in high school students with asthma in Jordan. Methods: In this cluster-randomized controlled trial, 4 high schools in Irbid, Jordan, were randomly assigned to receive the Adolescent Asthma Action program or standard practice. Bilingual health workers trained 24 peer leaders from Year 11 to deliver asthma education to younger peers from Year 10 (n = 92), who in turn presented brief asthma skits to students in Years 8 and 9 (n = 148) and to other members of the school community in the intervention schools. Students with asthma (N = 261) in Years 8, 9, and 10 completed baseline surveys in December 2006 and 3 months after the intervention. Results: Students from the intervention group reported clinically significant improvements in health-related quality of life (mean difference: 1.35 [95% confidence interval: 1.04–1.76]), self-efficacy to resist smoking (mean difference: 4.63 [95% confidence interval: 2.93–6.35]), and knowledge of asthma self- management (mean difference: 1.62 [95% confidence interval: 1.15–2.19]) compared with the control group. Conclusions: This trial demonstrated that the Adolescent Asthma Action program can be readily adapted to suit different cultures and contexts. Adolescents in Jordan were successful in teaching their peers about asthma self-management and motivating them to avoid smoking. The findings revealed that peer education can be a useful strategy for health promotion programs in Jordanian schools when students are given the opportunity and training.

Prevalence, Patterns and Correlates of Cigarette Smoking in Male Adolescents in Northern Jordan, and the Influence of Waterpipe Use and Asthma Diagnosis: A Descriptive Cross-Sectional Study

Our study investigates the prevalence, patterns and predictors of tobacco smoking among early adolescent males in Northern Jordan and whether asthma diagnosis affects smoking patterns. A descriptive cross sectional design was used. Males in grades 7 and 8 from four randomly selected high schools in the city of Irbid were enrolled. Data on waterpipe (WP) use and cigarette smoking patterns were obtained (n = 815) using a survey in Arabic language. The overall prevalence of ever having smoked a cigarette was 35.6%, with 86.2% of this group smoking currently. Almost half of the sample reported WP use. The most common age in which adolescents started to experiment with cigarettes was 11–12 years old (49.1%), although 10 years was also common (25.3%). Significant predictors of male cigarette smoking were WP use (OR = 4.15, 95% CI = 2.99–5.76), asthma diagnosis (OR = 2.35, 95% CI = 1.46–3.78), grade 8 (OR = 1.52, 95% CI = 1.10–2.11), and having a sibling who smokes (OR = 2.23, 95% CI = 1.53–3.24). However, this cross-sectional study cannot establish causality, thus longitudinal studies are needed. Public health programs and school-based anti-tobacco smoking interventions that target children in early years at high schools are warranted to prevent the uptake of tobacco use among this vulnerable age group. High school students with asthma should be specifically targeted.

Agreement Between Exhaled Breath Carbon Monoxide Threshold Levels and Self-Reported Cigarette Smoking in a Sample of Male Adolescents in Jordan

This study aimed to measure the percent agreement between Exhaled Breath Carbon Monoxide (eBCO) measure using a piCO+ smokerlyzer® and self-reported cigarette smoking status and to determine the optimal thresholds for definite identification of cigarette smokers of male school students in Jordan. A descriptive, cross sectional, study of a random sample of male adolescents in grades 7 and 8 from four public high schools in Irbid, completed an adaptation of a standardized Arabic-language tobacco smoking questionnaire and an eBCO measure. Sensitivity and specificity of the eBCO were calculated against self-reported cigarette smoking. Participants (n = 439) had a mean age of 12.5 years (SD = 0.50) and 174 (39.9%) reported being an ever smoker of whom 59 (33.9%) reported being a recent (30-day) smoker. The optimal eBCO cut-off point for recent smoking was 4.5 ppm with a sensitivity of 84.7% and specificity of 65.5%. Overall, eBCO can accurately identify recent smokers and distinguish them from non-smokers. The eBCO use enables healthcare professionals and researchers to assess efficacy of smoking cessation and prevention programs without necessarily relying on self-report. Further research is indicated to validate our findings and should be expanded to include females, detailed characteristics of cigarette and waterpipe smoking.

Cigarette smoking lowers blood pressure in adolescents: the Irbid-TRY

Abstract Objective: Tobacco consumption adversely affects cardiovascular (CV) disease (CVD) and risk profile, including hypertension. The long-term effect of cigarette smoking on blood pressure (BP) in adolescents is still, however, equivocal. Thus, the current study examined the CV indices in male adolescent cigarette smokers versus nonsmokers. Method: Resting heart rate, systolic BP (SBP) and diastolic BP (DBP), mean arterial pressure (MAP), pulse pressure (PP) and rate pressure products (RPP) were examined using automatic oscillatory method, while smoking status was determined with Youth Risk Behavior Survey. Results: After controlling for cofactors, the ANCOVA showed that CV measures in the male adolescent smokers were lower (p < 0.05) than nonsmokers. Additionally, regression showed that smoking status explained 20.6% of SBP, 5.0% of DBP, 13.4% of MAP, 7.5% of PP and 13.4% of RPP. Conclusion: The results suggest that cigarette smoking lowers CV measures in adolescents. However, more studies are needed to describe the mechanism(s) for lowering CV measures and explain the relationship of adolescent smoking with adulthood CVDs.

Dual tobacco smoking is the new trend among adolescents: Update from the Irbid-TRY

ABSTRACT The current study evaluated the prevalence and contributing factors to smoking styles, particularly cigarette (Cg) and waterpipe (Wp), and dual (combined Cg and Wp) smoking, in adolescents. Tobacco consumption pattern and style, and demographic and socioeconomic characteristics were obtained from all participants. A total of 2,407 adolescents participated, of which 57.6% consumed tobacco. The prevalence of dual was 30%, which was greater than Wp only (21.1%) and Cg only (6.7%). Additionally, male adolescents are more likely to smoke Cg only (OR = 2.15; 95%CI: 1.3/3.4; p = 0.001), Wp only (OR = 1.3; 95%CI: 1/1.8; p = 0.05), and dual (OR = 2.95; 95%CI: 2.2/3.9; p = 0.001). Adolescents in grade 10 were more likely to be dual smokers as compared to grades 7 (OR = 0.5; 95%CI: 0.3/0.7; p = 0.001) and 8 (OR = 0.5; 95%CI: 0.3/0.7; p = 0.001). The study indicates that gender and grade can predict smoking status with dual is most prevalent in older boys. The data also show that dual smoking exceeds combined Cg-only and Wp-only smoking. Compared with previous studies, we are witnessing an increase in dual consumption, while Wp only and Cg only are decreasing, suggesting a shift in adolescent smoking-style selections. Therefore, studies and cessation programs for adolescents, especially for dual smoking among older boys, are warranted. Additionally, studies are needed to examine the health effects of dual smoking among adolescents.

Investigating the Effects of Exposure to Waterpipe Smoke on Pregnancy Outcomes Using an Animal Model

INTRODUCTION In recent years, waterpipe tobacco smoking has been increasing in popularity all over the world. In this study, we explored effects of waterpipe smoking on pregnancy outcomes in rats. METHODS Animals were exposed to waterpipe tobacco smoking using a whole body exposure system 2 hours per day during pregnancy. A control group was exposed to fresh air only. RESULTS The results showed significant association between exposure to waterpipe smoke during pregnancy and low birth weight (P < .01) and neonatal death (P < .01). In addition, the rate of growth of offspring of the waterpipe group was significantly lower than that of control group as measured by body weight gain during the first 3 months of life (P < .001). No effect was found for waterpipe smoking on mean number of progeny and male to female ratio among offspring. CONCLUSION Waterpipe smoking is associated with adverse effects on pregnancy outcomes. IMPLICATIONS In this study, we investigated for the first time the effect of waterpipe smoking on pregnancy outcomes using animal model. The results clearly showed that waterpipe smoking is associated with adverse effects on pregnancy outcomes that include low birth weigh, neonatal survival, and growth retardation.

“Class smoke-free” pledge impacts on nicotine dependence in male adolescents: A cluster randomized controlled trial

Abstract Objective: To test the effectiveness of a school-based, peer-led smoking and asthma education program with an additional “class smoke-free” pledge on smoking-related knowledge and perception, nicotine dependence, and asthma control in male high school students in Jordan 4 months post-intervention. Methods: In this cluster-randomized controlled trial, four male schools in Irbid, Jordan, were randomly assigned to the intervention (n = 215) or comparison (n = 218) groups. Trained educators trained senior students from the four schools to be peer leaders (n = 53), who then taught peers in grades 7 and 8 (n = 433). The peer leaders in the intervention schools implemented the smoke-free pledge within the 7th and 8th graders, who voluntarily signed the pledge for 4 months. The comparison group received the same intervention components as the intervention group, minus the smoke-free pledge. Data were collected from students in grades 7 and 8 at baseline and 4 months post-intervention. Results: Students from the intervention group reported significant improvements in smoking-related knowledge and perception and lower nicotine dependence as compared to the comparison group. Improvement in asthma control was greater in nonsmokers versus smokers. Conclusions: Voluntary group commitment smoke-free through a pledge is an incentive to motivate adolescents to abstain from smoking. Using social influences approaches in schools is useful in countering current aggressive tobacco marketing campaigns in Arab youth.

Parkinson’s disease in Jordan: Barriers and motivators to exercise

ABSTRACT Background: Perceived barriers to engaging in exercise in people with Parkinson’s disease (PD) are becoming more defined in countries such as the UK and the US. This, however, may vary by culture and environment. This study aimed to explore the perceptions of exercise and barriers that may affect participation in people with PD from Jordan. Methods: Two focus groups and seven individual interviews were conducted with people with PD. Additionally, individual interviews were conducted with two neurologists. Conversations were digitally recorded and transcribed. Transcripts were analyzed using thematic analysis and validated via researcher triangulation and peer checking. Results: Most of the PD participants lacked previous participation in any disease-specific exercises. Several barriers were perceived by PD participants for such lack of participation. Barriers included difficulty of diagnosis, lack of informational support provided by neurologists, lack of referral to physiotherapy services, disease-specific issues, and setting-related issues. Neurologists indicated a number of barriers in counseling their PD patients on exercise including lack of time and lack of health system resources. Motivators to participate in future exercise included outcome expectations and family support. Conclusions: Findings of the study shed light into large areas of unmet needs of supporting exercise and physiotherapy for people with PD in developing countries as per Jordan. For better patient outcomes, findings of the study suggest that it is crucial to raise awareness among all PD-related stakeholders on the benefits of early referrals to physiotherapy and early engagement in exercise programs.

Seroepidemiology and risk factors of Toxoplasma gondii infection in undergraduate university female students in Jordan.

This study estimated the seroprevalence and risk factors for acquiring Toxoplasma gondii infection by undergraduate female university students in Jordan. A cross-sectional study from September 2013 to July 2014 analysed 202 blood samples for IgG and IgM antibodies by enzyme-linked immunosorbent assay and a semi-constructed questionnaire was completed by participants to gather information about Toxoplasma infection risk factors. T. gondii IgG antibodies were detected in 66.5% of the females. Only one sample was positive for both IgG and IgM. Using χ2 test, six factors showed significant association with T. gondii infection (P ⩽ 0.01). The multivariate logistic regression model showed that female students living in houses, wet areas, with income >US

Anthropometric measurements of newborns of women who smoke waterpipe during pregnancy: a comparative retrospective design

750/month and using spring (untreated) water were 47.42, 10.20, 5.00, 3.25 more times at risk to be seropositive for T. gondii, respectively, compared to female students living in apartments, dry areas, with income ≤ US