Sukaina Alzyoud

Waterpipe Smoking among Middle and High School Jordanian Students: Patterns and Predictors

Despite the increase in attention to waterpipe tobacco smoking, the patterns and predictors of this method of tobacco use among Jordanian youth are not well known. The current study was conducted to assess the patterns and the predictors of waterpipe tobacco smoking among school aged students in one of Jordan’s Central Governorates. A cross-sectional survey was conducted to investigate the patterns and predictors of waterpipe tobacco smoking among youth (grades 6, 8, 10 and 12). Using a multistage random sampling more than 1,000 students was selected. Data were collected using the Arabic Youth Tobacco Use Composite Measure (YTUCM). Waterpipe smoking was assessed for “past 12 months”, “past month” and “past week”. Students’ ages ranged from 11 to 18 years, (mean age ± 14.7; SD ± 1.9 years). The percentage of girls who smoked waterpipe was greater for all frequencies of use than it was for boys. Age, gender, and belief that smoking makes more friends were predictors of smoking among study participants. This is the first known study to examine waterpipe smoking among youth aged 11 and 12. Our findings illustrate the need for public health campaigns to reach and educate youth, their families, teachers and school systems regarding the growing recognized health risks of waterpipe smoking.

Knowledge of substance abuse among high school students in Jordan.

Objectives: The purpose of this study was to explore the knowledge, attitude, and beliefs about substance abuse among Jordanian adolescents (aged 15-18 years). Design: A descriptive design was employed using a self-administrated questionnaire to collect the data from 400 high school students. Methods: A multistage, random sample was generated in selecting schools from the educational directorate located in a large urban city located in the north of Jordan.This city district contains 23 public secondary schools and serves 56.8% of the adolescents in the entire province. Results: The results revealed the following: Students of both sexes were knowledgeable about aspects of substance abuse, including its harmful effects on the body and society and reported that even occasional or frequent use of cigarettes, alcohol, and other drugs was extremely harmful. A majority of the students perceived substance abuse as a problem, although the older students were more acutely aware than the younger group. However, the results revealed that the students lack in-depth knowledge of substance abuse. In addition, the adolescents consistently refer to Islamic principles forbidding use of intoxicants but mistakenly presume that mosques are sources for assistance regarding substance abuse. Conclusions: Policy makers, health workers, and religious leaders must collaborate to build structured educational programs and readily accessible, evidence-based treatment programs for adolescents. Given that young people constitute the majority of the Jordanian population and that drug trafficking is prevalent in the region, the implications of prevention programs are critical to maintaining gains in public health outcomes as well as economic progress and development in Jordan.

Screening for domestic violence in Jordan: validation of an Arabic version of a domestic violence against women questionnaire

Objectives: Abuse against women causes a great deal of suffering for the victims and is a major public health problem. Measuring lifetime abuse is a complicated task; the various methods that are used to measure abuse can cause wide variations in the reported occurrences of abuse. Furthermore, the estimated prevalence of abuse also depends on how abuse is culturally defined. Researchers currently lack a validated Arabic language instrument that is also culturally tailored to Arab and Middle Eastern populations. Therefore, it is important to develop and evaluate psychometric properties of an Arabic language version of the newly developed NorVold Domestic Abuse Questionnaire (NORAQ). Design and methods: The five core elements of the NORAQ (emotional abuse, physical abuse, sexual abuse, current suffering of the abuse, and communication of the history of abuse to the general practitioner) were translated into Arabic, translated back into English, and pilot tested to ensure cultural sensitivity and appropriateness for adult women in the Eastern Mediterranean region. Participants were recruited from the Jordanian Ministry of Health-Maternal and Child Health Care Centers in two large cities in Jordan. Results: A self administered NORAQ was completed by 175 women who had attended the centers. The order of factors was almost identical to the original English and Swedish languages questionnaire constructs. The forced 3-factor solution explained 64.25% of the variance in the measure. The alpha reliability coefficients were 0.75 for the total scale and ranged from 0.75 to 0.77 for the subscales. In terms of the prevalence of lifetime abuse, 39% of women reported emotional abuse, 30% physical abuse, and 6% sexual abuse. Conclusion: The Arabic version of the NORAQ has demonstrated initial reliability and validity. It is a cost-effective means for screening incidence and prevalence of lifetime domestic abuse against women in Jordan, and it may be applicable to other Middle East countries.

Tobacco smoking status and perception of health among a sample of Jordanian students.

Limited data are available from Jordan examining patterns of tobacco use among adolescents, or how use is related to health perceptions. This study aims to estimate the prevalence of tobacco use and to assess the relationship between use and health-related perceptions. A cross-sectional survey was conducted among a sample of 11–18 year old school students from a major governorate in Jordan. Using a multistage random sampling 1050 students were selected. Students were categorized as non-smokers, cigarette-only smokers, waterpipe-only smokers, or dual smokers. Rates of waterpipe-only and cigarette-only smoking were 7% and 3%, respectively, and were similar for boys and girls. In contrast, the rate of dual use was much higher than for single product use and was double in girls compared to boys (34% vs. 17%). Dual-smokers were significantly more likely to think that it is safe to smoke as long as the person intends to quit within two years compared to non-smokers, and had lower self-rated health status than other groups. This is the first study among Arab adolescents to document high rates of dual tobacco use, especially pronounced among girls. The study findings have significant implications for designing tobacco smoking prevention programs for school health settings.

Waterpipe Use and Susceptibility to Cigarette Smoking Among Never-Smoking Youth

INTRODUCTION Susceptibility to cigarette smoking, defined as the lack of a firm decision against smoking, is a strong predictor of regular smoking and addiction. Several modifiable risk factors have been identified among never cigarette smokers, and one potential factor of interest is waterpipe use. The purpose of this study is to determine the association of waterpipe use with susceptibility to cigarette smoking among never-smoking youth. METHODS In a pooled analysis of 17 Arab nations with nationally representative Global Youth Tobacco Surveys conducted during 2002-2011, tobacco-related information was obtained from 30,711 never-smoking adolescents representing 4,962,872 youth. Study outcome was susceptibility to cigarette smoking, and primary exposure was waterpipe use. Data were analyzed in 2014 using weighted logistic regression models, including stratified models by gender, to determine the odds of susceptibility to cigarette smoking with waterpipe use, adjusting for confounders. RESULTS Overall, 20% of never-smoking youth were susceptible to cigarette smoking, ranging from 13.1% in Oman to 32.6% in Somalia; 5.2% currently used waterpipe, ranging from 0.3% in Morocco to 23.5% in Kuwait. The estimated odds of susceptibility to cigarette smoking were 2.5 (95% CI=1.9, 3.4) times higher for adolescents who used waterpipe in the past month compared with those who did not, controlling for confounders. Estimates were similar when stratified by gender. CONCLUSIONS Waterpipe use is associated with susceptibility to cigarette smoking. Study findings identify a novel risk factor for never smokers to initiate smoking and will help the public health community develop and implement policies around waterpipe use prevention.

Waterpipe Use and Cognitive Susceptibility to Cigarette Smoking Among Never-Cigarette Smoking Jordanian Youth: Analysis of the 2009 Global Youth Tobacco Survey

INTRODUCTION Susceptibility to cigarette smoking, defined as lack of a firm decision to not initiate smoking, predicts youth smoking initiation and experimentation and is a first step in the transition to regular smoking. This study investigated whether waterpipe (WP) smoking, an increasingly prevalent form of tobacco use among Arab adolescents, was associated with increased susceptibility to cigarette smoking. METHODS A secondary analysis of the 2009 Jordan Global Youth Tobacco Survey was conducted to assess the association between WP use and cigarette susceptibility, after adjusting for important confounders. RESULTS A total of 1,476 youth aged 13-15 years old who had never smoked cigarettes were identified and represented 166,593 never-cigarette smoking Jordanian youth. We found 40% of boys and 29% of girls were susceptible to cigarette smoking, and both boys (adjusted odds ratio [AOR] = 1.49, 95% confidence interval [CI] = 1.41-1.54) and girls (AOR = 1.95, 95% CI = 1.83-2.04) who had ever smoked WP were more susceptible to cigarette smoking than those who never smoked WP. CONCLUSION This is the first study to report that WP use may increase youths susceptibility to initiate cigarette smoking.

secondhand smoking in Jordan: clearing the Air for One of the Highest Tobacco prevalence countries in the Middle east

As the rate of tobacco consumption in Jordan increases, Jordanian policy makers are urged to develop guidelines on smoking exposures. This paper is concerned with the magnitude of exposure and harm caused by secondhand smoke (SHS) on childbearing women and young children. Despite a strict policy that limits tobacco advertising and efforts by the Ministry of Health, which include cessation programs and education on the adverse effect of smoking, the country sustains its high smoking rate, especially among men. According to the data gathered in this paper, special concern should be directed toward childrens SHS exposure. Only four recent studies on SHS exposure among Jordanian women and children were encountered. Moreover, Jordan has legislation that bans smoking in public institutions; however, the enforcement of the law is extremely poor in most locations. Recommendations are presented to aid policy makers and law enforcement agencies in addressing this issue.

Knowledge, Attitudes, and Behavior in Avoiding Secondhand Smoke Exposure Among Non-Smoking Employed Women with Higher Education in Jordan

Secondhand smoke (SHS) exposure is a serious public health threat worldwide; in the developing world there are less serious efforts towards controlling women’s and children’s exposure to SHS. Knowledge, attitudes and avoidance practices among Jordanian women have never been thoroughly studied. The purpose of this study was to assess the knowledge, attitudes, and avoidance behavior towards SHS exposure among employed Jordanian women with higher education. Methods A survey was conducted among employed Jordanian women at two universities. A total of 209 women were included in the analysis. Two questionnaires regarding SHS exposure were used to measure knowledge, attitudes and avoidance practices. Results Most respondents were regularly exposed to SHS in various locations during daily life, even though they were very knowledgeable about the dangers of SHS exposure for women and children. However, the subject’s attitudes and avoidance behavior did not reflect the level of knowledge about SHS risks. The results suggests there is a large discrepancy between SHS exposure, knowledge, attitudes and avoidance behavior among highly educated Jordanian women that is likely influenced by culture and traditional gender roles. Public health initiatives are needed in Jordan to address public policy, institutional practices and to empowerment of women to reduce SHS exposure.

Patterns of Waterpipe Use among Arab Immigrants in the USA: A Pilot Study

Aim: Waterpipe smoking is becoming increasingly popular in the U.S., especially among minority groups. The purpose of this preliminary study was to explore the patterns of waterpipe use, as well as the association between acculturation factors and waterpipe use among Arab immigrants living in the Richmond, Virginia (VA) metropolitan area. Methods: We surveyed self-identified Arab American Immigrants in Middle Eastern Original Research Article British Journal of Medicine & Medical Research, 4(3): 816-827, 2014 817 restaurants/lounges and Middle Eastern groceries, in the Richmond, VA metropolitan area. A total of 221 Arab Americans participated in this study. Results: In this sample, higher rates of waterpipe use were found among male subjects (66.6%) than females (31.4%).Our results indicated no significant association between the type of tobacco used (exclusive versus dual) and desire or future intentions to quit waterpipe use. Upon examining the proxy indicators of acculturation, none of them was significant for the entire sample. However, upon stratifying the results by group (exclusive vs. dual), exclusive waterpipe use was significantly correlated with proportion of life lived in the US as r(16)=0.56, p=0.02 but the correlation remained not significant among dual smokers r( 23)= 0.08, p=0.6. Conclusion: Further studies are needed to confirm the relatively high prevalence of waterpipe use among Arab Americans. There is a need to develop effective prevention strategies that will consider the acculturation process when trying to control the spread of waterpipe use among minority groups in the U.S.

Collision of waterpipe and cigarette smoking epidemics among youth in Arab countries

Abstract Background: Waterpipe tobacco smoking (WTS) emerges as a new component of the global tobacco epidemic. Adolescents smoking waterpipe are susceptible to cigarette smoking, but limited research has characterized dual (cigarette plus waterpipe) users. The study objective is to determine the prevalence estimates of dual users to understand how “collision” of the two epidemics is evolving in the Arab countries.Methods: Data (n = 31,359; N = 6,109,572) were obtained from nationally representative Global Youth Tobacco Surveys (GYTSs) from 17 Arab countries. Current tobacco use was categorized into four groups—cigarette smoking only, WTS only, dual use, and never use. Weighted age-, sex-, and country-specific prevalence estimates along with 95% confidence intervals were reported.Results: Overall 3.0%, 6.1%, and 3.8% of youth were cigarette smokers only, WTS only, and dual users. Boys reported high prevalence estimates of cigarette smoking only (5.1% vs 1.1%), WTS only (7.4% vs 4.6%), and dual use (3.7% vs 2.1%) than girls. Dual-use estimates ranged from 0.7% in Oman to 15.0% in West Bank and WTS only ranged from 0.9% in Oman to 6.6% in United Arab Emirates.Conclusion: Dual use and WTS is well established among Arab youth and represents a new dimension to the global tobacco epidemic that may not respond to traditional tobacco control interventions.