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1.  The association between watching television and obesity in children of school-age in Saudi Arabia 
Background:
There is little information on the association between watching Television (TV) and obesity in the Arabian Peninsula.
Aim of the Study:
The aim of this study was to explore the association between the watching of television and obesity in Saudi children of school-age.
Materials and Methods:
A case-controlled study was conducted with students between the ages of 9 and 14 years who attended the school health clinic in King Abdulaziz Housing for National Guard (Iskan), Riyadh, Saudi Arabia, during the study period (February to April 2012). During each clinic, children were selected by simple random sampling (five obese and five non-obese). For data collection, two trained physicians interviewed the participants using a 20-item Arabic questionnaire. Well-trained nurses collected the anthropometric measurements of weight and height.
Results:
The study included 397 students. Higher (body mass index) BMI was associated with a higher number of televisions at home (P < 0.001), watching TV for more than three hours per day at the weekend (P = 0.047), eating more than three snacks per day (P = 0.005), watching TV at night (P = 0.026), and siblings’ decisions on how much TV to watch (P = 0.025). The prevalence of childhood obesity was significantly lower among those whose mothers determined how much TV they could watch (P = 0.03). In logistic regression analysis, the increase in the child's age, the presence of more than one TV at home, having his or her own TV, and an increase in the number of hours of watching TV over the weekend were significantly associated with an increased risk of childhood obesity. Personal computers and the Internet were not significantly associated with an increased risk of childhood obesity.
Conclusion:
The present investigation revealed that watching TV represents an important risk factor for obesity in children of school-age.
doi:10.4103/2230-8229.114767
PMCID: PMC3748652  PMID: 23983559
Obesity; Saudi Arabia; school-age children; television
2.  Predicting tobacco use among high school students by using the global youth tobacco survey in Riyadh, Saudi Arabia 
Annals of Thoracic Medicine  2012;7(3):122-129.
OBJECTIVE:
To identify the predictors that lead to cigarette smoking among high school students by utilizing the global youth tobacco survey in Riyadh, Kingdom of Saudi Arabia (KSA).
METHODS:
A cross-sectional study was conducted among high school students (grades 10–12) in Riyadh, KSA, between April 24, 2010, and June 16, 2010.
RESULTS:
The response rate of the students was 92.17%. The percentage of high school students who had previously smoked cigarettes, even just 1–2 puffs, was 43.3% overall. This behavior was more common among male students (56.4%) than females (31.3%). The prevalence of students who reported that they are currently smoking at least one cigarette in the past 30 days was 19.5% (31.3% and 8.9% for males and females, respectively). “Ever smoked” status was associated with male gender (OR = 2.88, confidence interval [CI]: 2.28–3.63), parent smoking (OR = 1.70, CI: 1.25–2.30) or other member of the household smoking (OR = 2.11, CI: 1.59–2.81) who smoked, closest friends who smoked (OR = 8.17, CI: 5.56–12.00), and lack of refusal to sell cigarettes (OR = 5.68, CI: 2.09–15.48).
CONCLUSION:
Several predictors of cigarette smoking among high school students were identified.
doi:10.4103/1817-1737.98843
PMCID: PMC3425042  PMID: 22924068
Adolescents; cigarettes; Saudi Arabia; tobacco
3.  Prevalence of Smoking and its Related Behaviors and Beliefs Among Secondary School Students in Riyadh, Saudi Arabia 
Objective:
To estimate the prevalence of smoking among secondary school students in National Guard area of Riyadh, and explore the reasons for the smoking and the attitude of non-smoker toward smoking habit.
Design:
A cross-sectional study was conducted in June 2009. By random sampling technique 255 students were enrolled from secondary school of National Guard area, Riyadh, Saudi Arabia. A self-administered questionnaire was used for data collection.
Results:
Current smokers represented 28.6% of the students. The most common reasons for smoking were: having free time (81.6%), for the relief of stress (63.2%) and seeing some of their teachers smoking (61.8%).
Most of the smokers started the habit before the age of 15 years old (89%). 84% of non-smokers suggested to ban smoking in public places. 42.2% of students were planning to start smoking in future.
Religion was the most important reason for not smoking among non smokers.
Conclusion:
The prevalence of smoking is big enough a problem to be considered as a warning for an impending epidemic Health education provision should have a greater role in schools Governmental commitment and social support are vital if health education and awareness and especially quit smoking programs are to be implemented and sustained.
PMCID: PMC3312769  PMID: 22489230
Secondary school student; smoking; shisha; magha; Riyadh
4.  PERCEPTION AND SATISFACTION OF SECONDARY SCHOOL STUDENTS WITH THE DERMATOLOGICAL SERVICES IN RIYADH CITY 
Background:
Health care that meets patient's expectations inevitably leads to a high level of patient satisfaction and in turn to an improved compliance of the patient with the prescribed management. Accordingly, health care services are more likely to improve. Numerous factors have been associated with patient satisfaction and studies have been done to investigate this relationship. However, not much work has been done in the field of dermatological service.
Objective:
This study was designed to investigate the experience, satisfaction and expectations of adolescents of the dermatological services provided in the outpatient ambulatory facilities.
Methods:
A cross-sectional study was conducted on 700 male and female secondary school students in Riyadh in Saudi Arabia. A self-administered questionnaire was used to collect data from the students. Data were related to the perception, expectation and satisfaction of a specific group of students. The overall and different items of satisfaction with the dermatological service including satisfaction with the physician providing the service, and satisfaction with the setting of the care were estimated.
Results:
The age range was 15-29 years with a mean of 18.1 ± 1.8 years. Of the 517 (74%) respondents, 267 (51.6%) males and 250 (48.4%) females, 457 (88.4%) were Saudis. With regard to expectation and preference, 385 (73.9%) would like to have dermatologists at each PHC center; 310 (59.5%) preferred a government setting for treatment. Statistically significant gender preference was observed (p<0.001); males preferred male dermatologist and females preferred female dermatologist, 142 (52.8 %) and 167 (66.5%), respectively. Only 14 (2.7 %) had no preference. As far as the experience with dermatological service was concerned, 273 (52.4%) had had one or more consultations, 225 (82.4%) had used the services for curative purpose, 91 (33.3%), 104 (38.1%) and 78 (28.6%) had used governmental, private and both facilities, respectively. Overall, 188 (68.9%) patients were satisfied, but of those who had availed themselves of the government services, 36 (42.3%) were not satisfied and 68 (24.9%) considered the waiting time too long.
Conclusion:
Dermatological services at the governmental facilities do not meet the expectations of the adolescent. Well-designed operational research studies on the appropriate sample, focusing on patients’ expectation and satisfaction with appropriate sample is required. Such studies will facilitate the work of the policy makers and service implementers and help them to develop appropriate human and other resources in order to tailor dermatologic services to the clients’ expectations.
PMCID: PMC3410092  PMID: 23012051
Perceptions; satisfaction; expectations; adolescents; Dermatological services
5.  Physical activity, sedentary behaviors and dietary habits among Saudi adolescents relative to age, gender and region 
Background
Few lifestyle factors have been simultaneously studied and reported for Saudi adolescents. Therefore, the purpose of the present study was to report on the prevalence of physical activity, sedentary behaviors and dietary habits among Saudi adolescents and to examine the interrelationships among these factors using representative samples drawn from three major cities in Saudi Arabia.
Methods
This school-based cross-sectional study was conducted during the years 2009-2010 in three cities: Al-Khobar, Jeddah and Riyadh. The participants were 2908 secondary-school males (1401) and females (1507) aged 14-19 years, randomly selected using a multistage stratified sampling technique. Measurements included weight, height, sedentary behaviors (TV viewing, playing video games and computer use), physical activity using a validated questionnaire and dietary habits.
Results
A very high proportion (84% for males and 91.2% for females) of Saudi adolescents spent more than 2 hours on screen time daily and almost half of the males and three-quarters of the females did not meet daily physical activity guidelines. The majority of adolescents did not have a daily intake of breakfast, fruit, vegetables and milk. Females were significantly (p < 0.05) more sedentary, much less physically active, especially with vigorous physical activity, and there were fewer days per week when they consumed breakfast, fruit, milk and diary products, sugar-sweetened drinks, fast foods and energy drinks than did males. However, the females' intake of French fries and potato chips, cakes and donuts, and candy and chocolate was significantly (p < 0.05) higher than the males'. Screen time was significantly (p < 0.05) correlated inversely with the intake of breakfast, vegetables and fruit. Physical activity had a significant (p < 0.05) positive relationship with fruit and vegetable intake but not with sedentary behaviors.
Conclusions
The high prevalence of sedentary behaviors, physical inactivity and unhealthy dietary habits among Saudi adolescents is a major public health concern. There is an urgent need for national policy promoting active living and healthy eating and reducing sedentary behaviors among children and adolescents in Saudi Arabia.
doi:10.1186/1479-5868-8-140
PMCID: PMC3339333  PMID: 22188825
Physical activity; sedentary behaviors; dietary habits; lifestyle factors; adolescents; Saudi Arabia
6.  The Global Youth Tobacco Survey: 2001–2002 in Riyadh region, the Kingdom of Saudi Arabia 
Background
Tobacco use is a major public health problem, and its prevalence is globally increasing, especially among children and adolescents.
Objective
The Global Youth Tobacco Survey aimed to explore the epidemiological trends and risk factors of tobacco smoking among intermediate school boys in Riyadh region of the Kingdom of Saudi Arabia.
Method
A two-stage cluster sample design was used to produce a representative sample of male students from selected schools. The participants (n = 1830) self recorded their responses on the Global Youth Tobacco Survey questionnaire.
Results
Lifetime prevalence of cigarette smoking was 35%, while 13% of students currently used other tobacco products. About 16% of students currently smoked at home, and 84% of students bought cigarettes without any refusal from storekeepers. Thirty-one percent and 39% of students were exposed to secondhand tobacco smoke inside and outside the house, respectively, which was definitely or probably harmful to health as opined by 87% of participants, and 74% voiced to ban smoking from public places. Among current smokers, 69% intended (without attempt) to quit and 63% attempted (but failed) to quit during the past year. Almost an equal number of students saw antismoking and prosmoking media messages in the last month, and 28% of students were offered free cigarettes by a tobacco company representative. In schools, more than 50% of students were taught about the dangers of cigarette smoking in the last year. Smoking by parents, older brothers, and close friends, watching prosmoking cigarette advertisements, free offer of cigarettes by tobacco company representatives, perception of smoking being not harmful, and continuing smoking which can be easily quit significantly increased the odds of smoking by students.
Conclusion
The common use of tobacco in school populations needs to be addressed by, among other tobacco control measures, a strict ban on cigarette selling to minors and intensive regular tobacco control campaigns involving health and religious messages.
Video abstract
doi:10.2147/SAR.S23626
PMCID: PMC3846322  PMID: 24474857
tobacco use; secondhand tobacco smoke; environmental tobacco smoke; intermediate school boys; Global Youth Tobacco Survey; Saudi Arabia
7.  Prevalence of psychological symptoms in Saudi Secondary School girls in Abha, Saudi Arabia 
Annals of Saudi Medicine  2009;29(4):275-279.
BACKGROUND AND OBJECTIVES:
Adolescence is characterized by rapid physiological, social and cognititive changes. Aim of the present work is to study mental health of Saudi adolescent secondary school girls in Abha city, Aseer region, Saudi Arabia.
METHODS:
A cross-sectional study was conducted in 10 secondary schools for girls using the Arabic version of the symptom-revised checklist 90 (SCL 90-R), a mental health questionnaire that was administered to the girls by fourth-year female medical students.
RESULTS:
The most prevalent mental symptoms in the 545 female students were phobic anxiety (16.4%), psychoticism (14.8%), anxiety (14.3%), and somatization (14.2%). The prevalence of depression, paranoid ideation and interpersonal sensitivity amounted to 13.9%, 13.8% and 13.8%, respectively. The least prevalent mental symptoms were hostility (12.8%) and obsessive-compulsive behavior (12.3%). Overall, psychological symptoms (in terms of a positive global severity index) were found in 16.3% of the girls. In a multivariate logistic regression analysis, no significant relationship was found with sociodemographic factors.
CONCLUSION:
Psychological symptoms and disorders are prevalent in secondary school girls and health professionals need to be able to recognize, manage and follow-up mental health problems in young people. Further research is needed to explore the magnitude of the problem at the national level.
doi:10.4103/0256-4947.55308
PMCID: PMC2841454  PMID: 19584586
8.  PREVALENCE OF SOMATIZATION AND MINOR PSYCHIATRIC MORBIDITY IN PRIMARY HEALTHCARE IN SAUDI ARABIA: A PRELIMINARY STUDY IN ASIR REGION 
Objective:
To determine the prevalence of psychological disorders and somatization among primary care patients from a semi-urban area of the Kingdom of Saudi Arabia.
Design:
Screening of consecutive patients with the 12-item and 28-item versions of the General Health Questionnaires and assessments of physical symptoms associated with somatization, using the HSCL-12. Eight primary care health centres in Assir, Saudi Arabia.
Results:
About half of the sample had one or more psychological disorders. The prevalence of somatization detected by the GHQ-28 was 16%. The prevalence of somatization indicated by GPs’ identification of medically unexplained symptoms was 14%. Women displayed higher levels of somatization than men.
Conclusion:
This study reported prevalence of psychological disorders that was as high as found in the more modern areas of Saudi Arabia such as Riyadh. The view that individuals in less open areas are protected from psychological disorders associated with stress and lifestyle pressure seems to be unsubstantiated. The results highlight the potential value of screening for psychological disorders using such simple instruments as the GHQ
PMCID: PMC3377053  PMID: 23012164
Psychological disorders; somatization; primary health care; Saudi Arabia
9.  Effect of educational intervention on physical activity-related knowledge, attitude and behavior of among first-grade students of male high schools 
Introduction:
Regular physical activity has positive effects on physical, mental and social aspects of individual and community health. Considering the prevalence of noncommunicable diseases such as primary hypertension, osteoporosis and cardiovascular diseases for which sedentary lifestyle is a responsible factor, health policy makers have planned to encourage people to do more physical activities. Development of beneficial health habits during childhood and early adolescence are very important because the behaviors, which start at adolescence tend to continue into adulthood, too. This study aimed to determine the effect of educational intervention on physical activity-related knowledge, attitude and behavior of the first grade students in male high schools of Bavanat in 2010.
Materials and Methods:
In this prospective experimental study, after selecting two qualified schools from five high schools, all students of one school (two classes including 42 individuals) were randomly assigned to the experimental group and all the students of another high school (two classes including 43 individuals) were randomly assigned to the control group. The data gathering tool was a 4-section questionnaire which included demographic questions, knowledge- and attitude-related questions and the questionnaire of physical activity performance. The first three sections of the questionnaire were the researcher-designed and validated by face and content validity. Test-retest and internal consistency (Cronbach's Alpha) methods were used to determine the reliability of knowledge questionnaire and attitude questionnaire, respectively. For the measurement of physical activity behavior, a self-reporting questionnaire (valid and reliable Garcia scale) was used in this study. After conducting the pretest, the educational intervention was done for the experimental group. Post-tests were conducted immediately and 1 month after intervention. The collected data were analyzed using SPSS18 statistical software (independent t-test, paired t-test, chi-square, Mann-Whitney test and repeated measures ANOVA). The participants voluntarily and consciously participated in this study.
Results:
The findings indicated no significant differences between the groups in terms of mean scores of knowledge (P = 0.934), attitude (P = 0.155) and behavior (P = 0.387) before the intervention. There was a significant difference between mean scores of knowledge in the immediate follow-up (P< 0.001) and 1 month after intervention follow-up (P < 0.001), and also between mean scores of attitude immediately (P < 0.001) and 1 month after intervention (P = 0.01) follow-ups in the experimental group compared with the control one. Mean scores of physical activity 1 month after the intervention in both experimental and control groups significantly increased (P < 0.001, P = 0.01, respectively), but the mean scores of physical activity between two groups were not significantly different (P = 0.390).
Discussion and Conclusion:
The results indicated the effectiveness of educational intervention, consequently increased knowledge and improved attitude of students, in the experimental group compared with the control one in terms of physical activities; thus, physical activity behavior of intervention group increased. Although the mean scores of physical activity in the control group significantly increased, other studies should be done which can control and consider confounding variables.
doi:10.4103/2277-9531.106642
PMCID: PMC3778575  PMID: 24083254
Attitude; behavior; knowledge; physical activity
10.  Asthma prevalence among 16- to 18-year-old adolescents in Saudi Arabia using the ISAAC questionnaire 
BMC Public Health  2012;12:239.
Background
Most of the studies investigating the prevalence of asthma in various countries have focused on children below the age of 15 years or adults above the age of 18 years. There is limited knowledge concerning the prevalence of asthma in 16- to 18-year-old adolescents. Our objective was to study the prevalence of asthma and associated symptoms in 16- to 18-year-old adolescents in Saudi Arabia.
Methods
A cross-sectional study was conducted in secondary (high) schools in the city of Riyadh utilizing the International Study of Asthma and Allergies in Children (ISAAC) questionnaire tool.
Results
Out of 3073 students (1504 boys and 1569 girls), the prevalence of lifetime wheeze, wheeze during the past 12 months and physician-diagnosed asthma was 25.3%, 18.5% and 19.6%, respectively. The prevalence of exercise-induced wheezing and night coughing in the past 12 months was 20.2% and 25.7%, respectively. The prevalence of rhinitis symptoms in students with lifetime wheeze, physician-diagnosed asthma and exercise-induced wheeze was 61.1%, 59.9% and 57.4%, respectively. Rhinitis symptoms were significantly associated with lifetime wheeze (OR = 2.5, p value < 0.001), physician-diagnosed asthma (OR = 2.2, p < 0.001), and exercise-induced wheeze (OR = 1.9, p value < 0.001).
Conclusions
The prevalence of asthma and associated symptoms in 16- to 18-year-old adolescents in Saudi Arabia is high, although it is within range of reported prevalence rates from various parts of the world.
doi:10.1186/1471-2458-12-239
PMCID: PMC3384472  PMID: 22443305
11.  Prevalence of short sleep duration and its association with obesity among adolescents 15- to 19-year olds: A cross-sectional study from three major cities in Saudi Arabia 
Annals of Thoracic Medicine  2012;7(3):133-139.
BACKGROUND:
Adequate sleep has been considered important for the adolescent's health and well being. On the other hand, self-imposed sleep curtailment is now recognized as a potentially important and novel risk factor for obesity. The present study aimed to assess the prevalence of short sleep duration and its association with obesity among Saudi adolescents.
METHODS:
This is a school-based cross-sectional study with self-reported sleep questionnaires. It was conducted during the years 2009/2010 in three cities in Saudi Arabia; Al-Khobar, Jeddah, and Riyadh. Participants were 2868 secondary-school males (1379) and females (1389) aged 15 to 19 years, randomly selected using a multistage stratified sampling technique. Measurements included weight, height, waist circumference, BMI, and sleeping duration. Logistic regression analysis while adjusted for age, gender, and location was used to examine the associations between sleep duration and obesity measures.
RESULTS:
The mean (SD) of sleep duration was 7.2 (1.6) hours/day with no significant differences between males and females. About 31% of the participants obtain less than 7 hours of sleep per day, while approximately 50% of the sample gets less than 8 hours of daily sleep. Two-way ANCOVA results while controlling for the effect of age revealed a significant gender by school-type interaction (P<0.001). In addition, adequate sleep duration increased the odds of having normal weight (adjusted odds ratios = 1.28, 95% CI = 1.08-1.50, P = 0.003).
CONCLUSION:
The present study observed a high prevalence of short sleep duration among Saudi adolescents 15- to 19-year olds and that short sleep duration was significantly associated with increased risk of overweight and obesity. Future interventions should investigate whether adopting a healthy lifestyle by adolescents with short sleep duration would improve their sleeping habits or not.
doi:10.4103/1817-1737.98845
PMCID: PMC3425044  PMID: 22924070
Adolescents; obesity; Saudi Arabia; sleep duration; waist circumference
12.  Methamphetamine use, aggressive behavior and other mental health issues among high school students in Cape Town, South Africa 
Drug and alcohol dependence  2010;109(0):14-19.
Objective
Methamphetamine use has become a growing problem in a number of countries over the past two decades, but has only recently emerged in South Africa. This study investigated the prevalence of methamphetamine use among high-school students in Cape Town and whether students reporting methamphetamine use were more likely to be at risk for mental health and aggressive behavior problems.
Method
A cross-sectional survey of 15 randomly selected high-schools in Cape Town, of 1561 male and female grade 8–10 students (mean age 14.9), was conducted using the Problem Oriented Screening Instrument for Teenagers (POSIT) and the Beck Depression Inventory (BDI).
Results
Findings indicated that 9% of the students had tried methamphetamine at least once. Ordinal logistic regression analyses showed that methamphetamine use in the past year was significantly associated with higher aggressive behavior scores (OR = 1.81, 95% CI: 1.04–3.15, p < 0.05), mental health risk scores (OR = 2.04, 95% CI: 1.26–3.31, p < 0.01) and depression scores (OR = 2.65, 95% CI: 1.64–4.28, p < 0.001).
Conclusions
Methamphetamine use has become a serious problem in Cape Town, particularly among adolescents. Screening adolescents in school settings for methamphetamine use and behavior problems may be useful in identifying youth at risk for substance misuse, providing an opportunity for early intervention. These findings have implications for other parts of the world where methamphetamine use may be occurring at younger ages and highlight the importance of looking at co-morbid issues related to methamphetamine use.
doi:10.1016/j.drugalcdep.2009.11.021
PMCID: PMC3784347  PMID: 20064699
Adolescents; methamphetamine use; aggression; mental health; South Africa
13.  Mental Health Service Use Among Adolescents with an Autism Spectrum Disorder 
Objective
This study examined prevalence and correlates of mental health service use among adolescents with an autism spectrum disorder (ASD).
Methods
Data from the National Longitudinal Transition Study-2 (NLTS2) was used to examine mental health service use among youth with an ASD (n=920). Nationally representative estimates generalize to students enrolled in the special education autism category. Regression models examined the association of predisposing, enabling, and need factors with service use overall then with receiving these services at school.
Results
Overall, 46% had used a mental health service in the past year. Of those that received a service, 49% had received it at school. Need variables were the strongest correlates of service use. African American youths, and youths from lower income families were more likely to receive school-based services.
Conclusion
The school plays a key role in providing services, especially for vulnerable populations. Focused attention on these youths is needed to ensure continuity of care as they leave high school.
doi:10.1176/appi.ps.62.8.975
PMCID: PMC3536479  PMID: 21807842
14.  The Effect of Parental Socioeconomic Class on Children’s Body Mass Indices 
Objective: To assess the effect of education and economic status of parents on obesity in children.
Methods: A cross-sectional survey was conducted in 2006 among school children in Riyadh, Saudi Arabia. A representative sample of 1243 (542 male and 701 female) children aged 6-16 years were contacted using multistage cluster sampling strategy. Social and demographic variables were collected using questionnaires completed by parents. Height and weight of the children were recorded by a trained team.
Results: The mean body mass index for all children was 19.8±5.4. The prevalence rates of overweight and obesity were 21.1% and 12.7%, respectively. Overweight and obesity were more prevalent in males than in females. By multivariate analysis, children were more likely to be overweight if they were male (OR=0.6, p<0.01), 12 years of age (OR=3.79, p<0.01, compared to age 6 years), and if their families had higher income (OR=3.12, p<0.01, compared to families with low income). Being male (OR=0.545, p <0.01), aged 12 years (OR=3.9, p=0.005, compared to the age of 6), and having a mother who is more educated were determined to be significant risk factors for obesity in children. Mothers educated at university level were found to have a three-fold higher risk of having obese children(OR=3.4, p<0.01, compared to mothers with lower education levels).
Conclusions: Overweight and obesity among Saudi children is associated with educated mothers and higher family income. This finding calls for introducing interventions in health education for both children and parents.
Conflict of interest:None declared.
doi:10.4274/Jcrpe.898
PMCID: PMC3701916  PMID: 23748064
children; overweight; obesity; socioeconomic; education
15.  School Mental Health Resources and Adolescent Mental Health Service Use 
Objective
Although schools are identified as critical for detecting youth mental disorders, little is known about whether the number of mental health providers and types of resources they offer influence student mental health service use. Such information could inform the development and allocation of appropriate school-based resources to increase service use. This paper examines associations of school resources with past-year mental health service use among students with 12-month DSM-IV mental disorders.
Method
Data come from the U.S. National Comorbidity Survey Adolescent Supplement (NCS-A), a national survey of adolescent mental health that included 4,445 adolescent-parent pairs in 227 schools in which principals and mental health coordinators completed surveys about school resources-policies for addressing student emotional problems. Adolescents and parents completed the Composite International Diagnostic Interview and reported mental health service use across multiple sectors. Multilevel multivariate regression was used to examine associations of school mental health resources and individual-level service use.
Results
Roughly half (45.3%) of adolescents with a 12-month DSM-IV disorder received past-year mental health services. Substantial variation existed in school resources. Increased school engagement in early identification was significantly associated with mental health service use for adolescents with mild/moderate mental and behavior disorders. The ratio of students-to-mental health providers was not associated with overall service use, but was associated with sector of service use.
Conclusions
School mental health resources, particularly those related to early identification, may facilitate mental health service use and influence sector of service use for youths with DSM disorders.
doi:10.1016/j.jaac.2013.03.002
PMCID: PMC3902042  PMID: 23622851
schools; mental health; services; adolescence
16.  Nocardiosis in a Tertiary Care Hospital in Saudi Arabia 
Background:
Nocardiosis is an uncommon bacterial infection that is caused by aerobic actinomycetes of the genus Nocardia. This pathogen has emerged as an important cause of mortality and morbidity among both immunocompetent and (more commonly) immunocompromised hosts. The prevalence of nocardiosis is unknown in Saudi Arabia. Only sporadic cases of cutaneous nocardiosis have been reported. In this study, we performed a 10-year retrospective review of all cases of nocardiosis identified at the King Fahad National Guard Hospital in Riyadh. Clinical presentation, risk factors, site of disease involvement, radiological features, and outcomes of 30 patients with pulmonary and disseminated nocardiosis are presented.
Materials and Methods:
A retrospective chart review of all cases of nocardiosis over the last ten years.
Results:
Thirty cases of nocardiosis were identified. The disease was more common in males. Fever and cough was the most common presentation. Most of the patients had an underlying pulmonary disease. Consolidation was the most prevalent radiological feature. Pleural effusion was common. Unfortunately, none of the isolates were sub-speciated. Cure was possible in 40% of the cases. Ten percent of patients died, while follow-up on the rest of the patients was lost.
Conclusion:
Nocardiosis is not uncommon in Saudi Arabia. Cases are not restricted to the classical immunocompromised host. A database is urgently needed to better evaluate the prevalence of the illness among the Saudi population.
doi:10.4103/0974-777X.81688
PMCID: PMC3125024  PMID: 21731298
Aerobic actinomycetes; Nocardia; Nocardiosis
17.  Predictors of smoking among male junior secondary school students in Riyadh, Saudi Arabia 
Tobacco Control  1996;5(1):26-29.
OBJECTIVE: To determine the prevalence and determinants of cigarette smoking among intermediate (junior secondary) schoolboys in Riyadh, Saudi Arabia. PARTICIPANTS: A sample of 1382 students (ages 12-19 years) in 45 classes randomly selected from 15 schools, using a two- stage stratified cluster sampling scheme. DESIGN: Students in the selected classes were requested to complete an anonymous questionnaire, under the supervision of trained interviewers. Univariate and multivariate statistical analyses of potential risk factors were performed. SETTING: Intermediate schools in Riyadh, Saudi Arabia. MAIN OUTCOME MEASURES: Association between current smoking and socio- demographic variables, history of smoking, age of smoking initiation, smoking behaviour among family members, knowledge of the harmful effects of smoking, and whether smoking is allowed in the presence of relatives and acquaintances. RESULTS: The prevalence of current smokers was 13.2% overall, ranging from 3.2% in those 12-13 years old to 31.1% in those aged 18-19. Some of the variables (nationality, father's education, and smoking allowed in the presence of parents or teachers) found to be associated with current smoking in a univariate analysis were no longer significantly associated with smoking in the multivariate analysis. By multivariate analysis, knowledge of the harmful effects of smoking, age, smoking allowed in the presence of friends or brothers, and previous smoking were statistically significant determinants of current smoking. CONCLUSIONS: Current health education activities against smoking should be continued and extended to the young population to further reduce the prevalence of smoking and its health consequences. Religious antipathy toward smoking should be emphasised in any local anti-smoking campaigns. 



PMCID: PMC1759483  PMID: 8795855
18.  Prevalence and characteristics of cigarette smoking among 16 to 18 years old boys and girls in Saudi Arabia 
Annals of Thoracic Medicine  2011;6(3):137-140.
OBJECTIVE:
To study the prevalence and characteristics of cigarette smoking among secondary school students (16- to 18-year-old boys and girls) in Riyadh city, Saudi Arabia.
METHODS:
We applied a standard two-stage, cross-sectional study design. Secondary schools for both boys and girls in Riyadh city were randomly selected using a cluster sampling method. We used the global youth tobacco survey (GYTS) tool to achieve our objectives.
RESULTS:
Among 1272 students (606 boys and 666 girls), the prevalence of those ever smoked cigarettes was 42.8% (55.6% of boys and 31.4% of girls). The prevalence of current smoking was 19.5% (31.2% of boys and 8.9% of girls). Despite the fact that the majority of students think smoking is harmful, most do not wish to stop smoking, and they had not tried to stop in the past year. Cigarette smoking is significantly associated with the male gender, having friends who smoke, and having parents who smoke, but is not significantly associated with the type of school attended.
CONCLUSION:
Smoking prevalence among secondary schools students in Saudi Arabia is high and alarming. There is a need to implement an education program about the risks of smoking and to include parents and friends as healthy models to prevent students from beginning to smoke.
doi:10.4103/1817-1737.82447
PMCID: PMC3131756  PMID: 21760845
Cigarette smoking; prevalence; Saudi Arabia
19.  ADOLESCENTS AND CANCER: A SURVEY OF KNOWLEDGE AND ATTITUDES ABOUT CANCER IN EASTERN PROVINCE OF SAUDI ARABIA 
Objective:
To determine the knowledge and attitudes of adolescents in the Eastern Province of Saudi Arabia towards cancer.
Methodology:
A pre-structured tested and revised questionnaire was administered to a randomly selected sample from four high schools (two males and two females) in Dhahran, Saudi Arabia.
Results:
Data were obtained from 572 adolescents. There was a marked variability in knowledge across informational items, particularly about the possible causes and how to avoid developing cancer.
Conclusion:
Students possess some knowledge of cancer, although this knowledge was not uniform. There were misconceptions about cancer and its pervention. The researcher concludes that the development and implementation of school health education programs on cancer are needed in this population.
PMCID: PMC3437078  PMID: 23008628
Cancer; Knowledge; Attitude; Saudi Arabia
20.  Ethnic and Gender Disparities in Needed Adolescent Mental Health Care 
Psychological problems are overlooked and undertreated in adolescents, especially in low-income and ethnically-diverse youth. School-based health centers are one way to increase health care utilization, and may be particularly important for accessing hard-to-reach populations. The present study examines adolescents’ psychological health and their experiences with receiving needed mental health care. Participants included 1,695 African-American (31%), Hispanic (38%), and White (31%) high-school students in southeast Texas. All students were from the same high school and all had access to a school-based mental health clinic. Twenty six percent of the sample had symptoms indicative of major depression, and 18% had scores consistent with subthreshold depression. Across all ethnicities, the prevalence of depressive symptoms was highest among females. Depressed White students were more likely than depressed minority youth to report having received a prior diagnosis of depression and to have been treated for depression. Thus, ethnic disparities in obtaining needed mental health care may persist even in settings where access to equivalent care is readily available.
doi:10.1353/hpu.2011.0029
PMCID: PMC3133675  PMID: 21317509
School-based mental health care; adolescents; ethnicity; gender; utilization
21.  Surveillance of Middle and High School Mental Health Risk by Student Self-Report Screener 
Introduction:
A 2009 National Academies of Sciences report on child mental health prevention and treatment concluded that screening for mental health risk is an essential component of service delivery. To date, however, there are few practical assessments available or practices in place that measure individual child risk, or risk aggregated at the school or community level. This study examined the utility of a 30-item paper and pencil student self-report screener of behavioral and emotional risk (BER) for surveying community risk among 7 schools.
Methods:
In 2010, 2,222 students in 3 middle and 4 high schools in a medium-sized school district in Georgia were administered the Behavioral and Emotional Screening System Self-Report Child/Adolescent form (BESS Student). The BESS is designed to measure 4 sub-syndromal BER factors for developing mental health disorders: inattention/hyperactivity, internalizing, school problems, and personal adjustment. Analysis of Variance and Chi Square analyses were used to assess the association between adolescent self-reported BER as an indicator of school BER, grade level, child ethnic identification and gender, socioeconomic status, and special education placement status.
Results:
BESS scores differentiated well between schools for overall BER and special education status, as well as between grade levels, ethnicity, and gender groups. One high school, known by the school administration to have numerous incidents of student behavior problems, had the most deviant 4 BER domain scores of all 7 schools. Girls rated themselves as having a higher prevalence of BER (14%) than boys (12%); middle school students reported fewer difficulties than high school students.
Conclusion:
Middle and high school students were capable of identifying significant differences in their own BER across schools, suggesting that universal mental health risk screening via student self-report is potentially useful for identifying aggregated community risk in a given school that may warrant differential deployment of mental health prevention and intervention strategies. BESS results reliably identified individual mental health risk associated with special education placement, which is documented to lead to poor school outcomes such as school dropout and lack of enrollment in post-secondary education.
doi:10.5811/westjem.2013.2.15349
PMCID: PMC3756705  PMID: 23997848
22.  The Path through Math: Course Sequences and Academic Performance at the Intersection of Race-Ethnicity and Gender 
Using new national data from Adolescent Health and Academic Achievement (AHAA), this article examines high school math patterns for students of different race-ethnicity and gender. Compared with white males, African American and Latino males receive lower returns from taking Algebra I during their freshman year, reaching lower levels of the math course sequence when they begin in the same position. This pattern is not explained by academic performance, and, furthermore, African American males receive less benefit from high math grades. Lower returns are not observed for minority female students, suggesting that more attention to racial-ethnic inequality in math among male students is needed.
doi:10.1086/506495
PMCID: PMC2889488  PMID: 20574544
23.  Sociodemographic Factors Associated With Tobacco Smoking Among Intermediate and Secondary School Students in Jazan Region of Saudi Arabia 
Substance Abuse  2013;34(4):381-388.
Background: The objectives of this study were to (i) determine the prevalence of and characteristics associated with tobacco smoking; (ii) identify the factors associated with tobacco smoking; and (iii) evaluate the association between tobacco smoking and khat chewing among intermediate and secondary school students in Jazan Region, Saudi Arabia. Methods: A cross-sectional study was conducted with a representative sample (N = 4100) of intermediate and secondary school students in Jazan Region. The data were collected using a pretested modified version of the global youth tobacco survey questionnaire. Results: A total of 3923 students from 72 intermediate and secondary schools for males and females in Jazan Region, Saudi Arabia, were included in this study. The ever having smoked prevalence was 17.3%, and the current smoking prevalence was 10.7%. The most important independent predictors of smoking were academic performance (odds ratio [OR]: 5.32), having friends who used khat (OR: 3.23), and having friends who used tobacco (OR: 2.88). Conclusions: Understanding the factors and predictors associated with tobacco use are crucial to identifying high-risk groups to design tobacco prevention and control programs. For the first time, a strong and statistically significant association was identified between tobacco smoking and khat chewing among intermediate and secondary school students in Jazan Region. Because the use of khat is increasingly spreading outside of its traditional areas to Europe and America, this finding may have an important impact on tobacco control efforts internationally.
doi:10.1080/08897077.2013.779361
PMCID: PMC3827661  PMID: 24159909
Co-substance use; priority/special populations; tobacco
24.  Lifestyle factors associated with overweight and obesity among Saudi adolescents 
BMC Public Health  2012;12:354.
Background
A better understanding of the relationships between obesity and lifestyle factors is necessary for effective prevention and management of obesity in youth. Therefore, the objective of this study was to evaluate the associations between obesity measures and several lifestyle factors, including physical activity, sedentary behaviors and dietary habits among Saudi adolescents aged 14–19 years.
Methods
This was a school-based cross-sectional study that was conducted in three cities in Saudi Arabia (Al-Khobar, Jeddah and Riyadh). The participants were 2906 secondary school males (1400) and females (1506) aged 14–19 years, who were randomly selected using a multistage stratified cluster sampling technique. Measurements included weight, height, body mass index (BMI), waist circumference, waist/height ratio (WHtR), screen time (television viewing, video games and computer use), physical activity (determined using a validated questionnaire), and dietary habits (intake frequency per week). Logistic regression was used to examine the associations between obesity and lifestyle factors.
Results
Compared with non-obese, obese males and females were significantly less active, especially in terms of vigorous activity, had less favorable dietary habits (e.g., lower intake of breakfast, fruits and milk), but had lower intake of sugar-sweetened drinks and sweets/chocolates. Logistic regression analysis showed that overweight/obesity (based on BMI categories) or abdominal obesity (based on WHtR categories) were significantly and inversely associated with vigorous physical activity levels (aOR for high level = 0.69, 95% CI 0.41–0.92 for BMI and 0.63, 95% CI 0.45–0.89 for WHtR) and frequency of breakfast (aOR for < 3 days/week = 1.44; 95% CI 1.20–1.71 for BMI and 1.47; 95% CI 1.22–1.76 for WHtR) and vegetable (aOR for < 3 days/week = 1.29; 95% CI 1.03–1.59 for WHtR) intakes, and consumption of sugar-sweetened beverages (aOR for < 3 days/week = 1.32; 95% CI 1.08–1.62 for BMI and 1.42; 95% CI 1.16–1.75 for WHtR).
Conclusions
The present study identified several lifestyle factors associated with obesity that may represent valid targets for the prevention and management of obesity among Saudi adolescents. Primary prevention of obesity by promoting active lifestyles and healthy diets should be a national public health priority.
doi:10.1186/1471-2458-12-354
PMCID: PMC3433359  PMID: 22591544
Adolescents; Dietary habits; Lifestyle; Overweight; Obesity; Physical activity; Saudi Arabia; Sedentary behaviors
25.  Common stressful life events and difficulties are associated with mental health symptoms and substance use in young adolescents 
BMC Psychiatry  2012;12:116.
Background
Stressful life events are associated with mood disorders in adults in clinical settings. Less described in the literature is the association between common life stressors and a wide range of psychopathology in young adolescents. This study uses a large non-clinical sample of young adolescents to describe the associations among worry or stress about common life events/difficulties, mental health and substance use.
Methods
Data on lifetime stress or worry about common life events/difficulties (i.e., romantic breakups, family disruption, interpersonal difficulties, and personal stress (health, weight, school work)), symptoms of depression, conduct disorder symptoms, and substance use were collected from 1025 grade 7 students (mean age 12.9 years; 45% male). The association between each source of stress and each mental health and substance use indicator was modeled in separate logistic regression analyses.
Results
The proportion of adolescents reporting worry or stress ranged from 7% for new family to 53% for schoolwork. Romantic breakup stress was statistically significantly associated with all the mental health and substance use indicators except illicit drug use. Family disruption was statistically significantly associated with depression symptoms, marijuana use, and cigarette use. Interpersonal difficulties stress was statistically significantly associated with depression symptoms. All sources of personal stress were statistically significantly related to depression symptoms. In addition, health-related stress was inversely related to binge drinking.
Conclusion
Young adolescents may benefit from learning positive coping skills to manage worry or stress about common stressors and in particular, worry or stress related to romantic breakups. Appropriate management of mental health symptoms and substance use related to common stressful life events and difficulties may help reduce emerging psychopathology.
doi:10.1186/1471-244X-12-116
PMCID: PMC3466152  PMID: 22900789
Adolescence; Stress, Mental health; Substances; Depression; Anxiety

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