PURPOSE To examine the temporal trends and risk of small for gestational age (SGA) phenotypes acr... more PURPOSE To examine the temporal trends and risk of small for gestational age (SGA) phenotypes across Asian American ethnic groups. METHODS We conducted a population-based retrospective study using the 1992-2018 natality data files obtained from the National Vital Statistics System. Joinpoint regression modeling was employed to calculate the average annual percentage change in SGA birth rates among Asian American sub-groups and NH-White women. Logistic regression was utilized to compute the adjusted odds ratio and 95% confidence interval for the association between maternal race (Asian American sub-groups vs. NH-White) and SGA birth and its phenotypes. RESULTS We analyzed data on 2,821,798 Asian Americans and 62,174,875 NH-White US live-born infants. Overall, NH-Whites had the lowest SGA rates, while all the Asian ethnic groups had almost consistently higher rates during the 27-year period. Disparity in SGA births in the Asian subgroups was observed. Compared to NH-Whites, stratified analyses showed varying and significantly higher odds of any SGA in all Asian ethnic groups. Asian Indians had the highest odds [adjusted odds ratio (AOR) = 2.23, 95% confidence interval (CI) = 2.22-2.23] of any SGA compared to NH-Whites. CONCLUSIONS Our findings support the evidence that Asian Americans are not a homogenous group and highlight the need to disentangle these differences when conducting population health research and interventions among Asian Americans.
Background The COVID-19 government public health measures are necessary to prevent the spread of ... more Background The COVID-19 government public health measures are necessary to prevent the spread of COVID-19, however, their efficacy is largely dependent on adherence. This study utilized the Health Belief Model (HBM) to explain the public’s adopted prevention practices during the COVID-19 outbreak in Saudi Arabia. Methods This study used “COVID-19 Snapshot MOnitoring (COSMO): monitoring knowledge, risk perceptions, preventive behaviours, and public trust in the current coronavirus outbreak” research protocol which is developed by the WHO Regional Office for Europe and the COSMO group. The COSMO questionnaire was translated into Arabic and distributed as an online survey via WhatsApp instant messaging application from May 2nd to May 26th, 2020. The dependent variable was the mean of adopting ten COVID-19 preventive practices. These practices were hand washing, avoiding touching eyes, nose and mouth, use of hand sanitizer, covering mouth and nose when coughing/sneezing, staying home when sick, avoiding close contact with infected persons, social distancing, wearing masks, home isolation, and lockdown. The independent variables included the HBM constructs (susceptibility to and severity of COVID-19, benefits of and barriers to adopting preventive behaviors, cues to action, health motivation, and self-efficacy), sociodemographic factors, presence of chronic illness, and perceived and actual knowledge. We conducted bivariate and multivariate analyses and reported significant findings (P ≤ 0.05). Results We analyzed 1027 surveys. About 38% adhered to all COVID-19 preventive behaviors and the mean for adherence was 9. The HBM perceived benefits (p = 0.001), perceived barriers (p = 0.004), and cues to action (p = 0.046) were associated with adherence to COVID-19 preventive behaviors after adjusting for all other factors. Respondents with the highest levels of education and income were less likely to adopt COVID-19 preventive behaviors compared to those in the lower ranks of education and income. Conclusion Our findings suggest that the HBM can be applied to understand adherence to COVID-19 prevention practices. The recognition of perceived health beliefs and practices is important for developing effective COVID-19 health intervention strategies.
Few studies have evaluated the oral effects of smokeless tobacco use in adolescents. This study d... more Few studies have evaluated the oral effects of smokeless tobacco use in adolescents. This study described the oral health status of adolescents who were daily users of local smokeless tobacco (shamma) in Saudi Arabia. A convenience sample of 270 middle-school male students completed a questionnaire and received an oral examination and a saliva cotinine test. Among the students, 96% had plaque deposits (mean plaque index score 1.66); 41% had gingivitis (mean clinical attachment loss 1.1 mm); 56% had dental caries (mean decayed, missing, filled teeth score 2.1) and 86% had at least 1 mucosal lesion. The levels of plaque, gingivitis, dental caries and periodontitis among smokeless tobacco users were similar to those of most adolescents regardless of tobacco use. Almost 9/10 students had a mucosal lesion that could be related to smokeless tobacco use. Strong measures should be taken to increase students' awareness of the adverse health effects of tobacco use and to control their access to tobacco.
Thesis (D.P.H.)--University of Alabama at Birmingham, School of Public Health, 2006. Includes bib... more Thesis (D.P.H.)--University of Alabama at Birmingham, School of Public Health, 2006. Includes bibliographical references (leaves 92-99).
Objectives: The Faculty of Dentistry at King Abdulaziz University (KAU) is planning to develop a ... more Objectives: The Faculty of Dentistry at King Abdulaziz University (KAU) is planning to develop a master's program in dental public health (DPH). To develop a curriculum for this program, a needs assessment was conducted in order to identify the level of DPH expertise that currently exists in Saudi Arabia, to identify gaps in knowledge, and to explore current perceptions regarding this type of program. Methods: A competency-based survey instrument was administered to private and government affiliated dental practitioners in Jeddah, Saudi Arabia. Participants' knowledge, attitudes, and competencies in DPH were assessed. In addition, questions were submitted that addressed preferred strategies of teaching, curriculum delivery methods, course content, and prerequisites for DPH. These data were combined with data previously collected from dentists holding academic positions at KAU (n = 146) and were analyzed using Statistical Analysis System version 9.3 software. Mean values and frequencies were calculated for the study variables. Proportional odds ratios and 95% confidence intervals were estimated to assess differences in educational preferences and DPH competencies according to age, gender, and qualification. Results: Most of the participants (95%) reported a need for a DPH graduate program. The respondents had a basic knowledge of DPH and moderate experience in DPH competencies. A variety of preferred educational strategies and methods were identified and differences in educational preferences according to age, gender, and qualification of the respondents were identified. The responses obtained also acknowledged skills and competencies that the participants considered most important for a DPH practice and that would be important for students accepted into a DPH graduate program. Conclusions: This needs assessment survey represents a preliminary step in establishing a DPH graduate program that addresses current gaps in knowledge and in the practice of public health
To determine the prevalence and identify significant socioeconomic predictors of dental caries am... more To determine the prevalence and identify significant socioeconomic predictors of dental caries among children aged 9 and 14 in Jeddah, Saudi Arabia. A random sample of 24 elementary and middle schools in Jeddah was selected. All 3rd and 8th graders were screened (N = 1655) for caries. A parent questionnaire was administered to collect information on selected socioeconomic indicators. Untreated caries was the outcome of interest. Categorical variables were reported as frequencies and percentages; crude and adjusted odds ratios of caries association with SES were produced with 95% confidence intervals and P-values. A total of 1655 students were examined. The overall caries experience was 83.13%. Untreated caries prevalence in primary and permanent teeth of all students was 63.01% and 56.7%, respectively. In primary teeth, mother's education, family income and having medical insurance were significant unadjusted predictors of caries. Family income was the only adjusted predictor of...
The objective of this study was to examine the relationship between private dentists' attitud... more The objective of this study was to examine the relationship between private dentists' attitudes toward Medicaid and Medicaid patients and their extent of Medicaid participation. A survey was mailed to all Medicaid dentists in Alabama in 2003 (N = 518). Descriptive statistics were calculated, and multiple regression models were tested. The "dentists' extent of participation" was a measure of the percentage of Medicaid patients seen in one month. Independent variables included dentists' personal and practice characteristics; market area characteristics; and dentists' attitudes toward Medicaid and Medicaid patients. A total of 277 (54%) surveys was returned. Non-Caucasian dentists in group practice had a higher mean of extent of Medicaid participation than Caucasian dentists in solo practice. Moreover, compared to privately insured families, dentists had significantly higher mean of extent of Medicaid participation if they perceived Medicaid reimbursement as g...
The purposes of this survey were to assess barriers to utilization of dental services among Medic... more The purposes of this survey were to assess barriers to utilization of dental services among Medicaid-enrolled Alabama children and identify families who used or did not use Medicaid-covered dental services. A random sample of 4,500 parents of Medicaid-eligible children ages 3 to 19 years was surveyed. Participants came from Medicaid enrollment data stratified by area of residence into 3 groups: (1) large urban; (2) town; and (3) rural. Univariate and multivariate analyses were conducted. The overall response rate was 40% (N = 1,766). Most respondents (71%) reported that their child had a dental visit in the past year. Compared to parents who had a dental visit, those who reported no visits were more likely to: (1) be non-Hispanic African American; (2) be less educated; (3) live in rural settings of Alabama; (4) have more children younger than 6 or older than 12; (5) have more children with disabling conditions; and (6) report poor perceived oral health. Respondents with no dental vi...
Objective: Dental caries critically impacts the health and development of children. Understanding... more Objective: Dental caries critically impacts the health and development of children. Understanding caries experience is an important task for Saudi Arabian policymakers to identify intervention targets and improve oral health. The purpose of this review is to analyze current data to assess the nationwide prevalence and severity of caries in children, to identify gaps in baseline information, and to determine areas for future research. Methods: A search of published and unpublished studies in PubMed, Google, and local Saudi medical and dental journals was conducted for the three keywords ''dental,'' ''caries,'' and ''Saudi Arabia.'' The inclusion criteria required that the articles were population-based studies that assessed the prevalence of dental caries in healthy children attending regular schools using a cross-sectional study design of a random sample. Results/discussion: The review was comprised of one unpublished thesis and 27 published surveys of childhood caries in Saudi Arabia. The earliest study was published in 1988 and the most recent was published in 2010. There is a lack of representative data on the prevalence of dental caries among the whole Saudi Arabian population. The national prevalence of dental caries and its severity in children in Saudi Arabia was estimated to be approximately 80% for the primary dentition with a mean dmft of 5.0 and approximately 70% for children's permanent dentition with a mean DMFT score of 3.5. The current estimates indicate that the World Health Organization (WHO) 2000 goals are still unmet for Saudi Arabian children.
A needs assessment survey or situational analysis is typically recommended as the foundation of a... more A needs assessment survey or situational analysis is typically recommended as the foundation of any curriculum development process. We conducted this survey to understand the level of DPH expertise existing in the country, to identify needs and gaps, and to explore perceptions in the area of DPH. Methods: A DPH competency based survey was emailed to all onsite Saudi faculty members, all DPH practitioners in Jeddah city, and a random sample of dental interns (n = 122). The questionnaire collected information about participants' demographics, knowledge of DPH, preferred method for gaining knowledge about DPH, perceptions about a new master's program in DPH, preferred teaching and delivery methods, prerequisite education, and self-assessment of participants' own DPH competency levels. Descriptive statistics, chi-square or Fisher's exact statistics, and proportional odds ratios were calculated to analyze data. Results: There was a total of 105 respondents (86.1%). About 98% had some knowledge of DPH. The most preferred method to gain knowledge on DPH was seminar series (47.6%). The most preferred methods for teaching instruction were using a "list of discussion topics" and "providing examples," and the most preferred method for delivery of coursework was "face-to-face classroom activities with online readings and assignments." The most preferred prerequisite education was having a bachelor's degree in dentistry. Most participants considered themselves as having moderate experience and basic range of knowledge of DPH practices and competencies. Conclusion: The survey has helped assess the participants' views on the need for a graduate program in DPH. It is a preliminary step in designing a well-structured program, which will address the needs and gaps in oral public health in the country and inform the development of course content.
A rapid rise in the number of tobacco users in Saudi Arabia has occurred in the past decade, part... more A rapid rise in the number of tobacco users in Saudi Arabia has occurred in the past decade, particularly among the youth. This study identified socio-cultural determinants of tobacco use and explored possible approaches to prevent adolescents' tobacco use in Saudi Arabia. A crosssectional survey was administered using a self-administered questionnaire for collecting information on risk and protective factors for tobacco use among middle school students. School selection was stratified by region, gender, and type (public or private). Of 1,186 7-9th grade students, 1,019 questionnaires were analyzed. Risk factors affecting tobacco use included all important others' perceptions; mother, sister, friend, teacher and important person's tobacco use; pressure to use tobacco from brother, sister, friend and important persons; easy access to tobacco and frequent skipping of classes. Protective factors for tobacco use included family's perception; friend, teacher and important person's tobacco use; parents' help; support from family, friends, and teachers; accessibility to tobacco; school performance and family income, father's education, and district of residence. The findings of this study show clear gender differences in social influences and attitudes towards tobacco use. Religious beliefs and access to tobacco products were significantly associated with attitudes towards tobacco use and future intention of use. Developing and implementing effective gender specific school-based tobacco prevention programs, strict reinforcement of tobacco control policies, and a focus on the overall social context of tobacco use are crucial for developing successful long-term tobacco prevention programs for adolescents.
Objectives: Tobacco use is the leading preventable cause of death worldwide and a major contribut... more Objectives: Tobacco use is the leading preventable cause of death worldwide and a major contributor to oral problems and diseases. Adolescent tobacco use remains a significant public health concern. Saudi Arabia is ranked third worldwide in the number of children and youth smoking. The objective of this study is to develop and test a school-based tobacco prevention program to prevent initiation of tobacco use for middle school students in Jeddah. Methods: A tobacco prevention program, Dentists Fighting Nicotine Dependence (DFND), was developed. A quasi-experimental design was used to test the effect of DFND. Seventh grade students were selected from four test (n=366) and four control schools (n=232). DFND consisted of a classroom curriculum, videos, media campaign, parents newsletters, and poster contest. Pre- and post-test questionnaires were administered. Attitudes, Subjective norms, perceived social pressure, perceived behavioral control, intention to use tobacco, level of tobacc...
PURPOSE To examine the temporal trends and risk of small for gestational age (SGA) phenotypes acr... more PURPOSE To examine the temporal trends and risk of small for gestational age (SGA) phenotypes across Asian American ethnic groups. METHODS We conducted a population-based retrospective study using the 1992-2018 natality data files obtained from the National Vital Statistics System. Joinpoint regression modeling was employed to calculate the average annual percentage change in SGA birth rates among Asian American sub-groups and NH-White women. Logistic regression was utilized to compute the adjusted odds ratio and 95% confidence interval for the association between maternal race (Asian American sub-groups vs. NH-White) and SGA birth and its phenotypes. RESULTS We analyzed data on 2,821,798 Asian Americans and 62,174,875 NH-White US live-born infants. Overall, NH-Whites had the lowest SGA rates, while all the Asian ethnic groups had almost consistently higher rates during the 27-year period. Disparity in SGA births in the Asian subgroups was observed. Compared to NH-Whites, stratified analyses showed varying and significantly higher odds of any SGA in all Asian ethnic groups. Asian Indians had the highest odds [adjusted odds ratio (AOR) = 2.23, 95% confidence interval (CI) = 2.22-2.23] of any SGA compared to NH-Whites. CONCLUSIONS Our findings support the evidence that Asian Americans are not a homogenous group and highlight the need to disentangle these differences when conducting population health research and interventions among Asian Americans.
Background The COVID-19 government public health measures are necessary to prevent the spread of ... more Background The COVID-19 government public health measures are necessary to prevent the spread of COVID-19, however, their efficacy is largely dependent on adherence. This study utilized the Health Belief Model (HBM) to explain the public’s adopted prevention practices during the COVID-19 outbreak in Saudi Arabia. Methods This study used “COVID-19 Snapshot MOnitoring (COSMO): monitoring knowledge, risk perceptions, preventive behaviours, and public trust in the current coronavirus outbreak” research protocol which is developed by the WHO Regional Office for Europe and the COSMO group. The COSMO questionnaire was translated into Arabic and distributed as an online survey via WhatsApp instant messaging application from May 2nd to May 26th, 2020. The dependent variable was the mean of adopting ten COVID-19 preventive practices. These practices were hand washing, avoiding touching eyes, nose and mouth, use of hand sanitizer, covering mouth and nose when coughing/sneezing, staying home when sick, avoiding close contact with infected persons, social distancing, wearing masks, home isolation, and lockdown. The independent variables included the HBM constructs (susceptibility to and severity of COVID-19, benefits of and barriers to adopting preventive behaviors, cues to action, health motivation, and self-efficacy), sociodemographic factors, presence of chronic illness, and perceived and actual knowledge. We conducted bivariate and multivariate analyses and reported significant findings (P ≤ 0.05). Results We analyzed 1027 surveys. About 38% adhered to all COVID-19 preventive behaviors and the mean for adherence was 9. The HBM perceived benefits (p = 0.001), perceived barriers (p = 0.004), and cues to action (p = 0.046) were associated with adherence to COVID-19 preventive behaviors after adjusting for all other factors. Respondents with the highest levels of education and income were less likely to adopt COVID-19 preventive behaviors compared to those in the lower ranks of education and income. Conclusion Our findings suggest that the HBM can be applied to understand adherence to COVID-19 prevention practices. The recognition of perceived health beliefs and practices is important for developing effective COVID-19 health intervention strategies.
Few studies have evaluated the oral effects of smokeless tobacco use in adolescents. This study d... more Few studies have evaluated the oral effects of smokeless tobacco use in adolescents. This study described the oral health status of adolescents who were daily users of local smokeless tobacco (shamma) in Saudi Arabia. A convenience sample of 270 middle-school male students completed a questionnaire and received an oral examination and a saliva cotinine test. Among the students, 96% had plaque deposits (mean plaque index score 1.66); 41% had gingivitis (mean clinical attachment loss 1.1 mm); 56% had dental caries (mean decayed, missing, filled teeth score 2.1) and 86% had at least 1 mucosal lesion. The levels of plaque, gingivitis, dental caries and periodontitis among smokeless tobacco users were similar to those of most adolescents regardless of tobacco use. Almost 9/10 students had a mucosal lesion that could be related to smokeless tobacco use. Strong measures should be taken to increase students' awareness of the adverse health effects of tobacco use and to control their access to tobacco.
Thesis (D.P.H.)--University of Alabama at Birmingham, School of Public Health, 2006. Includes bib... more Thesis (D.P.H.)--University of Alabama at Birmingham, School of Public Health, 2006. Includes bibliographical references (leaves 92-99).
Objectives: The Faculty of Dentistry at King Abdulaziz University (KAU) is planning to develop a ... more Objectives: The Faculty of Dentistry at King Abdulaziz University (KAU) is planning to develop a master's program in dental public health (DPH). To develop a curriculum for this program, a needs assessment was conducted in order to identify the level of DPH expertise that currently exists in Saudi Arabia, to identify gaps in knowledge, and to explore current perceptions regarding this type of program. Methods: A competency-based survey instrument was administered to private and government affiliated dental practitioners in Jeddah, Saudi Arabia. Participants' knowledge, attitudes, and competencies in DPH were assessed. In addition, questions were submitted that addressed preferred strategies of teaching, curriculum delivery methods, course content, and prerequisites for DPH. These data were combined with data previously collected from dentists holding academic positions at KAU (n = 146) and were analyzed using Statistical Analysis System version 9.3 software. Mean values and frequencies were calculated for the study variables. Proportional odds ratios and 95% confidence intervals were estimated to assess differences in educational preferences and DPH competencies according to age, gender, and qualification. Results: Most of the participants (95%) reported a need for a DPH graduate program. The respondents had a basic knowledge of DPH and moderate experience in DPH competencies. A variety of preferred educational strategies and methods were identified and differences in educational preferences according to age, gender, and qualification of the respondents were identified. The responses obtained also acknowledged skills and competencies that the participants considered most important for a DPH practice and that would be important for students accepted into a DPH graduate program. Conclusions: This needs assessment survey represents a preliminary step in establishing a DPH graduate program that addresses current gaps in knowledge and in the practice of public health
To determine the prevalence and identify significant socioeconomic predictors of dental caries am... more To determine the prevalence and identify significant socioeconomic predictors of dental caries among children aged 9 and 14 in Jeddah, Saudi Arabia. A random sample of 24 elementary and middle schools in Jeddah was selected. All 3rd and 8th graders were screened (N = 1655) for caries. A parent questionnaire was administered to collect information on selected socioeconomic indicators. Untreated caries was the outcome of interest. Categorical variables were reported as frequencies and percentages; crude and adjusted odds ratios of caries association with SES were produced with 95% confidence intervals and P-values. A total of 1655 students were examined. The overall caries experience was 83.13%. Untreated caries prevalence in primary and permanent teeth of all students was 63.01% and 56.7%, respectively. In primary teeth, mother's education, family income and having medical insurance were significant unadjusted predictors of caries. Family income was the only adjusted predictor of...
The objective of this study was to examine the relationship between private dentists' attitud... more The objective of this study was to examine the relationship between private dentists' attitudes toward Medicaid and Medicaid patients and their extent of Medicaid participation. A survey was mailed to all Medicaid dentists in Alabama in 2003 (N = 518). Descriptive statistics were calculated, and multiple regression models were tested. The "dentists' extent of participation" was a measure of the percentage of Medicaid patients seen in one month. Independent variables included dentists' personal and practice characteristics; market area characteristics; and dentists' attitudes toward Medicaid and Medicaid patients. A total of 277 (54%) surveys was returned. Non-Caucasian dentists in group practice had a higher mean of extent of Medicaid participation than Caucasian dentists in solo practice. Moreover, compared to privately insured families, dentists had significantly higher mean of extent of Medicaid participation if they perceived Medicaid reimbursement as g...
The purposes of this survey were to assess barriers to utilization of dental services among Medic... more The purposes of this survey were to assess barriers to utilization of dental services among Medicaid-enrolled Alabama children and identify families who used or did not use Medicaid-covered dental services. A random sample of 4,500 parents of Medicaid-eligible children ages 3 to 19 years was surveyed. Participants came from Medicaid enrollment data stratified by area of residence into 3 groups: (1) large urban; (2) town; and (3) rural. Univariate and multivariate analyses were conducted. The overall response rate was 40% (N = 1,766). Most respondents (71%) reported that their child had a dental visit in the past year. Compared to parents who had a dental visit, those who reported no visits were more likely to: (1) be non-Hispanic African American; (2) be less educated; (3) live in rural settings of Alabama; (4) have more children younger than 6 or older than 12; (5) have more children with disabling conditions; and (6) report poor perceived oral health. Respondents with no dental vi...
Objective: Dental caries critically impacts the health and development of children. Understanding... more Objective: Dental caries critically impacts the health and development of children. Understanding caries experience is an important task for Saudi Arabian policymakers to identify intervention targets and improve oral health. The purpose of this review is to analyze current data to assess the nationwide prevalence and severity of caries in children, to identify gaps in baseline information, and to determine areas for future research. Methods: A search of published and unpublished studies in PubMed, Google, and local Saudi medical and dental journals was conducted for the three keywords ''dental,'' ''caries,'' and ''Saudi Arabia.'' The inclusion criteria required that the articles were population-based studies that assessed the prevalence of dental caries in healthy children attending regular schools using a cross-sectional study design of a random sample. Results/discussion: The review was comprised of one unpublished thesis and 27 published surveys of childhood caries in Saudi Arabia. The earliest study was published in 1988 and the most recent was published in 2010. There is a lack of representative data on the prevalence of dental caries among the whole Saudi Arabian population. The national prevalence of dental caries and its severity in children in Saudi Arabia was estimated to be approximately 80% for the primary dentition with a mean dmft of 5.0 and approximately 70% for children's permanent dentition with a mean DMFT score of 3.5. The current estimates indicate that the World Health Organization (WHO) 2000 goals are still unmet for Saudi Arabian children.
A needs assessment survey or situational analysis is typically recommended as the foundation of a... more A needs assessment survey or situational analysis is typically recommended as the foundation of any curriculum development process. We conducted this survey to understand the level of DPH expertise existing in the country, to identify needs and gaps, and to explore perceptions in the area of DPH. Methods: A DPH competency based survey was emailed to all onsite Saudi faculty members, all DPH practitioners in Jeddah city, and a random sample of dental interns (n = 122). The questionnaire collected information about participants' demographics, knowledge of DPH, preferred method for gaining knowledge about DPH, perceptions about a new master's program in DPH, preferred teaching and delivery methods, prerequisite education, and self-assessment of participants' own DPH competency levels. Descriptive statistics, chi-square or Fisher's exact statistics, and proportional odds ratios were calculated to analyze data. Results: There was a total of 105 respondents (86.1%). About 98% had some knowledge of DPH. The most preferred method to gain knowledge on DPH was seminar series (47.6%). The most preferred methods for teaching instruction were using a "list of discussion topics" and "providing examples," and the most preferred method for delivery of coursework was "face-to-face classroom activities with online readings and assignments." The most preferred prerequisite education was having a bachelor's degree in dentistry. Most participants considered themselves as having moderate experience and basic range of knowledge of DPH practices and competencies. Conclusion: The survey has helped assess the participants' views on the need for a graduate program in DPH. It is a preliminary step in designing a well-structured program, which will address the needs and gaps in oral public health in the country and inform the development of course content.
A rapid rise in the number of tobacco users in Saudi Arabia has occurred in the past decade, part... more A rapid rise in the number of tobacco users in Saudi Arabia has occurred in the past decade, particularly among the youth. This study identified socio-cultural determinants of tobacco use and explored possible approaches to prevent adolescents' tobacco use in Saudi Arabia. A crosssectional survey was administered using a self-administered questionnaire for collecting information on risk and protective factors for tobacco use among middle school students. School selection was stratified by region, gender, and type (public or private). Of 1,186 7-9th grade students, 1,019 questionnaires were analyzed. Risk factors affecting tobacco use included all important others' perceptions; mother, sister, friend, teacher and important person's tobacco use; pressure to use tobacco from brother, sister, friend and important persons; easy access to tobacco and frequent skipping of classes. Protective factors for tobacco use included family's perception; friend, teacher and important person's tobacco use; parents' help; support from family, friends, and teachers; accessibility to tobacco; school performance and family income, father's education, and district of residence. The findings of this study show clear gender differences in social influences and attitudes towards tobacco use. Religious beliefs and access to tobacco products were significantly associated with attitudes towards tobacco use and future intention of use. Developing and implementing effective gender specific school-based tobacco prevention programs, strict reinforcement of tobacco control policies, and a focus on the overall social context of tobacco use are crucial for developing successful long-term tobacco prevention programs for adolescents.
Objectives: Tobacco use is the leading preventable cause of death worldwide and a major contribut... more Objectives: Tobacco use is the leading preventable cause of death worldwide and a major contributor to oral problems and diseases. Adolescent tobacco use remains a significant public health concern. Saudi Arabia is ranked third worldwide in the number of children and youth smoking. The objective of this study is to develop and test a school-based tobacco prevention program to prevent initiation of tobacco use for middle school students in Jeddah. Methods: A tobacco prevention program, Dentists Fighting Nicotine Dependence (DFND), was developed. A quasi-experimental design was used to test the effect of DFND. Seventh grade students were selected from four test (n=366) and four control schools (n=232). DFND consisted of a classroom curriculum, videos, media campaign, parents newsletters, and poster contest. Pre- and post-test questionnaires were administered. Attitudes, Subjective norms, perceived social pressure, perceived behavioral control, intention to use tobacco, level of tobacc...
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