An investigation into the perceptions of male smokers and health care professionals in the smoking cessation clinics in Riyadh on the Tobacco Control Program in Saudi Arabia

Aim: The aim of this dissertation is to produce an original piece of investigative research into perceptions of smoking cessation services provided by the TCP in the Riyadh region. Objectives: In order to realise this aim, the dissertation has the following objectives: 1. To investigate perceptions of the extent of the health care (smoking cessation) services provided under the TCP for smokers in the Riyadh region. 2. To investigate the perceptions of male clients and health care services professionals in the smoking cessation clinics in this region, on the effectiveness of the clinics in raising awareness of the dangers of smoking, in order to encourage smokers to quit. 3. To identify the perceived strengths and limitations of health care (smoking cessation) services provided for smokers in the Riyadh region specifically as a platform for developing those strengths in the future. Design: Primary data was collected through questionnaires administered to male clients attending the smoking cessation clinics in Riyadh, Saudi Arabia, and professional staff working in those same clinics. The views of respondents represent their individual subjective experience of one specific aspect of an objective social experience, in this case the functioning of the Tobacco Control Program. Methods: A questionnaire was devised based on the policies and activities of the Tobacco Control Programme in Saudi Arabia. Convenience sampling was used, conducting the survey among 500 male clients attending the smoking cessation clinics in Riyadh and 30 staff in the clinics. The sampling was purposive, seeking to obtain the views of service-users and service-providers in the clinics, as those who would be expected to be more informed about the Tobacco Control Programme rather than a random sample drawn from the general population, such as a household survey. The Pilot Study was conducted in a smoking cessation clinic run by an anti-smoking charity in Riyadh. Results: The results obtained from both sets of questionnaires indicated in Sections A and B that respondents considered that the Tobacco Control Program was actively engaged in a series of activities relating to tobacco control, in raising awareness of the hazards of smoking and providing treatment. Responses in Sections C and D suggested that clients and staff 3 perceived that the Tobacco Control Program was operating effectively, despite some difficulties occasioned by a lack of resources. Conclusions: The level of satisfaction with the performance of the Tobacco Control Program indicated in the responses was high. The uniformity of the responses may be responsible due to two factors – a relative lack of cultural diversity among respondents, and limitations of the study itself in overcoming potential problems of reporting bias. Given the setting of the study and the methods chosen, this may have resulted in a measure of unwillingness to criticise aspects of the Program. Nevertheless, as the first study of satisfaction with the TCP since its inception in 2002, valuable lessons will be learned for future surveys to obtain data, perhaps based more closely on surveys such as those conducted in the UK to measure satisfaction with the NHS. A more standardised international approach should, therefore, be the way forward in terms of research design and methods

Impact Of Covid-19 Lockdown On Smoking (Waterpipe And Cigarette) And Participants\u27 Bmi Across Various Sociodemographic Groups In Arab Countries In The Mediterranean Region

INTRODUCTION Tobacco smokers are at high risk of developing severe COVID-19. Lockdown was a chosen strategy to deal with the spread of infectious diseases; nonetheless, it influenced people\u27s eating and smoking behaviors. The main objective of this study is to determine the impact of the COVID-19 lockdown on smoking (waterpipe and cigarette) behavior and its associations with sociodemographic characteristics and body mass index. METHODS The data were derived from a large-scale retrospective cross-sectional study using a validated online international survey from 38 countries (n=37207) conducted between 17 April and 25 June 2020. The Eastern Mediterranean Region (WHO-EMR countries) data related to 10 Arabic countries that participated in this survey have been selected for analysis in this study. A total of 12433 participants were included in the analysis of this study, reporting their smoking behavior and their BMI before and during the COVID-19 lockdown. Descriptive and regression analyses were conducted to examine the association between smoking practices and the participant\u27s country of origin, sociodemographic characteristics, and BMI (kg/m2). RESULTS Overall, the prevalence rate of smoking decreased significantly during the lockdown from 29.8% to 23.5% (p\u3c0.05). The percentage of females who smoke was higher than males among the studied population. The highest smoking prevalence was found in Lebanon (33.2%), and the lowest was in Oman (7.9%). In Egypt, Kuwait, Lebanon, and Saudi Arabia, the data showed a significant difference in the education level of smokers before and during the lockdown (p\u3c0.05). Smokers in Lebanon had lower education levels than those in other countries, where the majority of smokers had a Bachelor\u27s degree. The findings show that the BMI rates in Jordan, Lebanon, Oman, and Saudi Arabia significantly increased during the lockdown (p\u3c0.05). The highest percentages of obesity among smokers before the lockdown were in Oman (33.3%), followed by Bahrain (28.4%) and Qatar (26.4%), whereas, during the lockdown, the percentage of obese smokers was highest in Bahrain (32.1%) followed by Qatar (31.3%) and Oman (25%). According to the logistic regression model, the odds ratio of smoking increased during the pandemic, whereas the odds ratio of TV watching decreased. This finding was statistically significant by age, gender, education level, country of residence, and work status. CONCLUSIONS Although the overall rates of smoking among the studied countries decreased during the lockdown period, we cannot attribute this change in smoking behavior to the lockdown. Smoking cessation services need to anticipate that unexpected disruptions, such as pandemic lockdowns, may be associated with changes in daily tobacco consumption. Public health authorities should promote the adoption of healthy lifestyles to reduce the long-term negative effects of the lockdown

COVID-19 and Substance Use Disorders:Recommendations to a Comprehensive Healthcare Response. An International Society of Addiction Medicine (ISAM) Practice and Policy Interest Group Position Paper

Coronavirus disease 2019 (COVID-19) is escalating all over the world and has higher morbidities and mortalities in certain vulnerable populations. People Who Use Drugs (PWUD) are a marginalized and stigmatized group with weaker immunity responses, vulnerability to stress, poor health conditions, high-risk behaviors, and lower access to health care services. These conditions put them at a higher risk of COVID-19 infection and its complications. In this paper, an international group of experts on addiction medicine, infectious diseases, and disaster psychiatry explore the possible raised concerns in this issue and provide recommendations to manage the comorbidity of COVID-19 and Substance Use Disorder (SUD).Publisher PDFPeer reviewe

A 10 year retrospective study of the National Rehabilitation Centre Abu Dhabi: Trends, population characteristics, associations and predictors of treatment outcomes

Data extracted from case notes of all NRC patients from February 2002 to August 2011were analyzed to obtain a descriptive profile and changes in trends during this period. The data were extracted manually using a template and entered into a spreadsheet for analysis. During the period under consideration only male patients were admitted to the NRC. Data were available on 591 patients to be included in the study. The results showed that the average age of the patients was 32.4 years, 42% were married, 44% were single and 13% were divorced. A very high percentage, 60%, was unemployed and 32% were employed or were students. Fifty-one percent% had not completed their secondary education, 33% had completed secondary education and 16% had post-secondary education. The main substance of abuse was alcohol (41%), followed by heroin (16%), marijuana (11%), Benzodiazepines (6%), inhalants (2%), amphetamines (2%). Other substances (20%) included prescription drugs, including. Painkillers such as Tramadol, Methadone, and codeine, sedatives such as Xanax and Valium, and substances such as Kemadrine, Artane and Khat amounted to 20%. Fifteen-percent of all patients tested positive for Hepatitis C, 2% positive for Hepatitis B and there we no reports of HIV. The presence of co-morbid psychiatric illnesses ranged from 9% to 25% depending on the substance of abuse. The changes in trends in the main drugs of abuse as well as other analysis of patterns of use are reported. Comparisons of the findings with other studies in the region, implications of the findings, the limitations of the study, as well as areas for future research are discussed

ALCOHOL POLICY IN MUSLIM MAJORITY COUNTRIES

Background: Due to the Islamic prohibition of alcohol consumption in Muslim Majority Countries (MMCs), alcohol policy research has been limited. However, consumption in MMCs has recently increased. Also, globalization and governmental transition can all affect alcohol policy development. This research examines the extent of civil alcohol prohibition in MMCs. Using Iran as a case study, it describes how alcohol prohibition can be translated into policy, including alcohol treatment policy, in a MMC. Methods: The research was conducted in three languages: Arabic, Persian and English. Policy analysis drew on case study and qualitative research methods and narrative synthesis for literature review. For Iran, publicly available literature and policy documents were collected, and information verified through consultation. Newspapers were reviewed over three time periods. Walt & Gilson’s framework was used to identify alcohol policy content, context, actors and process, including in treatment policy. Results: Four broad approaches to civil alcohol policy in MMCs were identified. From the 50 MMCs, only five have total prohibition, 10 have prohibition with concessions, others have restriction or regulation policies. Despite its approach of prohibition with concessions for non-Muslims, Iran has used nine out of ten recommended WHO alcohol policy strategy domains in a context-specific way. Pricing and taxation is not used. Iran has started a multisectoral approach to treatment of unhealthy alcohol consumption. Conclusion: MMCs face challenges in creating alcohol policies. Many have implemented civil alcohol policies that are not limited to Islamic prohibition. However, WHO alcohol policy assessment tools do not detect many MMC alcohol policies, because tools were designed for non-Muslim and developed countries. Policy formation in MMCs could benefit from external expert support and relevant research

Experiences of young smokers in quitting smoking in twin cities of Pakistan : a phenomenological study

Background: Smoking is highly prevalent in Pakistan claiming the lives of over 100,000 individuals every year. A significant proportion of smokers (24.7%) make an attempt to quit each year but 97.4% fail to quit successfully. Little is known about the reasons for, and experiences of, failed quit attempts. This study was carried out to explore the experiences of young male smokers in quitting smoking in the twin cities of Pakistan Method: A qualitative study was carried out using a phenomenological approach in Rawalpindi and Islamabad. A total of 11 participants were interviewed. All study participants were male and had made at least one quit attempt. Study participants were a mix of smokers who failed to quit smoking, intermittent smokers and successful quitters. Streubert’s (1991) method of phenomenology was followed during data analysis. Results: The experiences of smokers while smoking “the smoking phase” have major effects on their journey towards quitting smoking. The smoking phase consists of three major stages: contact with initial smoking stimuli, the journey from first puff to enjoying smoking and then finally smoking becoming part of life. However, the journey towards quitting smoking is not as simple as the journey towards becoming a smoker. Instead, smokers get trapped in three overlapping cycles of smoking and quit attempts: smoking & forced quitting, smoking & intentional quitting, and smoking & intermittent smoking before successful quitting. Breaking the cycle is not easy in the presence of trapping factors (addiction, high availability, easy affordability, conducive social setup and low perceived risks of smoking). Three factors play a major role in breaking these cycles which are strong will power, continuous peer support and avoidance of smokers’ company. Conclusion: A young smoker, during his experience of quitting smoking gets entrapped in several overlapping cycles of smoking & quit attempts before successful quitting. There are known entrapping factors as well as factors which help in breaking these cycles. Targeted interventions are needed to facilitate smoking cessation among young smokers in Pakistan

Hospitalised Saudi problem drinkers: A psychosocial profile

Many characteristics of those entering alcohol treatment in Saudi Arabia remain unknown. Above all, their psychosocial characteristics and their patterns of drinking. In order to provide adequate and effective treatment and prevention intervention, it is necessary, before anything else, to elicit the facts about those with alcohol problems. As part of solving the mystery of alcohol problems in Saudi Arabia, the main objective of this research is to draw a general profile and investigate the patterns of drinking of hospitalised problem drinkers in Saudi Arabia. To achieve this goal, 136 hospitalised patients and 11 therapists were interviewed. The interviewed patients consisted almost entirely of male patients who, at the time of data collection, were hospitalised for having an alcohol problem in four of Saudi Arabia's treatment hospitals (Al-Amal hospitals in Riyadh, Jeddah, Dammam, and Qaseem). Two instruments were implemented for use with the patients. The first was a comprehensive instrument devised by the researcher to elicit information regarding the psychosocial profile of hospitalised problem drinkers. The second was the Alcohol Use Disorders Identification Test (AUDIT), which was used to identify problem drinking as well the frequency and the quantity of drinking. The therapists, however, were selected from Al-Amal hospital in Riyadh. Unlike the patients' interviews, the therapists' interviews were semi-structured and were aimed at eliciting more information regarding problem drinking and its treatment from the therapist's point of view. The results showed that a typical profile of a hospitalised Saudi problem drinker is that he is most likely to be of younger age (20-35 years old), married, of little education (high school or less), on a low income (less than 3000SR), and unemployed. In addition, if currently or previously employed, the hospitalised Saudi problem drinker is likely to hold an administrative post, live in a city, occupy a house which is owned by others and shared with seven people or more. The parents of a typical hospitalised Saudi problem drinker are most likely not living together, as a result of either separation, divorce or the death of one or both of them. The parents are most likely to be illiterate, and have a history of remarriage. Furthermore, if married or previously married, the hospitalised Saudi problem drinker is most likely to have an uneducated housewife and more than three children. Contrary to the drinking practices in many countries where alcohol is allowed, araq and cologne are the most common types of alcohol consumed by hospitalised problem drinkers. Although it is forbidden, alcohol is easily accessible, especially in the form of cologne. Alcohol drinking mostly takes place in hidden places, at home, in private resorts or outside the city. Many hospitalised problem drinkers restrict the time of their drinking to weekends. Another finding of this research shows that about a quarter of the patients are not really alcohol dependants. Most hospitalised problem drinkers, including those with high alcohol dependence, abstain during the holy month of Ramadan. The majority of hospitalised problem drinkers are smokers (cigarettes and shisha), and users of illegal drugs (hashish is the commonest). The interviews with therapists confirmed many of the research findings produced by investigations of the patients. Also, they provided many suggestions regarding the improvement of treatment and prevention of alcohol problems in Saudi Arabia. The implications of the research findings are discussed in depth in the last chapter

An epidemiological investigation of health-related behaviours among male high school adolescents in Riyadh, Saudi Arabia

PhD ThesisObjective: Little is known about health-related behaviours and their co-occurrence among male adolescents in Saudi Arabia. The main purpose of this study was to determine the prevalence of health related behaviours, and to investigate the associations between socio-demographic variables and health related behaviours and the clustering of health risk behaviours. Research Methods: A cross-sectional study using a self-completion anonymous questionnaire was undertaken between February and April, 2008. A stratified random sample of 1501 male adolescents was recruited from one private and public high school in each of the five districts in the city of Riyadh, Saudi Arabia. Main Outcome Measures: Prevalence and associations between health, social and demographic factors and health-related behaviours, including dietary behaviours, oral health, physical activity, smoking, violence, injuries and safety, and mental health factors. Results: The results of this study showed that only 24.2% and 39.9% of the students consumed fruit and vegetables on a daily basis (at least once every day), and only 7% and 13.7% ate fruit and vegetables 3 times or more every day. Also, only 52.4% consumed dairy products at least once every day and only 18.3% of the students consumed dairy products 3 times or more every day. 48.1% reported to not consume any fish products on any day of the week. About 48.7%, 60.2% and 25.2% of the students consumed sweets, soft drinks, and energy drinks at least once every day. The results of this study also showed that only 36.7% of students eat breakfast regularly (≥ 5 days per week). Eating breakfast regularly was positively associated with lower age, liking school, good academic performance, not eating high fat food every day, drinking soft drinks ≤ 1 time/day, drinking milk every day, low BMI, brushing teeth every day, physical activity ≥ 3 days/week, and not engaging in physical fights. Around half (51.3%) participants reported good teeth health status, 22.6% brushed their teeth two times daily, 29.7% brushed their teeth once daily, whereas 47.7% of the subjects do not brush their teeth daily and 54.3% never visited the dentist during the past year. About 29.5% of participants suffered teeth pain sometimes or most of the time and 16.4% missed some school days for this reason. Brushing teeth every day was positively associated with higher standards of parental education, attending private school, living district, good academic performance, liking school, visiting dentist during the last year, good teeth status, and not suffering from teeth pain. Only 18.4% of the students were physically active and only 65.2% participated in physical activity classes in schools. Regular physical activity was positively associated with younger age, liking school, good health status, lower BMI, father’s, mother’s, siblings’ and peers’ physical activity, not smoking, not fighting, not wanting to use drugs or alcohol, and not feeling lonely. Over a third (36.3%) of the participants were overweight or obese. A fifth (20.8%) of the adolescents were current smokers. 20.8% of the students were current smokers. Smoking among students was positively associated with higher age, studying in private school, poor health status, poor school performance, not liking school, father smoking, mother smoking, sibling smoking, peers smoking, low physical activity, wanting to use drugs and alcohol, carrying weapons, fighting, performing car drifting, and being abused by teachers. ii Over half the sample (55.5%) reported an injury, 21.8% had been threatened or injured by weapons. Just under half (49%) of the adolescents reported they were involved in a physical fight. Moreover, fighting among students was positively associated with the interaction of low parental education, not liking school, poor academic performance, skipping breakfast, low physical activity, current smoking, being threatened or injured by weapons, carrying weapons, joining people performing car drifting, bullying others, being abused by teachers. Carrying weapons during the last 30 days was reported by 36.6% of the sample. Carrying weapons was positively associated with higher age, not liking school, poor academic performance, current smoking, fighting, being threatened or injured by weapons, performing car drifting, joining people performing car drifting, taking part in bullying others, and being abused by family. Some (26.1%) of participants reported having been bullied and 24.6% of the students reported bullying others. Many of the adolescents reported being abused by a family member (34.4%) or one of their school teachers (39.5%) during the past 12 months preceding the survey. During this time period, many of the students reported feeling lonely (22.8%), feeling very worried about something that they could not sleep at night sometimes or more (27.0%), and feeling very sad or hopeless almost every day for two weeks or more (40%). About 14% of the participants in this study reported that they had wanted to use alcohol or drugs. A small but notable proportion (13.9%) of the participants reported that they had thought of attempting suicide and 6.9% had actually attempted suicide. Over a third (36.1%) of adolescents had performed car drifting 12 months preceding the survey. However, car drifting was positively associated with higher age, attending a private school, not liking school, poor academic performance, not brushing teeth every day, current smoking, wanting to use drugs and alcohol, carrying weapons, joining people who performing car drifting, bullying others, and attempting suicide. The majority (78.7%) of participants drove vehicles and 96% and 97.7% reported that they did not use a seat belt when doing so and did not use a seat belt when riding in a car as a passenger, respectively. Only 2.1% and 1.4% of participants wore a helmet when used motorized vehicle or nonmotorized. Conclusions and implications: The results of this study reveal that the adolescents engage in multiple health-risk behaviours, and these risk behaviours are relatively common among adolescents and cluster together. Health related behaviours are associated with several socio-demographic variables (age, father’s and mother’s education, school factors, health status and living districts), although not necessarily in the same order. However, the data emphasized the need for further quantitative and indepth qualitative research throughout Saudi Arabia, including other cities, rural communities, female adolescents, and other Middle Eastern countries. Cross-sectional research to gather evidence on youth health to collect population-based data on a range of health-related behaviours along with physical and social environments amongst school-age students and out-of-school youth facilities are important and highly needed to investigate health-related behaviours and associated risk factors and to measure change over time

Development of a Theory and Evidence-based Public Health Weight Management Intervention for Female University Students in the Kingdom of Saudi Arabia

Saudi female university students are particularly vulnerable to weight gain, with 48% of this population being overweight or having obesity, contributing to non-communicable diseases. To address this public health issue, my current research aimed to develop a weight management intervention based on the Behaviour Change Wheel (BCW) framework, targeting female university students who are overweight in Kingdom of Saudi Arabia (KSA), using a theoretically-driven systematic approach. The research comprised five stages. First, I conducted a systematic review to identify effective weight management interventions for female university students, including successful behaviour change techniques (BCTs) and programme lengths. Effective weight management interventions used a combination of interventions with the support of particular BCTs and lasted 12+ weeks. Stage two involved conducting focus group discussions with 18 female university students to identify barriers and facilitators to healthy eating, physical activity and attending a weight management programme. The Theoretical Domains Framework (TDF) and the BCW were used to identify additional BCTs to incorporate into the programme. Findings pointed to multiple personal, social, and environmental factors influencing weight management, including several specific culture of KSA, such as food and hospitality norms. In Stage three, these findings were combined with existing evidence to inform the design of the weight management programme entitled Better Healthy Lifestyle (BHL). Stage four involved conducting a feasibility study with 15 female, overweight university students. The programme included 12 sessions focusing on nutrition and physical activity education and specific BCTs to promote weight loss. Overall, the study was feasible, but it highlighted the need to assess target behaviours and acceptability. Finally, I interviewed 14 feasibility study participants to explore the effects of the BHL programme. Participants reported experiencing significant changes in self-perception and self-belief that facilitated behaviour change maintenance post-intervention and during the COVID-19 pandemic