Challenges and lessons learnt from a workplace based program to control tobacco use in Tunisia 2009-2014

Background Tobacco use has become the leading preventable cause of death worldwide. Therefore, Tunisia has ratified the WHO Framework Convention on Tobacco Control in 2010. Objectve: We aimed to outline an experience of implementing a workplace based program of tobacco control in Sousse, Tunisia (2009-2014) in order to identify barriers and recommendations for future interventions in low and middle income countries. Methods We conducted a quasi-experimental study among a representative sample of employees in Sousse, Tunisia with two groups, intervention and control. Our three years workplace program consisted of a collective intervention (Smoking free workplace, open sensitization day : films and workshops on tobacco harmful effects) and an individual one (Free clinics for tobacco cessation offering free nicotine replacement therapy products). Participants enrolled at the pre intervention and post intervention assessments belonged to two independant samples in each group. Results Overall, the intervention showed positive effets in improving the knowledge of the participants on the harmful effects of active and passive smoking and on light cigarettes. The intervention was associated to a significant increase of the employers involvment in tobacco control efforts. Regarding the smoking behaviors, in the intervention group, the prevalence of tobacco use decreased from 39.2% at the pre-assessment to 37.5% at the post assessment (p=0.43) with no substantial difference in the number of cigarettes consumed. Conclusions Despite the absence of positive effect of this project on smoking behavior, severall lessons may be deducted and it would be therefore considered as a corner stone. The fight against tobacco use is dependent on deep environmental changes. The role the employer is crucial but not sufficient. A multisectoral approach garanteeing an actual involvement of all the stakeholders and topped by a political will is strongly needed

Second hand smoking among schoolchildren in the region of Sousse

Background Secondhand smoke (SHS) contains an estimated 4000 toxic chemicals and is a serious health hazard to non-smokers. Exposure to tobacco smoke causes extremely serious damages, placing exposed persons at increased risk of a number of adverse health outcomes, such as asthma, lung cancer and cardiovascular diseases. In this context, this work was carried out in order to evaluate exposure to smoking among schoolchildren in the region of Sousse. Methods We conducted a cross sectional design study among a representative sample of students from all colleges in the delegation of Sousse Jawhra and Sousse Erriadh. We used an Arabic, pre tested and self administered questionnaire to collect data about Socio -demographic characteristics and student's smoking behavior. Results Our population was composed of 2170 students. Girls accounted for 1100 (51.3%) and 1070 (48.7%) boys. The mean age of our population was 13.23±(1,19). The prevalence of smoking in our population was 4.8%. In the month preceding our study 75% of our population was exposed to a second-hand smoking. 36.7 % was exposed at home and almost one third (27.3%) at school. But second hand smoking was affecting smoking and non smoking students. We noticed that 74.5% of non smoker were exposed to secondhand smoking despite the that the majority (92.0 %) knew that second hand smoking is dangerous . We highlighted also that non-smokers were significantly more in favor of implementing tobacco control laws (94.6% vs 94% of smokers ; p=0.02). Conclusions Exposure to an involuntary smoke is an urgent issue, because there is no safe level of SHS exposure, even minimal exposure is harmful. And as we noticed the Second hand smoking is very high among students in the Sousse region. Therefore there is an urgent need for a program to prevent and control this scourge of active and passive smoking among schoolchildren

Three year school based intervention for Tobacco prevention in the region of Sousse: quasi experimental design 2009-2014

Background Tobacco use is one of the biggest public health threats the world has ever faced. Tunisia is one of the countries suffering from the heavy burden of tobacco use. It is in this context that the Chronic Disease Prevention Research Center in Sousse established a school based intervention for tobacco control and prevention. Our objective was to evaluate the feasibility and effectiveness of our intervention in tobacco control and prevention by the evaluation of smoking behavior among schoolchildren at pre and post assessment in both intervention and control groups. Methods We conducted a three years school based quasi-experimental study with an intervention and a control groups. We enrolled a representative sample of schoolchildren from all colleges of intervention and control areas. We have carried out a pre-assessment before the intervention in 2009-2010 and a post assessment of the same parameters at the end of the intervention in both groups in 2013-2014. We used a pre tested self administered questionnaire to assess tobacco use. Results Overall, 4003 schoolchildren were included: 1929 in the intervention group and 2074 in the control group. After the intervention, 4275 schoolchildren participated in the evaluation with respectively 2170 and 2105 in each group. The age of the schoolchildren varied between 11 and 16 years. There was a decrease in tobacco use in the intervention group from 5.7% to 4.8% contrary to an increase in the control group from 7.5% to 9.2%. Among boys, the prevalence of tobacco use decreased in both groups. However, among girls, in the intervention group a decrease was noticed in the contrary to the control group where a significant increase was observed from 1.1% to 5.2%. Conclusions Tobacco prevention needs multi-sectored approach and an extended intervention to be effective. That's why a political will is important for such interventions

Tobacco use: the most influential risk factor on cannabis use among middle schoolchildren in Sousse, Tunisia

Background Early adolescence is a critical period usually associated with substances experimentation. In Tunisia, some studies were carried out recently to evaluate tobacco and cannabis use in the colleges and high schools. However, few studies were led in the middle schools. While onset of substances use usually occur during early adolescence. Aims: To evaluate the prevalence of tobacco and cannabis use and to determine if there is an association between their use among the young adolescents of Sousse. Methods A cross-sectional study was conducted in the region of Sousse, Tunisia during the 2013/2014 school year among a proportional and stratified sample of 4272 schoolchildren randomly selected in 16 public middle schools from the region of Sousse. Data about sociodemographic characteristics, tobacco products and cannabis use among the schoolchildren, their parents, their siblings and their friends were collected using a self administrated questionnaire. Results Females represented 50.5% (2157) of participants. The mean age of schoolchildren was 13.3 ±1.2 years. Among participants, 12.9% (CI 95% : 11.9%-13.9%) reported lifetime tobacco use, 4.5% (CI 95% : 3.9%-5.1%) were current cigarette smokers, 3.2% (CI 95% : 2.7%-3.7%) were current water pipe users and 1.9% (CI 95% : 1.5%-2.3%) reported lifetime cannabis use. The age of tobacco use onset (11.2 ±2.7 years) was significantly inferior to the age of cannabis use onset (13.1±2 years) (p< 0.001). The most influential risk factor on cannabis use was current cigarette smoking with an adjusted odds ratio of 7.3 (CI 95% : 4.2-12.5). Conclusions National school-based substances use prevention program is required in Tunisia. Tobacco use prevention deserves more efforts as it is a gateway to other substances use such cannabis