Long term effect of a school based intervention to prevent chronic diseases in Tunisia, 2009-2015

Background & Objectives: We aimed to evaluate the long term effect of school based intervention to prevent non- communicable disease risk factors.Methods: It was a quasi experimental study conducted during the period of 2009-2015. We involved school children aged from 11 to 16 years old. For the assessment of the program’s effectiveness, subjects in both groups were examined at baseline, at the end of the 3-year intervention period and at the follow-up, one year after program’s cessation.Results: In the intervention group, the prevalence of school children who reported to be eating 5 fruits and vegetable sdaily increased significantly from 30.0% at pre-assessment to 33.2% at post-assessment, one year after (p=0.02, p=0.41 respectively). For the control group, this prevalence had significantly decreased from 40.2% at baseline to 35.0% at post-intervention, at the follow up, this proportion increased to 44.5%(p=0.001, p<10-3 respectively). Concerning smoking habits, we observed a decreasing trend in the intervention group from 5.7% at pre-assessment, to 4.8% at post-assessment and to 3.4% at the follow-up (p=0.19 and p=0.25 respectively). There was also a significant decrease in school children who did recommended physical activity in the same group.Conclusion: The present work showed that interventions promoting healthy lifestyles should be maintained. Developing countries should be encouraged and supported to design, conduct, and evaluate robust preventive interventions.Keywords: Schools, lifestyle, intervention

Clustering of risk factors in the smoking habits of schoolchildren in Sousse, Tunisia

Background: In Tunisia, little is known about the association between tobacco use and other chronic disease risk factors. This is the case for both adults and children. It is important to know the characteristics of young smokers to facilitate the creation and implementation of future programs for tobacco prevention. Aim: The aim of this study was to determine the association between tobacco use and other lifestyle factors among schoolchildren in Tunisia. Methods: We conducted a 2009/2010 cross-sectional questionnaire survey of 4003 randomly selected school children aged 13 years old (7th and 9th grades) to evaluate their knowledge, attitudes towards, and beliefs about the three risk factors for chronic disease (unhealthy diet, physical inactivity, and tobacco use). Written informed consent was obtained from each child's parents who allowed their child to participate. Results: The mean age of our sample was 13.36±1.28 years. The proportions of daily smokers were 2.2% and 0.1% among boys and girls, respectively. The proportions of irregular smokers were 9.1% and 1.5% among boys and girls, respectively. In our population, 19.1% (n=767) had ever experimented to smoke, with 29.8% among boys and 9% among girls (p<0.001). The proportions of schoolchildren who reported daily participation in physical activity were different between smokers and nonsmokers with 17.7% and 11.5%, respectively (p=0.03). Concerning eating habits, there was no significant difference in the consumption of fruits and vegetables; however, smokers frequently ate more high fat foods and in fast food restaurants. Similar results were found while comparing regular smoking children with those who experimented but who never became hooked on smoking. Conclusion: This study and previous research suggest the importance of early intervention in adolescents on smoking and combing these efforts with interventions focusing on physical activity and dietary habit

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

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

Challenges and results of a school-based intervention to manage excess weight among school children in Tunisia 2012-2014

Obesity is a serious health issue and predisposes individuals to an increased risk of morbidity and mortality. Its prevalence in children has increased worldwide

Challenges and results of a school-based intervention to manage excess weight among school children in Tunisia 2012-2014

AbstractBackground: Obesity is a serious health issue and predisposes individuals to an increased risk of morbidity and mortality. Its prevalence in children has increased worldwide. Objective: To demonstrate the feasibility and effectiveness of a school-based management program based on healthy lifestyle promotion for obese and overweight adolescents in Sousse, Tunisia. Methods: We conducted a quasi-experimental study among overweight and obese school children enrolled in 7th and 8th grades in Sousse, Tunisia with two groups, intervention and control. The 1-year intervention was based on promoting healthy eating and physical activity through a collective intervention for all recruited children and an individual intervention only for obese children who require intensive managing. Data collection was done before, at the end and at a 4-month follow up of the intervention, both in intervention and control groups. Results: The body mass index Z score decreased significantly from pre-intervention to post-intervention (1.89±0.57 to 1.76±0.63, p<0.001) and from post-intervention to the follow-up (1.76±0.63 to 1.55±0.68, p<0.001) in the intervention group. In the control group, it decreased significantly from pre-intervention to post-intervention but not significantly from post-intervention to follow-up assessment. Calorie intake decreased significantly both in intervention and control groups. Conclusion: This project began with introducing a new culture of health management in schools on one side and with increasing awareness of the importance of obesity prevention and treatment. The support of authorities for this type of action is very important to guarantee its sustainability