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International Journal of Adolescent Medicine and Health

Editor-in-Chief: Merrick, Joav

Editorial Board Member: Birch, Diana ML / Blum, Robert W. / Greydanus, MD, Dr. HC (Athens), Donald E. / Hardoff, Daniel / Kerr, Mike / Levy, Howard B / Morad, Mohammed / Omar, Hatim A. / de Paul, Joaquin / Rydelius, Per-Anders / Shek, Daniel T.L. / Sher, Leo / Silber, Tomas J. / Towns, Susan / Urkin, Jacob / Verhofstadt-Deneve, Leni / Zeltzer, Lonnie / Tenenbaum, Ariel

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

1 / Jihen Maatoug1 / Imed Harrabi1 / Sonia Hmad1 / Mmyléne Belkacem1 / Slim Slama2 / Mustafa al’Absi3 / Harry Lando4 / Hassen Ghannem1

1Department of Epidemiology, University Hospital Farhat Hached, Sousse, Tunisia

2Department of Community Medicine, Primary care and Emergency, University Hospitals of Geneva, Switzerland

3Duluth Medical Research Institute, University of Minnesota, MN, USA

4Department of Epidemiology and Community Health, University of Minnesota, MN, USA

Corresponding author: Asma Nouira, Department of Epidemiology, University Hospital Farhat Hached, Sousse, Tunisia, E-mail:

Citation Information: International Journal of Adolescent Medicine and Health. Volume 26, Issue 2, Pages 267–273, ISSN (Online) 2191-0278, ISSN (Print) 0334-0139, DOI: 10.1515/ijamh-2013-0511, July 2013

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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 habits.

Keywords: risk factors; smoking habits; schoolchildren

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International Journal of Adolescent Medicine and Health, 2016, Volume 0, Number 0

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