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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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Volume 26, Issue 2 (May 2014)


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

Asma Nouira
  • Corresponding author
  • Department of Epidemiology, University Hospital Farhat Hached, Sousse, Tunisia
  • Email:
/ Jihen Maatoug
  • Department of Epidemiology, University Hospital Farhat Hached, Sousse, Tunisia
/ Imed Harrabi
  • Department of Epidemiology, University Hospital Farhat Hached, Sousse, Tunisia
/ Sonia Hmad
  • Department of Epidemiology, University Hospital Farhat Hached, Sousse, Tunisia
/ Mmyléne Belkacem
  • Department of Epidemiology, University Hospital Farhat Hached, Sousse, Tunisia
/ Slim Slama
  • Department of Community Medicine, Primary care and Emergency, University Hospitals of Geneva, Switzerland
/ Mustafa al’Absi
  • Duluth Medical Research Institute, University of Minnesota, MN, USA
/ Harry Lando
  • Department of Epidemiology and Community Health, University of Minnesota, MN, USA
/ Hassen Ghannem
  • Department of Epidemiology, University Hospital Farhat Hached, Sousse, Tunisia
Published Online: 2013-07-26 | DOI: https://doi.org/10.1515/ijamh-2013-0511


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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About the article

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

Received: 2013-03-09

Accepted: 2013-05-15

Published Online: 2013-07-26

Published in Print: 2014-05-01

Citation Information: International Journal of Adolescent Medicine and Health, ISSN (Online) 2191-0278, ISSN (Print) 0334-0139, DOI: https://doi.org/10.1515/ijamh-2013-0511. Export Citation

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