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International Journal of Adolescent Medicine and Health

Editor-in-Chief: Merrick, Joav

Editorial Board: 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

CiteScore 2018: 0.79

SCImago Journal Rank (SJR) 2018: 0.350
Source Normalized Impact per Paper (SNIP) 2018: 0.476

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Volume 31, Issue 4


Clustering of chronic diseases risk factors among adolescents: a quasi-experimental study in Sousse, Tunisia

Emna Dendana
  • Department of Epidemiology, University Hospital Farhat Hached, Sousse, Tunisia
  • Department of Endocrinology, University Hospital Farhat Hached, Sousse, Tunisia
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Rim Ghammem / Jihene Sahli
  • Corresponding author
  • Department of Epidemiology, University Hospital Farhat Hached, Sousse, Tunisia, Phone: 00216 73 219 496, Fax: 00216 73 226 702
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Jihen Maatoug / Sihem Ben Fredj / Imed Harrabi / Molka Chaieb / Hassen Ghannem
Published Online: 2017-06-21 | DOI: https://doi.org/10.1515/ijamh-2017-0022



The objective of the study was to evaluate the effectiveness of a school-based physical activity and nutritional behavior intervention, on the reduction of clustering of chronic diseases risk factors among school children.

Materials and methods

A quasi-experimental school-based intervention was conducted with an intervention group and a control group in the region of Sousse in Tunisia. The intervention was implemented between 2010 and 2013, with data collected at pre and at post intervention. Studied risk factors were: smoking, sedentary behavior, low fruit and vegetable intake and obesity. Odds ratios (ORs) were used to calculate the clustering of two risk factors. We calculated ORs in each group before and after the intervention.


In the intervention group, the prevalence of adolescents that had no risk factors has significantly increased (p = 0.004). In the control group the prevalence of adolescents carrying two or more risk factors has increased (p = 0.06). The results showed that all risk factors tended to cluster together in both groups. In the intervention group, the calculated OR for smoking and sedentary behavior decreased after assessment (OR = 5.93) as well as the OR for smoking and low fruit and vegetable intake (OR = 3.26). In the control group, all ORs increased, showing an enhancement of the association.


This study showed the effectiveness of a school-based intervention in reducing the clustering of chronic diseases risk factors.

Keywords: adolescent; chronic diseases; cluster analysis; risk factors


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About the article

Received: 2017-02-08

Accepted: 2017-03-22

Published Online: 2017-06-21

Citation Information: International Journal of Adolescent Medicine and Health, Volume 31, Issue 4, 20170022, ISSN (Online) 2191-0278, DOI: https://doi.org/10.1515/ijamh-2017-0022.

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