Health-Related Behaviours among Adolescents in Saudi Arabia: A Comparison Between Adolescents in Cities that Have Implemented the WHO Healthy Cities Programme and Other Cities that Have Not in the Qassim Region

Abstract

<p>There is growing evidence that morbidity and mortality in later life are linked to health risk behaviours initiated during the adolescence period. Adolescence is a critical period of peoples’ life and is influenced by physical, psychological, and emotional challenges. There is a need for a thorough understanding of adolescents’ health risk behaviours to enable behavioural modification approaches to promote healthy behaviours during this challenging period of life. This thesis presents five published manuscripts that are focused on three key health risk behaviours prevalent in Saudi Arabia, namely smoking, physical inactivity and poor dietary practices. The first two manuscripts are systematic review articles that were aimed to provide a review of the current evidence related to the prevalence and determinants of smoking, physical inactivity, and poor dietary practices among the adolescents in Saudi Arabia. In the context of this thesis, the key findings and conclusions of these systematic reviews were significant and contributed to shaping the research direction presented in later chapters. These systematic review chapters are followed by three original research articles that were aimed to investigate the prevalence and determinants of smoking, insufficient physical activity and poor dietary practice among the adolescents and compare these behaviours between the cities which has implemented the World Health Organization’s (WHO) Healthy Cities Programme (HCP) and the cities which has not implemented such programme in the Qassim region, Saudi Arabia, respectively.</p> <p>Using multi-stage cluster sampling with probability proportionate to size, I surveyed 1133 school-going adolescents from three HCP cities and three NHCP cities in the Qassim region, Saudi Arabia, between April and September 2017. Multivariable logistic regression analyses were conducted to investigate the predictors of insufficient levels of PA and excessive screen time.</p> <p>The prevalence of smoking among school-going adolescents in the Qassim region was 5.2%. Among the socio-demographic variables, smoking was significantly associated with gender, age, and academic performance. The prevalence of smoking among the adolescents was significantly higher in HCP cities than in NHCP cities. The prevalence of < 60 minutes of moderate-to vigorous-intensity physical activity/day was 82.4% and < 3 days of vigorous intensity physical activity/week among adolescents was 59%. There was no significant association between the level of physical activity and the HCP city. The odds of insufficient daily PA are higher among girls than boys. Increasing age is positively associated with insufficient weekly PA). The prevalence of daily breakfast consumption was 27.7% among the adolescents. Prevalence of daily vegetables, fruits and milk or milk products consumption was 35.9%, 28.6% and 51.1%, respectively. Meanwhile, the prevalence of daily consumption of fast-food and carbonated drinks was 7.5% and 37.1%, respectively. No evidence of a significant association was found between living in the HCP cities and daily intake of breakfast, fruits, vegetables, or milk/milk products, and the daily intake of fast-food or carbonated drinks. This research reports that adolescents in Saudi Arabia are involved in several health risk behaviours including smoking, physical inactivity, and unhealthy diet. However, the study did not find significant differences in the prevalence of these health risk behaviours between adolescents living HCPs and those living in NHCPs. Such findings add considerably to the existing literature and are important as they emphasize the need for further research on the HCP in Saudi Arabia to measure the efficacy of these programmes. Adolescents in Saudi Arabia deserve greater attention from policymakers to meet their health needs in future public health programmes.</p>