Cross-sectional study of co-occurring addiction problems among high school students in Tunisia.

Background: Addictive behaviours are a major public health problem, especially among adolescents, who are susceptible to experiencing multiple co-occurring addictions. Aim: To assess the prevalence of addiction problems and co-occurrences of addictive behaviours (substance abuse, problematic video gaming and social media addiction) and disorders among high school students in Sousse, Tunisia. Methodology: A cross-sectional study was conducted in 2018 in public high schools, in the urban area of Sousse, Tunisia. A structured self-administered questionnaire was used to obtain relevant information from the students. Statistical analysis was performed using SPSS version 10 and confidence intervals of 95% were calculated. Chi-square test was used to compare qualitative variables and multinomial regression was conducted to determine independent factors related to the number of addictive behaviour co-occurrences. Results: Of the 1399 high school students, 60.5% were girls and mean age was 17 ± 2.28 years. Analysis of single addiction problems revealed 20.9% prevalence for all tobacco products, 10.1% for alcohol, 7.0% for all drugs, 36.1% for Facebook, and 35.3% for video games. Analysis of co-occurring addiction problems showed that 46.0% of the study population had 1 addiction problem, 12.2% had 2 addiction problems, 4.5% had 3, and 2.7% had the maximum number of 4 addiction problems. Multinomial regression showed an increase in co-occurrence of addiction problems among boys (aOR = 217.004; P < 0.001), participants who had repeated a school grade (aOR = 0.232; P < 0.001), those who had moderate or severe depression (aOR = 0.232; P < 0.001), and those who were anxious (aOR = 0.335; P = 0.003) and had alexithymia (aOR = 0.361; P = 0.005). Conclusion: The rate of co-occurrent addictions among adolescents in Sousse, Tunisia, is alarming. Problematic use of Facebook, gaming and tobacco use were the most frequent addictive behaviours. There is an urgent need for effective and multisectoral programmes to prevent addictions among children in Tunisia and other countries in the Middle East and North Africa Region.

Surveillance of tobacco use among young adolescents: trends and predictors across three years in Sousse, Tunisia.

BACKGROUND: In developed countries, there was an overall decrease in tobacco use over the last decades. In Tunisia, a national strategy to reduce tobacco use was set up since 2008. However, this strategy was rarely evaluated. The objective of the current study was to examine the trends in tobacco use among the middle schoolchildren of the governorate of Sousse (Tunisia) between 2014 and 2016 and to determine predictors of its experimentation. METHODS: Three cross-sectional studies were conducted in 2014, 2015 and 2016 school years among middle schoolchildren randomly selected from the governorate of Sousse-Tunisia. The required sample size for each study was 760 participants. Each year, the same procedure was used to recruit pupils from the same middle schools. The same pre-established and pre-tested questionnaire was self-administered anonymously to participants in their classrooms. RESULTS: Lifetime tobacco use rose from 11% in 2014 to 17.3% in 2016 (p = 0.001). Across the 3 years of survey, predictors of lifetime tobacco use were: The male sex (OR, 95% CI: 4.4 [3.2-6.1]), age above 13 (OR, 95% CI: 2.3 [1.7-3.1]), lifetime illicit substances use (OR, 95% CI: 3.9 [1.1- 13.8), lifetime inhalant products use (OR, 95% CI: 2.2 [1.2-4.3]), tobacco use among the father (OR, 95% CI: 2.2 [1.2-4.3]), tobacco use among siblings (OR, 95% CI: 1.7 [1.2-2.4]) and current anxiety symptoms (OR, 95% CI: 1.8 [1.4-2.4]). CONCLUSION: Lifetime tobacco use is in expansion among the young adolescents of Sousse. The current national tobacco prevention program should be strengthened and expanded to cover other substances use issues with emphasis on secondhand smoking and mental health problems.

Screening and health education practices related to cardiovascular risk factors among adults: results of a households survey in Sousse, Tunisia.

In Tunisia, despite the implementation of national strategies to prevent some of cardiovascular risk factors, these diseases still represent the leading cause of death. The current study aimed to determine the prevalence of cardiovascular risk factors and assess the screening and health education practices related to these factors among the adults of Sousse (Tunisia). A cross-sectional study was conducted in 1000 households in Sousse, Tunisia. To collect data, a team of trained medical doctors administered by interview a pre-tested questionnaire and performed blood pressure and anthropometric measures at the participants' homes. In total, 1977 adults participated in the study. Their mean age was 39.8 (± 13.8) years. The Females/Males sex ratio was 1.5. Weight excess and lack of physical activity were found in 65.4% and 60.7% of participants. Screening for obesity and android obesity were reported by 36.6% and 5.7% of health services users. Advices from a healthcare professional to practice the recommended physical activity and eat healthily were reported by less than a third of these latter. Screening and health education practices related to cardiovascular risk factors should be reinforced in the Tunisian healthcare facilities. The implementation of multisectoral actions is necessary at the national level in order to obtain an environment that promotes a healthy lifestyle.

Effectiveness of an osteoporosis prevention educational program in Tunisian premenopausal women working in sedentary occupations: a quasi-experimental study.

The objective of this study was to examine the effectiveness of an osteoporosis prevention program on knowledge and perception of self-efficacy in adopting preventive osteoporosis behaviors in premenopausal women working in sedentary occupations. Results show the improvement in knowledge and self-efficacy was statistically significant respectively (p < 0.001) and (p = 0.001). INTRODUCTION: The main purpose of the study was to evaluate the effectiveness of an osteoporosis prevention educational program on knowledge and perception of self-efficacy in adopting preventive osteoporosis behaviors in Tunisian premenopausal women working in sedentary occupations. METHODS: A quasi-experimental pre-post intervention study design. Our study population was composed of female employees, aged 35-50 years, of a company located in the industrial zone Sousse, situated in the center East of Tunisia. Three data collection methods were used: a questionnaire exploring socio-demographic characteristics and anthropometric measures, the Osteoporosis Knowledge Test, and the Osteoporosis Self-Efficacy Scale. The intervention consisted of an educational program relating to the promotion of calcium intake and physical activity. We are referred to the "Health Belief Model." RESULTS: A survey conducted on 97 women. Only 81 subjects completed the study and are included in data analyses. The total knowledge score regarding osteoporosis improved by + 14.57 which corresponds to percentage of 109% between the pre- (T1) and post-test (T2). This improvement in knowledge was statistically significant (p < 0.001), going from 13.41 ± 3.94 at T1 to 27.98 ± 2.49 at T2. The total osteoporosis self-efficacy score has increased by + 9.56, or a percentage of 15% between the pre- and post-test. This improvement in self-efficacy was statistically significant (p = 0.001), going from 64.18 ± 20.84 at T1 to 73.73 ± 14.35 at T2. CONCLUSION: It is important to create an appropriate environment for the adoption of favorable behaviors to healthy bones and to promote health education with political commitment and collaboration with different sectors.

Studying SARS-CoV-2 vaccine hesitancy among health professionals in Tunisia.

BACKGROUND: People's lives were seriously affected by the emergence and the spread of the COVID-19 disease. Several vaccines were developed in record time to overcome this pandemic. However, putting an end to this public health problem requires substantial vaccination coverage rate. This latter depends on the acceptance of these vaccines especially by health professionals; the leaders of the current war against COVID-19. In fact, they have a central role in promoting vaccination against the SARS-CoV-2. In the developed countries, hesitancy rates towards these vaccines among health professionals vary from 4.3% to 72%. In the developing countries, few studies focused on this issue. OBJECTIVE: To estimate the prevalence and the predictors of SARS-CoV-2 vaccine hesitancy among the Tunisian health professionals. METHODS: A cross-sectional study was led online between the 7th and the 21th of January 2021 among Tunisian health professionals. At least 460 participants were required. Snowball sampling method served to recruit participants. Data were collected using a pre-established and pre-tested questionnaire recorded in a free Google form. The link of the questionnaire was disseminated online to be self-administered anonymously to the participants. The generated online Google Sheet was uploaded and exported to SPSS software for analysis. RESULTS: Of the 546 responses, 493 were retained. The mean age of participants was 37.4 (± 9.5) years. Females represented 70.2% of participants. Social media represented the most frequently used source of information about COVID-19. The prevalence of SARS-CoV-2 vaccine hesitancy among participants was 51.9% (95% CI: 47.5-56.3)). Female sex, working far from the capital and having concerns about the vaccines components predicted more hesitancy among participants. In contrast, the use of the national COVID-19 information website predicted less hesitancy among them. CONCLUSIONS: The current Tunisian communication plan about COVID-19 vaccines must be reinforced. Social media represent a cost effective communication channel that can serve to reassure Tunisian health professionals regarding the safety of COVID-19 vaccines. Special interest should be paid to females, paramedical professionals and those working far from the capital.

The prevalence of high blood pressure and its determinants among Tunisian adolescents.

Hypertension can originate in childhood and remain undetected unless special screening is performed. The burden of hypertension in adolescents in Tunisia is unknown. The aim of this study was to investigate the prevalence of blood pressure (BP) within the hypertension range and its association with other risk factors among Tunisian adolescents. A cross-sectional study that included 1385 secondary school students in Sousse, Tunisia, was performed during 2017-2018. A two-stage cluster sampling strategy was used to obtain a representative sample of the study population. BP within the hypertension range (HBP)was classified following the European guideline recommendations for measuring BP in children and adolescents. Anthropometric indices were measured using a standard protocol. A structured questionnaire collected information about sociodemographic characteristics, lifestyle, mental health status, and addictions. Adjusted logistic regression models were used to assess hypertension-related risk factors. Our study included 39.5% boys and 60.5% girls. The mean age of our population was 17 ± 1.5 years. The prevalence of HBP was 15.4% (13.1-18.0%), and it was significantly higher in boys (22.8%) than in girls (10.6%, p value < 0.001). In the multivariate logistic regression model, overweight [OR = 1.72(1.18-2.51)] and obesity [OR = 3.73(2.55-5.41)] were independent risk factors for HBPrange, (p value < 0.001), whereas female sex [OR = 0.41(0.29-0.56), p value < 0.001] and depression [OR = 0.67(0.51-0.88), p value = 0.008] were independent protective factors. Among Tunisian secondary school adolescents, the prevalence of HBP was high and associated with excess body weight. A comprehensive strategy for the prevention of hypertension and its risk factors among youth is urgently needed.

Effectiveness of a 3-year community-based intervention for blood pressure reduction among adults: a repeated cross-sectional study with a comparison area.

Raised blood pressure is the leading risk factor for cardiovascular diseases. We aimed to demonstrate the effectiveness of a 3-year community-based healthy lifestyle promotion intervention at a neighbourhood level for blood pressure reduction among adults in the context of a political transition. We conducted repeated cross-sectional surveys including 1880 (940 from each area) participants at baseline and 1977 (1001 in the intervention area; 976 comparison area) participants at follow-up. Data collection was conducted through home visits. Multiple linear regression models were used to identify the intervention effect and factors associated with blood pressure change in each area. The prevalence of hypertension was 4.4% lower (35.8% vs. 31.4%) in the intervention area after 3 years (p = 0.044). The mean systolic and diastolic blood pressures changed significantly in the intervention area, from 132.4 ± 19.2 mmHg at baseline to 130.6 ± 17.7 mmHg at follow-up (p = 0.035) and from 78.7 ± 11.8 mmHg to 76.9 ± 11.1 mmHg (p < 10-3), respectively. In the control group, the mean systolic blood pressure increased from 129.4 ± 17.8 mmHg to 130.4 ± 17.9 mmHg (p = 0.38). A significant protective effect of the intervention on systolic (ß = -0.4; 95% CI: -0.76; -0.06) and diastolic blood pressures (ß = -0.22; 95% CI: -0.38; -0.07) was found in the intervention area. In the control area, the effect was not significant for systolic blood pressure. Lifestyle intervention at the neighbourhood level, in the context of a sociopolitical transition, was found to be effective for reducing blood pressure in Sousse, Tunisia. This approach could be scaled up and applied in other similar settings. Future research also needs to focus on designing, implementing, and evaluating multisectoral action plans and legislative measures.

Reversibility of pancreatic ß-cells dysfunction after vitamin D and calcium supplementation: a pilot study in a population of obese and prepubescent North-African children.

The mechanisms of diabetogenesis in children remain largely obscure. This study aimed to determine the impact of vitamin D and calcium supplementation on pancreatic ß-cells function in terms of insulin secretion and sensitivity. This was a quasi-experimental study involving 30 obese and prepubescent Tunisian children (57% boys). During three months, the children received calcium and vitamin D supplementation at therapeutic doses. An oral glucose tolerance test (OGTT) was performed at the beginning and at the end of the study. The following metabolic definitions were applied: i) hyperinsulinism: insulinemia sum > 300 µ UI/ml during OGTT, ii) insulin-resistance: homeostatic model assessment of insulin-resistance > 2, iii) normal glycaemic profile: normal plasma levels during OGTT without any spike, and iv) pancreatic ß-cells dysfunction reversibility: disappearance of the aforementioned disorders. The means ± standard-deviation of age and body mass index were 10.87 ± 1.9 years, and 30.17 ± 4.99 kg/m2, respectively. All children were at the stage of hyperinsulinism associated with insulin-resistance. These disturbances were noted even in children having a normal glycaemic profile at OGTT. After calcium and vitamin D supplementation, glycaemic profile as well as insulin-secretion improved significantly (p < 0.0001). Hyperinsulinism and insulin-resistance decreased significantly by 56.67% (p < 0.0001) and 70.00% (p < 0.0001), respectively. Complete reversibility of these two disorders was noted in 26.6% of children. To conclude, in obese and prepubescent children, vitamin D and calcium supplementation led to the reversibility of the pancreatic ß-cells dysfunction.

Validity and reliability of a modified short version of a stigma scale for use among Tunisian COVID-19 patients after quarantine: A cross-sectional study.

BACKGROUND AND AIM: The COVID-19 is a stigmatizing infectious disease even after healing. Until now, no COVID-19 stigma scale validated in Tunisian Arabic language among the general population is available. Developing such tools is necessary to detect COVID-19 stigma and reduce it effectively. Indeed, stigmatization of COVID-19 patients could increase the spread of this disease and its related mental health issues. We aimed at testing the validity of a translated and modified version of the 12-item HIV stigma scale among Tunisian COVID-19 patients. METHODS: A cross-sectional study was conducted between November and December 2020 among a representative sample of COVID-19 patients in the governorate of Sousse, Tunisia, after quarantine. The 12-item HIV stigma scale was translated in Tunisian Arabic and then modified to be adapted to the Tunisian context. The preliminary modified version was administrated to the participants by pretrained medical doctors during phone calls. It consisted on 20 items covering the four stigma dimensions (personalized stigma, disclosure concerns, concerns with public attitudes, and negative self-image). The psychometric evaluation of this version included internal consistency as well as principal component analysis (PCA). RESULTS: The responses of 346 COVID-19 patients were obtained. Their median age was 40 years (interquartile range: 30-54.5). Females represented 60.4% of them. The PCA resulted in a three factor solution with 14 items. This 14-item scale demonstrated good internal consistency with a global Cronbach's α of 0.91 and values of 0.94, 0.93, and 0.98 for social stigma, negative self-image, and disclosure concerns, respectively. CONCLUSION: This study provides a reliable and valid instrument for stigma measuring among Tunisian COVID-19 patients. The use of this scale would contribute in reducing the spread of this new infectious disease and its related mental health issues.

PASCAR and WHF Cardiovascular Diseases Scorecard project.

Data collected by the Pan-African Society of Cardiology for the World Heart Federation's scorecard project regarding the current state of cardiovascular disease prevention, control and management along with related non-communicable diseases in Tunisia are presented. Furthermore, the strengths, threats, weaknesses and priorities identified from these data are highlighted in concurrence with related sections in the incorporated infographic. Information was collected using open-source data sets available online and relevant government publications.

Effect of a school-based intervention in eating habits among school children: quasi experimental study, Tunisia.

OBJECTIVE: The present study aimed to assess whether six months intervention program with parents' implication in primary schools is able to decrease morning snack consumption among children aged 6-12 years. METHODS: We carried out a quasi-experimental study with two groups of schoolchildren in the region of Sousse (Tunisia) from 2015 to 2016. One primary school in each group was selected. In each school, we randomly selected a sample size of schoolchildren and their parents. The intervention was based on healthy eating habits promotion. RESULTS: The consumption of morning snacks the day before data collection, reported by children, decreased significantly in post-intervention in both intervention and control groups. The decrease of consumption of morning snacks was significantly higher in intervention group (p=0.009). According to parents, the proportion of children who had the habit of eating morning snack decreased significantly from pre to post-intervention in intervention group (p<0.001). CONCLUSION: A healthy environment should be created through effective school policies to prevent obesity.

Adherence of North-African Pulmonologists to the 2017-Global Initiative for Chronic Obstructive Lung Disease (GOLD) Pharmacological Treatment Guidelines (PTGs) of Stable Chronic Obstructive Pulmonary Disease (COPD).

BACKGROUND: No previous study has investigated the adherence rate of North-African pulmonologists to the 2017-GOLD PTGs. AIMS: To investigate the adherence rate of Tunisian pulmonologists to the 2017-GOLD PTGs and to identify the barriers to their adherence. METHODS: This was a cohort study involving clinically stable COPD patients who presented to a pulmonology outpatient consultation. The patients were classified as having been appropriately and inappropriately (over- or undertreatment) treated for the GOLD group. Logistic regression was performed to determine the adherence barriers to the 2017-GOLD PTGs. RESULTS: A total of 296 patients were included (88.1% males, mean age: 68 ± 10 years; GOLD A (7.1%), B (36.1%), C (4.1%), and D (52.7%)). The pulmonologists' adherence rate to the 2017-GOLD PTGs was 29.7%. There was a significant statistical difference between the adherence rates among the four GOLD groups (A: 19.0%, B: 20.6%, C: 8.3%, and D: 39.1%; p = 0.001). Differences were statistically significant between the GOLD group D and groups B (p = 0.001). Differences were statistically significant between the GOLD group D and groups B (p = 0.001). Differences were statistically significant between the GOLD group D and groups B (. CONCLUSION: The adherence rate of Tunisian pulmonologists to the 2017-GOLD PTGs is low. It seems that the patients' age, socioeconomic level, national health insurance coverage, and GOLD groups influenced their adherence.

Validation of the Arabic version of the Bergen Facebook Addiction Scale in Tunisian adolescents.

BACKGROUND: Facebook is by far the most popular social network. Thus, it is important to use a valid measuring tool. This study aimed to validate an Arabic version of the Bergen Facebook Addiction Scale (BFAS). METHODS: It was a cross-sectional study conducted among public secondary schools, within the city of Sousse, Eastern Tunisia over 2 months. Students completed self-administrated questionnaires. The revised test-retest version of the scale was given to a sample of ten pilot students in order to check the readability of the translation. Internal consistency was measured using Cronbach's alpha coefficient in order to assess the extent to which the BFAS items were interrelated. RESULTS: A total of 1399 participants took part in the study (60.5% females). Among 1353 students who are using Facebook, 71.8% had non-problematic use. The median score of addiction was 13 ranging from 6 to 30. The median time spent each day on Facebook was 3 h. The Cronbach's alpha coefficient was 0.87. Students with higher Facebook addiction scores were significantly more addicted to video games (p = 0.001), and more depressed (p < 0.0001). CONCLUSION: The Arabic-BFAS is consistent as a screening test for Facebook addiction among secondary school students due to having good reliability and validity.

Understanding and acting on the developmental origins of health and disease in Africa would improve health across generations.

Data from many high- and low- or middle-income countries have linked exposures during key developmental periods (in particular pregnancy and infancy) to later health and disease. Africa faces substantial challenges with persisting infectious disease and now burgeoning non-communicable disease.This paper opens the debate to the value of strengthening the developmental origins of health and disease (DOHaD) research focus in Africa to tackle critical public health challenges across the life-course. We argue that the application of DOHaD science in Africa to advance life-course prevention programmes can aid the achievement of the Sustainable Development Goals, and assist in improving health across generations. To increase DOHaD research and its application in Africa, we need to mobilise multisectoral partners, utilise existing data and expertise on the continent, and foster a new generation of young African scientists engrossed in DOHaD.

Sustainability of the results of a non communicable diseases prevention program among youth in the region of Sousse, Tunisia.

INTRODUCTION: Implementation of a healthy lifestyle at an early age is described as a successful intervention to prevent non communicable diseases. However, successful programs are not necessarily sustainable. The purpose of this study was to evaluate a 1-year sustainability of a 3-year comprehensive intervention conducted to promote a healthy lifestyle among schoolchildren. MATERIALS AND METHODS: A cohort study of 204 schoolchildren enrolled in middle schools was conducted after a quasi-experimental study in the region of Sousse, Tunisia. The survey lasted 1 year. An exposed group (n=105) was selected from the intervention group and the not-exposed group (n=99) was selected from the control group. The exposition was the intervention. The same questionnaire used at pre-intervention and post-intervention was self-administered to collect data about tobacco use, physical activity and eating habits. The biometric measurements were taken by trained medical doctors at schools. RESULTS: After 1 year of follow-up, none of participants became smokers in the exposed group. However, in the not-exposed group five (5.1%) participants became smokers. The proportion of schoolchildren who experimented with tobacco for the first time increased insignificantly by 2.9% (p=0.77) in the exposed group versus a significant increase by 11.1% (p=0.001) in the not-exposed group. Concerning the recommended physical activity practice, fast food and fried food consumption and overweight, there were no significant changes in the two groups. CONCLUSION: A 3-year non communicable diseases prevention program has limited sustainable effects among schoolchildren in the short-term. Its repetition or a continued program through multisectoral actions is required.

Effectiveness of a Community-Based Intervention Program to Reduce Hypertension Prevalence Among Adults: Results of a Quasiexperimental Study With Control Group in the Region of Sousse, Tunisia.

BACKGROUND: High blood pressure is preventable and is directly related to lifestyle habits such as an unbalanced diet, low levels of physical activity, and tobacco use. OBJECTIVES: This quasiexperimental study aimed to assess the effectiveness of a 3-year community intervention targeting healthy lifestyle promotion in reducing hypertension prevalence among adults. METHODS: A quasiexperimental design was used to evaluate the effectiveness of a 3-year intervention for healthy lifestyle that was implemented between 2010 and 2013 in a community of adults in the region of Sousse in Tunisia. The population study was randomly selected in both intervention and control groups at pre-assessment and post-assessment. After considering a type 1 error α of 5%, a type 2 error ß of 20%, and a change in the prevalence of various risk factors of 6% between pre-intervention and post-intervention, the sample size was fixed to 2,000 adults in intervention and control areas. RESULTS: The intervention group was composed of 940 and 1,001 adults, and the control group was composed of 940 and 976, respectively, at pre-assessment and post-assessment. The prevalence of hypertension decreased in the intervention group globally from 37.3% to 33.7% but not significantly (p = 0.1). In the control group, this proportion increased from 31.1% to 33.4% without significant difference (p = 0.28). In the intervention group, after stratification for age, a significant decrease (p = 0.007) in the prevalence of hypertension was observed for participants younger than 40 years old: it decreased from 22.8% to 16.2%. In the control group, it increased from 14% to 15.4% (p = 0.52). In intervention group, a significant decrease of the hypertension from 31.4% to 26% (p = 0.03) was observed among nonobese participants after stratification for weight status. No significant change was observed in the control group. CONCLUSIONS: This study showed the feasibility and effectiveness of a community-based intervention to reduce the prevalence of hypertension in the context of a developing country.

Socio-demographic association of non communicable diseases' risk factors in a representative population of school children: a cross-sectional study in Sousse (Tunisia).

INTRODUCTION: A better understanding of socio-demographic characteristics of subgroups, which have a high risk to develop chronic diseases, is essential to develop more efficient interventional programs especially for youth. This study aimed to determine the association between clusters of non communicable diseases (NCDs') risk factors and the socio-demographic characteristics among a sample of Tunisian school children. MATERIALS AND METHODS: We conducted, in 2013/2014, a cross-sectional study among a proportional and stratified school children sample, selected in 17 elementary public schools in Sousse (Tunisia). A cluster analysis was used to identify different NCDs risk factors clusters, based on tobacco use, physical inactivity, unhealthy diet, and excess weight. Subsequent χ2-tests were used to identify differences between the NCDs risk factors clusters in regards to socio-demographic characteristics. RESULTS: Four clusters of NCDs risk factors were found: 1) Cluster 1: physical inactivity behavior with normal weight, 2) Cluster 2: physical inactivity behavior associated to excess weight, 3) Cluster 3: unhealthy diet associated to excess weight and low practice of physical activity, and 4) Cluster 4: smoking behavior with physical activity behavior. The pattern of cluster membership differed across sex (<10-3), school level, and socioeconomic level (<10-3) but there was no significant difference between clusters for mother's education levels and household tenure. CONCLUSION: This study can have important implications for health policy and practice. Indeed, it found that many subjects have simultaneous multiple NCDs risk factors which leads to identify groups at risk and implement integrated intervention program.

Assessment of the validity of self-reported smoking status among schoolchildren in Sousse, Tunisia.

INTRODUCTION: Tobacco use, which begins in adolescence and childhood and continues in later life, is the major avoidable risk for non-communicable diseases and death in the world. Self-reports have frequently been used to estimate smoking prevalence and health consequences. This study explores the validity of self-reports of smoking behavior among schoolchildren in Tunisia. MATERIALS AND METHODS: This study was conducted in March 2014 among a sample of 147 schoolchildren randomly selected. Data concerning the smoking habit were collected by a questionnaire designed for the purposes of this work. Then, exhaled CO, a biochemical marker of smoke exposure, was measured using piCO+ Smokerlyzer® breath CO monitor among participants. Sensitivity and specificity of self-reports were calculated. RESULTS: The prevalence of reported smoking was 9.5% with 16.7% and 1.7% respectively among boys and girls. Their mean age was 14.5±1.28 years old. When considering 4 ppm as the cut-off level of breath CO, sensitivity and specificity of self-reports were 100% and 93.7%, respectively. But at a breath CO cut-off of 3 ppm, self-reporting was 62.5% sensitive and 93.5% specific. CONCLUSION: According to our findings, we suggest that self-reports can be considered as a good tool to be used with a reasonable confidence to assess the smoking status.

School-Based Intervention as a Component of a Comprehensive Community Program for Overweight and Obesity Prevention, Sousse, Tunisia, 2009-2014.

INTRODUCTION: Combating obesity at an early age, by improving physical activity and nutrition-related behaviors, is vital to the prevention of more critical health concerns in adulthood. This intervention study evaluated the effectiveness of a school-based component of a community behavioral intervention on overweight and obesity rates of adolescents in Sousse, Tunisia. METHODS: A quasi-experimental school-based intervention was conducted with an intervention group (in Sousse Jawhara and Sousse Riadh) and a control group (in Sousse Msaken). The intervention (which was a physical activity and nutrition program) lasted 3 years, with data at preintervention collected during the 2009-2010 school year and at postintervention collected during the 2013-2014 school year. Descriptive statistics and multivariate analysis were used to determine the effect of the intervention on risk of excess weight. RESULTS: Results showed a significant increase in fruit and vegetable intake by the intervention group (P = .04). The intervention group had an increase in students in the normal weight category (P = .03) and a decrease in students in the overweight category (P = .03).The intervention effect was a protective factor against excess weight for the participating schoolchildren (OR, 0.84; P = .02). CONCLUSION: This study showed that a school-based intervention is successful in increasing healthy dietary habits and in reducing risk of excess weight. It also showed the importance of a multisectoral approach to provide an environment conducive to healthy behaviors for adolescents.

A 3-Year Workplace-Based Intervention Program to Control Noncommunicable Disease Risk Factors in Sousse, Tunisia.

OBJECTIVE: To assess the effectiveness of a 3-year workplace-based intervention program on the control of the main noncommunicable disease risk factors (poor nutrition, physical inactivity, and tobacco use) among the employees of Sousse, Tunisia. METHODS: We conducted a quasi-experimental study (pre- and postassessments with intervention and control groups) in six companies of the governorate of Sousse in Tunisia.The intervention program consisted of health education programs (eg, workshops, films and open sensitization days). We also scheduled free physical activity sessions and free smoking cessation consultations. RESULTS: Our intervention program showed meaningful improvement among the employees toward dietary and physical activity behaviors but not for tobacco use. CONCLUSIONS: Workplace is a crucial setting for health promotion, and future programs should consider a multisectoral approach to control the main noncommunicable disease risk factors.