Skip to main content

Advertisement

SpringerLink
Log in

Health Behaviors Among School-Aged Children: a Cross Sectional Study in Lebanese Private Schools

  • Published:
International Journal of Mental Health and Addiction Aims and scope Submit manuscript

Abstract

There is insufficient data on health-risk behaviors of school students in Lebanon. The objective of our study is to provide data about the prevalence of cigarette and waterpipe smoking as well as alcohol drinking patterns among school students, focusing on gender differences and searching for tobacco and alcohol uses’ predictors. The dissemination of such information is required in order to promote health and assist the local authorities in Lebanon in designing tobacco and alcohol control prevention programs with a particular attention to youth. Using a convenient sample of Lebanese students, aged between 11 and 20 years, a cross-sectional study was carried out in nine private schools in Beirut and Mount Lebanon. A standardized questionnaire was used for collecting data related to socio-demographic characteristics, tobacco and alcohol consumption, entourage consumption, and health-related behaviors. Additional questions related to the general perception of personal health and life satisfaction, social activities, physical activity and sedentary behavior, school environment, family and peer relationships were also included in the questionnaire. The summary of responses is analyzed using two methods: bivariate and multivariable analyses. Among 1982 participants, 10.3, 16.9, and 42.4 % are cigarette smokers, waterpipe smokers, and alcohol consumers respectively. Higher rates of smoking and alcohol consumption are found out among boys as opposed to girls (p < 0.001). We identified that a significant association exists between tobacco and alcohol consumption based on age, district, socioeconomic status, connectivity with family, family and entourage influence, days spent with friends, drunkenness and binge drinking, energy drink consumption, weight status, self-rated health, electronic media communication, and last quarter average (aOR going from 0.50 till 0.87 for protective factors and inverse relationships and from 1.19 till 5.80 for positive associations). Substantial proportions of school students in Lebanon adopt risky behaviors. Health-promotion activities need to be established in order to decrease the occurrence of such behaviors and prevent deleterious health outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  • Adlaf, E. M., Begin, P., & Sawka, E. (2005). Canadian Addiction Survey (CAS): a national survey of Canadians’ use of alcohol and other drugs: prevalence of use and related harms: detailed report. Ottawa: Canadian Centre on Substance Abuse.

    Google Scholar 

  • Alikaşifoğlu, M., Erginöz, E., Ercan, O., Uysal, O., Albayrak-Kaymak, D., & Ilter, O. (2004). Alcohol drinking behaviors among Turkish high school students. The Turkish Journal of Pediatrics, 46(1), 44–53.

    PubMed  Google Scholar 

  • Atkin, C. K. (1993). Effects of media alcohol messages on adolescent audiences. In G. A. Comstock (Ed.), Adolescent medicine: state of the art review. Philadelphia: Hanley and Belfus.

    Google Scholar 

  • BMA Board of Science. (2007). Breaking the cycle of children’s exposure to tobacco smoke. London: British Medical Association.

    Google Scholar 

  • Carvajal, S. C., Wiatrek, D. E., Evans, R. I., Knee, C. R., & Nash, S. G. (2000). Psychosocial determinants of the onset and escalation of smoking: cross-sectional and prospective findings in multiethnic middle school samples. Journal of Adolescent Health, 27(4), 55–65.

    Article  Google Scholar 

  • Connolly, G. M., Casswell, S., Stewart, J., Silva, P. A., & O’Brien, M. K. (1993). The effect of parents’ alcohol problems on children’s behavior as reported by parents and by teachers. Addiction, 88(10), 1383–1390.

    Article  CAS  PubMed  Google Scholar 

  • Currie, C., Roberts, C., Morgan, A., Smith, R., Settertobulte, W., Samdal, O., Rasmussen, V. B. (2004). Young people’s health in context. Health Behavior in School-aged Children (HBSC) study: international report from the 2001/2002 survey. Copenhagen, Denmark: WHO Regional Office for Europe. Retrieved from http://www.euro.who.int/__data/assets/pdf_file/0008/110231/e82923.pdf.

  • Currie, C., Nic Gabhainn, S., Godeau, E., Roberts, C., Smith, R., Currie, D., & Barnekow, V. (2008). Inequalities in young people’s health: HBSC international report from the 2005/2006 survey. Copenhagen: WHO Regional Office for Europe.

    Google Scholar 

  • Department of Health & Human Services. (1994). Preventing tobacco use among young people: A report of the surgeon general. Washington D.C: Department of Education.

    Google Scholar 

  • El-Roueiheb, Z., Tamim, H., Kanj, M., Jabbour, S., Alayan, I., & Musharrafieh, U. (2008). Cigarette and waterpipe smoking among Lebanese adolescents, a cross-sectional study, 2003–2004. Nicotine &Tobacco Research, 10(2), 309–314.

    Article  Google Scholar 

  • Engels, R., Knibbe, R. A., de Vries, H., & Drop, M. J. (1998). Antecedents of smoking cessation among adolescents: who is motivated to change? Preventive Medicine, 27(3), 348–357.

    Article  CAS  PubMed  Google Scholar 

  • Engels, R., & ter Bogt, T. (2001). Influences of risk behaviors on the quality of peer relations in adolescence. Journal of Youth and Adolescence, 30(6), 675–695.

    Article  Google Scholar 

  • Ferrante, M., Fiore, M., Leon, L., Costantidines, F., Castaing, M., Fallico, R., & Modonutti, G. B. (2010). Age of smoking initiation, tobacco habits and risk perception among primary, middle and high school students in Southern Italy. Italian Journal of Public Health, 7(3), 262–267.

    Google Scholar 

  • Gabhainn, S. N., Nolan, G., Kelleher, C., & Friel, S. (2002). Dieting patterns and related lifestyles of school-aged children in the Republic of Ireland. Public Health Nutrition, 5(3), 457–462.

    Article  PubMed  Google Scholar 

  • Ghandour, L. A., Karam, E. G., & Maalouf, W. E. (2009). Lifetime alcohol use, abuse and dependence among university students in Lebanon: exploring the role of religiosity in different religious faiths. Addiction, 104(6), 940–948.

    Article  PubMed  Google Scholar 

  • Godeau, E., Navarro, F., Arnaud, C. (2012). dir. La santé des collégiens en France/2010. Données françaises de l’enquête internationale Health Behaviour in School-aged Children (HBSC). Saint-Denis : Inpes, coll. études santé, 254Retrieved March 10, 2014, from http://www.inpes.sante.fr/CFESBases/catalogue/pdf/1412.pdf.

  • Guo, J., Collins, L. M., Hill, K. G., & Hawkins, J. D. (2000). Developmental pathways to alcohol abuse and dependence in young adulthood. Journal of Studies on Alcohol, 61, 799–808.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Henderson, A. J. (2008). The effects of tobacco smoke exposure on respiratory health in school-aged children. Paediatric Respiratory Reviews, 9(1), 21–7. quiz 27–28.

    Article  CAS  PubMed  Google Scholar 

  • Hibell, B., Andersson, B., Bjarnason, T., Ahlström, S., Balakireva, O., Kokkevi, A., Morgan, M. (2004). The ESPAD Report 2003: alcohol and other drug use among students in 35 European countries. Stockholm, Sweden: The Swedish Council for Information on Alcohol and Other Drugs and the Pompidou Group at the Council of Europe.

  • Hill, E. M., Nord, J. L., & Blow, F. C. (1992). Young-adult children of alcoholic parents: protective effects of positive family functioning. British Journal of Addiction, 87(12), 1677–1690.

    Article  CAS  PubMed  Google Scholar 

  • Iannotti, R. (2012). Student Questionnaire, HBSC, 2009–2010. United States Department of Health and Human Services. National Institutes of Health. Eunice Kennedy Shriver National Institute of Child Health and Human Development, Inter-university Consortium for Political and Social Research. Retrieved March 08, 2014 from http://www.icpsr.umich.edu/icpsrweb/NAHDAP/studies/34792.

  • Jackson, C., Geddes, R., Haw, S., & Frank, J. (2012). Interventions to prevent substance use and risky sexual behavior in young people: a systematic review. Addiction, 107(4), 733–747.

    Article  PubMed  Google Scholar 

  • Järvelaid, M. (2004). Adolescent tobacco smoking and associated psychosocial risk factors. Scandinavian Journal of Primary Health Care, 22, 50–53.

    Article  PubMed  Google Scholar 

  • Jason, L. A., Berk, M., Schnopp-Wyatt, D. L., & Talbot, B. (1999). Effects of enforcement of youth access law on smoking prevalence. American Journal of Community Psychology, 27, 143–160.

    Article  CAS  PubMed  Google Scholar 

  • Jawad, M., Lee, J. T., & Millett, C. (2014). The relationship between waterpipe and cigarette smoking in low and middle income countries: cross-sectional analysis of the global adult tobacco survey. PLoS One, 9(3), e93097. doi:10.1371/journal.pone.0093097.

    Article  PubMed  PubMed Central  Google Scholar 

  • Johnston, L. D., O’Malley, P. M., Bachman, J. G., & Schulenberg, J. E. (2006). Monitoring the future national survey results on drug use, 1975–2005. Bethesda: National Institute on Drug Abuse.

    Google Scholar 

  • Kuntsche, E., & Silbereisen, R. K. (2004). Parental closeness and adolescent substance use in single and two-parent families in Switzerland. Swiss Journal of Psychology, 63(2), 85–92.

    Article  Google Scholar 

  • Kuntsche, E., Simons-Morton, B., Fotiou, A., ter Bogt, T., & Kokkevi, A. (2009). Health Behavior in School-Aged Children Study. Decrease in adolescent cannabis use from 2002 to 2006 and links to evenings out with friends in 31 European and North American countries and regions. Archives of Pediatrics and Adolescent Medicine, 163(2), 119–125.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kwan, M., Bobko, S., Faulkner, G., Donnelly, P., & Cairney, J. (2014). Sport participation and alcohol and illicit drug use in adolescents and young adults: a systematic review of longitudinal studies. Addictive Behaviors, 39(3), 497–506.

    Article  PubMed  Google Scholar 

  • Leena, K., Tomi, L., & Arja, R. R. (2005). Intensity of mobile phone use and health compromising behaviors—how is information and communication technology connected to health-related lifestyle in adolescence? Journal of Adolescence, 28(1), 35–47.

    Article  PubMed  Google Scholar 

  • Lei, L., & Wu, Y. (2007). Adolescents’ paternal attachment and Internet use. Cyberpsychology & Behavior, 10(5), 633–639.

    Article  Google Scholar 

  • Lesch, O.-M., Walter, H., Wetschka, C., Hesselbrock, M., Hesselbrock, V. (2011) Alcohol and tobacco: Medical and sociological aspects of use, abuse and addiction. doi:10.1007/978-3-7091-0146-9.

  • Luciano, A., Livieri, C., Di Pietro, M. E., Bergamaschi, G., & Maffeis, C. (2003). Definition of obesity in childhood: criteria and limits. Minerva Pediatrica, 55(5), 453–459 [in Italian].

    CAS  PubMed  Google Scholar 

  • Magarey, A. M., Daniels, L. A., Boulton, T. J., & Cockington, R. A. (2003). Predicting obesity in early adulthood from childhood and parental obesity. International Journal of Obesity and Related Metabolic Disorders, 27, 505–513.

    Article  CAS  PubMed  Google Scholar 

  • Mahalik, J. R., Burns, S. M., & Syzdek, M. (2007). Masculinity and perceived normative health behaviors as predictors of men’s health behaviors. Social Science & Medicine, 64(11), 2201–9.

    Article  Google Scholar 

  • Maxwell, K. A. (2002). Friends: the role of peer influence across adolescent risk behaviors. Journal of Youth and Adolescence, 32, 267–277.

    Article  Google Scholar 

  • Maziak, W., Nakkash, R., Bahelah, R., Husseini, A., Fanous, N., Eissenberg, T. (2013). Tobacco in the Arab world: Old and new epidemics amidst policy paralysis. Health Policy Plan, 5.

  • Mazur, J., & Woynarowska, B. (2004). Risk behaviors syndrome and subjective health and life satisfaction in youth aged 15 years. Medycyna Wieku Rozwojowego, 8, 567–583 [in Polish].

    PubMed  Google Scholar 

  • Miller, J. W., Naimi, T. S., Brewer, R. D., & Jones, S. E. (2007). Binge drinking and associated health risk behaviors among high school students. Pediatrics, 119, 76–85.

    Article  PubMed  Google Scholar 

  • Moffitt, T. (2006). A review of research on the taxonomy of life-course persistent versus adolescence-limited antisocial behavior. In F. T. Cullen, J. P. Wright, & K. R. Blevins (Eds.), Taking stock: the status of criminological theory (1st ed., pp. 277–312). New Brunswick: Transaction Publishers.

    Google Scholar 

  • National Institute of Alcohol Abuse and Alcoholism. (2000). Tenth special report to the U.S. Congress on alcohol and health. Bethesda, MD: National Institute of Health. Retrieved April 18, 2015, from http://www.cdc.gov/alcohol/fact-sheets/alcohol-use.htm.

  • Pärna, K., Usin, J., & Ringmets, I. (2008). Cigarette and waterpipe smoking among adolescents in Estonia: HBSC survey results, 1994–2006. BMC Public Health, 8, 392.

    Article  PubMed  PubMed Central  Google Scholar 

  • Rasmussen, M., Damsgaard, M. T., Holstein, B. E., Poulsen, L. H., & Due, P. (2005). School connectedness and daily smoking among boys and girls: the influence of parental smoking norms. European Journal of Public Health, 15(6), 607–612.

    Article  PubMed  Google Scholar 

  • Rehm, J., Mathers, C., Popova, S., Thavorncharoensap, M., Teerawattananon, Y., & Patra, J. (2009). Global burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders. Lancet, 373(9682), 2223–2233.

    Article  PubMed  Google Scholar 

  • Roberts, B. (2004). Drinking like a man: the paradox of excessive drinking for seventeenth-century Dutch youths. Journal of Family History, 29(3), 237–52.

    Article  PubMed  Google Scholar 

  • Roberts, S. C. M., Bond, J., Korcha, R., & Greenfield, T. K. (2013). Genderedness of bar drinking culture and alcohol-related harms: a multi-country study. International Journal of Mental Health and Addiction, 11(1), 50–63. doi:10.1007/s11469-012-9398-x.

    Article  PubMed  Google Scholar 

  • Saade, G., Warren, C. W., Jones, N. R., Asma, S., & Mokdad, A. (2008). Linking Global Youth Tobacco Survey (GYTS) data to the WHO Framework Convention on Tobacco Control (FCTC): the case for Lebanon. Preventive Medicine, 47(Suppl 1), S15–19.

    Article  PubMed  Google Scholar 

  • Salamé, J., Barbour, B., & Salameh, P. (2013). Do personal beliefs and peers affect the practice of alcohol consumption in university students in Lebanon? Eastern Mediterranean Health Journal, 19(4), 340–347.

    PubMed  Google Scholar 

  • Salameh, P., Salamé, J., Waked, M., Barbour, B., Zeidan, N., & Baldi, I. (2014). Waterpipe dependence in university students and effect of normative beliefs: a cross sectional study. BMJ Open, 4(2), e004378. doi:10.1136/bmjopen-2013-004378.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Salameh, P., Zeenny, R., Antoun, E., Salamé, J., Waked, M., Barbour, B., & Izabelle, B. (2015). Is waterpipe smoking a gateway to cigarette smoking among youth? Journal of Addictive Behaviors Therapy and Rehabilitation, 4, 2.

    Google Scholar 

  • Simantov, E., Schoen, C., & Klein, J. D. (2000). Health compromising behaviors: why do adolescents smoke or drink? Archives of Pediatrics and Adolescent Medicine, 2(1), 85–101.

    Google Scholar 

  • Simons-Morton, B. G., Farhat, T., ter Bogt, T. F., Hublet, A., Kuntsche, E., Gabhainn, N., & Kokkevi, A. (2009). HBSC Risk Behavior Focus Group. Gender specific trends in alcohol use: cross-cultural comparisons from 1998 to 2006 in 24 countries and regions. International Journal of Public Health, 54(Suppl 2), 199–208.

    Article  PubMed  PubMed Central  Google Scholar 

  • Tohmé-Tabet, A. (2001). Women, intangible heritage and development in Arab States. Paris, United Nations Educational, Scientific and Cultural Organization. Retrieved December 5, 2014, from http://www.unesco.org/culture/ich/doc/src/00161-EN.pdf.

  • Tyas, S. L., & Pederson, L. L. (1998). Psychosocial factors related to adolescent smoking: a critical review of the literature. Tobacco Control, 7, 409–420.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • U.S. Department of Health and Human Services. (2010). How Tobacco Smoke Causes Disease: What It Means to You. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.

  • U.S. Department of Health and Human Services. (2014). The Health Consequences of Smoking—50 Years of Progress A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.

  • Varsano, S., Ganx, I., Eldor, N., & Garenkin, M. (2003). Water-pipe tobacco smoking among school children in Israel: frequencies, habits and attitudes. Harefuah, 142(11), 736–741 [in Hebrew].

    PubMed  Google Scholar 

  • Waked, M., Salameh, P., & Aoun, Z. (2009). Water-pipe (narguile) smokers in Lebanon: a pilot study. Eastern Mediterranean Health Journal, 15(2), 432–442.

    CAS  PubMed  Google Scholar 

  • Waked, M., Khayat, G., & Salameh, P. (2012). Cigarette smokers’ profile in Lebanese adults. Journal of Research in Health Sciences, 12(2), 75–80.

    PubMed  Google Scholar 

  • Windle, M. (2003). Alcohol use among adolescents and young adults. Alcohol Research & Health, 27(1), 79–85.

    Google Scholar 

  • World Health Organization. (2011). Adolescent Health. WHO website. 2011. Retrieved May 29, 2014, from http://www.who.int.

  • World Health Organization. (2011). Global status report on alcohol and health. Geneva: WHO website. Retrieved April 18, 2015, from http://www.who.int/substance_abuse/publications/global_alcohol_report/msbgsruprofiles.pdf.

  • World Health Organization. (2011). Why do we need to invest in the health and development of adolescents?. WHO website. Retrieved May 29, 2014, from http://www.who.int.

  • World Health Organization. (2012). WHO Report on the Global Tobacco Epidemic, 2011: warning about the dangers of tobacco. WHO website. Retrieved November 29, 2014, from http://whqlibdoc.who.int/publications/2011/9789240687813_eng.pdf.

  • Yen, J. Y., Yen, C. F., Chen, C. C., Chen, S. H., & Ko, C. H. (2007). Family factors of internet addiction and substance use experience in Taiwanese adolescents. Cyberpsychology & Behavior, 10(3), 323–331.

    Article  Google Scholar 

  • Zahlan, L., Ghandour, L., Yassin, N., Afifi, R., & Martins, S. S. (2014). Double trouble: exploring the association between waterpipe tobacco smoking and the nonmedical use of psychoactive prescription drugs among adolescents. Drug and Alcohol Dependence, 145, 217–223.

    Article  PubMed  Google Scholar 

  • Zambon, A., Lemma, P., Borraccino, A., Dalmasso, P., & Cavallo, F. (2006). Socio-economic position and adolescents’ health in Italy: the role of the quality of social relations. European Journal of Public Health, 16(6), 627–632.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to acknowledge the support of the participating private schools, particularly administrators, faculty and staff.

Contributors

PS conceived the study, participated in its design and coordination, and edited the manuscript. RZ contributed to data interpretation, manuscript drafting and final approval. RA participated in the study design, performed the measurement, the statistical analysis, and the interpretation of the data and drafted the manuscript. All authors read, revised critically and approved the final draft of the manuscript.

Notes on contributors

Rachel Abdo, PharmD, MPH is a pharmacist. She holds a Masters of Public Health in epidemiology and biostatistics. She is currently enrolled in a joint PhD program at the Lebanese University, Lebanon and Paris Est, France.

Rony Zeenny, PharmD, BCPS-AQ ID is a clinical assistant professor at the Lebanese American University. Dr. Zeenny achieved and maintains his certification as board certified pharmacotherapy specialist with added qualifications in infectious diseases. Dr. Zeenny has a University Diploma in principles of clinical research. He is currently completing a Masters of Public Health in epidemiology and biostatistics.

Pascale Salameh, PharmD, MPH, PhD, is currently an associate dean for academic affairs at the school of pharmacy at the Lebanese American University. She is also a professor of epidemiology at the Lebanese University: School of Pharmacy, School of Public Heath, and Doctoral School of Sciences & Technologies. Dr. Salameh is a health services researcher with high expertise in research design, data collection, data management and analysis, including basic and advanced statistical operations. Dr. Salameh is well-versed in research direction. She holds a Diploma in the « Ability to Direct Research ». She has over 100 publications.

Author information

Authors and Affiliations

  1. Laboratory of Clinical and Epidemiological Research, Faculties of Pharmacy & of Public Health, Lebanese University, Beirut, Lebanon

    R. Abdo & P. Salameh

  2. Department of Pharmacy Practice, School of Pharmacy, Lebanese American University, Jbeil, Lebanon

    R. Zeenny & P. Salameh

Authors
  1. R. Abdo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. Zeenny
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. P. Salameh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to R. Abdo.

Ethics declarations

Informed Consent

Informed consent was obtained from all study participants.

Ethical Approval

Ethical approval was not required for this type of study.

Conflict of Interest

To the best of our knowledge, no conflict of interest, financial or other, exists. The ideas expressed in this manuscript are those of the authors and in no way represent the position of the Lebanese University or the Lebanese American University.

Additional information

Key messages

• Considerable proportions of substance users have been found among adolescents in private schools in Lebanon where 10.3, 16.9 and 42.4 % are identified as current cigarette, WP and alcohol consumers respectively.

• The study shows that there is a clear correlation among WP, cigarette and alcohol consumption.

• All three behaviors are associated with age, time spent with friends, entourage and energy drink consumption.

• Anti-tobacco smoking and anti-excessive drinking intervention strategies, which target children in early years at high schools, are recommended in order to limit health-risk behaviors among this vulnerable age group.

Appendix

Appendix

Table 5 Frequency of each type of alcohol drinks
Full size table

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Abdo, R., Zeenny, R. & Salameh, P. Health Behaviors Among School-Aged Children: a Cross Sectional Study in Lebanese Private Schools. Int J Ment Health Addiction 14, 1003–1022 (2016). https://doi.org/10.1007/s11469-016-9677-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11469-016-9677-z

Keywords

Search

Navigation