Prevalence of tobacco use among young adults in Palestine

Understanding the interplay of colorectal cancer awareness and attitudes among Palestinians: a national cross-sectional study

BACKGROUND

In Palestine, colorectal cancer (CRC) is the second most common cause of cancer-related mortality after lung cancer. No studies have examined the relationship between CRC awareness and attitudes. This study aimed to investigate the interplay between CRC awareness and attitudes among the Palestinian population.

METHODS

A nationwide cross-sectional survey was carried out between July 2019 and March 2020. Convenience sampling was used to collect data from hospitals, primary healthcare facilities, and public areas in 11 governorates. Modified, translated-into-Arabic versions of the validated Bowel Cancer Awareness Measure and Cancer Awareness Measure-Mythical Causes Scale were utilized to assess the awareness of CRC signs/symptoms, risk factors, and causation myths. The cumulative awareness score for each domain was computed and stratified into tertiles. The top tertile denoted 'high' awareness, while the remaining two tertiles denoted 'low' awareness.

RESULTS

The final analysis included 4,623 participants; of whom, 3115 (67.4%) reported positive attitudes toward CRC. In total, 1,849 participants (40.0%) had high awareness of CRC signs/symptoms. There was no association between displaying a high awareness of CRC signs/symptoms and having positive attitudes toward CRC. A total of 1,840 participants (38.9%) showed high awareness of CRC risk factors. Participants with high CRC risk factor awareness were more likely to display positive attitudes toward CRC (OR = 1.22, 95% CI: 1.07-1.39). Only 219 participants (4.7%) had high awareness of CRC causation myths. Participants with high awareness of CRC causation myths were more likely to exhibit positive attitudes toward CRC (OR = 2.48, 95% CI: 1.71-3.58).

CONCLUSION

A high awareness level of CRC risk factors and causation myths was associated with a greater likelihood of demonstrating positive attitudes toward CRC in terms of perceived susceptibility, importance of early detection, and consequences of developing the disease. Future educational interventions should focus on raising public awareness about CRC, with a particular emphasis on risk factors and causation myths, to maximize the potential for shaping favorable attitudes toward the disease.

Differences in colorectal cancer awareness between screening eligible vs. ineligible Palestinians: a national cross-sectional study

BACKGROUND

This study aimed to compare colorectal cancer (CRC) awareness between screening-eligible and ineligible individuals in Palestine.

METHODS

Convenience sampling was utilized to recruit Palestinian adults from diverse settings, including hospitals, primary healthcare centers and public spaces across 11 governorates. The evaluation of CRC awareness in terms of signs/symptoms, risk factors and causation myths was conducted using Arabic-translated, modified versions of the validated instruments, the Bowel Cancer Awareness Measure and the Cancer Awareness Measure-Mythical Causes Scale.

RESULTS

The final analysis included 2698 participants, with 2158 (80.9%) eligible for CRC screening and 540 (19.1%) ineligible for it. The most recognized CRC sign/symptom was 'lump in the abdomen' in both screening-eligible (n = 386, 71.5%) and ineligible (n = 1582, 73.3%) groups. 'Lack of physical activity' was the most recognized risk factor in both groups (eligible: n = 451, 83.5%; ineligible: n = 1766, 81.8%). The most reported causation myth in both groups was 'having a physical trauma' (eligible: n = 340, 63.0%; ineligible: n = 1353, 62.7%). In the screening-eligible group, only 210 participants (38.9%) demonstrated high awareness of CRC signs/symptoms, 213 participants (39.4%) showed high awareness of CRC risk factors and only 46 participants (8.5%) displayed high awareness of CRC causation myths. There were no significant associations between being eligible for screening colonoscopy and the awareness levels of CRC signs/symptoms, risk factors and causation myths.

CONCLUSION

Overall, awareness levels of CRC signs/symptoms, risk factors and causation myths were notably low among screening-eligible participants. There were no differences in awareness levels between individuals eligible for colonoscopy and those who were not.

Factors contributing to the rising prevalence of waterpipe smoking dependence among university students: a cross-sectional study

INTRODUCTION

Waterpipe smoking (WPS) has been associated with a variety of adverse health effects, consequences, and symptoms of nicotine dependence. This study aims to determine the prevalence of WPS dependence among Palestinian university waterpipe smoking students, their normative beliefs about WPS, and their relationship to dependence.

METHODS

A cross-sectional study of current WPS university students at five major Palestinian universities was conducted from September to December 2022. Participants were recruited using convenient sampling, and data collection was carried out via an interviewer-administered questionnaire. We assessed students' WPS dependence using the Lebanese Waterpipe Dependence Scale. We used the Poisson regression model with robust variance to analyze factors independently associated with high WPS dependence.

RESULTS

The study included 746 current WPS university students. Results revealed a high prevalence of WPS dependence, with 69.4% (95%CI: 66.0-72.7%) exhibiting high dependence. Factors contributing to high WPS dependence included dual cigarette smoking (aPR: 1.18; 95%CI: 1.12-1.25), studying medical sciences (aPR: 1.13; 95%CI: 1.10-1.18), friends' approval of WPS (aPR: 1.25; 95%CI: 1.17-1.34), daily WPS frequency (aPR: 1.98; 95%CI: 1.39-2.23), spending more than 50% of daily allowance on WPS (aPR: 1.37; 95%CI: 1.10-1.64), and morning WPS sessions (aPR: 1.97; 95%CI: 1.31-2.27). The study highlighted the influence of social factors, such as peers' approval and perceived prevalence, on WPS dependence.

CONCLUSIONS

WPS dependence is prevalent among university students, and it is associated with morning WPS, dual smoking, and increased WPS frequency. Notably, peer and cultural factors are essential primary motivators. As a result, it is critical to incorporate WPS considerations into Palestine's antismoking health promotion program. Therefore, it is vital to incorporate WPS into the Palestinian antismoking health promotion policy, and the health education of adolescents regarding the dangers of WPS should coincide with antismoking initiatives.

Screening Perspectives: The Role of Colorectal Cancer Awareness in Shaping Attitudes Toward Colonoscopy in Palestine

PURPOSE

To assess colorectal cancer (CRC) awareness and its influence on attitudes toward colonoscopy in Palestine.

MATERIALS AND METHODS

Convenience sampling was used to recruit Palestinian adults from hospitals, primary health care centers, and public spaces across 11 governorates. To evaluate the awareness of CRC signs/symptoms, risk factors, and mythical causes, the Bowel Cancer Awareness Measure and Cancer Awareness Measure-Mythical Causes Scale were used after translation into Arabic. For each correctly recognized item, one point was given. The total awareness score of each domain was calculated and categorized into tertiles; the top tertile was considered high awareness, and the other two tertiles were considered low awareness.

RESULTS

A total of 4,623 questionnaires were included. Only 1,849 participants (40.0%) exhibited high awareness of CRC signs/symptoms. High awareness of CRC symptoms was associated with higher likelihood of showing positive attitudes toward colonoscopy (odds ratio [OR], 1.21 [95% CI, 1.07 to 1.37]). A total of 1,840 participants (38.9%) demonstrated high awareness of CRC risk factors. Participants with high awareness of CRC risk factors were more likely to display positive attitudes toward colonoscopy (OR, 1.20 [95% CI, 1.07 to 1.37]). Only 219 participants (4.7%) demonstrated high awareness of CRC causation myths. There was no association between awareness of CRC causation myths and positive attitudes toward colonoscopy.

CONCLUSION

Awareness of CRC was poor with less than half of the study participants demonstrating high awareness of CRC signs/symptoms and risk factors, and a minority (<5%) displaying high awareness of CRC causation myths. High awareness of CRC signs/symptoms and risk factors was associated with greater likelihood of demonstrating positive attitudes toward colonoscopy. Educational initiatives are needed to address knowledge gaps and dispel misconceptions surrounding CRC.

Differences in Colorectal Cancer Awareness Between Vegetarians and Nonvegetarians: A National Cross-Sectional Study From Palestine

PURPOSE

To compare colorectal cancer (CRC) awareness between vegetarians and nonvegetarians in Palestine.

MATERIALS AND METHODS

The validated Bowel Cancer Awareness Measure and Cancer Awareness Measure-Mythical Causes Scale were translated into Arabic and used to assess awareness of CRC signs/symptoms, risk factors, and mythical causes. The total awareness score of each domain was calculated and categorized into tertiles; the top tertile was considered as good awareness. Multivariable logistic regression analysis was used to examine the association between being a vegetarian and displaying good awareness in each domain.

RESULTS

This study included 4,623 participants: 560 vegetarians (12.1%) and 4,063 nonvegetarians (87.9%). Lump in the abdomen was the most recognized CRC sign/symptom among both nonvegetarians (n = 2,969, 73.1%) and vegetarians (n = 452, 80.7%). Vegetarians were less likely than nonvegetarians to display good awareness of CRC signs/symptoms (odds ratio, 0.59 [95% CI, 0.48 to 0.72]). Lack of physical activity was the most identified modifiable CRC risk factor in both nonvegetarians (n = 3,368, 82.9%) and vegetarians (n = 478, 85.4%). Similarly, having a bowel disease was the most identified nonmodifiable risk factor among both nonvegetarians (n = 2,889, 71.1%) and vegetarians (n = 431, 77.0%). There were no associated differences between both groups in the awareness levels of CRC risk factors. The most recognized food-related CRC causation myth in nonvegetarians was drinking from plastic bottles (n = 1,023, 25.2%), whereas it was eating burnt food in vegetarians (n = 176, 31.4%). Having a physical trauma was the most recognized food-unrelated myth in both nonvegetarians (n = 2,356, 58.0%) and vegetarians (n = 396, 70.7%). There were no associated differences in the awareness of CRC causation myths between both groups.

CONCLUSION

Awareness of CRC was notably low in both Palestinian vegetarians and nonvegetarians. Particularly, vegetarians demonstrated lower awareness of CRC signs and symptoms.

Life stressors, tobacco use, and mental health among Palestinian youths: The mediating role of quality of life and physical activity

The current study tested the association between life stressors and tobacco use and mental health outcomes, including depression and anxiety, among Palestinian youths and whether quality of life (QoL) and physical activity can mediate the association between these variables. The sample consisted of 405 Palestinian youths, 245 male and 160 female; all were selected using online methods. Our findings revealed that life stressors were positively correlated with tobacco use (r = .20, p < .01), anxiety (r = -0.32, p < .01), and depression (r = .23, p < .01), while life stressors were negatively correlated with physical activity (r = -0.15, p < .01) and QoL (r = -0.41, p < .01). Results of structural equation modeling (SEM) indicated that QoL and physical activity mediated the association between life stressors and depression and anxiety. Our findings underline the importance of increasing physical activity levels among youths as a protective factor against tobacco use, depression, and anxiety. Moreover, community and school-based interventions to promote QoL and positive mental health in adolescents and youths should incorporate frequent physical activity and engagement in individual or team sports.

Menstrual health and hygiene among young Palestinian female university students in the West Bank: a cross-sectional study

OBJECTIVE

We investigated some aspects of menstrual health and hygiene among young female students at Birzeit University in the West Bank of the occupied Palestinian territory.

DESIGN

Cross-sectional study in a large central university.

PARTICIPANTS

Out of a total of 8473 eligible female students, a calculated sample size of 400 students aged between 16 and 27 years was obtained.SettingLarge central university, West Bank, occupied Palestinian territory (oPt).

MEASURES

An anonymous structured international research instrument consisting of 39 questions based on the Menstrual Health Questionnaire, in addition to few questions relevant to the context, was administered.

RESULTS

30.5% of participants were not informed about menstruation before menarche, and 65.3% reported that they were not ready when they got their first period. The highest reported source of information regarding menstruation was family (74.1%), followed by school (69.3%). About 66% of respondents reported that they need more information on various topics of menstruation. The most common type of menstrual hygiene products used were single-use pads (86%), followed by toilet paper (13%), nappies (10%) and reusable cloths (6%). Of the total 400 students, 14.5% reported that menstrual hygiene products are expensive, and 15.3% reported that they always/sometimes had to use menstrual products that they do not like because they are cheaper. Most (71.9%) of the respondents reported that they used menstrual products for longer time than recommended due to inadequate washing facilities at the university campus.

CONCLUSIONS

The findings provide useful evidence on the lack and the need for menstrual-related information for female university students, inadequate infrastructure to help them manage their menstruation with dignity and pointed to some menstrual poverty in accessing menstrual products. A national intervention programme is needed to increase awareness regarding menstrual health and hygiene among women in local communities and female teachers in schools and universities to enable them to disseminate information to and meet the practical needs of girls at home, at school and at the university.

Burden of tracheal, bronchus, and lung cancer in North Africa and Middle East countries, 1990 to 2019: Results from the GBD study 2019

Objective

To provide estimates on the regional and national burden of tracheal, bronchus, and lung (TBL) cancer and its attributable risk factors from 1990 to 2019 in the North Africa and Middle East (NAME) region.

Methods and materials

The Global Burden of Disease (GBD) 2019 data were used. Disability-adjusted life years (DALYs), death, incidence, and prevalence rates were categorized by sex and age groups in the NAME region, in 21 countries, from 1990 to 2019. Decomposition analysis was performed to calculate the proportion of responsible factors in the emergence of new cases. Data are presented as point estimates with their 95% uncertainty intervals (UIs).

Results

In the NAME region, TBL cancer caused 15,396 and 57,114 deaths in women and men, respectively, in 2019. The age-standardized incidence rate (ASIR) increased by 0.7% (95% UI -20.6 to 24.1) and reached 16.8 per 100,000 (14.9 to 19.0) in 2019. All the age-standardized indices had a decreasing trend in men and an increasing trend in women from 1990 to 2019. Turkey (34.9 per 100,000 [27.6 to 43.5]) and Sudan (8.0 per 100,000 [5.2 to 12.5]) had the highest and lowest age-standardized prevalence rates (ASPRs) in 2019, respectively. The highest and lowest absolute slopes of change in ASPR, from 1990 to 2019, were seen in Bahrain (-50.0% (-63.6 to -31.7)) and the United Arab Emirates (-1.2% (-34.1 to 53.8)), respectively. The number of deaths attributable to risk factors was 58,816 (51,709 to 67,323) in 2019 and increased by 136.5%. Decomposition analysis showed that population growth and age structure change positively contributed to new incident cases. More than 80% of DALYs could be decreased by controlling risk factors, particularly tobacco use.

Conclusion

The incidence, prevalence, and DALY rates of TBL cancer increased, and the death rate remained unchanged from 1990 to 2019. All the indices and contribution of risk factors decreased in men but increased in women. Tobacco is still the leading risk factor. Early diagnosis and tobacco cessation policies should be improved.

Current situation and future directions of lung cancer risk factor awareness in Palestine: a cross-sectional study

OBJECTIVES

To evaluate lung cancer (LC) risk factor awareness among Palestinians and identify factors associated with good awareness.

DESIGN

Cross-sectional study.

SETTINGS

Participants were recruited using convenience sampling from hospitals, primary healthcare centres (PHCs) and public spaces located at 11 governorates in Palestine.

PARTICIPANTS

Of 5174 approached, 4817 participants completed the questionnaire (response rate=93.1%). A total of 4762 questionnaires were included: 2742 from the West Bank and Jerusalem (WBJ) and 2020 from the Gaza Strip. Exclusion criteria were working or studying in a health-related field, having a nationality other than Palestinian and visiting oncology departments or clinics at the time of data collection. TOOL: A modified version of the validated LC Awareness Measure was used for data collection.

PRIMARY AND SECONDARY OUTCOMES

The primary outcome was LC risk factor awareness level as determined by the number of factors recognised: poor (0-3), fair (4-7) and good (8-10). Secondary outcomes include the recognition of each LC risk factor.

RESULTS

Smoking-related risk factors were more often recognised than other LC risk factors. The most recognised risk factors were 'smoking cigarettes' (n=4466, 93.8%) and 'smoking shisha (waterpipes)' (n=4337, 91.1%). The least recognised risk factors were 'having a close relative with LC' (n=2084, 43.8%) and 'having had treatment for any cancer in the past' (n=2368, 49.7%).A total of 2381 participants (50.0%) displayed good awareness of LC risk factors. Participants from the WBJ and the Gaza Strip had similar likelihood to display good awareness (50.6% vs 49.1%). Being≥45 years, having higher education and monthly income, knowing someone with cancer and visiting hospitals and PHCs seemed to have a positive impact on displaying good awareness.

CONCLUSION

Half of study participants displayed good awareness of LC risk factors. Educational interventions are warranted to further improve public awareness of LC risk factors, especially those unrelated to smoking.

Palestinian Patients with Cancer at King Hussein Cancer Center

Background

The Palestinian Ministry of Health (MoH) routinely refers Palestinian patients with cancer to King Hussein Cancer Center (KHCC), the largest cancer center in the Middle East.

Aims

We aimed to describe the characteristics of Palestinian patients with cancer.

Methods

We performed a retrospective chart review of all Palestinian patients with cancer who were treated at KHCC during 2018 and 2019, of which demographic and clinical characteristics were presented.

Results

We initially started with 521 cases, out of which 41 (7.9%) cases were excluded due to misdiagnosis as malignant on pathology review. We included 480 patients with a confirmed diagnosed of cancer. Most patients were adults (88.8%) with a mean age of 50.0 ± 15.0 years ranging from 19 to 87 years. The most common cancer sites in adult men, who comprised 46.9% of the cohort were the hematolymphoid system (23.5%), followed by the digestive system (17.5%), and lung and pleura (11.5%). In women (53.1%), the most common cancer sites were the breast (46.0%), followed by the digestive system (15.0%), and the hematolymphoid system (10.2%). Children and adolescents accounted for 11.3% of the total cases, among which the hematolymphoid system was the most common cancer site (50%), followed by the brain (14.8%). About 36.0% of all patients presented with advanced-stage disease (i.e., distant metastasis).

Conclusion

The most common cancer sites in our cohort are generally similar to data from the Palestinian territories. Many patients presented with advanced-stage disease, which signals the need for awareness campaigns and screening programs. Benign tumors are misdiagnosed in many patients as cancer. The limited resources and facilities including human resources remain important challenges to the proper and timely diagnosis and management of cancer among Palestinians living in the Palestinian Territories.

Awareness of Colorectal Cancer Risk Factors in Palestine: Where Do We Stand?

To assess the public awareness level of colorectal cancer (CRC) risk factors in Palestine and identify factors associated with the good awareness level.

A national study in Palestine finds low awareness of colorectal cancer risk factors.

Tobacco Research in the Eastern Mediterranean Region: A Scoping Review of Published Studies from Seven Countries

While surveillance on a global scale has been showing a decline in tobacco smoking in the past decade, rates in the Eastern Mediterranean Region (EMR) remained stable with some countries showing rising trends. This study aimed to analyze the landscape of tobacco research in the EMR, present data on publication trends, and identify research gaps and opportunities to guide future tobacco research in the region. We conducted a scoping review of tobacco research in seven countries from January 2000 to December 2013. Three hundred and forty eight studies were identified, the majority of which were published in international journals and in English language. There was an increase in publications over time, with a significant positive linear trend (p = 0.03). Descriptive cross-sectional and case-control studies were the most common study designs (67.0%), and only 8% were longitudinal studies. Papers that reported, in part or solely, on waterpipe tobacco smoking (WTS) constituted 25.6% of the total publication pool. Tobacco consumption was treated as an exposure variable in half of the papers and mostly in relation to cancer and cardiovascular diseases, as an outcome measure in 37.7%, and as a confounding variable in 14.7% of the papers. Studies that examined associations of tobacco with other behaviors (5.3%) were lacking. The scarcity of high-evidence tobacco research in the EMR, together with the relatively deficient data on WTS and associations with other factors warrant the need for discussions on research priority setting and guidance on funding allocations in the region.

Determinants of smoking cessation counseling favorable practice for primary care physicians: A cross-sectional study from Palestine

Background:

Smoking cessation counseling is not well established in Middle East countries including Palestine. This study assesses the practice of smoking cessation counseling among primary healthcare (PHC) physicians in Palestine and its determinants.

Methods:

Over the period from April to September 2019, general practitioners, family medicine physicians, obstetricians and gynecologists, and dentists working at the PHC Centers in Palestine were approached through a cross-sectional design using a self-reported questionnaire. Proportionate stratified random sampling approach has been used. Sociodemographic, medical background, smoking cessation counseling training, smoking history, practice, knowledge, attitude, and confidence were evaluated. The proportion of favorable practice has been determined and its relationship with all variables has been evaluated. Ethical approval was received from the National University of An-Najah.

Results:

295 physicians were enrolled in the study with an 86% response rate. 75.5% (n = 222) were males with a mean age of 39.9 ± 9 years. The majority were General Practitioners (76.5%, n = 252). Most of them (84.3%, n = 215) had not received any training. The favorable practice was seen in 36.6% (95% CI 31–41%). Attitude is the main predictor of favorable practice (P value = 0.002, adjusted OR = 1.1).

Conclusion:

Palestinian PHC physicians have a low level of counseling for smoking cessation. Given the efficacy of counseling for smoking cessation and the high level of the tobacco epidemic in the area, health policy to ensure all healthcare personnel-especially physicians-receive training in cessation counseling and call for a public health campaign for control of tobacco should be taken into account.

Comparison between Smoking and Nonsmoking Palestinian Medical Students in the Health-Promoting Behaviors and Lifestyle Characteristics

Objectives

This study was aimed at comparing the predictors of health-promoting lifestyle behaviors between smoking and nonsmoking medical students at An-Najah National University located in Palestine.

Methods

A descriptive cross-sectional study was performed during the academic year 2017/2018. Medical students were asked to complete a self-reported questionnaire that involved the predictors of Health-Promoting Lifestyle Profile-II. With the use of a suitable available sample composed of a total of 430 medical students, 400 had successfully completed the questionnaire and were included in the study. The data was analyzed by using SPSS version 24 software.

Results

The sample included 400 medical students with a mean age of 18.7 years, 311 (77.7%) were females, and 89 (22.3%) were males. The prevalence of smokers in the sample was 110 (27.5%). For the health status of over half the students, 211 (52.8%) were excellent. The total HPLP-II score for smoking students resulted to be significantly lower in comparison to nonsmoking students (131.2 versus 135.7). This significant difference was clear in the interpersonal relation subscale (25.6 versus 26.8) for smoking and nonsmoking students, respectively. The score differences in other subscales were generally lower in smoking students. However, these differences were not consistent with statistical significance.

Conclusion

The significant lower total Health-Promoting Lifestyle Profile-II score in smoking students necessitates the urgent need for awareness programs, not only towards smoking but also on how to enhance student health-promoting lifestyle behaviors.