Monitoring tobacco use among a sample of Tunisian high school pupils

Background

Smoking is the leading cause of preventable death. This risk behavior usually begins during adolescence. However, only the third of the countries are monitoring this risk behavior among adolescents.

Objective

To assess the prevalence of tobacco use and to determine the predictors of its experimentation among high school students from Sousse (Tunisia) in 2018 and 2019.

Methods

In 2018 and 2019, two cross-sectional studies were led among 1399 and 1342 adolescents randomly selected from the same four high schools in Sousse. For data collection, the same pre-tested questionnaire was self-administered anonymously to the participants in the presence of pre-trained investigators.

Results

Girls represented 60.5% and 63.2% of participants in 2018 and 2019 respectively. The prevalence of tobacco experimentation was of 29.4% in 2018 and of 26.7% in 2019. Current cigarette smoking was objectified in 9.8% and 7.4% of participants in 2018 and 2019. Regardless of the year of the study, the main predictors of lifetime tobacco use among them were: current use of e-cigarette (adjusted OR of 6.4 [4.5-9.0]), cannabis experimentation (adjusted OR of 5.3 [2.7-10.7] and alcohol consumption (adjusted OR of 3.9 [2.5-6.3]).

Conclusions

Experimentation and current use of tobacco are common among the high school students of Sousse. The national smoking prevention program should be reinforced by multisectoral prevention actions targeting not only tobacco use but also the consumption of other substances.

Key messages

• Tobacco experimentation is high among the adolescents of Sousse.

• Tobacco experimentation is strongly associated with other substances use among the adolescents of Sousse.

Video game addiction among Tunisian adolescents in Sousse: A cross-sectional study in high schools

Background

Addiction to video games is a theme regularly mentioned and associated with the risks that concern adolescents. This study aimed to determine the prevalence of video game addiction (VGA) among adolescents and identify its associated factors.

Methods

We conducted a cross-sectional study within public high schools, in Sousse, Tunisia in 2019. The target population was high school students. A structured self-administered questionnaire was used to collect data about sociodemographic characteristics, lifestyle behaviors, and mental health disorders, and we used the 21-item Game Addiction Scale to objectify video game addiction. Statistical analysis was carried out using the program SPSS v.20.

Results

A total of 1342 participants were recruited for the study,36.8% of whom were boys. The average age was 17.5 ±1.44 years. The analysis of mental health disorders showed that 67% were anxious, 66.8% were alexithymic, 65.4% were depressed and 39% had low self-esteem. The analysis of lifestyle behaviors showed that a lack of physical activity was reported by 57.6% of participants. Problematic use of the Internet (>2 hours per day) was reported among 72.4% of the students. The prevalence of video game addiction was 13%. Boys were more prone to be addicted than girls (66.2% versus 33.8%, p < 0.001). ≥17 years old students had a higher rate of VGA than those aged<17 years old (57.3% vs 42.7%, p = 0.031). VGA was higher among students who follow the non-scientific study section (69.4%, p = 0.007). Students who had moderate depression had the highest percentages of VGA (35.7%, p = 0.005). Students who had problematic use of the internet were more addicted to video games (80.3%) than those not having problematic use (19.7%), p = 0.009.

Conclusions

This study allowed us to identify the students who are vulnerable to VGA. Also, a huge responsibility is accorded to school staff and parents to tackle this health problem by sensitizing their children and setting up some protective family rules.

Key messages

• Several factors were significantly associated with video game addiction, especially problematic internet use.

• Further research is needed to understand the underlying mechanisms of video game addiction and to explore effective preventive or interventional strategies.

Prospective prediction of alcohol consumption among a Tunisian sample of adolescents

Background

During adolescence, alcohol consumption represents a new experience with the advantage of facilitating the integration of a peer group. The global overall prevalence of this risk behavior among the 15-19 years old was over 25% in 2018. However, this prevalence varies between countries.

Objectives

To determine the incidence and the predictors of alcohol consumption among high school students in Sousse, Tunisia between 2017/2018 and 2018/2019.

Methods

A prospective longitudinal study was conducted in four high schools in the governorate of Sousse during the 2018-2019 school year. Pre-trained medical doctors used an anonymous self-administered questionnaire to collect data about socio-demographic and educational features, alcohol consumption, tobacco use, illicit substances use and emotional disorders.

Results

Participants accounted for 404. Their average age was 16.4 (±1.1) years. Females represented 68%. The prevalence of alcohol consumption in 2017/2018 was 5.9% while the cumulative incidence during the 2018/2019 school year was 3.5%. Among males, this incidence was of 11.9%. Among females, it was of 3% (p = 0.020). Illicit substance use among friends was the main predictor of becoming alcohol consumer with an adjusted odds ratio of 6.4 (95% CI: 1.9-21.3) on the other hand, having an anxiety trouble predicted less this risk behavior (adjusted odds ratio =0.2 95% CI: 0.1-0.8).

Conclusions

Alcohol consumption is becoming more and more common among the adolescents of Sousse especially among males. The current national strategy against substances use in schools should be reinforced. Implementation of a social skills training among adolescents to improve assertiveness is essential.

Key messages

• Alcohol consumption has an upword trend among the adolescents of Sousse.

• The current prevention programs targetting adolescents in Tunisia should be revised and integrate a comprehensive and multisectoral program.

Prospective prediction of substances use among a cohort of Tunisian adolescents

Background

The risk of substances use increases during adolescence. In Sousse (Tunisia), an upward trend of these risk behaviors has been observed during the last years among young adolescents. Among older adolescents, the trend of their use is unknown.

Objectives

To determine the incidences and the most influencing factors on substances use among high school students in Sousse between 2018 and 2019.

Methods

A prospective longitudinal study was conducted among a cohort of high school students from Sousse. The same pre-tested questionnaire served to collect data in 2018 and 2019 from the same participants in their classes and in the presence of pre-trained investigators.

Results

A total of 404 high school students have participated in the study. Their median age was of 17 (IIQ: 15.8-17.6) years. Girls represented 66.8% of participants. The incidence rates of lifetime tobacco use, alcohol consumption, lifetime inhalants use and lifetime illicit substances use between 2018 and 2019 were 13%, 3.5%, 1.8% and 2 .9% respectively. Lifetime tobacco use was the main predictor of inhalants experimentation. This latter was the main predictor of becoming a user of e-cigarettes while alcohol consumption was the most influencing factor on cannabis experimentation among high school students. On the other hand, illicit substances use among friends predicted e-cigarette use, alcohol consumption, and cannabis experimentation among participants.

Conclusions

The existing prevention programs aiming at reducing tobacco use and substances use in the schools of Tunisia should be reinforced and integrate a comprehensive and multi-sectoral prevention program. The implementation of a national observatory of substances use would ensure the continuous improvement of this program.

Key messages

• There is an upward trend on using substances among the adolescents of Sousse, Tunisia.

• Tobacco experimentation and alcohol consumption are the gateway to later substances experimentation among the adolescents of Sousse, Tunisia.