The percentage of smokers is increasing it reaches up to 25% in the GCC countries

1. Effectiveness of Educators on The Prevention of
Adolescent Smoking
Professor Faisal Abdullatif Alnasir MBBS, FPC, FRCGP, MICGP, FFPH, PhD
Chairman; Dept of Family & Community Medicine
Arabian Gulf University. Bahrain
Former President; Scientific Council Family & Com. Medicine
Arab Board for Medical Specializations
General Secretary: Inter. Society for the History of Islamic Medicine
Prof Faisal Alnasir 2016 1

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3. • In Jordan and Tunisia it is 43% and
45% respectively
• In Oman it is 13% in men.
Hawari FI & Bader RK.2014
• In Kuwait the current smokers is
18.4% and previous was 16%.
Behbehani NN ,et al, 2004
• 20% of Bahrainis aged 20 to 64
years had ever smoked tobacco.
Ministry of Health Bahrain.2010
Prof Faisal Alnasir 2016 3
The prevalence of smoking among the general population:

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Adolescentcigarettesmokingisacomplexpublic
healthproblem

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Adolescents' smoking:
• Is highly influenced by home
environment or school life
• Will tend to be similar to that of his or her
peers
Kirke, 2004
• Usually start out of a desire for social
self-growth, to be treated as an adult, or
out of resistance to established
regulations.
• Poor attitudes to family, school and
community.

6. Among children and adolescent
students, smoking is a behavior that
they would copy when they observe a
model person, such as school teachers
who smoke.
Close contacts, such as parents,
siblings and friends also affect the
children’s behaviors.
Therefore, teachers can play a role in
promoting or preventing smoking
among students Prof Faisal Alnasir 2016 6

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Adolescents‘ smoking is a
gateway to all kinds of
substance abuse.
Sang-hee Park,2011
• Three times more likely to use alcohol.
• Eight times more likely to use marijuana.
• 22 times more likely to use cocaine.
• Associated with other risky behaviors:
-Fighting
-Engaging in unprotected sex
CDC, 1994

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 Evidence shows that cigarette displays in
shops can encourage young people to
start smoking
 Every year more than 300000 under 16
years try smoking for the first time
 5% of children aged 11-15 are regular
smokers
 39% of smokers started <16 years of age.

10. The prevalence of smoking among students:
• In Bahraini school was 25.8% in 1996
Haddad N, 1998
• In Saudi intermediate schoolboys was 13.2%
Jarallah JS, et al,1996
• Among adolescents in USA is around 23%
CDC,2006
Prof Faisal Alnasir 2016 10

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Smoking prevalence among medical
students in Bahrain increased, from
1993 to 2005, from 27.5 % to 35.2%
among males and from 2.3% to 7.0% in
females.
Hamadeh RR. 2013
The overall prevalence of shisha
smoking was 8.4%, and was highest in
the age group 20-29 (12.4%).
National Non-communicable Diseases Risk Factors Survey 2007

12. Smoking among school teachers:
• In Malaysia 40.6%
• 52.1% male Syrian teachers and 12.3%
females
• In Bahrain 7% of the teachers were smokers.
And the duration of smoking increased as
years of employment increased (p<0.001).
[Faisal Alnasir, 2004]
Prof Faisal Alnasir 2016 12

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• In Spain, teachers were
allowed to smoke in their own
offices in 61.6% of the centers
and 18.6% of schools allowed
students to smoke
[Ballestín M, et al, 1999]

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Prevention of adolescent smoking

19. Any anti-smoking policy should include,
besides other known measures, raising
the level of teachers’ knowledge about
the effect of smoking on health and
discouraging them from smoking in
public places, especially in schools.Prof Faisal Alnasir 2016 19

20. • Programs must be implemented in schools
with the aim of raising the students’
awareness of the danger of smoking.
• Engage in exercise; Physical activity in
adolescent is inversely associated with
smoking (Students who play at least one sport are 40% less likely to be
regular smokers)
Holmen et al.2002
•Effect of mass-media interventions for
preventing smoking in students. Prof Faisal Alnasir 2016 20

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The National Guidelines for Tobacco prevention in schools
in the USA (Canters for Disease control). All schools
should:
CDC , 1994
1. Develop and enforce policy on tobacco use. Prohibit tobacco use by all
students, and visitors
2. Provide tobacco prevention education in kindergarten through 12th
grade.
3. Provide instructions about immediate and long-term consequences of
tobacco use and schools should provide behavioral skills for resisting
social influences that promote tobacco use.
4. Improve curriculum implementation and overall program effectiveness.
5. Provide program-specific training for teachers.
6. Involve parents or families in support of school-based programs to
prevent tobacco use.

22. Current students’ smokers are the least
knowledgeable (69.4%) about smoking
hazard whilst non-smokers (89.3%) were
more knowledgeable.
Almas et al, 2002. Alfaris, 1995
The fact that smoking students were least
knowledgeable could be a reflection of a
deficiency in the transfer of knowledge to
them from their teachers, or a weakness of
our public health campaign role of other
factors.
Prof Faisal Alnasir 2016 22

23. Providing written material for the
students could enhance health
education programs to prevent
smoking, both in terms of current
smoking and future intent to
smoke.
Prof Faisal Alnasir 2016 23

24. Teachers are able to increase
the limited students’
knowledge of medical
problems related to smoking, if
themselves have adequate
knowledge about these
problems.
Faisal Alnasir, 2004
Prof Faisal Alnasir 2016 24

25. • Teachers’ knowledge about smoking in Bahrain was
increasing as the duration of their occupation increased.
• Their knowledge about the effect of passive smoking was
deficient.
• More teachers in the primary schools were knowledgeable
than the intermediate and the secondary schools. This
may imply that early role modeling of not smoking by
teachers might deter the students from smoking.
Faisal Alnasir, 2004
Prof Faisal Alnasir 2016 25

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The general climate in school is
one conducive to the
establishment of a comprehensive
smoking education program. It
also indicates that the teachers'
attitudes and behavior towards
smoking education were closely
related to their smoking behavior.
Chen TL, Rakip WR 1975

27. Students, who received
information on the health
effects of smoking from family
and teacher had higher overall
knowledge, attitude, and
preventive efforts scores than
students who received
information from other sources.
Faisal Alnasir 2004Prof Faisal Alnasir 2016 27

28. It is recommended that:
• Teachers’ training be conceptualized
as a behavior change process with
explicit teachers motivation
components included to help effect the
intended behavior.
• Teachers to take personal interest in
the students’ welfare so that they
would influence the students’ smoking
habit. Prof Faisal Alnasir 2016 28

29. It is recommended that:
• Lectures on smoking should be included in
the curriculum of teachers' training courses
• Set a good example
• Any anti-smoking policy should include
prohibition of teachers from smoking in
school and maintenance of an in-service
teachers’ education about the hazards of
smoking.
Prof Faisal Alnasir 2016 29

30. It is recommended that:
• There should also be active
involvement of teachers,
religious leaders, parents,
and other influential groups in
all tobacco related prevention
efforts to maximize their
effectiveness.
Prof Faisal Alnasir 2016 30

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Quit tobacco clinics
(QTC) were
established in three
health centers in the
Bahrain since 2004 to
provide services to
clients who wished to
quit smoking. (Quit rate 55%
for cig.)

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Alwast Newspaper April2016

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