Hygiene practices
A study in Al-Hassa, Saudi Arabia found that only 24.65% of the students brush their teeth twice or more per day, while 44.6% used Miswak as an alternative method of dental cleaning. In a study in Madina, Saudi Arabia, a total of 61% of the adolescents testified that they brushed their teeth at least once a day and 16 % of the surveyed population claimed to use the Miswak chewing stick as a means of dental cleaning (AL-Tamimi & Petersen, 1998). Another study conducted in Riyadh revealed that Miswak was practiced by more than half of Saudi people (AL-Khateeb et al, 1990).
According to Wyne & khan (1995), 75% of school children in Riyadh were using canned soft drinks and packed fruit juices, and 41% of children were not brushing their teeth. Almas et al (2003) found 7% of male intermediate school students (age 12-15 years) and 3% of female and in secondary schools 14% of male and 3.5% of female students never cleaned their teeth. The daily oral hygiene habit was prevalent among 19% male and 20% female students in intermediate and 25.4% male and 19% female students in secondary schools. A toothbrush was most commonly used by both male and female students at intermediate (28.9% male, 44.5% female) and at secondary school (28.8% male and 63.7% female).
Approximately 24% of secondary school male students used brush often, as compared to use of Miswak. Furthermore, toothpaste was commonly used with a toothbrush in both groups of students. 11.3% of male secondary school students did not use anything with a toothbrush. The study further showed that toothpaste was used with Miswak by 4% male and 11% female students in intermediate and 4.6% male and 8.3% female students in secondary schools. Brushing the teeth once in a day was prevalent among 42.6% male and 27.6% female at intermediate and 61.4% male and 26.8% female students at secondary schools. Miswak was used more than 3 times a day by male students 53.1% and 55.8% in intermediate and secondary schools. Once daily use of Miswak was common among female students ranging from 49.5%-55.2%. Majority of the students used Miswak more than 3 minutes per day (Almas et al 2003).
Additionally, 65% of students brushed their teeth at least once in a day, according to a study done in an intermediate school in Riyadh. However, only 5.1 % used the dental floss. Moreover, over 65% of the students ate sugary foods products at a minimum of one time in a day (AL-Sadhan, 2003).
Eating habit
Obesity is becoming a universal problem impacting on all stages in the society, and can be described as a global epidemic (WHO1998). The prevalence of childhood obesity is high in the Middle East (James, 2004). For example, in Saudi Arabia; one in every six children aged 6-18 years old is obese (AL-Nuaim, 1996). There is no clear explanation of overweight. Intake of food has been associated with obesity both in terms of the amount (volume) of food ingested and quality, as well as the composition of the diet. AL Sadhan found that over 65% of intermediate students in Riyadh consumed sweetened products at least once a day (AL-Sadhan, 2003). As well, Amin found in his study that a high proportion of children reported higher frequency of soft drinks, sweets and candy, and less frequently fresh fruits and vegetables (Amin et al, 2008). Food and physical inactivity have likely contributed to the increase in the prevalence of overweight and obesity in Saudi children (Magbool et al, 1993). A study conducted during 2007 in intermediate and secondary school in Riyadh, which includes boys and girls, indicated that the frequency of reported consumption of sugar sweetened carbonated beverage (SSCB).
Increased with age in both male and female children, suggestiona trend directed to the foods rich in sugar and far from the healthier choces of food as the age advances. this happend together with a declinein milk consumtion asper the weekly reports. fruit,vegetable,and fish. This observation seems to confirm other related studies that indicatethat the children’s diets quality decreased over time (Lytle et al, 2000). Additionally, consumption of SSCB and added sugar associated withhot beverages was importantly higher wih boys that have their ages between 14-19 as compared their girls of the same age, in mantaining the previous observations in Saudi (Bello & AL-Hammad, 2006).
Seat belts
Saudi Traffic Authority statistics show that, on average, more than 4100 people are being killed and 28,000 are being wounded yearly because of roughly 29,000 traffic accidents that take place every year (Traffic General Directorate, 2003).
Seat belts cut down the severity of wounds sustained by car occupants involved in accidents by retaining them in their seats and preventing them from hitting objects around them and from being ejected through the windows. Wearing seat belts is regarded a very efficient measure of safety. Many studies have indicated that seat belt use extensively cut down on the number of road accident injuries or minimizes the extent of these wounds (Cooper, 1994; Evans, 1996; Koushki et al., 2002). As per the 1999 report by the National Safety Council in USA has indicated that 9553 lives could have been saved in a year in the United States, if the people had used seat belts (National Safety Council, 1999). Using safety belts for both the front seat passenger and the driver (FSP’s) was made compulsory in Saudi Arabia on 5 December 2000. A study in 2005 shows that seat belt use rate in two Riyadh suburbs: a central suburb (chosen randomly from among middle-class suburbs) and an eastern suburb (chosen randomly from among working-class suburbs) was 33.3% in the working-class suburb and 86.7% in the middle-class suburb for drivers and 4% in the former and 41.3% in the latter for FSP’S. As much as the usage of safety belts is not high, it is positively increasing as compared to when the law was not enacted. Further, different types of wounds sustained as a result of accidents was noted to decrease after the law on wearing safety belts was enacted.
Smoking
Saudi Arabia does not grow tobacco or manufacture cigarettes but smoking has existed in this country for more than 50 years (Faris, 1995; Jarallah et al, 1999). The annual tobacco imports in Saudi Arabia have increased dramatically over the years and the annual cost of cigarettes imported by Saudi Arabia was estimated to be around $150 million (Faris, 1995; Jarallah et al, 1999). Very few studies on the prevalence of tobacco smoking among adolescents have been performed in Saudi Arabia (Jarallah, 1992; Faris et al, 1994; Rowland& Shipster, 1987; Taha et al, 1991; Felimban, 1993; Saeed1987). In a study conducted in three regions in Saudi Arabia found that the prevalence of smoking among male was 21% and for female 0.9% most smokers were young. Smoking Prevalence was higher among uneducated people and those in certain occupations: manual worker, office workers.
The kingdom of Saudi Arabia (KSA) is a relatively ‘young’ nation. Development in this nation has been rapid, with corresponding changes in wealth and lifestyle of the population.
Persistence in unhealthy behaviors is seen among adolescents in Saudi Arabia. This could be due to failing to address the underlying causes and explore why young people are drawn to these behaviors and the nature of the social and individual influences them. In addition, relying on the media and education as a primary source to change the behaviors in Saudi Arabia people does not fully fight this vice (Faris, 1995). The social-political factors are the main health factors but are largely not considered because the oral health programmers in Saudi Arabia major on the person’s behavior change. Conventional oral health education is neither successful nor well-organized in this country (Sheiham & Watt, 2000). Rather than laying focus only on individuals, the approach requires to attain a better balance of focusing on both individual level factors as well as the social environment in which health behaviors of individuals are developed and sustain Sander et al, 2006). Most of the orally administered health programmers are generated and implemented in segregation from the other heath programmers. This usually results to inconsistent messages being passed on to the public (Sheiham & Watt, 2000).
Oral health is largely depended on personal hygiene, alcohol and cigarette intake, diet as well as lifestyle involved, which can come up with stress related issues. This can be implemented in many ways; Food policy, Smoking policy and Health Promoting school (Sheiham & Watt, 2000).
Health and risk behavior by socioeconomic status
Many studies have demonstrated that the health of individuals from the lower end of the socio-economic scale is markedly worse than that of individuals from the upper end. This relationship exists across a broad range of health indicators, including dental health (Locker, 2000). The existence of socio-economic inequalities has been partly attributed to social differences in health behaviors (Lynch, 1997; Marmot & Wilkinson, 2006). Wael et al, (2009) states that there is a clear socio-economic disparity in behaviors such as smoking, dental visit, and the frequency of fruits and vegetables intake. Additionally, numerous evidence has accumulated concerning an inverse relationship between socioeconomic status and the behavioral and psychological characteristics which are important risk factors for poor health. For instance, health survey for England in 1994 shows that women in low socio economic status are less often to eat healthy food than those who belong to higher social class. This association may be due to many factors such as an inadequate access to education and information, as well as poverty itself, rather than reflecting a single invariant cause (Marmot & Wilkins, 2006). Furthermore, psychological characteristics, such as depression has considered as potential explanations for why people at the bottom of the social hierarchy have poorer health (Kaplan, 1995).
There is evidence of a moderately consistent pattern relating socioeconomic status with fruit consumption and physical activity, both which do the conferring health benefits in the short and longer term (HBSC, 2006). Furthermore, a study conducted by Lynch et al (1997) have shown that poor adult health behavior is related to a poor socioeconomic status start in life, low levels of education and blue collar employment. Higher education status, as inferred by high occupational status, may explain the greater incidence of health promoting behavior in young people of less poor families (HBSC, 2006). As well as, dental visit correlate with the occupational and educational status of the parents in Finland (Honkala et al, 1997).
Many studies have examined the impact of socio-economic inequalities in health related behaviors of adults; very few have focused on adolescents. This is due to problems in measuring SES in adolescents (Curries et al, 2008; west & Sweeting, 2004). Family SES is generally used as the proxy for adolescents, which is difficult to collect from adolescents because they either not know or may not be willing to reveal such information (Jung et al, 2010).
Family affluence scale (FAS) is a brief and easily comprehensible measure that can be used as a measure of family SES for adolescents (currie et al, 2008). Young people with low family influence were, in general, more likely to report daily smoking and weekly consumption of beer, cider and wine as well as were more likely to report cannabis use (HBSC, 2006). Additionally, Adolescences with low family affluence were more likely to report that they smoked daily compared to those with medium and high family affluence this was particularly clear among boys. Ferri (1993) reported that cigarette smoking at age 16 increased from 24% among those from the most affluent homes to 48% among the most deprived. Jung et al (2010) found that family affluence had a linear relationship with health enhancing behaviors among Korean adolescents. Brushing teeth and visiting a dental clinic were more frequent among adolescents from more affluent families, confirming previous studies (Maes et al, 2006; Petersen et al, 2008). On the other hand, they found that health compromising behaviors such as smoking, dinking soft drinks and eating confectionary, were more linked to other factors than with family affluence such as school type and family structure pocket money. These findings suggest that childhood, adolescents and adulthood are all potentially important stages for attempts to alter the health related behavioral profiles of adults (HBSC, 2006).
Friestad and Klepp (2006) conducted a prospective cohort study in Norway among adolescents at the age of 13-21, to do investigation of health behaviors measured as one variable and as health behavior patterns’ composite indices, and their link to socioeconomic status’ different proxies; occupation as well as parental education, and educational aspirations of adolescents. The result showed that quite a number of relationships were observed amid reported health behavior of adolescents and parental daily undertakings when the former is broken down as single behaviors. Rather than single forms of behavior, an important social factor in the health enhancing behavior is noted during health behavior measuring.
Social context
Many studies have shown that behavioral pattern are formed, influenced, and changed by social and societal conditions (Honkala, 1993). The immediate environment strongly predicts health behaviors; and the economic cultural process within the wider environment directly or indirectly influence the choices and decisions young people make concerning health behaviors (Kuusela et al.,1997).
In summary, the review of literature on health behaviors in adolescents reveals some common findings:
- Universal pattern of oral hygiene behaviors.
- Female adolescents were more likely to practice good oral hygiene than males.
- Children with higher SES more likely to practice oral hygiene.
- The older the adolescents the better their oral hygiene.
Rational for this study
Growing concern over the long- term effects of unhealthy behaviors such as unhealthy eating and smoking among children and young people has highlighted the need to explore and monitor young people’s health behaviors. Up to know, few studies are available on health related behaviors among Saudi female schoolchildren in Riyadh. Additionally, all the studies available are focused on tooth brushing frequency, dietary habits and dental attendance with the absence of general health behaviors (AL-Sadhan, 2003; Wyne & khan, 1995; Almas, 2003). Moreover, few studies are conducted on risk behaviors such as smoking among female schoolchildren in Riyadh (Jamal et al, 2010).
Therefore, the purpose of this study is to provide information on the current pattern of health behaviors among a sample of female school children aged 13 -18 years in selected schools in Riyadh. The results from this study will be valuable in several ways. First, implementation of a successful oral health promotion programmer depends on both information about the prevalence of such behaviors and an understanding of their determinants. Secondly, the result will be used to compare the health behaviors of female schoolchildren in the region with the health behaviors of similarly aged schoolchildren in other regions or countries. Thirdly, information about patterns of health related behaviors can provide important data for adjustment of health education interventions within the context of health promotion programmer.
Hypothesis
Based upon this review the hypothesis for this study is an adolescent with better socio economic status are more likely to practice general and oral hygiene behaviors.
- Aim & objectives
- Aim
The aim is to explore the oral and general health behaviors among a sample of female students in a selected school in Riyadh and to assess whether socio- economic status is related to health behaviors.
Objectives
- To explore oral and general health behaviors of female students aged between 13 and 18-year-old.
- To assess the association between socio-economic status (SES) and oral health related behaviors in Saudi adolescents.
- To explore and look into between relationship to socioeconomic status and health behaviors measured as single variables as well as composite.