Adolescents in the Arab Culture

1. Adolescents in the Arab Culture Ashraf T Soliman MD PhD FRCP Profesor of Pediatrics and Endocrinology

3. Arab World

4. The Arab World • Arabic-speaking countries stretching from the Atlantic Ocean in the west to the Arabian Sea in the east, and from the Mediterranean Sea in the north to the Horn of Africa and the Indian Ocean in the southeast. • It consists of 25 countries and territories with a combined population of 358 million people straddling North Africa and Western Asia.

5. Arab World • The Arabic language forms the unifying feature of the Arab World. • Though different areas use local varieties of Arabic, all share in the use of the standardized classical language, which was constructed from Classical Arabic

6. Religion • The majority of people in the Arab World adhere to Islam and the religion has official status in most countries. • Overall, Arabs make up less than one quarter of the world's 1.4 billion Muslims

7. Christians • There are sizeable numbers of Christians, living primarily in Egypt, Syria, Lebanon, Iraq, Jordan, Palestine and Sudan.

8. Poor and Rich • There are economic disparities between oil-rich and oil-poor countries, and, particularly in the more sparsely populated states of the Arabian Gulf and Libya, triggering extensive labor immigration • Four Arab Gulf states, Saudi Arabia, the UAE, Kuwait, and Qatar, are among the top ten oil or gas exporters worldwide

9. Rich and poor • Algeria, Libya, Iraq, Bahrain, Egypt, Tunisia, and Sudan all have smaller but significant oil reserves

10. Literacy in Arab Adolescents • In 2004, the regional average of youth literacy was 90% for male and 80 % for female • Illiteracy for 15-24 year olds ranges from less than 1% in Jordan to 50% in Yemen. • >one third of youth remain illiterate in the some Arab countries (Djibouti, Mauritania, Somalia, Sudan, and Yemen)

11. Youth Unemployment the Arab Labor Organization (ALO) rates unemployment in the Arab world as the worst worldwide. According to the report the general rate of unemployment in Arab countries exceeds 14 % youth rate of unemployment in Arab world exceeds 26% , which means that the Arab region has more than 17 million unemployed. Algeria--- 46 percent; Bahrain is 27 percent; Saudi Arabia, 26 percent The UAE has the lowest rate, 6.3 percent..)

12. The reasons behind the rise in youth unemployment • Failure of development, • Neglect of critical social aspects, • poor economic performance (as indicated through inadequate growth averages), • The inefficacy of education and its failure to meet the requirements of the job market, • The failure to create attractive investment climates Hamdi Selim . Unemployment in the Arab World. 26/07/2008, Alsharq Alawsat newspaper

13. Problems of education qualityThe MENA region • According to the “the most worrying aspect of the crisis in education is education’s inability to provide the requirements for the development of Arab societies • In cases when education is available, it suffers from the low quality of its educational system, lack of educational materials or qualified teachers. • Access to colleges or universities is still limited. 2002 Arab Human Development Report, Education in the Middle East and North Africa Wikipedia

14. Problems of education quality (universities) • Crowded facilities • Centralization of most Arab universities in national capitals and primary cities. • Low living standards of university faculty. • “Many universities in the Arab world operate in seclusion from their surroundings, unable to open up and interact with society • Little or no academic freedom • Low-quality research with unclear goals (<0.5 % of public income is spent over research) • lack of a good and effective management, poor integration across the university programs • the absence of a link between pre-university and university education.

15. Democracy? in Arab countries • Arab adolescents lack the right to freely express their social and political opinions • Presidents and kings remain too powerful. Constitutions and laws deliberately keep them that way. • Countervailing institutions remain weak, if they exist at all • Lack of broad-based political organizations pushing for democracy—political parties, social movements, labor unions, large civic organizations.

16. Parenting Styles, and Mental Health of Arab Adolescents • The Psychological State Scale, Multigenerational Interconnectedness Scale, and the Parental Authority Questionnaire were administered to 2,893 Arab adolescents in eight Arab societies. Journal of Cross-Cultural Psychology, Vol. 37, No. 3, 262-272 (2006)

17. Parenting Styles, and Mental Health of Arab Adolescents • Authoritative parenting was associated with: 1. Higher level of connectedness with the family and 2. Better mental health of adolescents. • A higher level of adolescent-family connectedness was associated with better mental health of adolescents. • Journal of Cross-Cultural Psychology, Vol. 37, No. 3, 262-272 (2006

18. Epidemiological Studies on Adolescent Disorders in the Arab World

19. SMOKING

20. Tobacco (Global Youth Tobacco Survey (GYTS) • GYTS gave information on tobacco use in 21/22 countries of the region. • cigarette smoking generally about 20% of 13-15 year olds in the region (in any country) are current users of any tobacco product. Outlier: Lebanon: 60% in 2005 • Need more on other forms of tobacco use, especially arghile

21. Smoking in Egyptian Adolescents ( n = 1930 students) • Male prevalence of ever-smoking, (34%) • 30-day smoking, (16%) • current smoking(8%) and • susceptibility to smoking(51%) • Female prevalence of ever-smoking, (16%) • 30-day smoking, (7%) • current smoking(4%) and • susceptibility to smoking(26%) Health Promotion International 2005 20(2):135-145

22. Qatar • 2004 ---(age 13-15 yrs) 16.6% are current tobacco users. • Currently ----20.2% currently use any tobacco product (boys = 25.9% and girls = 14.9%). (GYTS, Qatar, fact sheet)

23. Algeria • (age 15-29) 24% of youth consumed tobacco at least once in their lives (42.3% among males and only 0.3% among females). • Average age for starting to smoke is 16.3 yrs . • Around 36% of males consume between one and two packs per week (papfam Algeria).

24. The WHO report • Smoking causes 90% of the lung cancer cases in Egypt • Tobacco-related cancers as a percentage of all cancers are on the rise

25. Prevention of adolescent smoking is crucial • Studies have shown that most adult smokers start smoking during adolescence • Smokers who initiate smoking at younger ages are more likely to continue smoking, have more severe health consequences and a lower probability of quitting • Therefore, if children can be guided through their teenage years without becoming addicted to nicotine, the likelihood of becoming a life-long tobacco user would drop dramatically

26. Alcohol & Other Drugs • Alcohol: data found for only three countries: Lebanon, Saudi Arabia, Syria (~5%) of alcohol in Saudi Arabia and Syria, (low) 40% in Lebanon • Drug use: only three countries: • Lebanon (10% ever), • Saudi Arabia (6% ever use) • Kuwait (self medication-92%)

27. Anorexia-Bulemia

28. Anorexia / BulemiaUnited Arab Emirates (UAE). • A representative stratified random sample of 495 adolescent girls completed the Eating Attitudes Test (EAT-40) • 23.4% scored above the recommended cut-off on EAT. • Half of those were found to have a propensity for anorexic behavior, while • 2% met the criteria for the full clinical syndrome. Eating Behaviors Volume 7, Issue 1, January 2006, 53-60

29. OMAN • 33% of Omani teenagers (29.4% females and 36.4% males) showed a propensity for anorexic-like behavior. • On the Bulimic Investigatory Test, 12.3% of Omani teenagers showed a propensity for binge eating or bulimia (13.7% females and 10.9% males). • In contrast, barely 2% of Omani adults showed either a presence of or a severity of disorderly behavior with food. J Am Acad of Child Adolescent Psychiatry Volume 41, Issue 9, Pages 1124-1130 (September 2002)

30. Eastern Mediterranean Health Journal Volume 5, Issue 2, 1999, Page 354-360

31. Eating Disorders Arab Adolescents

32. Summary • These studies demonstrate that eating disorders are not restricted to Western societies.

33. Obesity

34. Obesity • Seems to be particularly a problem in GCC countries – 25-30% of various samples are overweight

35. Obesity in Adolescents Comparison between Lebanon and other Eastern Mediterranean Region Countries who have completed the GSHS and have fact sheets on the web http://www.cdc.gov/GSHS/results/index.htm accessed Sept. 30th 2006

36. Reproductive Health (RH)Survey on Knowledge, Attitude and Practice (KAP ) • An inventory of KAP studies in the MENA (Middle east north Africa) region was published by UNFPA in 2004 (Algeria, Bahrain, Egypt, Iraq, Jordan, Lebanon, Morocco, Oman, Syria, Tunisia)

37. RH General knowledge • The concept of RH is unknown; • knowledge of reproductive system anatomy & physiology is low in most countries • knowledge of at least one modern contraceptive is generally high

38. RH General knowledge • knowledge (heard of) of HIV/AIDS is generally high but of other STIs is generally low; • knowledge of transmission of HIV/AIDS by sexual contact is high but of other modes of transmission is quite low; • The main source of knowledge seems to be the mass media specifically TV and the preferred sources of knowledge are parents and health professionals.

39. RH attitude • In general, youth agree with the concept of family planning/contraceptive use and spacing of births. • Overall, youth feel they are not susceptible to HIV infection.

40. RH behavior • Most of the data on behavior across countries is related to: • age at marriage, • number of children, and • use of contraception when married. • Results overall indicate the presence of a KAP gap

41. EGYPT YOUTH RH (KAP)( n = 1660 adolescents 14:24 years , 55% females, 80% single, 20% married)

42. Those using Contraceptives

43. Conclusion • There is a relative lack of knowledge of certain kinds of family planning methods, especially condoms • The relative lack of knowledge of STDs other than AIDS • The lack of knowledge about STD prevention

44. VIOLENCE

45. Violence - GSHS Comparison between Lebanon and other Eastern Mediterranean Region Countries who have completed the GSHS and have fact sheets on the web http://www.cdc.gov/GSHS/results/index.htm accessed Sept. 30th 2006

46. Mental health Comparison between Lebanon and other Eastern Mediterranean Region Countries who have completed the GSHS and have fact sheets on the web http://www.cdc.gov/GSHS/results/index.htm accessed Sept. 30th 2006

47. Attention deficit hyperactive disorder (ADHD) • ADHD rates in Arab populations were similar to those in other cultures Lynn FJornal of Attention Disorders, v13 n3 p211-222 2009

48. (2006) Qatar - 1,541 Adolescent students • (14.1%) in Boys • (4.4%)in Girls • Total 9.4% scored above the cutoff for ADHD symptoms. • Students who have a higher score for ADHD symptoms have school performance poorer than those with lower scores (p = .003) Journal of Attention Disorders, Vol. 10, No. 1, 77-82 (2006)

49. (2008) In Qatar (Schools)947 boys and 922 girls • Boys (16.7%) • Girls (5.4%) • Scored above the cut-off (15) for ADH symptoms. • Giving an overall prevalence of 11.1% (95% CI 9.7-12.6). • Med Princ Pract 2008;17:440-446 (DOI: 10.1159/000151564)

50. In Oman (1500 adolescent Students) • 7.8 % of the sample exhibited hyperactivity, • This was strongly associated with indices of conduct disorder, poor school performance, and behavioral disorders (such as aggression, stealing, and lying).