Prevalence and Risk Factors for Smoking among Palestinian Adolescents: Findings from the National Study of Palestinian School Children

Background: Multiple risk behavior plays an important role in association of youth smoking with individual health risk behaviors yet the importance of this observation has not been examined in the Arab communities. Objective: To examine the strengths of associations between individual health risk behaviors and the occurrence of smoking in the West bank and Gaza Strip and whether risks for youth smoking increased in accordance with the number of risk behaviorsidentified in an additive scale. Setting: World Health Organization collaborative cross-national survey of health behavior in school-aged children. Participants: A national representative sample of 17,437 students from grades 6, 8, 10 and 12. Main Exposure Measures: Additive score consisting of counts of self-reported health risk behaviors: unintentional injuries, nonuse of seat belts, involved in physical fight, carried weapon in last 30 days, being bullied and bullied others, excess time with friends, alienation at school and home, truancy, an unusually poor diet, suicide ideation, suicide attempt and lack of physical activity. Main Outcome Measure: cigarette smoking. Results: Strong gradients in risk for smoking were observed according to the numbers of risk behaviors reported. Overall, youth reporting the largest number ( 5 health risk behaviors) experienced smoking rates that were 6.87 times higher (95% confidence interval, 5.23-9.02) than those reporting no risk behaviors (adjusted odds ratios for 0 to 5 reported behaviors: 1.00, 1.20, 1.63, 2.52, 3.54, and 6.87, respectively; P .001 for trend). Conclusions: In Palestine, gradients in risk for youth smoking increased in association with numbers of risk behaviors reported. This finding indicates that the issue of multiple risk behavior, as assessed via an additive score,merits attention as an etiological construct. This concept may be useful in future cigarette smoking prevention programs conducted among populations of young people.