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Title: Indicators of urban health in the youth population of Kuwait City and Jahra, Kuwait
Author: Alzarban, Fayez
ISNI:       0000 0004 7658 9181
Awarding Body: University of Liverpool
Current Institution: University of Liverpool
Date of Award: 2018
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Introduction: Kuwait, a country situated in the Middle East, is one of the most urbanised countries in the world and with a large proportion of young people. The government of Kuwait has acknowledged the importance of understanding the needs of its youth population in its current healthcare policy focusing on three main health issues: overweight/obesity, tobacco and cannabis use, and general mental and psychological health. However, little is currently known about the health status of its young people due to the limited epidemiological data at a national and city level. As Kuwait is considered part of the Arab States, it is essential to understand the cultural and social dynamics shared by young people living in the region. Objectives: To describe, compare and summarise the urban health profile of the youth population in the State of Kuwait, aged 14-16 years, in two Kuwaiti cities: Kuwait City (an affluent city with high economic activity) and Jahra (a less affluent, more deprived city), with a focus on the three urban health topics highlighted in the current Kuwaiti healthcare policy: overweight/obesity, tobacco smoking and cannabis use, and general psychological health. The urban health issues found in young people in Kuwait City and Jahra, Kuwait were compared to the findings in European cities in the EURO-URHIS2 study in 15 youth urban health indicators. Methods: Validated and standardised urban health indicator (UHI) questionnaires, specifically designed for young people, were adopted from a large European Health Survey (EURO-URHIS2 project) developed to collect relevant and comparable data on the health and its determinants in young people residing in cities. The EURO-URHIS2 youth questionnaire was translated to the Arabic language and piloted in schools in Kuwait prior to conducting the survey. Data were collected in a classroom setting in Kuwait City and Jahra, Kuwait. Results: Comparisons of urban health profiles for young people in Kuwait City and Jahra: 530 students were surveyed in Kuwait City and 527 in Jahra. Significant socio-economic status differences (measured by Family Affluence Scale) were observed between the two cities, with students in Kuwait City reporting higher family affluence scores than in Jahra. Compared to Kuwait City, young people in Jahra reported an overall poorer urban health profile and significant differences were observed in health status, lifestyle factors and environmental factors. The poor health situation, both in terms of health and determinants of health, was more apparent in girls in Jahra compared to girls in Kuwait City. Priority Urban Health Indicators for Kuwaiti public health policy: Overall, a very high proportion of students from both cities (approximately 60%) were found to be overweight and obese, and approximately one third of students in both cities were obese. Unhealthy dietary factors were widespread in both cities, particularly in the high consumption of sugar-rich products and fizzy drinks and the low consumption of fruit and vegetables. In both cities, only 1 in 3 students reported regular consumption of fruit and less than half of all students reported regular consumption of salads and vegetables. Consumption of fizzy drinks and sugar-rich food products was significantly higher in Jahra than in Kuwait City. Low engagement in physical activity was widely reported in both cities, with less than 1 in 10 students engaging in the WHO recommended daily physical activity. In Kuwait City, students that engaged in weekly vigorous or 60 minutes of daily physical activity were significantly less likely to be obese. Additionally, obese students in Kuwait City were significantly more likely to perceive their health as poor. Smoking appeared to be predominantly an issue for boys rather than girls in both Jahra (OR=11.05) and Kuwait City (OR=9.80). Half of the boys in both cities reported smoking tobacco in the past and approximately 1 in 5 were daily tobacco smokers. In both cities, students that self-reported living in an area with crime, violence and vandalism were approximately 90% more likely to have ever smoked tobacco. In Jahra, elevated risk of psychological distress (measured by SDQ scores) was independently associated with (ever) smoking. While cannabis use was highlighted as a Kuwaiti government public health priority, only 3% of students reported using cannabis in the past in both cities. In terms of mental health, self-reported psychosomatic symptoms were significantly more common in Jahra compared to Kuwait City. Elevated risk of psychological distress was reported two-fold higher in Jahra than in Kuwait City, with the highest proportion reported in girls in Jahra (27%). Girls were 66% more likely than boys to be at an elevated risk of psychological distress in Jahra. Students that were victims of bullying were more likely to report an elevated risk of psychological distress in both cities. Environmental indicators, such as living in an area with crime and violence and exposure to severe noise, were independently associated with psychological distress in Jahra. An extremely high proportion of youths in both cities reported suffering from low back pain (LBP) in the past month and this was significantly more pronounced in Jahra (75%) compared to Kuwait City (64%). Gender was independently associated with LBP in Jahra, with girls twice as likely than boys to report suffering from it. In both cities, elevated risk of psychological distress was independently associated with LBP. The presence of other psychosomatic symptoms was significantly associated with LBP in Kuwait City. In Jahra, environmental indicators continued to carry an importance with students that lived in an area with crime/violence were significantly more likely to suffer from low back pain. Comparing the findings in Kuwait City and Jahra with the EURO-URHIS2 project: In terms of health status UHIs (self-perceived health, psychological distress, psychosomatic symptoms), Kuwait City appeared to show a similar picture to that of the EURO-URHIS2 project average for young people, with the exception of LBP where it was reported higher than in Europe. Jahra students presented with higher rates of adverse health status attributes than Kuwait City and the European mean, with Jahra girls reporting higher rates than boys. For UHIs in lifestyle factors, the overall prevalence of self-reported physical activity was lower in Kuwait City and Jahra than in the European mean in the EURO-URHIS2 project and the prevalence appeared to be considerably lower in girls for both cities compared to Europe. Regular fruit consumption was lower in Jahra and Kuwait City than the European mean, while regular vegetable/salad consumption was similar to the European mean in Jahra but lower in Kuwait City. With regards to daily tobacco smoking, the prevalence in Kuwait City and Jahra appeared to be similar to the European mean for boys only, while the prevalence for this UHI was lower than the European mean for girls in both cities. There were clear environmental UHI differences between Kuwait City, Jahra and European cities. While crime, violence and vandalism were self-reported higher in Jahra compared to Kuwait City, the prevalence was lower than the European mean. Bullying appeared to be more of an issue in Jahra, (and to a lesser extent in Kuwait City) compared to Europe, particularly in the high prevalence reported by girls. The proportion of students who were involved in a road traffic accident in both cities was slightly higher than the European mean. Conclusions: Young people in Jahra, particularly girls, face poorer health status in many key urban health indicators compared to Kuwait City. The findings of this research in young people present a similar picture of the social and gender inequalities observed in the limited epidemiological data on the adult Kuwaiti population in Jahra compared to Kuwait City. As the current Kuwaiti Healthcare Legislative Plan is being revised in 2019, there is a need to address the main findings observed in this research for public health policy indicators (overweight/obesity, tobacco use and mental health). With regards to the alarming rates of obesity, two possible drivers in determining childhood obesity need to be addressed through policy in Kuwait: unhealthy dietary intake and low engagement in physical activity. Policy efforts should aim to reduce population BMI, using measures such as improving 'nutritional literacy', school and family-focused behavioural interventions. Considering the findings presented in this research for tobacco use, efforts to tackle its use in young people should remain a priority for public health policy in implementing effective tobacco strategies, both in terms of upstream and downstream interventions. There is a need to address the lack of implementation of anti-smoking laws, including package warnings and anti-tobacco advertising, and smoking cessation programmes in clinical settings. For mental health, the findings of this research indicate that efforts must be made to improve the social environment, particularly in the school setting. Due to the alarming prevalence of LBP in both cities, and its known presentation as a psychosomatic symptom, this indicator should remain a focus for future research in Kuwait. Future Kuwaiti public health policy should take into consideration the observed differences between the two cities and national or targeted policies should not widen existing health inequalities. While there is a dearth of epidemiological research with respect to urban health in youths, the findings of this study could provide a baseline for future public health research in Kuwait and other Arab States.
Supervisor: Pope, Daniel ; Stanistreet, Debbi Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral