Elsevier

Preventive Medicine

Volume 49, Issues 2–3, August–September 2009, Pages 224-228
Preventive Medicine

Tobacco use among Palestine refugee students (UNRWA) aged 13–15

https://doi.org/10.1016/j.ypmed.2009.06.001Get rights and content

Abstract

Objective

The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) has made tobacco use prevention a primary health issue. UNRWA provides education, health, relief and social services in five fields of operation: Jordan, Lebanon, Syria, Gaza Strip and the West Bank. The purpose of this paper is to compare tobacco use among Palestine refugee students and students in the general population of the five fields of operation.

Methods

Global Youth Tobacco Survey (GYTS) data were collected from representative samples of students in UNRWA schools in each of the five fields of operation in 2008. For comparison, previous data are included from GYTS conducted in Gaza Strip, Lebanon, and the West Bank (2005) and in Jordan and Syria (2007). Data are presented for three groups of students: refugees attending schools within and outside the camps and non-refugee students in the general population.

Results

In each of the five fields of operation, there was no difference in current cigarette smoking, current use of shisha, or susceptibility to initiate smoking among the three groups of students. Cigarette smoking and susceptibility was lowest in the Gaza Strip and highest in the West Bank; shisha use was lowest in the Gaza Strip but over 30% in Lebanon, Syria, and the West Bank. Exposure to secondhand smoke in public places was greater than 60% in almost all sites. Exposure to indirect advertising was almost 10%.

Conclusions

The similarity in tobacco use among the three groups of students suggests that a coordinated plan between the UNRWA and the governmental authority could be most beneficial in reducing the burden of tobacco-related morbidity and mortality.

Introduction

The United Nations General Assembly established the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) following the 1948 Arab–Israeli conflict (UN, 1949). UNRWA is a relief and human development agency, providing education, healthcare, social services and emergency aid to over 4.6 million Palestine refugees living in five fields of operation: Jordan, Lebanon, Syria, the West Bank and Gaza Strip (UNRWA, 2007). Approximately one-third of the refugees live in one of the 59 recognized camps in the fields of operation; the other two-thirds live in cities, towns or villages in the five fields of operation, many close to the camps (UNRWA, 2008). Over 500,000 children are enrolled in UNRWA schools in these five fields of operation. Most of the UNRWA schools are located near or in the camps and serve only refugee children (UNRWA, 2007).

UNRWA has made tobacco use prevention a primary health issue. To obtain baseline information on tobacco use among adolescent refugees, the UNRWA conducted the Global Youth Tobacco Survey (GYTS) in 2008 in UNRWA schools in each of the five fields of operation.

For each of the five fields of operation, 2008 UNRWA GYTS data can be compared to previous GYTS data collected in national surveys in Lebanon (2005), Jordan (2007) and Syria (2007); and geographic region surveys in the West Bank (2005) and Gaza Strip (2005). The purpose of this paper is to compare tobacco use in adolescents among Palestine refugees enrolled in UNRWA schools living within and outside UNRWA camps respectively in the five fields of operation, and non-refugees living in the same geographical areas (identified as “host sites” for the remainder of this paper).

Section snippets

Methods

The GYTS was developed by the World Health Organization (WHO), the U.S. Centers for Disease Control and Prevention, and the Canadian Public Health Association to assist WHO Member States in establishing continuous tobacco control surveillance and monitoring (CDC, 2008). GYTS uses a standardized methodology for constructing sampling frames, selecting schools and classes, preparing questionnaires, carrying out field procedures, and processing data (CDC, 2008). The survey queries prevalence of

Current cigarette smoking

Across the five fields of operation, there were no significant differences in current cigarette smoking among UNRWA students living in camps, UNRWA students living outside of camps but in the fields of operation, or non-refugee students living in the host sites (Table 1). For the three groups of students, current cigarette smoking was lowest in the Gaza Strip (3.2%–6.6%, respectively) and highest in the West Bank (16.5%–24.4%, respectively). Among the UNRWA students, boys were significantly

Tobacco use

The findings from this study highlight a number of important tobacco control program challenges facing UNRWA. First, the uniformity in tobacco use of the refugee and host site students within each of the five fields of operation is alarming, although not completely unexpected. Previous studies of refugee and other migrant groups have shown that smoking rates change over time to reflect the countries' population as part of a broader acculturation process that involves adopting attitudes, values,

Limitations

The findings in this report are subject to at least four limitations. First, the findings apply only to youths who were in school on the day the survey was administered and who completed the survey. However, student response was high (over 85% in all countries), suggesting that bias attributed to absence or non-response was limited. Second, because the GYTS was limited to youths attending school, it is not representative of all youths aged 13–15 years. However, there is no evidence of gender

Conclusion

UNRWA has made tobacco use prevention a primary health issue and, in support of this effort conducted the GYTS in each of their five fields of operation: Jordan, Lebanon, Syria, Gaza Strip and the West Bank. UNRWA provides education, health, relief and social services to eligible refugees in the five fields of operation. However, laws and regulations regarding tobacco control are determined by governmental authorities in the host sites. Jordan, Lebanon and Syria have ratified the WHO FCTC; thus

Conflict of interest statement

The authors declare that there are no conflicts of interest.

References (16)

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