title: The role of family background on adolescent khat chewing behavior in Jazan Region.
abstract: BACKGROUND
  Khat is a well-known natural stimulant from the Catha edulis plant and is widely used in certain Red Sea countries, including Yemen and the province of Jazan in Saudi Arabia. Jazan is located in the southwestern part of the Kingdom of Saudi Arabia adjacent to Yemen, where the practice of khat chewing is deeply rooted throughout the entire population. The main objective of this paper was to assess the association between family background, i.e., parent and sibling khat use, and adolescents' khat chewing behavior in Jazan. Other variables were also tested for association, including parents' education levels, family income, and peer influence.
  
  
  METHODS
  A cross-sectional study was conducted with a representative sample (n = 4,100) of intermediate and upper secondary school students of Jazan. The participants were selected using a three-stage cluster random sampling. A structured self-administered questionnaire was used for data collection. Descriptive statistics, a chi-squared test, and logistic regression were performed to examine the associations and predictors of khat chewing.
  
  
  RESULTS
  A total of 3,923 students of both genders from 72 intermediate and upper secondary schools in Jazan were involved in this study. Of these participants, 42.8% (1,678) were from intermediate schools and 43.8% (1,717) were females. The prevalence of current khat chewing among the students was 20.5% (95% confidence interval (CI) 19.27-21.79) and was significantly higher for males at 33.1% (95% CI 31.16-35.08) than for females, of whom 4.3% (95% CI 3.39-5.31) (P < 0.001) chew khat. The multivariate logistic regression analysis suggests that the most important independent predictors of student khat chewing included the students' smoking status (odds ratio (OR) = 14.03, P < 0.001), a friend using khat (OR = 5.65, P < 0.001), a sister using khat (OR = 2.04, P < 0.05), a father using khat (OR = 1.45, P < 0.001), and a brother using khat (OR = 1.56, P < 0.05).
  
  
  CONCLUSIONS
  The results highlight the significant impact of peer and familial khat abuse in adolescent khat chewing behavior. The findings suggest that khat control programs need to focus on peers and family members to reduce the prevalence of the habit along with its unfavorable consequences.
authors.affiliation: Family and Community Medicine Department, Faculty of Medicine, Jazan University, PO Box 2531, Jazan 45142, Saudi Arabia. mm.mahfouz@gmail.com.
authors.forename: Mohamed Salih
authors.initials: MS
authors.lastname: Mahfouz
authors.forename: Rashad Mohammed
authors.initials: RM
authors.lastname: Alsanosy
authors.forename: Abdelrahim Mutwakel
authors.initials: AM
authors.lastname: Gaffar