title: Clustering of risk factors in the smoking habits of schoolchildren in Sousse, Tunisia.
abstract: BACKGROUND
  In Tunisia, little is known about the association between tobacco use and other chronic disease risk factors. This is the case for both adults and children. It is important to know the characteristics of young smokers to facilitate the creation and implementation of future programs for tobacco prevention.
  
  
  OBJECTIVE
  The aim of this study was to determine the association between tobacco use and other lifestyle factors among schoolchildren in Tunisia.
  
  
  METHODS
  We conducted a 2009/2010 cross-sectional questionnaire survey of 4003 randomly selected school children aged 13 years old (7th and 9th grades) to evaluate their knowledge, attitudes towards, and beliefs about the three risk factors for chronic disease (unhealthy diet, physical inactivity, and tobacco use). Written informed consent was obtained from each child's parents who allowed their child to participate.
  
  
  RESULTS
  The mean age of our sample was 13.36 ± 1.28 years. The proportions of daily smokers were 2.2% and 0.1% among boys and girls, respectively. The proportions of irregular smokers were 9.1% and 1.5% among boys and girls, respectively. In our population, 19.1% (n=767) had ever experimented to smoke, with 29.8% among boys and 9% among girls (p<0.001). The proportions of schoolchildren who reported daily participation in physical activity were different between smokers and nonsmokers with 17.7% and 11.5%, respectively (p=0.03). Concerning eating habits, there was no significant difference in the consumption of fruits and vegetables; however, smokers frequently ate more high fat foods and in fast food restaurants. Similar results were found while comparing regular smoking children with those who experimented but who never became hooked on smoking.
  
  
  CONCLUSIONS
  This study and previous research suggest the importance of early intervention in adolescents on smoking and combing these efforts with interventions focusing on physical activity and dietary habits.
authors.forename: Asma
authors.initials: A
authors.lastname: Nouira
authors.forename: Jihen
authors.initials: J
authors.lastname: Maatoug
authors.forename: Imed
authors.initials: I
authors.lastname: Harrabi
authors.forename: Sonia
authors.initials: S
authors.lastname: Hmad
authors.forename: Mmyléne
authors.initials: M
authors.lastname: Belkacem
authors.forename: Slim
authors.initials: S
authors.lastname: Slama
authors.forename: Mustafa
authors.initials: M
authors.lastname: Al'absi
authors.forename: Harry
authors.initials: H
authors.lastname: Lando
authors.forename: Hassen
authors.initials: H
authors.lastname: Ghannem
mesh_terms: D000293:Adolescent; D003430:Cross-Sectional Studies; D015444:Exercise; D005247:Feeding Behavior; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology*; D014416:Tunisia / Q000453:epidemiology