Adolescents in the Arab Culture
Ashraf T Soliman MD PhD FRCP
Profesor of Pediatrics and Endocrinology
Arab World
The Arab World

Arabic-speaking countries stretching from the
Atlantic Ocean in the west to the Arabian Sea in the
east, and from the Mediterranean Sea in the north to
the Horn of Africa and the Indian Ocean in the
southeast.

It consists of 25 countries and territories with a
combined population of 358 million people straddling
North Africa and Western Asia.
Arab World


The Arabic language forms the unifying
feature of the Arab World.
Though different areas use local varieties of
Arabic, all share in the use of the
standardized classical language, which was
constructed from Classical Arabic
Religion

The majority of people in the Arab World
adhere to Islam and the religion has official
status in most countries.

Overall, Arabs make up less than one
quarter of the world's 1.4 billion Muslims
Christians

There are sizeable numbers of Christians,
living primarily in Egypt, Syria, Lebanon, Iraq,
Jordan, Palestine and Sudan.
Poor and Rich

There are economic disparities between oilrich and oil-poor countries, and, particularly
in the more sparsely populated states of the
Arabian Gulf and Libya, triggering extensive
labor immigration

Four Arab Gulf states, Saudi Arabia, the
UAE, Kuwait, and Qatar, are among the top
ten oil or gas exporters worldwide
Rich and poor

Algeria, Libya, Iraq, Bahrain, Egypt, Tunisia,
and Sudan all have smaller but significant oil
reserves
Literacy in Arab Adolescents

In 2004, the regional average of youth literacy was
90% for male and 80 % for female

Illiteracy for 15-24 year olds ranges from less than
1% in Jordan to 50% in Yemen.

>one third of youth remain illiterate in the some Arab
countries (Djibouti, Mauritania, Somalia, Sudan, and
Yemen)
Youth Unemployment
the Arab Labor Organization (ALO) rates unemployment in the Arab world
the worst worldwide.
as
According to the report the
general rate of unemployment in Arab countries exceeds 14 %
youth rate of unemployment in Arab world exceeds 26%
, which means that the Arab region has more than 17 million unemployed.
Algeria--- 46 percent;
Bahrain is 27 percent;
Saudi Arabia, 26 percent
The UAE has the lowest rate, 6.3 percent..)
The reasons behind the rise in youth
unemployment





Failure of development,
Neglect of critical social aspects,
poor economic performance (as indicated
through inadequate growth averages),
The inefficacy of education and its failure to
meet the requirements of the job market,
The failure to create attractive investment
climates
Hamdi Selim . Unemployment in the Arab World. 26/07/2008, Alsharq
Alawsat newspaper
Problems of education quality
The MENA region

According to the “the most worrying aspect of the crisis in
education is education’s inability to provide the requirements for
the development of Arab societies

In cases when education is available, it suffers from the low
quality of its educational system, lack of educational materials
or qualified teachers.

Access to colleges or universities is still limited.
2002 Arab Human Development Report,
Education in the Middle East and North Africa Wikipedia
Problems of education quality
(universities)

Crowded facilities

Centralization of most Arab universities in national capitals and primary cities.

Low living standards of university faculty.

“Many universities in the Arab world operate in seclusion from their surroundings, unable to
open up and interact with society

Little or no academic freedom

Low-quality research with unclear goals (<0.5 % of public income is spent over
research)


lack of a good and effective management, poor integration across the university programs
the absence of a link between pre-university and university education.
Democracy? in Arab countries




Arab adolescents lack the right to freely express
their social and political opinions
Presidents and kings remain too powerful.
Constitutions and laws deliberately keep them that
way.
Countervailing institutions remain weak, if they exist
at all
Lack of broad-based political organizations pushing
for democracy—political parties, social movements,
labor unions, large civic organizations.
Parenting Styles, and Mental Health of Arab
Adolescents

The Psychological State Scale,
Multigenerational Interconnectedness Scale,
and the Parental Authority Questionnaire
were administered to 2,893 Arab adolescents
in eight Arab societies.
Journal of Cross-Cultural Psychology, Vol. 37, No. 3, 262-272 (2006)
Parenting Styles, and Mental Health of Arab
Adolescents

Authoritative parenting was associated with:
1. Higher level of connectedness with the family and
2. Better mental health of adolescents.
 A higher level of adolescent-family connectedness
was associated with better mental health of
adolescents.

Journal of Cross-Cultural Psychology, Vol. 37, No. 3, 262-272 (2006
Epidemiological Studies on
Adolescent Disorders in the Arab
World
SMOKING
Tobacco (Global Youth Tobacco
Survey (GYTS)



GYTS gave information on
tobacco use in 21/22 countries
of the region.
cigarette smoking generally
about 20% of 13-15 year olds
in the region (in any country)
are current users of any
tobacco product.
Outlier: Lebanon: 60% in 2005
Need more on other forms of
tobacco use, especially arghile
Smoking in Egyptian Adolescents ( n =
1930 students)








Male prevalence of ever-smoking, (34%)
30-day smoking, (16%)
current smoking (8%) and
susceptibility to smoking (51%)
Female prevalence of ever-smoking, (16%)
30-day smoking, (7%)
current smoking (4%) and
susceptibility to smoking (26%)
Health Promotion International 2005 20(2):135-145
Qatar

2004 ---(age 13-15 yrs) 16.6% are current tobacco users.

Currently ----20.2% currently use any tobacco product (boys =
25.9% and girls = 14.9%).
(GYTS, Qatar, fact sheet)
Algeria



(age 15-29) 24% of youth consumed tobacco at least
once in their lives (42.3% among males and only
0.3% among females).
Average age for starting to smoke is 16.3 yrs .
Around 36% of males consume between one and
two packs per week (papfam Algeria).
The WHO report


Smoking causes 90% of the lung cancer
cases in Egypt
Tobacco-related cancers as a percentage of
all cancers are on the rise
Prevention of adolescent smoking is
crucial

Studies have shown that most adult smokers start
smoking during adolescence

Smokers who initiate smoking at younger ages are more
likely to continue smoking, have more severe health
consequences and a lower probability of quitting

Therefore, if children can be guided through their teenage
years without becoming addicted to nicotine, the likelihood
of becoming a life-long tobacco user would drop
dramatically
Alcohol & Other Drugs

Alcohol: data found for only three countries:
Lebanon, Saudi Arabia, Syria
(~5%) of alcohol in Saudi Arabia and Syria, (low)
40% in Lebanon




Drug use: only three countries:
Lebanon (10% ever),
Saudi Arabia (6% ever use)
Kuwait (self medication-92%)
Anorexia-Bulemia
Anorexia / Bulemia
United Arab Emirates (UAE).




A representative stratified random sample of 495
adolescent girls completed the Eating Attitudes Test
(EAT-40)
23.4% scored above the recommended cut-off on
EAT.
Half of those were found to have a propensity for
anorexic behavior, while
2% met the criteria for the full clinical syndrome.
Eating Behaviors
Volume
7, Issue 1, January 2006, 53-60
OMAN



33% of Omani teenagers (29.4% females and 36.4%
males) showed a propensity for anorexic-like
behavior.
On the Bulimic Investigatory Test, 12.3% of Omani
teenagers showed a propensity for binge eating or
bulimia (13.7% females and 10.9% males).
In contrast, barely 2% of Omani adults showed either
a presence of or a severity of disorderly behavior
with food.
J Am Acad of Child Adolescent Psychiatry
Volume 41, Issue 9, Pages 1124-1130 (September 2002)
Eastern Mediterranean Health Journal Volume 5, Issue
2, 1999, Page 354-360
Eating Disorders Arab Adolescents
Number
UAE (495)
Egypt
Jordan
Males
Females
Abnormal eating
attitude
23.4%
Bulemia/ Nervosa
2%
Abnormal eating
attitude
11.4%
Bulemia/ Nervosa
1.2%
Abnormal eating
attitude
12.5
Bulemia/ Nervosa
1%
Summary

These studies demonstrate that eating
disorders are not restricted to Western
societies.
Obesity
Obesity

Seems to be particularly a problem in GCC
countries – 25-30% of various samples are
overweight
Obesity in Adolescents
Dietary behavior
Percent of students who are
overweight
Percent of students at risk for
becoming overweight
Lebanon
– 2005
Jordan 2004
Oman - UAE –
2005
2005
2.7
3.5
NR
11.8
15.7
13.9
NR
21.3
Comparison between Lebanon and other Eastern Mediterranean Region Countries who have completed the GSHS
and have fact sheets on the web http://www.cdc.gov/GSHS/results/index.htm accessed Sept. 30th 2006
Reproductive Health (RH)
Survey on Knowledge, Attitude and Practice
(KAP )

An inventory of KAP studies in the MENA (Middle east north
Africa) region was published by UNFPA in 2004 (Algeria,
Bahrain, Egypt, Iraq, Jordan, Lebanon, Morocco, Oman, Syria,
Tunisia)
RH General knowledge

The concept of RH is unknown;

knowledge of reproductive system anatomy &
physiology is low in most countries

knowledge of at least one modern contraceptive
is generally high
RH General knowledge



knowledge (heard of) of HIV/AIDS is generally
high but of other STIs is generally low;
knowledge of transmission of HIV/AIDS by
sexual contact is high but of other modes of
transmission is quite low;
The main source of knowledge seems to be the
mass media specifically TV and the preferred
sources of knowledge are parents and health
professionals.
RH attitude

In general, youth agree with the concept of family
planning/contraceptive use and spacing of births.

Overall, youth feel they are not susceptible to HIV
infection.
RH behavior

1.
2.
3.

Most of the data on behavior across
countries is related to:
age at marriage,
number of children, and
use of contraception when married.
Results overall indicate the presence of a
KAP gap
EGYPT YOUTH RH (KAP)
( n = 1660 adolescents 14:24 years , 55% females,
80% single, 20% married)
Illiterate
15%
University degree
9%
Ideal age of marriage
Married before 18 years
95% knew about
77% knew about
53% knew about
92% Knew about
21.5 y for Females
25 y for Males
15%
Family planning
Use of contraceptive pills
Injectable contraceptives
IUD
Those using Contraceptives
Use IUD
67%
Use Injectable
Contraceptives
Use oral
Contraceptives
14%
19%
Conclusion



There is a relative lack of knowledge of
certain kinds of family planning methods,
especially condoms
The relative lack of knowledge of STDs other
than AIDS
The lack of knowledge about STD prevention
VIOLENCE
Violence - GSHS
Violence
Lebanon –
2005
Jordan 2004
Oman –
2005
UAE –
2005
Percent of students who
were physically attacked
one or more times in the last
12 months
40.5
NR
38.6
31.9
Percent of students who
were in a physical fight one
or more times in the last 12
months
45.9
46.6
41.6
43.2
Percent of students who
were bullied on one or more
days during past 30 days
33.9
46.4
36.0
20.9
Comparison between Lebanon and other Eastern Mediterranean Region Countries who have completed the GSHS
and have fact sheets on the web http://www.cdc.gov/GSHS/results/index.htm accessed Sept. 30th 2006
Mental health
Mental health
Lebanon
– 2005
Jordan 2004
UAE –
2005
Percent of students who
felt lonely most of the time
or always in last 12 months
12.0
15.8
14.4
Percent of students who
seriously considered
suicide
15.8
15.1
12.7
Percent of students who
have no close friends
3.2
4.9
6.2
Comparison between Lebanon and other Eastern Mediterranean Region Countries who have completed the GSHS and
have fact sheets on the web http://www.cdc.gov/GSHS/results/index.htm accessed Sept. 30th 2006
Attention deficit hyperactive disorder
(ADHD)

ADHD rates in Arab populations were similar
to those in other cultures
Lynn F Jornal of Attention Disorders, v13 n3 p211-222 2009
(2006) Qatar - 1,541 Adolescent
students

(14.1%) in Boys
(4.4%)in Girls

Total 9.4%

scored above the cutoff for ADHD symptoms.

Students who have a higher score for ADHD
symptoms have school performance poorer than
those with lower scores (p = .003)
Journal of Attention Disorders, Vol. 10, No. 1, 77-82 (2006)
(2008) In Qatar (Schools)
947 boys and 922 girls





Boys (16.7%)
Girls (5.4%)
Scored above the cut-off (15) for ADH symptoms.
Giving an overall prevalence of 11.1% (95% CI 9.712.6).
Med Princ Pract 2008;17:440-446 (DOI: 10.1159/000151564)
In Oman (1500 adolescent Students)

7.8 % of the sample exhibited hyperactivity,

This was strongly associated with indices of
conduct disorder, poor school performance,
and behavioral disorders (such as
aggression, stealing, and lying).
ADHD in the USA

US children aged 8 to 15 years, 8.7%, an
estimated 2.4 million, meet DSM-IV criteria
for ADHD.

Arch Pediatr Adolesc Med. 2007;161(9):857-864
DEPRESSION
Depression in UAE Adolescent Students
(15% )
Ghareeb A G
Royal college of psyciatrics Regional meeting in Bahrain 1991
In Egypt

2043 Adolescents in schools screened for
Depression CDI Scores for junior and senior
high schools.

Males

16% and 17.5%
Females 13.5 % and 15%
Ghareeb and Beshai 1998.
Depression in 2ry school
adolescents Egypt/Oman

552 Omani and 1544 Egyptian students
screened
 Oman
: 10.5 boys and 7.5 % girls
 Egypt: 7.0% in boys and 12.8 % in girls

In the whole sample; history of physical abuse during childhood and
personal history of organic illness were correlates of depression

For girls, age, relationship with parents and current cigarette smoking
were exclusive predictors
RELATIONSHIP BETWEEN DEPRESSION AND ANXIETY AMONG
UNDERGRADUATE STUDENTS IN 18 ARAB COUNTRIES

To gain more understanding of the relationship between anxiety and
depression, the Kuwait University Anxiety Scale (KUAS; Abdel-Khalek,
2000) and the Beck Depression Inventory II (BDI-II; Ghareek, 2000)
were administrated to 9168 participants (4230 males and 4938
females) in 18 Arab countries, (18-25 yr)

Findings indicate that depression is positively
significantly correlated with anxiety (mdn= 0.66 p<
0.01).
Alansari, Bader M Social Behavior and Personality January 1, 2005
Suicide
WHO/ Suicide rates per 100,000 by country, year
and sex 2009

Male
Female
EGYPT
0.1
0.0
BAHRAIN
4.9
0.5
SYRIA
0.2
0.0
FRANCE
25.5
9.0
ITALY
9.9
2.8
GERMANY
17.9
KUWAIT
2.5
USA
17.7
6.0
1.4
4.5
In Egypt- Past
In Cairo, Egypt, attempted suicide rate
1. 2.8 per 100,000 in 1959
2. 3.8 per 100,000 in 1979
3. 3 per 100,000 in 2005 (Alahram newspaper)
60% of the attempters were between 15-24 years of
age.
In Egypt – recent (2009)


Recent data collected from Alexandria, Egypt,
showed that
30% of the 1621 high-school adolescents sampled
experienced a strong death wish in the year before
the study
However, for many reasons, adolescents' suicide is
still neglected in the Middle East.
Summary

Prevalence of emotional & behavioural
disorders is increasing in Arab adolescents.

Concern about inability of specialist child and
lack or deficiency of adolescent mental health
services to meet growing need and demands.

Results = unmet need, deterioration in mental
well-being, huge costs to services and children
and families.
Recommendations

A clear education policy that fulfills goals, measuring up to international
education standards. More freedom to educational institutions

Adoption of a clear adolescent health education policy including (reproductive
and mental health)

Introducing adolescent medical care as a specialty in public health facilities

Active Preventive measure for adolescent smoking and obesity
Economic and political reforms
THANK YOU