|Year : 2020 | Volume
| Issue : 2 | Page : 82-87
Community health perceptions of smoking, physical activity and eating habits: A cross-sectional, descriptive study
Nabil Sulaiman1, Amal Hussein1, Basema Saddik1, Salah Elbadawi2, Ahmed Hasswan1, Zahra Emad1, Ibrahim Mahmoud1
1 Department of Family and Community Medicine and Behavioral Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
2 Primary Health Care Services Sector, CEO Office, Dubai Health Authority, Dubai, United Arab Emirates
|Date of Web Publication||9-May-2020|
Department of Family and Community Medicine and Behavioral Sciences, College of Medicine, University of Sharjah, Sharjah
United Arab Emirates
Source of Support: None, Conflict of Interest: None
Background: Non-communicable diseases (NCDs) have become a major health problem in the United Arab Emirates (UAE). A number of NCDs share predisposing risk factors related to an unhealthy lifestyle. Aims: The aim of this study is to measure healthy lifestyle awareness in reference to smoking, physical activity and healthy diet among the population of the Northern Emirates of the UAE. Methods: A cross-sectional descriptive study was conducted at primary health-care centres in the Northern Emirates of the UAE. Results: A total of 2373 participants were surveyed. The mean age of participants was 32.9 years (standard deviation ± 10.6), with the majority being females (64%). Almost three-quarters of participants perceived that smoking had harmful effects on their health and 14.2% reported being current smokers. The majority of participants recognised the benefits of physical activity for improving the health of lungs, the heart, weight loss and promoting health. Only 23.9% of participants admitted that they wanted ‘total change’ to their physical activity habits and a high percentage (63.4%) of participants agreed that certain food types could lead to disease. Conclusions: Overall, participants in this study have shown a high level of awareness on the dangers of smoking, the necessity for everyday physical activity, and importance of healthy dietary habits despite the fact that the prevalence of those indices does not match with awareness levels. Further research is recommended to explore and identify the barriers and factors associated with low levels of practice within the UAE community.
Keywords: Dietary habits, non-communicable diseases, perception, physical activity, smoking
|How to cite this article:|
Sulaiman N, Hussein A, Saddik B, Elbadawi S, Hasswan A, Emad Z, Mahmoud I. Community health perceptions of smoking, physical activity and eating habits: A cross-sectional, descriptive study. Hamdan Med J 2020;13:82-7
|How to cite this URL:|
Sulaiman N, Hussein A, Saddik B, Elbadawi S, Hasswan A, Emad Z, Mahmoud I. Community health perceptions of smoking, physical activity and eating habits: A cross-sectional, descriptive study. Hamdan Med J [serial online] 2020 [cited 2021 Sep 27];13:82-7. Available from: http://www.hamdanjournal.org/text.asp?2020/13/2/82/284046
| Introduction|| |
Non-communicable diseases (NCDs) are major public health challenges of the 21st century. The four main types of NCDs are cardiovascular diseases (CVDs), cancers, chronic respiratory diseases and diabetes. These chronic diseases are usually long-term with slow progression and are by far the leading causes of death worldwide. More than 36 million people die annually from NCDs (80% of global deaths are due to the four main types), including 14 million people who die prematurely before the age of 70. More than 90% of premature deaths from NCDs that occur in low- and middle-income countries are preventable., By the year 2020, it is expected that NCDs will be responsible for 7 out of 10 deaths in developing countries. The United Arab Emirates (UAE) has managed to eradicate many of the communicable diseases that are still present in much of the region. However, due to the increasing sedentary lifestyles, high tobacco use and unhealthy eating behaviors, some of the highest incidences of NCDs in the world are found in this country, with high prevalence rates. The World Health Organisation (WHO) estimated that NCDs account for 77% of all deaths in the UAE. The most common among them are CVDs, cancer, chronic respiratory diseases and diabetes, which claim 40%, 12%, 5% and 5% of total deaths, respectively. In addition, 15% of deaths from NCDs remain uncategorised.
Most premature deaths are linked to common, modifiable behavioural risk factors, including tobacco use, unhealthy diets and physical inactivity.,
The benefits of following a healthy lifestyle have been widely established among all age groups. Rapid urbanisation and globalisation of unhealthy diets and the lack of physical activity are contributing to increases in the risk of CVD, obesity, diabetes, malignancy, mental disorders and cognitive dysfunction.,
Research shows that eating practices and nutritional intake may have long-term impacts on health. In recent decades, dietary habits in the UAE have changed considerably due to socio-economic and lifestyle changes. Many people in the younger generations engage in unhealthy dietary practices such as irregular eating patterns, greater dependence on fast foods and other foods high in fat and sugar, as well as low intakes of fruits and vegetables, all of which are believed to be responsible for the epidemic of obesity in this country.,, The 2010 UAE global school-based student health survey showed that over 50% of students in the UAE were overweight or obese and over 40% of them drink carbonated soft drinks one or more times per day.
Physical inactivity is another aspect of an unhealthy lifestyle that has been associated with the increasing prevalence of chronic diseases worldwide. According to the WHO estimates, approximately 3.2 million deaths each year are attributable to insufficient physical activity. A recent study in the UAE found alarming rates of physical inactivity among residents, with a quarter of participants reporting a sedentary lifestyle with no physical activity and fewer than half reporting mild involvement in physical activity.
Tobacco use is a major risk factor that has been proven to be associated with chronic diseases such as cancer and heart disease. Smoking is the leading cause of preventable death and causes 6 million deaths per year worldwide with a predicted mortality rate of 8 million by the year 2030. Despite numerous efforts to reduce the prevalence of smoking worldwide, the number of tobacco users has remained steady, with an estimated 28.7% of people smoking tobacco products worldwide. According to the WHO report on the global tobacco epidemic in 2017, the prevalence of smoking among adults in the UAE is estimated at 28% in males and 0.9% in females. As for youth aged between 13 and 15 years where tobacco use most commonly starts, the estimated prevalence for males was 16% and 8.2% in females.
The UAE Ministry of Health has adapted the UAE national agenda for 2021 and has created a UAE national plan to prevent NCDs and related risk factors in collaboration and partnership with stakeholders that include both governmental and non-governmental sectors., To achieve this objective, a target key initiative was developed, which stated, ‘The implementation of community-based studies to measure the level of awareness of healthy lifestyles in the society'., In line with this key initiative, this study was conducted among the population of the Northern Emirates of the UAE to measure healthy lifestyle awareness in reference to smoking, physical activity and healthy diet.
| Methods|| |
Study design and procedures
A cross-sectional descriptive study was conducted in 18 primary health-care centres administered by the Ministry of Health and Prevention of the UAE, across the Northern Emirates (Dubai, Sharjah, Ajman, Umm Al-Quwain, Fujairah and Ras Al Khaima).
A total sample size (n) of 2384 patients who attended the primary health-care centres during the study period (December 2009 to December 2013) was recruited in the study. Patients were selected using two-stage cluster sampling method, where clusters within each emirate were identified, and centres were randomly selected using random sampling techniques. Patients within the centres were randomly selected using a sampling numbering method based on their visit to the primary health-care centres. The sample included both local citizens and expatriates between the ages of 11 and 83 years.
Informed verbal consent was obtained from all participants or their guardians.
Data were collected through an interviewer-administered questionnaire. The interviewers were health care workers from different primary health-care centres. The questionnaire collected data on five different domains, including demographic data, information about eating habits and awareness levels of nutritional information foods, information about physical activity and awareness and perception of benefits of physical activity, smoking and tobacco use and awareness and perception of effects of smoking. Participants were also asked about which sources they felt were useful avenues for dissemination of health information.
Participants expressed their responses on different measurements including Likert scales of strongly agree to strongly disagree, yes/no responses and choosing from a selection of answers.
The questionnaire was developed in English and was translated to Arabic by a bilingual translator and back-translated to English to ensure the reliability of translation. The questionnaire was reviewed by a panel of family physicians and health professionals to ensure content validity. A pilot of the questionnaire was conducted to ensure clarity, conciseness and face validity. All health-care professionals involved in the data collection were required to attend a half-day training workshop on the use and administration of the questionnaire to ensure consistency.
Descriptive statistics were used to describe the demographic characteristics of the study participants. Mean and standard deviations were reported for continuous variables. Frequencies with proportions were reported for categorical variables.
Data were analysed using the Statistical Package for the Social Sciences Version 22 (IBM, NewYork, USA).
| Results|| |
A total of 2373 participants responded to the questionnaire out of 2384 participants (99.5% response rate). The majority of the participants were aged 25 years and above (76.8%), females were (64%) and local Emiratis (70%). The demographic characteristics of the participants are displayed in [Table 1].
Participants revealed that their sources for obtaining awareness messages about smoking, physical activity and healthy food were mainly through the media (76%), including TV, magazines and Internet, followed by health-care professionals (41%) [Figure 1]. One-third of participants (33%) revealed that a health-care professional had talked to them about the health hazards of smoking and the importance of quitting within the past year [Figure 1]. While less than half (46%) of the participants had a health-care professional talked to them about the benefits of physical activity and healthy eating practices within the past year [Figure 1].
|Figure 1: Sources of awareness messages about smoking, physical activity and healthy food, (n = 2241)|
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[Table 2] reports the perceptions of participants on the dangers/effects of smoking. Overall, there was a high level of awareness about the effects/dangers of smoking cigarettes and shisha among participants. However, only 27% of smokers considered quitting smoking. Compared to smoking cigarettes, 44% of participants perceived that smoking shisha was more harmful, 29% stated that it was the same and 16% considered it less harmful.
Physical activity awareness
Majority of participants agreed that physical activity contributes to overall health and considered walking (83%), going up the stairs (70%) or riding bicycle (60%) to be highly beneficial.
More than half of the participants (57%) believed that a person should practice moderate physical activity for at least 30 min per day. When asked about intentions to change their lifestyle, 55.2% of participants stated that they wanted ‘partial change’ to their physical activity habits, whereas 23.9% said they wanted ‘total change’ to their physical activity habits. [Figure 2] demonstrates participants’ perceived benefits of physical activity, in percentages.
|Figure 2: Benefits of physical activity as reported by participants, (n = 2241)|
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Healthy diet awareness
About 63.4% of participants agreed that the choice of food type could lead to disease. [Figure 3] shows the responses of participants about diseases they believed are caused by food-containing fats and cholesterol. When asked about the frequency of certain nutrition consumptions, the majority of participants reported they should consume fruit, vegetables and dairy products ‘many times per day’ or ‘twice per day', while they believed that they needed to consume fish and cereals ‘every 2 days’ or ‘twice/week’ [Figure 4].
|Figure 4: Thoughts of participants on consumption of certain nutritional products, (n = 2241)|
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| Discussion|| |
This study has reported lifestyle awareness levels of smoking, physical activity and healthy eating behaviours among the population of the Northern Emirates in the UAE. The results of this study are encouraging, in that overall health awareness levels were high among participants; however, in reality, a wide gap continues to exist between the high awareness levels reported and the actual practice.
Effective population-based strategies for health promotion and disease prevention are essential, both for people with existing chronic diseases as well as for healthy populations, to prevent widespread growing risk factors associated with these diseases. Health professionals play a crucial role in disseminating health information as well as playing an active role in health promotion and disease prevention. However, the results of this study have shown that the sources of health promotion/health awareness messages for participants were mainly various media outlets and not health professionals. This finding raises concerns about the perceived role of health professionals as well as the type of information that is being disseminated. In the digital age we live in, patients’ health-seeking behaviours have changed, and patients are playing an active and lead role in seeking their own health information. While media sources, including social media, can be effective tools for patient education and raising public health awareness, there are several risks involved, including the quality and accuracy of online information.,
In this study, we found high awareness of tobacco and shisha smoking harm, but there was only a small percentage of participants who considered quitting. The study revealed that only one-third of participants, within the past year, had a health worker talked to them about health hazards of smoking and the importance of quitting. Consequently, the role of health-care professionals should be enhanced in raising awareness about the harmful effects of tobacco. Questions like, ‘Are you a tobacco user?’ and ‘Have you considered quitting smoking?’ should become vital questions that are part of the routine history-taking of patients attending every health-care institution and that are as important as taking the patient's pulse or blood pressure. This could provide a great opportunity to enhance the role of health professionals in delivering awareness messages.
In addition, more focussed health awareness is needed on the harmful effects of shisha smoking since fewer than half the participants assume that smoking shisha is more harmful than cigarette smoking. According to the available scientific evidence, a shisha smoking session may expose the smoker to more smoke over a longer period than occurs when smoking a cigarette. For example, cigarette smokers usually take 8–12 puffs, inhaling 0.5–0.6 l of smoke over around 5–7 min. In contrast, shisha-smoking sessions normally last 20–80 min, during which the smoker may take 50–200 puffs which range from around 0.15 to 1 l each.,, Therefore, a shisha smoker may inhale as much smoke during one session as a cigarette smoker would inhale consuming 100 or more cigarettes.
In this study, participants agreed that physical activity contributes to overall health, such as improving heart and lung health and considered going up the stairs or walking to be highly beneficial. Furthermore, the majority of participants recognised the benefits of physical activity, which included health, social and psychological benefits. In addition, more than half of the participants thought that the recommended time per day to practice moderate-intensity physical activity is at least 30 min per day. This finding coincides with the WHO recommendation that adults should spend at least 150 min of moderate-intensity physical activity per week or should spend at least 75 min of vigorous-intensity physical activity throughout the week.,
Despite the results showing high levels of awareness towards the benefits of physical activity, we witnessed reporting of high levels of physical inactivity among the UAE population in previous research. Barriers to increased physical activity have to be identified and dealt with. According to Musaiger et al., (a study done in seven Arab countries, including UAE), in identifying barriers to physical activity, the climate was found to be the greatest barrier for females, while males rated lack of time to perform physical activities as their greatest barrier. Providing indoor places for exercise and incorporating physical activity into daily life should be considered.
Unhealthy diet correlates with physical inactivity as a major cause for obesity and one of the leading global risks to health. The WHO recommends that energy intake (calories) should be in balance with energy expenditure. In the study sample, participants, once again, showed high levels of awareness about the importance of healthy diet with its different components and its association with different diseases and medical conditions. However, the compelling levels of people who are overweight or obese in the region indicate that it is vital to examine this high level of awareness in relation to existing nutrition practices, to identify gaps and misconceptions, and to improve people's engagement to healthy eating practices.
Youth in the UAE are a main component of society and represent over one-third of the population. The prevalence of overweight and obese youth is considered to be the highest in the UAE, compared to other age groups., Previous research has shown that youth have little concern for healthy eating and their peers have a strong influence on their eating practices.,, Therefore, messages encouraging youth to implement healthy eating recommendations should include components of peer acceptance and commitment. Engaging youth in the preparation and delivery of healthy eating messages and consulting with them on effective ways of committing to healthy eating practices may attain engagement with healthy eating practices among their counterparts.,
Furthermore, as was discussed regarding smoking, the role of health-care professionals must be emphasised as fewer than half the participants had a physician or health-care professional talked to them about the benefits of physical activity and healthy eating practices within the past year. Therefore, the role of health-care professionals in medical institutions and schools is vital in raising the actual levels of physical activity undertaken and healthy diet to the levels of awareness recorded.
This study had important limitations. The results may not be generalisable to the UAE population as the sample was limited to patients who attended primary health-care centres in the Northern emirates. Furthermore, locals were overrepresented in the study sample, and this may decrease the generalisability of the study findings. The very high percentage of locals in the sample, as compared to what is expected in the general population, is because locals are registered in the nearby centres and all services are offered free of charge; however, expatriates are not registered and have to pay for services. However, despite these limitations, the findings of this study should not be ignored and will provide baseline data for future research.
| Conclusions|| |
The study revealed high levels of awareness regarding smoking, the significance of the physical activity, and the importance of consuming healthy diet. Nonetheless, the degree of applying the knowledge was not compatible with the level of awareness. A targeted approach should be followed, and solutions should be embraced by health-care professionals to transform the high levels of knowledge and awareness into practiced healthy lifestyles. Further research combining prevalence, perception and barriers is highly recommended to lower the prevalence of NCDs.
Ethical approval was obtained from the University of Sharjah Research Ethics Committee and UAE Ministry of Health (Al-Qassimi Hospital) Research Ethics Committee on March 15th, 2012 as well. Written informed consent was obtained from all study participants.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2]