Alarming trends in Tobacco use in high school Tunisian adolescents: MedSPAD2013-2021

Abstract Background Tobacco use is a global health concern, with smoking initiation often beginning in adolescence. In Tunisia, published data assessing trends of tobacco consumption at the national level only concerns middle school students aged 13 to 15 years. No data related to high school students are however published yet. We aimed to determine tobacco smoking prevalence in Tunisian adolescents and assess trends from 2013 to 2021. Methods Pooled data from three Mediterranean school surveyson alcohol and other drugs (MedSPAD surveys: 2013, 2017, and 2021) were used. Based on three-stage stratification sampling method, teenagers aged between 15 and 17 years, were enrolled. Were not included students enrolled in vocational training centers and out-of-school adolescents. Data collection was performed using a self-administered standardized questionnaire assessing socio-demographic characteristics and risky behaviours. We studied weighted prevalence estimates of cigarettes and water pipe (WP) smoking. All statistical analysis, including trend analysis, were performed with STATA software. Results A total of 14.723 students were enrolled with sex ratio (M/F) equal to 0.6 and mean age of 16.2±0.8 years. The prevalence of cigarette smoking increased from 17.8%, to 20.2% then to 24.7% for 2013, 2017 and 2021, respectively. As for WP smoking, its prevalence increased from 14.8%, to 16.7% then to 19.9% for 2013, 2017 and 2021, respectively. Trends analysis concluded to significant increase over study period for cigarettes and WP smoking (p < 10-3). The increase was most alarming for girls regarding WP smoking (consistent increase over the study period). Conclusions Our findings underscore the alarming increasing trend for different forms of tobacco smoking among Tunisian youth. It is therefore crucial to strengthen tobacco control measures among young adolescents in order to counteract the tobacco industry’s expanding marketing of new products primarily targeting this population. Key messages • The prevalence of cigarette and water pipe smoking increased significantly among high school Tunisian adolescents from 2013 to 2021. • A better commitment to the implementation of MPOWER measures for tobacco control is therefore urgent.


Issue/problem:
Contact tracing is an important and widely used method to control transmission of communicable diseases. The COVID-19 pandemic presented a new and big challenge with a high number of confirmed cases and contacts and subsequent high burden on contact tracing activities. Naturally, the effectiveness of such interventions needs to be assessed, and appropriate measures are still rather underdeveloped. Description of the problem: We propose two new measures for assessing contact tracing effectiveness: ''number needed to quarantine'' (NNQ), which is the number of quarantined person-days needed to prevent one infectious person-day, and the proportion of infectious days prevented by the quarantined (PPID). We have applied these measures to assess COVID-19 contact tracing effectiveness in COVID-19 confirmed cases diagnosed between July and mid-September 2020 in a local Public Health Unity in the Northern region of Portugal (Espinho/Gaia). For robustness checks and accounting for the uncertainty of the infectiousness period, we used three different scenarios.

Results:
Depending on the infectiousness period considered, we have found a NNQ between 19.8 and 41.8 and a PPID between 19.7% and 38.2%. Contact tracing effectiveness was higher for some specific groups such as cohabitants and symptomatic contacts. Effectiveness also decreased with the increasing time from diagnosis or symptom onset to contact isolation Lessons: NNQ and PPID are straightforward and easy to use measures to evaluate contact tracing effectiveness in communicable diseases. Although this example focuses in the COVID-19 pandemic at a local setting, these measures can also be used for different communicable diseases and at different levels. This assessment step can be important for priority setting of transmission control activities but also on a health management perspective.

Key messages:
New measures to evaluate contact tracing effectiveness are proposed: ''number needed to quarantine'' and ''proportion of prevented infectious days''. These measures allow the identification of priority groups that must be quarantined, as well as time periods of intervention, for better transmission control.

Background:
Tobacco use is a global health concern, with smoking initiation often beginning in adolescence. In Tunisia, published data assessing trends of tobacco consumption at the national level only concerns middle school students aged 13 to 15 years. No data related to high school students are however published yet. We aimed to determine tobacco smoking prevalence in Tunisian adolescents and assess trends from 2013 to 2021.

Methods:
Pooled data from three Mediterranean school surveyson alcohol and other drugs (MedSPAD surveys: 2013, 2017, and 2021) were used. Based on three-stage stratification sampling method, teenagers aged between 15 and 17 years, were enrolled. Were not included students enrolled in vocational training centers and out-of-school adolescents. Data collection was performed using a self-administered standardized questionnaire assessing sociodemographic characteristics and risky behaviours. We studied weighted prevalence estimates of cigarettes and water pipe (WP) smoking. All statistical analysis, including trend analysis, were performed with STATA software.

Results:
A total of 14.723 students were enrolled with sex ratio (M/F) equal to 0.6 and mean age of 16.2AE0.8 years. concluded to significant increase over study period for cigarettes and WP smoking (p < 10-3). The increase was most alarming for girls regarding WP smoking (consistent increase over the study period).

Conclusions:
Our findings underscore the alarming increasing trend for different forms of tobacco smoking among Tunisian youth. It is therefore crucial to strengthen tobacco control measures among young adolescents in order to counteract the tobacco industry's expanding marketing of new products primarily targeting this population. Key messages: The prevalence of cigarette and water pipe smoking increased significantly among high school Tunisian adolescents from 2013 to 2021. A better commitment to the implementation of MPOWER measures for tobacco control is therefore urgent.

Background:
Nonmedical use of prescription drugs such as sedatives and anxiolytics is a fast growing public health threat in several countries. In Tunisia, although several studies have investigated the prevalence of nonmedical use of anxiolytics among school-age students, there is a gap in knowledge regarding trends in anxiolytics misuse. We aimed to determine the prevalence of nonmedical use of anxiolytics and examine trends between 2013 and 2021.

Methods:
Pooled data from three Mediterranean school surveys on alcohol and other drugs (MedSPAD I-2013, MedSPAD II-2017, MedSPAD III-2021) were used. Based on three-stage stratification sampling method, teenagers in first and second grades of secondary education, were enrolled. Were not included students enrolled in vocational training centers and out-of-school adolescents. Data collection was performed using a self-administered standardized questionnaire. We studied weighted lifetime nonmedical use of prescription anxiolytics and performed global and by gender trend analysis. Epi data software was used for data entry and all statistical analysis, were performed with STATA software.

Results:
A total of 14.723 students were enrolled with sex ratio (Male/ Female) equal to 0.61 and mean age of 16.2AE0.8 years. The prevalence of nonmedical anxiolytics' use increased from 2.1% to 3% then to 8.4% for 2013, 2017 and 2021, respectively. Global and by gender trends analysis concluded to significant increase from 2017 to 2021 (p < 10-3). However, a nonsignificant increase was revealed from 2013 to 2017.

Conclusions:
Our study is the first to confirm a significant increasing trend in non-medical use of anxiolytics among Tunisian adolescents. These findings emphasize the urgent need for early detection of psychological vulnerability among adolescents in order to prevent their engagement in such risky behaviors.
Key messages: Decision makers should be sensitized regarding the alarming increasing trend in non-medical use of anxiolytics, among Tunisian adolescents.
The state control of these substances accessibility and early detection of psychological vulnerability, are highly required.

Background:
Mortality data represent a primary source of information for monitoring a population health status over years. In Tunisia, the national Information System on Causes of Death (ISCD) lacks completeness (average coverage rate of 40%); however, in order to examine covid-19's effect on mortality data, the ISCD was reinforced. We aimed to give an overview of leading causes of death in Tunisia for 2020.

Methods:
Data were obtained from Medical Certificates of Cause Of Death (MCCOD) sent by municipalities to the National Institute of Health in accordance with the legislative framework. Causes of Death (CoD) coding process was performed based on the International Classification of Diseases, Tenth Revision (ICD-10). The underlying cause of death was identified based on IRIS software, and mortality statistics were presented based on the world health organization causeof-death lists for tabulating mortality statistics. Data analysis was performed using SPSS software.

Results:
A total of 46.420 MCCOD among 75.365 deaths officially declared by the National Institute of Statistics, were analyzed (coverage rate of 61.2%). The 10 leading causes of death for both sexes, in rank order were: diabetes mellitus, cerebrovascular diseases, covid-19, ischemic heart diseases, external causes of death, digestive and pulmonary malignant neoplasms, conditions of neonatal period, hypertensive diseases, and influenza and pneumonia. Leading causes of infant deaths were: certain conditions originating in perinatal period, congenital malformations, deformations and chromosomal abnormalities, diseases of respiratory system, certain infectious and parasitic diseases, and diseases of nervous system.

Conclusions:
The COVID-19 pandemic was an opportunity to improve the Tunisian ISCD's coverage rate. However, efforts should be maintained to optimize system completeness, and decision makers should be more sensitized regarding the urgent need for system digitalization.

Key messages:
Mortality statistics have shown that covid-19 ranks third among leading causes of death in Tunisia for 2020; and non communicable disease accounted for 6 out of 10 leading causes of deaths. The ISCD coverage rate was improved in 2020 reaching 61.2%; however the system digitalization is an essential and sustainable solution to optimize completeness.