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\"Through the voices of 25 diverse individuals and their experiences, the authors examine childhood, parenting practices, traumatic incidents, generational and cultural disparities that influence family units in Greece and the Middle East, alongside significant literature to bring readers into the inimitable worlds of individuals and their stories\"-- Provided by publisher.

Recently, the State of Kuwait has witnessed a steady rise in the prevalence of obesity among children and adolescents. The present study aims to provide an update on the rate of overweight or obesity among Kuwaiti adolescents and examines the associations between adolescents' overweight/obesity levels and their perception of body weight as seen by parents or friends. A cross-sectional study was conducted in Kuwaiti secondary schools and included adolescents between the ages of 15 and 18 years, using a multistage stratified random sampling method. Body weight and height were measured. A specifically designed self-report questionnaire was used to assess parents' and friends' perceptions of an adolescent's body weight. A total of 706 adolescents were included the study. The prevalence of overweight or obesity among Kuwaiti adolescents reached nearly 50%, with males (54.3%) having a significantly higher overweight or obesity percentage than females (44.6%). No significant difference in the prevalence of obesity relative to age, from 15 to 18 years, was found. In addition, logistic regression analysis, adjusted for age and gender, revealed that adolescents perceived their parents (p = 0.011 and p < 0.001) or friends (p = 0.002 and p < 0.001) as more likely to classify their weight as overweight or obese, respectively. Overweight or obesity levels appear to be high among Kuwaiti adolescents, and appears to have reached a plateau recently. Efforts to combat obesity and promote physical activity and healthy nutrition are needed. Future studies should seek to identify important moderators of parental and social underestimation/overestimation of children's overweight or obesity.

Objectives The objectives were first, to assess the lifetime and 12-month prevalence of physical, psychological, and sexual abuse among a stratified random sample of Kuwaiti high school students and second, to explore the association of child abuse with parental characteristics, subjective quality of life (QOL), self-esteem, anxiety, and depression. Method We assessed the students for experience of abuse by their mothers, fathers, and others, using standard scales on psychological, physical and sexual abuse. They also completed the short version of the World Health Organization’s QOL Instrument; the Rosenberg self-esteem scale, and a scale for anxiety and depression. Results We obtained responses from 4,467 students (49% boys), mean age 16.9 years. About 18, 15, and 18%, indicated that for at least six times in the past 12 months, they experienced psychological abuse by their mothers, fathers and others, respectively. The corresponding figures for lifetime experience were similar. The respective figures for experience of physical abuse during the past 12 months were 4.3, 5.8, and 6.4%. For lifetime experience, the corresponding figures were 3.4, 5.3, and 5.8%. The girls had significantly higher physical/psychological abuse scores. There were no significant gender differences in the prevalence of sexual attacks (8.6%) and someone threatening the subjects with sex (5.9%). The prevalence of someone sexually exposing themselves to the students (15.3%) and unwanted touching of sexual parts (17.4%) was significantly higher among the boys. Over one-third of those abused had experienced multiple abuses. Child abuse was significantly associated with parental divorce, diminished QOL and self-esteem, high scores on anxiety/depression, and difficulty with studies, and social relationships. In the regression analysis involving only the abuse indices, psychological abuse by mothers was the most important predictor of depression, anxiety, and self-esteem (11.5–19.7% of variance). Good quality of parental relationship seemed protective. Conclusion The findings support the impression that, despite the conservative culture, child abuse is being experienced by a significant number of children in the Arab world. Preventive education in this culture should include limits on child disciplinary measures, the vulnerable groups identified, the impact on psychosocial functioning, and the protective effect of parental harmony.

This cross-sectional study provides a general profile of mothers of children with ASDs in Kuwait and examines their use of social support resources and coping strategies (using the Brief COPE questionnaire). The majority of mothers reported decreased ability to perform social duties (62.4%) and take care of themselves (50.5%). Overall, 57.7% of mothers reported a decreased ability to enjoy life; this difference was more pronounced among non-Kuwaiti mothers compared to Kuwaiti mothers (p value = 0.03), and in mothers with a bachelor’s degree or higher (p value = 0.011). There was a significant association between the mothers’ ability to enjoy life and receiving support from the family (p value = 0.021) and support groups (p value = 0.003). “Religion”, “Acceptance”, and “Positive Reframing” were the 3 most common coping strategies.

Objective The COVID-19 pandemic restrictions have substantially affected people’s health and rapidly changed their daily routines. This is a prospective study that investigated the impact of the pandemic on primary school children with Type 1 diabetes and their parents during the first lockdown in Kuwait. Methods A questionnaire battery related to mental health, well-being, and lifestyle was administered at baseline in Summer 2019 (face-to-face, at a diabetes outpatient clinic) and at follow-up during lockdown in Summer 2020 (via telephone, in adherence with COVID-19 restrictions). Data were collected for 70 dyads with children aged 9–12 years. Results Significant differences were found in most scores for both children and parents. Their mental health worsened to a higher level of depression, anxiety, stress, and a poor level of wellbeing. The average scores on the follow-up tests fell within a clinical range on these measures. Significant differences in their lifestyle, compared to before the lockdown, included decreased levels of physical activity and lower healthy core nutritional intake. Conclusions Our findings indicate that the COVID-19 lockdown has had a significant psychological and possibly physiological impact on children with Type 1 diabetes and their parents. We conclude that there is a need for mental health support services focusing on these groups. Although full lockdown restrictions will have stopped in the past year, post-pandemic stressors may be expected to continue to adversely affect this cohort.

Background: Mothers’ perceptions of their children’s weight remain mostly unknown in oil-rich countries of the Middle East. Aims: To compare maternal perceptions of their children’s weight with actual body weight. Methods: We used the Kuwait nutritional surveillance data for 5 consecutive years (2015-2019) (N = 5119), which were collected through face-to-face interviews with mothers of children aged 2-5 years attending vaccination centres. Results: Of the 5119 mothers in the study, 163 (3.18%) and 332 (6.48%) had obese or overweight children, respectively. Among 4624 mothers who had normal weight children, 1350 (29.20%) perceived their children’s weight as below normal. Seventy-nine (48.47%) and 16 (9.82%) mothers of children with obesity thought their children had normal weight or were underweight, respectively. Conclusion: Mothers in Kuwait often underestimate the weight of their children, including those children who have normal weight. This highlights the importance of addressing maternal misperceptions during visits to the primary healthcare centre.

Background: Child maltreatment occurs across all cultures and societies. Research in Kuwait is necessary to document its prevalence and related factors. Aims: To determine the prevalence of childhood abuse reported by first year students of Kuwait University in 2010 and its association with depression. Methods: A random sample of first year undergraduates completed the Arabic version of the ISPCAN Child Abuse Screening Tools for young adults and were assessed for depression using the Patient Health Questionnaire (PHQ-9). Results: Among 2508 respondents (70.9% female), 35.6%, 53.5% and 19.8% experienced at least one form of physical, emotional and sexual abuse, respectively. Physical abuse was more prevalent among boys (P < 0.001). For emotional and sexual abuse, sex differences were not statistically significant. Physical abuse was associated with living with the father, emotional abuse with living with the mother and sexual abuse with living with non-parents (P < 0.001). Most perpetrators were non-parents. Abuse was more prevalent among students whose parents were separated/divorced, whose fathers were polygamous and where monthly family income was < US$ 1800. Depression was significantly associated with all types of abuse and in multiple regression indicated it was one of the most important predictors of physical and sexual abuse. Conclusion: Kuwaiti first year undergraduates commonly reported experiencing abuse. There is a strong need for child protection policies, improved legislation and prevention strategies. Keywords: child abuse, maltreatment, depression, students, Kuwait Citation: Almazeedi H; Alkandari S; Alrazzuqi H; Ohaeri J; Alfayez G; Prevalence of child abuse and its association with depression among first year students of Kuwait University: a cross-sectional study. East Mediterr Health J. 2020;26(8):948-956. Received: 23/09/18; accepted: 05/07/19 Copyright [c] World Health Organization (WHO) 2020. Open Access. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license (

Introduction: Thirdhand smoke (THS) is the toxic residue of tobacco smoke that persists long after tobacco smoking on the clothing and hair of smokers and in the surrounding environment. This study aimed to assess parents’ beliefs about THS in terms of harm and persistence in the environment and evaluate associations between parents’ THS beliefs and home smoking rules. Methods: A sample of parents living in Kuwait were enrolled in a cross-sectional study. Parents reported home smoking rules (strict, partial, and no, home smoking ban) and completed the 9-item Beliefs About ThirdHand Smoke (BATHS) scale that assessed parents’ overall, health, and persistence beliefs about THS. Associations between the quartiles of THS overall, health, and persistence beliefs scores and home smoking rules were evaluated using a modified Poisson regression, and adjusted prevalence ratios (APR) and 95% confidence intervals (CI) were estimated. Results: In total, 536 parents (404 females) were enrolled in the study, with 42.0% (n=225) and 43.6% (n=234) reporting a strict or partial home smoking ban, respectively. The prevalence of a strict home smoking ban was higher among never smokers than among ever smokers (49.1% vs 25.2%, p< 0.001). The majority of participants indicated that THS exposure harms the health of children (67.2%) and adults (60.6%) and THS residue could remain for days in the environment (58.9%). The prevalence of a strict home smoking ban increased as THS overall (APRQ4 vs Q1 = 1.48; 95% CI: 1.12 – 1.96), health (APRQ4 vs Q1 = 1.22; 1.02 – 1.45), and persistence (APRQ4 vs Q1 = 1.55; 1.17 – 2.05) beliefs scores increased. Conclusions: Parents’ harm and persistence beliefs about THS were associated with enforcing a strict home smoking ban, which provides a safer environment for children and non-smokers. Therefore, tobacco prevention programs need to incorporate educational messages about the harm of THS in an attempt to promote smoke-free homes.

Background: Nationally representative data are lacking on cigarette smoking in adolescents in Afghanistan, Oman and Kuwait, which are considered low-income, middle-income and high-income countries respectively of the World Health Organization Eastern Mediterranean Region. Aims: This study examined the effect of parental monitoring on the tobacco use of adolescent school students in Afghanistan, Oman and Kuwait. Methods: Using data from the 2014 Afghanistan, 2015 Oman and 2015 Kuwait Global School-based Student Health surveys, factors associated with cigarette smoking and tobacco use among the students in the 30 days before the survey were analysed. These factors included: parental understanding of their problems/worries, parental awareness of how they spent their free time, parents searching their belongings without their approval, and parents checking if homework was done. Logistic regression analysis was used to determine the association between tobacco use and parental monitoring. Results: The prevalence of cigarette smoking and/or use of other tobacco products by the students on one or more days in the 30 days before the survey was 10.6% in Afghanistan, 9.3% in Oman and 28.8% in Kuwait. Adolescents whose parents understood their problems, were aware of how they spent their free time, and checked if their homework was done were less likely to be current tobacco users in all three countries (P < 0.05). Adolescents in Oman and Kuwait whose parents searched their belongings were more likely to use tobacco (P < 0.01). Conclusion: The prevalence of tobacco use in the adolescents, especially in Kuwait, suggests the need for better schoolbased health education and promotion programmes in these countries.

Obesity and prediabetes are common among adolescents; however, it is unclear whether they jointly influence lipid levels. Hence, this study sought to assess whether obesity and prediabetes independently or jointly influence lipid levels among adolescents. A cross-sectional study enrolled school students aged 14-19 years (n = 1584). Body mass index (BMI)-for-age z-scores were estimated, and glycated hemoglobin A1c (HbA1c) and lipid profile were measured in capillary blood. Prediabetes was defined as 5.7≤ HbA1c% ≤6.4. Geometric means of lipids were calculated, and linear regression was used to estimate the ratio of geometric means (RoGM) and their 95% confidence intervals (CI). All analyses were stratified by sex. Of the total study participants, 52.1% (826/1584) were females and the majority were aged between 14.0 (5th percentile) and 18.0 (95th percentile) years. Based on BMI-for-age categories, 356 (22.5%) and 494 (31.2%) participants were classified as overweight and obese, respectively. Moreover, 34.3% (543/1584) of the study participants met the prediabetes definition. Compared to those with normal BMI and no prediabetes (reference category), participants classified as obese and having prediabetes had elevated levels of total cholesterol (TC; RoGM=1.09, 95% CI: 1.06-1.13), low-density lipoprotein cholesterol (LDL-C; 1.21, 1.13-1.29), non-high-density lipoprotein cholesterol (non-HDL-C; 1.20, 1.14-1.26), and triglycerides (TG; 1.18, 1.09-1.27) and reduced HDL-C (0.91, 0.88-0.95) levels. Independent of prediabetes, obesity was associated with all the investigated lipids. Prediabetes alone was associated with reduced levels of LDL-C and increased levels of HDL-C only among females. Obesity independently and in combination with prediabetes demonstrated unfavorable effects on lipids among male and female adolescents, whereas prediabetes independently influenced LDL-C and HDL-C favorably only among females.