The health of Saudi youths: current challenges and future opportunities

The Saudi Health Information Survey (SHIS) was a cross-sectional national multistage
survey of individuals aged 15 years or older performed between April and June 2013.
For the purpose of this survey, KSA was divided into 13 regions, and each region was
divided into subregions and blocks. All regions were included, and a probability proportional
to size method was used to randomly select subregions and blocks. Households were
randomly selected from each block. A roster of household members was conducted, and
one individual aged 15 or older was randomly selected from the household to be surveyed.
If the randomly selected person was not present, surveyors made another appointment
to return, up to three times, before considering the household as a nonresponse. For
the current study, we selected the subsample of 15-to 24-year-old youths from the
SHIS dataset. More details on the methods and other findings of this survey are available
in previously published reports 14]–20].

Ethics, consent and permissions

The Saudi Ministry of Health and its Institutional Review Board (IRB) approved the
study protocol. The University of Washington IRB deemed the study as IRB-exempt, since
the Institute for Health Metrics and Evaluation received de-identified data for this
analysis. All respondents consented and agreed to participate in the study. If the
respondent was between the ages of 15 and 17 years old, the parent (s) or legal guardian
of that individual consented as well.

Trained local health professional staff performed the interviews with same-sex respondents.

The survey included questions on socio-demographic characteristics, a selected list
of risk factors, chronic conditions, functional status, and health care use.

We measured self-rated health by asking respondents “In general, would you say your
health is excellent, very good, good, fair, or poor?” with a per-question explanation
about its timeframe during the past 30 days.

Individuals were classified into three groups of never smokers, former smokers, and
current smokers through two questions: “Have you ever smoked any tobacco products,
such as cigarettes, cigars or pipes, or shisha?” and “Do you currently smoke any tobacco
products, such as cigarettes, cigars, pipes or shisha?” Interviewers also asked respondents
about daily use of shisha, pipe, or flavored shisha, which was considered as daily
shisha smoking.

A total of three blood measurements were taken with the participant resting and at
five-minute intervals. The guidelines of the National Health and Nutrition Examination
Survey (NHANES) were used for measuring blood pressure levels 21]. Individuals were classified based on measures of systolic (SBP) and diastolic blood
pressure (DBP) as having: normal blood pressure (SBP???120 and DBP???80), pre-hypertension
(120??SBP??140 or 80??DBP??90), Stage 1 hypertension (140???SBP??160 or 90???DBP??100), and Stage 2 hypertension (SBP???160 or DBP???100).

Trained interviewers measured weight and height to calculate body mass index (BMI)
as kg/m
²
. Participants were classified into four groups: underweight (BMI??18.5), normal
weight (18.5???BMI??25), overweight (25???BMI??30), and obese (BMI???30).

We used the short form of the International Physical Activity questionnaire to measure
physical activity in occupational and recreational settings. The respondents were
classified into four groups: met vigorous physical activity, met moderate physical
activity, insufficient physical activity to meet vigorous or moderate levels, and
no physical activity 22].

Respondents were asked, “In a typical week, how much time do you usually spend in
front of the television or on the computer?” Respondents were also asked to rate their
ability to perform activities. They were asked for their ability to perform vigorous
activities (“Does your health now limit you in doing vigorous activities, such as
running, lifting heavy objects, or participating in strenuous sports?”), mild activities
(“During the past 30 days, how difficult was it to perform any of the following activities:
walking a short distance, standing from a seated position, standing for a short period
of time, climbing one step of stairs?”), their usual work or house activities (“During
the past 30 days, how difficult was it to perform your work or house activities?”),
and specific functional abilities (“Are you able to climb up five steps?”). Interviewers
also asked whether or not the respondent required the use of special equipment such
as a cane, a wheelchair, a special bed, or a special telephone.

We computed the servings of fruits and vegetables consumed per day from a detailed
dietary questionnaire as the sum of the average daily servings. Respondents were asked,
“In a typical week, how many days do you eat processed meats such as sausage, or other
packaged cold cuts, lunch meats, or deli meats?” and “How many servings of processed
meats do you eat on one of those days?” Similar questions were asked for “other processed
foods, such as fast foods, canned foods, packaged entrees, or soup,” “fast foods,”
and “regular soda or pop that contains sugar, sweetened iced teas, sports drinks,
or fruit drinks.”

To assess diagnosed cases of asthma, diabetes mellitus (and type of diabetes), congestive
heart failure, renal failure, and cancer, interviewers asked, “Has a doctor or other
health professional ever told you that you had [that condition]?” Questions about
talking on a mobile or using a handset or hands-free device while driving, following
speed limits, and using seatbelts in different settings of driving or traveling in
a car were asked in order to assess driving safety.

We used stata 13.1 for Windows (StataCorp LP, TX, USA) for survey analysis. Data were
weighted to account for the probability of selection and age and sex post-stratification.
We used individual sampling weights to account for the probability of selecting a
respondent within a household, the probability of selecting a household within a stratum,
and the post-stratification differences in age-and sex-distribution between the Saudi
population and the sample.

Descriptive data are reported as percent and standard error (SE) for categorical variables
or mean and SE for numerical variables. We used stepwise multivariate logistic regression.
We used Chi-square and pooled t tests to compare measures between subcategories of
sex or between younger (15-to 19-year-old) and older (20-to 24-year-old) youths.