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Hakeem FF, Hammudah HA, Masoudi AA, Habeeb AT, Aljohani RM, Almutairi SN. Is Parental Rating of Child's Oral Health Associated with Caries Experience in Children? A Cross-Sectional Study. J Int Soc Prev Community Dent 2023; 13:485-492. [PMID: 38304534 PMCID: PMC10829284 DOI: 10.4103/jispcd.jispcd_110_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/25/2023] [Accepted: 11/09/2023] [Indexed: 02/03/2024] Open
Abstract
Aim The Parents' view to the oral health of their children is a significant factor that can impact oral health practices and behaviors. The aim of this research was to investigate how parental assessment of their child's oral health associates with caries experience in children receiving dental treatment at the hospital of Taibah University Dental College. Materials and Methods This cross-sectional study enrolled 127 children who underwent dental treatment at Taibah University Dental College and Hospital during 2020-2021. Dental caries experience was assessed using the dmft/DMFT index, and parental rating of oral health was obtained through a questionnaire. Three logistic regression models were used to assess the correlation between dental caries experience and parental rating of oral health while controlling for sociodemographic and behavioral factors. Results Most parents rated the oral health of their child as good (60.4%), followed by excellent (18.8%) and very good (15.6%). The mean dmft/DMFT score was 3.47 ± 3.46, with 43.8% of children having high/very high dental caries experience. Logistic regression analysis showed that children whose parents rated their oral health as poor were more likely to have high/very high dental caries experience compared to those rated as excellent/very good/good/fair (adjusted odds ratio = 4.45, 95% confidence interval 1.23-16.07). Conclusion This study suggests a link between parental assessment of their child's oral health and an elevated prevalence of dental caries in children. The study found that children whose parents rated their oral health as suboptimal had higher odds of having high dental caries experience. These findings emphasize the significance of parental perception of their child's oral health and suggest a necessity for customized interventions to enhance parental knowledge and practices concerning children's oral health.
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Affiliation(s)
- Faisal F Hakeem
- Department of Preventive Dental Sciences, College of Dentistry, Taibah University, Al-Madinah al-Munawwarah, Saudi Arabia
| | - Hassan A Hammudah
- College of Dentistry, Taibah University, Al-Madinah al-Munawwarah, Saudi Arabia
| | | | - Abdulsamad T Habeeb
- College of Dentistry, Taibah University, Al-Madinah al-Munawwarah, Saudi Arabia
| | - Rola M Aljohani
- College of Dentistry, Taibah University, Al-Madinah al-Munawwarah, Saudi Arabia
| | - Shahad N Almutairi
- College of Dentistry, Taibah University, Al-Madinah al-Munawwarah, Saudi Arabia
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AlJasser R, Alsinaidi A, Bawazir N, AlSaleh L, AlOmair A, AlMthen H. Association of oral health awareness and practice of proper oral hygiene measures among Saudi population: a systematic review. BMC Oral Health 2023; 23:785. [PMID: 37875884 PMCID: PMC10594747 DOI: 10.1186/s12903-023-03522-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 10/10/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Several studies have proven that increasing oral hygiene knowledge correlates with good oral health status compared to those who lack this knowledge. Therefore, the aims of the study to evaluate the overall oral health awareness among the Saudi population based on knowledge and practice of proper oral hygiene measures. METHODS A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews guidelines. Cross-sectional, cohort, and case-control studies were included in the study and framed into a PICO question. Initially, a search was conducted on PubMed/Medline, Google Scholar, and Cochrane databases. Four independent reviewers screened the identified titles, abstracts, and full texts. Cohen's Kappa score was used to evaluate the level of agreement between the reviewers. RESULTS Forty cross-sectional studies and one prospective cohort study were included. Several studies showed that most students across all departments of universities knew the protective effects of fluoride on teeth. Two studies assessing the attitude and practice of oral hygiene found that most students knew that poor oral health leads to gum disease, and 59.1% were aware of maintaining oral hygiene using a toothbrush and paste. Most participants knew the importance of oral and dental care before pregnancy and how to reduce dental problems during pregnancy. Pregnant women clean their teeth daily and consider brushing and using toothpaste essential for pregnant women. Studies on oral hygiene practices of patients with diabetes reported that flossing habits were rated less important and most of their respondents never flossed their teeth. CONCLUSION Strong correlation between oral health knowledge and practices was observed, with the higher the knowledge level, the better the practice. Therefore, new technologies and strategies must be tested for an effective oral health system. TRIAL REGISTRATION A protocol was specified and registered with the International Prospective Register of Systematic Reviews (PROSPERO) on August 2020 (registration number CRD 42,020,200,373).
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Affiliation(s)
- Reham AlJasser
- Department of Periodontic and Community, College of Dentistry, King Saud University, PO Box 60169, Riyadh, 11545, Saudi Arabia.
| | - Aljoharah Alsinaidi
- Department of Periodontic and Community, College of Dentistry, King Saud University, PO Box 60169, Riyadh, 11545, Saudi Arabia
| | - Noor Bawazir
- Collage of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Lama AlSaleh
- Collage of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Aseel AlOmair
- Collage of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Haifa AlMthen
- Collage of Dentistry, King Saud University, Riyadh, Saudi Arabia
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Sabbagh HJ, Aljehani SA, Abdulaziz BM, Alshehri NZ, Bajkhaif MO, Alrosini SK, Al-Amoudi RM, Elkhodary HM. Oral Health Needs and Barriers among Children in Saudi Arabia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13584. [PMID: 36294162 PMCID: PMC9603417 DOI: 10.3390/ijerph192013584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 06/16/2023]
Abstract
(1) Background: Understanding oral health needs and barriers is important to overcome the oral disease burden, especially after the COVID-19 pandemic. The aim of this study was to assess oral health needs and barriers among Saudi children after the COVID-19 pandemic wave started. (2) Methods: Parents of healthy children aged 3-11 years from five regions of Saudi Arabia were surveyed using an electronically administered validated questionnaire from Febuary-2021 to July-2021. Oral lesions/manifestations during the last 12 months reported by parents included tooth discoloration, ulcers, abscess, swelling of the gingiva, halitosis, gingival bleeding, dry mouth, pain while eating, difficulty in speaking or eating, burning sensation, and white spots. Barriers were assessed according to the WHO Oral Health Questionnaire. (3) Results: Children experiencing toothaches were reported by 1098 (72.4%) respondents. When reported, oral manifestations and lesions were associated with a higher inability to visit a dentist (p < 0.001). Barriers to dental care were more frequent among parents with lower education (p < 0.001; adjusted-odds ratio (AOR), 1.815) and a greater number of children (p < 0.001; AOR, 1.197). (4) Conclusion: Parents reported a high frequency of unmet oral health needs. Education could play an important role in improving oral health care in children and as a predictor of public health concerns.
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Affiliation(s)
- Heba Jafar Sabbagh
- Pediatric Dentistry Department, Faculty of Dentistry, King Abdulaziz University, Jeddah 22254, Saudi Arabia
| | | | | | | | | | | | - Reham Mohammed Al-Amoudi
- Pediatric Dentistry Department, Taif Dental Specialty Center, Ministry of Health, Taif 26514, Saudi Arabia
| | - Heba Mohamed Elkhodary
- Pediatric Dentistry Department, Faculty of Dentistry, King Abdulaziz University, Jeddah 22254, Saudi Arabia
- Department of Pedodontics and Oral Health, Faculty of Dental Medicine for Girls, Al Azhar University, Cairo 11651, Egypt
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Basir L, Khanehmasjedi M, Khanehmasjedi S. Knowledge, attitudes, and practices regarding the oral health of children. BRAZILIAN JOURNAL OF ORAL SCIENCES 2022. [DOI: 10.20396/bjos.v21i00.8668274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Parents are responsible for their children’s health care, and their oral health-related knowledge, attitude, and habits can affect their children’s oral health. Aim: The objective of this study was to evaluate parents’ knowledge, attitudes, and practices regarding their children’s oral health. Methods: In this study, a sample of 398 parents of 4- to 6-year-old children completed a self-designed questionnaire. The parents’ oral health-related knowledge, attitudes, and practices were assessed. Children’s oral health was evaluated using decayed, missing, and filled tooth index (dmft). Data were analyzed using the SPSS version 23.0 with a p < 0.05 as statistically significant. Categorical data were reported as frequency (%), and continuous data were reported as mean ± SD. Moreover, Spearman’s correlation, multiple regression, Mann-Whitney test, Kruskal Wallis test, and Kolmogorov-Smirnov test were used. Results: Most of the parents had a satisfactory level of knowledge and positive attitudes regarding their children’s oral health. The knowledge and attitude scores were higher among parents with higher education (p<0.001), and the knowledge score was higher among mothers (p=0.004). Also, the attitude score was correlated with the number of decayed, missed, and filled teeth of children (p=0.01, p=0.04, and p=0.007, respectively). However, there was no significant relationship between dmft and the parents’ knowledge, attitudes, and practices using multiple regression. The mean dmft of children was 6.86 ± 3.56, and most of the parents had poor oral health-related practices. Conclusion: The parents’ level of knowledge and attitudes were satisfactory, but they had poor oral health practices. Moreover, there was no significant relationship between children’s oral health and their parents’ level of knowledge, attitudes, and practices. Educating programs and strategies are needed to enhance parents’ oral health-related attitudes and knowledge and, more importantly, change their oral health practices.
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Al Mejmaj DI, Nimbeni SB, Alrashidi RM. Association between Demographic Factors Parental Oral Health Knowledge and their Influences on the Dietary and Oral Hygiene Practices followed by Parents in Children of 2-6 Years in Buraidah City Saudi Arabia: A Pilot Study. Int J Clin Pediatr Dent 2022; 15:407-411. [PMID: 36875969 PMCID: PMC9983587 DOI: 10.5005/jp-journals-10005-2409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Preschool children's oral hygiene maintenance is greatly prejudiced by their parent's knowledge and understanding regarding oral health. When parents are devoid of the basic awareness of caries-associated factors, the significance of primary teeth, and oral healthcare, it is challenging to program disease prevention strategies and apply them effectively. Aims and objectives This pilot study aimed to assess the knowledge regarding oral health, its effects, and the influence of demographic values on the parental practices among the parents of 2-6-year-old children by using a self-administered pretested questionnaire. Materials and methods The questionnaire was randomly distributed among parents of 2-6-year-old children who visited Buraidah Central Hospital. The sample size taken for this pilot study was 1,000. The questionnaire included 26 questions associated with the parent's knowledge about the oral health of the child, hygiene maintenance, and dietary habits. The collected data was analyzed using SPSS software. Results In the present research, a total of 1,000 parents participated in the study. It was observed that parental knowledge and hygiene practices increased as the educational status increased. It was also observed that as the number of children decreased in the family, the dietary practices and hygiene practices improved. All these observations were found to be statistically significant (p < 0.05). Conclusion Parent's education and knowledge reflect in their child's development of healthy practices. Thus the parents need to know about oral health, which can be put into practice in their children. Clinical significance This research helps us to understand the significance of parental knowledge and education in the oral health practices and maintenance among the children inculcated by parents, which can help in bringing down the oral health diseases in children in future. How to cite this article Al Mejmaj DI, Nimbeni SB, Alrashidi RM. Association between Demographic Factors Parental Oral Health Knowledge and their Influences on the Dietary and Oral Hygiene Practices followed by Parents in Children of 2-6 Years in Buraidah City Saudi Arabia: A Pilot Study. Int J Clin Pediatr Dent 2022;15(4):407-411.
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Affiliation(s)
- Daniya I Al Mejmaj
- Department of Pedodontics and Preventive Dentistry, Mustaqbal University, Buraydah, Al-Qassim, Saudi Arabia
| | - Shruti B Nimbeni
- Department of Pediatric Dentistry, Mustaqbal University, Buraydah, Al-Qassim, Saudi Arabia
| | - Renad M Alrashidi
- Department of Pedodontics and Preventive Dentistry, Mustaqbal University, Buraydah, Al-Qassim, Saudi Arabia
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Hashem D, Abu Hammad O, Farran J, Faran A, Odeh ND. Perspectives on Dental Caries: A Cross-Sectional Study among Parents of Primary School Children in Saudi Arabia. Open Dent J 2022. [DOI: 10.2174/18742106-v16-e2201060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Dental caries is one of the most prevalent chronic childhood diseases affecting many people worldwide. Many people do not recognize the early signs of dental caries or its causes, which is crucial for the prevention and early intervention of the disease and consequently less-invasive and cheaper treatment options.
Objective:
This study aimed to evaluate the perspectives of parents about the meaning, causes, and early signs of dental caries, the association of tooth discoloration with decay, and the effect of different socio-demographic variables on the knowledge of patients regarding caries.
Methods:
Questionnaires were distributed to parents of primary school children in the region of Madinah, Saudi Arabia. Meaning of dental caries, early signs, causes of tooth discoloration related to decay, and the effect of different socio-demographic variables were calculated. Multiple linear regression analysis was carried out to identify significant predictor variables associated with caries knowledge scores.
Results:
There was a total of 2690 respondents. The majority had average caries knowledge scores. Lighter shades of tooth discoloration were reported to be associated with stains and warranted home care only, while darker shades were associated with caries and yielded a necessity for a visit to the dentist. Different socio-demographic variables had an effect on the caries knowledge of the parents.
Conclusion:
There is a need for increased knowledge about the early signs of dental caries among parents. Delayed recognition of signs of dental caries has a detrimental effect on the teeth of children and leads to seeking dental care at the later stages of the disease process. Community-oriented programs are fundamental for improving caries knowledge, its clinical presentations starting from its early signs, causes, and prevention.
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Hashem D, Abu Hammad O, Farran J, Faran A, Odeh ND. Perspectives on Dental Caries: A Cross-Sectional Study among Parents of Primary School Children in Saudi Arabia. Open Dent J 2022. [DOI: 10.2174/18742106-v16-2201060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Dental caries is one of the most prevalent chronic childhood diseases affecting many people worldwide. Many people do not recognize the early signs of dental caries or its causes, which is crucial for the prevention and early intervention of the disease and consequently less-invasive and cheaper treatment options.
Objective:
This study aimed to evaluate the perspectives of parents about the meaning, causes, and early signs of dental caries, the association of tooth discoloration with decay, and the effect of different socio-demographic variables on the knowledge of patients regarding caries.
Methods:
Questionnaires were distributed to parents of primary school children in the region of Madinah, Saudi Arabia. Meaning of dental caries, early signs, causes of tooth discoloration related to decay, and the effect of different socio-demographic variables were calculated. Multiple linear regression analysis was carried out to identify significant predictor variables associated with caries knowledge scores.
Results:
There was a total of 2690 respondents. The majority had average caries knowledge scores. Lighter shades of tooth discoloration were reported to be associated with stains and warranted home care only, while darker shades were associated with caries and yielded a necessity for a visit to the dentist. Different socio-demographic variables had an effect on the caries knowledge of the parents.
Conclusion:
There is a need for increased knowledge about the early signs of dental caries among parents. Delayed recognition of signs of dental caries has a detrimental effect on the teeth of children and leads to seeking dental care at the later stages of the disease process. Community-oriented programs are fundamental for improving caries knowledge, its clinical presentations starting from its early signs, causes, and prevention.
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Shaheen R, AlShulayyil M, Baseer MA, Saeed Bahamid AA, AlSaffan AD, Al Herbisch R. Self-Reported Basic Oral Health Knowledge of Primary School Students and Teachers in Rural Areas of Saudi Arabia. Clin Cosmet Investig Dent 2021; 13:521-529. [PMID: 34908879 PMCID: PMC8664646 DOI: 10.2147/ccide.s341240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 11/12/2021] [Indexed: 11/23/2022] Open
Abstract
Background Oral health knowledge is essential for establishing healthy behaviors. Aim The purpose of the study was to determine and compare the basic oral health knowledge of 3–6th grade government primary school students and teachers in rural areas of Saudi Arabia. Methods A cross-sectional study was conducted among government primary school students and teachers in a rural area (Thadig and Ad-Delam) of the Riyadh region of Saudi Arabia using validated, structured, close-ended and self-administered questionnaires. The questionnaire comprised demographic variables and 18 multiple-choice items. A convenience sampling methodology was employed to select the study sample. Results A total of 1864 subjects from rural area government primary schools [students (N = 1538) and teachers (N = 326)] participated in this study. The majority of the students were females 841 (54.7%), Saudi nationals 1376 (89.5%), and studying in 5th grade 446 (29%). Most teacher participants were females, 199 (61.0%), and Saudi nationals, 326 (100.0%). Teachers (12.62 ± 2.36) demonstrated significantly higher overall mean knowledge scores compared to the students (9.63 ± 2.36) (p < 0.001). Females and non-Saudi students showed significantly higher mean knowledge scores compared to their counterparts. However, 4th standard students showed significantly lower mean knowledge scores compared to other graders. Female teachers (13.17 ± 2.25) demonstrated significantly higher overall oral health knowledge scores compared to male teachers (11.75 ± 2.26) (p < 0.001). Conclusion Basic oral health knowledge was adequate among 3–6th grade government primary school students and teachers in rural areas of the Riyadh region.
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Affiliation(s)
- Rakan Shaheen
- Department of Preventive Dentistry, College of Dentistry, Riyadh Elm University, Riyadh, Saudi Arabia
| | | | - Mohammad Abdul Baseer
- Department of Preventive Dentistry, College of Dentistry, Riyadh Elm University, Riyadh, Saudi Arabia
| | | | | | - Reem Al Herbisch
- College of Dentistry, Riyadh Elm University, Riyadh, Saudi Arabia
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Alhareky M, Nazir MA. Dental Visits and Predictors of Regular Attendance Among Female Schoolchildren in Dammam, Saudi Arabia. Clin Cosmet Investig Dent 2021; 13:97-104. [PMID: 33762854 PMCID: PMC7982434 DOI: 10.2147/ccide.s300108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 02/27/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose Regular dental visits are important for the maintenance of optimal oral health and improved quality of life. The purpose of the study was to evaluate patterns of dental visits and factors associated with routine dental attendance among female schoolchildren in Dammam, Saudi Arabia. Patients and Methods This cross-sectional study was performed on 449 female primary schoolchildren (6–11 years old) in Dammam, Saudi Arabia. The study included clinical examination for decay in the first permanent molars in children and questionnaire administration among their parents. The World Health Organization’s oral health questionnaire was used to collect data about children’s dental visits, oral hygiene behaviors, dental problems, and dietary practices. Bivariate and multivariate analyses were performed to evaluate factors associated with routine dental visits. Results Most children (64.1%) visited the dentist during the past one year, 22.1% performed no dental visit during the past one year, and 8.3% never visited the dentist. Among children who visited the dentist, the pain was the most common reason for dental visits (39.10%, N=170), followed by routine dental check-ups (18.60%, N=81). In bivariate analysis, education of parents, family income, daily tooth brushing, no decay in the first permanent molar, no toothache, no consumption of soft drinks, biscuits, cakes, and cream were significantly associated with routine dental attendance (P <0.05). However, the final logistic regression model showed that university education of mothers (OR 2.52, P = 0.005), not having toothache or discomfort (OR 2.88, P = 0.001), tooth brushing once or twice daily (OR 2.43, P= 0.034), and not consuming soft drinks (OR 1.96, P= 0.027) were significant predictors of routine dental visits. Conclusion The study found that higher education of mothers, daily tooth brushing, not having dental pain, and not consuming soft drinks were significantly associated with routine dental visits in this sample of female schoolchildren. Routine dental attendance may be used to improve oral hygiene and reduce dental pain and consumption of soft drinks in children.
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Affiliation(s)
- Muhanad Alhareky
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Muhammad Ashraf Nazir
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Sabbagh HJ, Khogeer LN, Hassan MHA, Allaf HK. Parental Knowledge and Attitude Regarding E-Cigarette Use in Saudi Arabia and the Effect of Parental Smoking: A Cross-Sectional Study. Risk Manag Healthc Policy 2020; 13:1195-1205. [PMID: 32884380 PMCID: PMC7443406 DOI: 10.2147/rmhp.s253749] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 07/27/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION E-cigarette use has been on the rise among children and adolescents. This study aimed to assess the knowledge and attitudes of the health hazards and laws regarding e-cigarette use among parents in Saudi Arabia. In addition, we evaluated the effect of parental smoking on parent's knowledge. METHODS This study was conducted with parents of children below 18 years of age in Jeddah, Saudi Arabia. Jeddah was divided into four areas (north, south, east, and west) and in each area, the largest shopping mall was selected. Data were gathered using a self-administered questionnaire. RESULTS Out of 1386 parents, 61.7% were smokers, 13.3% reported that their children used e-cigarettes, and 73.6% did not discuss e-cigarette use with their children. In total, 77.3% of parents thought it was important to be educated about e-cigarette use. However, their ability to discuss e-cigarette use with their children was 13.9% lower than their ability to discuss regular cigarette smoking with their children. Parents who were smokers were more accepting of their children using e-cigarettes (P<0.0001). Mothers who smoked were more accepting than fathers of their children using e-cigarettes (P<0.0001). CONCLUSION Parents reported a lack of knowledge and attitudes regarding e-cigarette use. Parental smoking, especially among mothers, was statistically significantly related to their e-cigarette use knowledge and attitudes. Parents agreed that it was important to educate parents regarding e-cigarette use.
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Affiliation(s)
- Heba Jafar Sabbagh
- Department of Pediatric Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Mona Hassan Ahmed Hassan
- Department of Biostatistics, High Institute of Public Health, Alexandria University, Alexandria, Egypt
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