Prevalence of smoking and smoking predictors among adolescents in Qassim, Saudi Arabia: does the Healthy City Programme make any difference?

Aim We compared the prevalence of smoking and smoking predictors among adolescents between cities running a Healthy City Programme (HCP cities) and cities not running such a programme (NHCP cities) in the Qassim region of Saudi Arabia.
Subject and methods Using multi-stage cluster sampling with probability proportionate to size, we surveyed 364 school-going adolescents from three HCP cities and 769 school-going adolescents from three NHCP cities in the Qassim region, Saudi Arabia, between April and September 2017.
Results The overall prevalence of smoking among school-going adolescents in the Qassim region was 5.2% (95% confidence interval [CI]: 3.9–6.5). Smoking prevalence among adolescents in the HCP cities was 8.8% (5.9–11.7), while in the NHCP cities, it was 3.5% (2.2–4.8). The prevalence of at least one smoker among close friends in HCP and NHCP cities was 67.3% (62.5–72.1) and 72.2% (69.0–75.3), respectively. The prevalence of at least one smoker in the family of the adolescents in HCP and NHCP cities was 58% (52.9–63.1) and 44.3% (40.8–47.9), respectively. Among the socio-demographic variables, smoking was significantly associated with gender, age, and academic performance. Overall, the prevalence of smoking among adolescents was significantly higher in HCP cities than in NHCP cities (odds ratio: 3.03; 95% CI: 1.7–5.4).
Conclusion The prevalence of smoking and key smoking risk factors were found to be higher in cities implementing the HCP, despite exposure to anti-smoking campaigns being higher. Given these findings, we recommend further in-depth evaluation of the programme.