SEU Non Communicable Tobacco Use Paper

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Environmental Risk Factors WORLD HEALTH SURVEY SAUDI ARABIA (KSAWHS) Published 2021 FOREWORD This report takes the overall findings of 2019 World Health Survey of Saudi Arabia further into details specifically around environmental risk factors. Within environmental risk factors we will be looking into two broad areas including use of tobacco in any form and household level factors such as air, water, sanitation. Firstly, we have explored the use of tobacco by the individuals whether in the form of smoked tobacco, smokeless tobacco or electronic cigarettes. Smoking is one of the main risk factors for many diseases, death and disability. It has long-term effects on many body organs, leading to cancer, cardiovascular disease, respiratory disease and other health problems. Secondhand smoke also has a detrimental effect on health. We have looked into and provide key statistics around smoking frequency and average daily consumption, according to age, gender, nationality, marital status, education and region and identified demographics that are more at risk due to their high tobacco consumption habits. Secondly, we looked into three key main areas at household level that are related to risk factors, including air pollution, drinking water and sanitation facilities. Household air pollution includes use of solid fuel for cooking and using incense. Household drinking water refers to source of drinking water and methods used to treat drinking water. And lastly, household sanitation refers to type of toilet facilities and their distribution by location. We believe the report provides an important summary on the key environmental risk factors at both individual and household level in Saudi Arabia. 2 TABLE OF CONTENTS 1. 2. 3. SURVEY BACKGROUND 1.1 Objectives 4 1.2 Methodology 4 1.3 Report Indicators 4 INDIVIDUAL LEVEL RISK FACTORS 2.1 Tobacco Smokers 6 2.2 Smokeless Tobacco Usage 7 2.3 Electronic Cigarettes Usage 7 HOUSEHOLD LEVEL RISK FACTORS 3.1 Indoor Air Pollution 8 3.2 Drinking Water Methods 9 3.3 Sanitation Facilities 9 3 measurement of priority health-related indicators at national level by urban and rural residence, and for each of the 13 administrative areas. The Master Sample Frame (MSF) used for the 2019 KSAWHS was based on the Population and Housing Census of the Kingdom, which was conducted in 2010 by the General Authority of Statistics (GASTAT). A nationally representative sample of completed interviews with 9,339 households was conducted from the 13 administrative regions according to population size. The KSAWHS 2019 followed a stratified three-stage sample design with a probability proportional to population size, as follows: sampling PSUs at the first stage, then a systematic sampling of households of a fixed size of eight households per PSU at the second stage, and at the third stage, an adult member of the household aged 15+ was selected using a random number generated by the tablet computer at the end of the household interview. A total of 8,912 individual interviews were conducted as a result of stage 3 selection. All analyses were performed using the survey design and the normalized weights of the households and individuals, so that the results would be representative at the national level as well as the domain level. 1. SURVEY BACKGROUND 1.1 OBJECTIVES A second round of WHS+ was implemented in 2019. The Saudi Arabian Ministry of Health (MoH) implemented the survey during 2019 in collaboration with the General Authority for Statistics (GASTAT) and the Saudi Health Council. The main objective of the Kingdom of Saudi Arabia World Health Survey (KSAWHS 2019) is to provide up-to-date, timely and relevant information on SDGs health-related indicators and WHO indicators, framework programmatic indicators, and socio-demographic stratifies. 1.2 METHODOLOGY The 2019 Kingdom of Saudi Arabia World Health Survey (KSAWHS 2019) was implemented by the MoH and designed to provide up-to-date and reliable Two questionnaires were used in this survey: household, and individual. The questionnaires were based on the WHO’s World Health Survey (WHS) questionnaires and the Tunisian 2015 WHS questionnaires (4, 5). Survey indicators were mapped to the Sustainable Development Goals (SDGs) and the WHO Global Reference List of 100 Core Health Indicators, and the questionnaires were further adopted to cover further indicators to meet national priorities. Field supervisors and interviewers were recruited based on the following criteria: 1-Being a physician or nurse (i.e. having a bachelor’s degree or above in medicine or nursing); 2-Being proficient in English and Arabic; 3-Having knowledge of the dialects of the region where they will work. The household questionnaire was administered to the head of the household or the most knowledgeable person of the house if the head of the household was not present at the time of the interview. Use of tablets/CAPI helped reduce errors and prevent missing data, remove the manual data entry steps and allow for timely monitoring of the quality of the data. 4 1.3 REPORT INDICATORS Statistically Significant Differences Wherever applicable, we have indicated the measures that are significantly different from overall result. Significantly above overall Significantly below overall Significance is measured on a 95% level of confidence for sample bases of >= 30. Regional Aggregates We have clubbed regions into mega regions for further analysis as well as a summary information on a broader basis. As such below categorization was used. • • • • • Central includes Riyadh and Qassim Western includes Makkah and Madina Eastern includes Eastern Provinces Southern includes Asir, Jazan, Najran and Bahah Northern includes Tabuk, Hail, Jawf and Northern Borders 5 2.2 EVER SMOKED BY DEMOGRAPHICS Certain demographic segments have extremely high incidence of ever smoking when compared to the overall average. Some with very high incidence of 20% and above is separated/divorced, Masters or Doctorate level education, Egyptians, Pakistanis, Filipino, Employed and across certain occupations. Ever Smoked % 13.7% Table 2.1 Overall Marital status Never married Currently married Separated/ Divorced Widowed 2. INDIVIDUAL LEVEL RISK FACTORS 2.1 TOBACCO USAGE Majority of 87% respondents mentioned that they have never smoked a tobacco (excluding smokeless tobacco). Tobacco smoking usage is significantly higher in Central region at 17.1% compared to the overall average of 13.6% in Saudi Arabia. And the usage is significantly lower in Eastern and Southern regions at below 10%. Exhibit 1: Tobacco Consumption by Region Never smoked Ever smoked tobacco 86.6% 82.9% 85.8% 90.7% 90.6% 86.2% 13.6% 17.1% 14.2% 9.3% 9.4% 13.8% Overall Central Western Eastern Southern Northern 14.0% 13.5% 23.9% 4.5% Highest educational level Cannot read and write Can read and write Less than primary Primary completed Intermediate completed Secondary completed Diploma/formation completed Univeristy completed Masters/high diploma completed Doctorate completed 5.1% 7.6% 11.2% 14.7% 8.4% 11.9% 19.3% 16.2% 20.4% 23.6% Nationality Saudi Indian Bangladeshi Yemeni Egyptian Syrian Pakistani Filipino Other 13.0% 16.5% 10.4% 14.5% 22.4% 13.6% 33.3% 26.7% 17.3% Employment status Yes No Never worked before 22.3% 8.6% 2.9% Main occupation-main job Managers and business managers Specialists in scientific, technical occupations Technicians in scientific, technical occupations Clerical occupations Basic engineering professions Sales occupations Service occupations Agriculture, hunting and animal Industrial/chemical processes Armed forces/military occupation Other Higher than overall average 27.4% 16.9% 21.3% 23.8% 30.8% 22.3% 18.1% 25.4% 28.6% 24.8% 13.5% Lower than overall average 6 2.3 TOBACCO FORMS DAILY USE OF TOBACCO FORMS ACROSS AGE Amongst tobacco smokers, Manufactured cigarette is the main form of tobacco being used followed by pipefuls of tobacco. Incidence of other forms are low in usage such as 14% use Cigars once or more per day, 11% use hand-rolled cigarettes once ore more per day and 6% mentioned using Water pipe. Table 2.4. Tobacco 51 or Less 31-40 41-50 above forms across Age than 31 year year years groups Manufactured cigarettes Hand-rolled cigarettes DAILY USE OF DIFFERENT TOBACCO FORMS Table 2.2 AT OVERALL LEVEL Do not Once a More than use day once a day Manufactured 18% 39% 43% cigarettes Hand-rolled cigarettes 89% 7% 4% Water pipe Cigars, cheroots, cigarillos, bidis 94% 3% 3% 86% 7% 7% Pipefuls of tobacco 61% 22% 17% Other 96% 2% 2% 79% 83% 86% 82% 9% 13% 11% 7% Water pipe 5% 6% 7% 6% Cigars, cheroots, cigarillos, bidis 9% 16% 15% 11% Pipefuls of tobacco 44% 40% 32% 29% Others 4% 3% 3% 10% 2.4 SMOKELESS TOBACCO Smokeless tobacco products are placed in the mouth and nose and include chewing tobacco, snuff and answer. Incidence of smokeless tobacco is very small with 1.4% respondents mentioning they have ever used smokeless tobacco and only 0.7% say they either use it daily or occasionally. Sample base of smokeless tobacco users is very small to carry out any further statistical analysis. Tobacco form use by region As shown in Table 2.3, amongst the Tobacco smokers, we can see the higher than average use of Manufactured Cigarettes of once or more than once is in Central, Southern and Northern regions. Similarly, differences across regions can be seen by the type of tobacco form used on a daily basis. Highest usage of tobacco form after manufactured cigarettes, is that of Pipefuls of tobacco which is highest in Central region. 2.5 ELECTRONIC CIGARETTE Electronic cigarette or E-cigarettes are batterypowered devices that usually contain liquid nicotine, and don’t produce smoke. Their Incidence is very small with 1.4% respondents mentioning they have ever used e-cigarette and only 0.5% mentioned they either use it daily or occasionally. Sample base of e-cigarette users is very small to carry out any further statistical analysis. Tobacco form use by age As shown in Table 2.4, amongst the Tobacco smokers, highest usage of manufactured cigarettes is amongst 41-50 year old. On the other hand, use of pipefuls of tobacco is higher amongst younger age groups of 40 or less. DAILY USE OF DIFFERENT TOBACCO FORMS ACROSS REGIONS Table 2.3 Overall Central Western Eastern Manufactured cigarettes 82% 90% 78% 52% 86% 89% Hand-rolled cigarettes 11% 14% 8% 5% 14% 6% 6% 7% 5% 3% 3% 7% Cigars, cheroots, cigarillos, bidis 14% 16% 11% 18% 15% 6% Pipefuls of tobacco 39% 49% 35% 35% 28% 23% 4% 1% 5% 13% 3% 4% Water pipe Other Higher than overall average Southern Northern Lower than overall average 7 Table 3.1 Frequency of incense use inside household by Region Overall Central Western Eastern Souther North n ern Daily 32.4% 33.4% 24.7% 31.1% 46.1% 35.2% Weekly 41.7% 43.4% 43.2% 39.2% 37.1% 41.8% Monthly 11.4% 13.4% 12.9% 12.1% 5.3% 8.7% Less often 6.3% 4.1% 9.9% 8.7% 2.7% 3.6% Never 5.7% 9.4% 8.9% 8.8% 10.7% 8.2% Significantly higher than overall Smoking Inside House by Region Table 3.2 shows the that smoking cigarette, waterpipe etc inside the house on a daily basis is significantly higher in the Northern region. Overall, 18.6% of households mentioned that someone in their household smokes inside the house on a daily basis. Table 3.2 3. HOUSEHOLD LEVEL RISK FACTORS Frequency of smoking inside household by Region Overall Central Western Eastern Souther North n ern Daily 18.6% 20.0% 18.9% 18.6% 12.5% 23.9% Weekly 2.9% 3.9% 3.2% 2.3% 1.6% 1.7% Monthly 0.7% 0.3% 1.5% 0.5% 0.3% 0.1% Less often 1.0% 1.0% 1.0% 1.3% 0.8% 0.6% Never 74.7% 75.4% 77.3% 84.8% 73.6% 76.7% 3.1 INDOOR AIR POLLUTION Significantly higher than overall All households in Saudi Arabia use clean fuel for cooking and almost all (99.7%) cook their food at home. However, in 92% of households, someone smokes in the house (32% daily and 42% monthly). The use of incense occurs in 23% of households. Table 3.3 shows that incense use is significantly higher in Villa or Story in a villa. Smoking inside the house by someone on a daily basis is significantly higher for Apartment type of house. 6 out of 10 households heat their house when it is cold where majority of 84% households use electricity for the heating. Incense Use Daily Weekly Incense Use by Region Overall 32.4% 41.7% Smoking Inside Daily Weekl y 18.6% 2.9% Traditional house 32.0% 34.2% 14.3% 2.0% Table 3.1 shows the daily use of incense by region and it is significantly above average in Southern region, while ‘never’ use is significantly higher in Western and Northern regions. Villa 42.7% 44.3% 18.4% 2.7% Story in villa 38.5% 48.8% 12.3% 3.5% Apartment 28.5% 41.9% 20.7% 3.1% Other, specify 20.4% 15.5% 16.5% 3.9% Table 3.3 8 3.2 DRINKING WATER 3.3 SANITATION FACILITIES Access to safe and clean drinking water and sanitation is a human right and is essential for good public health. Contaminated water and poor sanitation lead to the transmission of diseases such as cholera, diarrhea and typhoid. Improved drinking water sources are used by 99% of households. The percentage of households with basic water services is 93%, limited drinking water services 6% and unimproved water sources 1%. Improved sanitation services are used by nearly 100% of households. Ninety- six percent of household have basic sanitation services while 4% have limited sanitation services. There are clear differences in the sources of drinking water across Urban and Rural dwellings. Use of piped into dwelling is significantly higher for Urban dwellings as a drinking source of water, while Rural is significantly higher for Bottled Water and Water tanker trucks. In Saudi Arabia, 99.8% of households use improved sanitation facilities. Flush toilets that flush to piped sewer water are the most common type (77% in urban households and 46% in rural households). Use of flush to septic tanks is higher in Rural areas compared to Urban. Table 3.6 Type of Toilet Facility Flush to piped sewer system Flush to septic tank Others Table 3.4 Sources of drinking water by Urban and Rural URBAN RURAL Piped into dwelling 45.0 21.0 Bottled water 44.2 59.0 Water tanker trucks 8.1 15.1 Other improved sources 1.9 4.9 Other (unimproved) 0.8 0.0 Sources of drinking water by region As shown in Table 3.5, clearly there are regional differences in terms of sources of drinking water. Central and Northern are significantly higher than overall in piped dwelling as well as water tankers. Bottled water usage is higher than overall average in Western, Eastern and Southern regions. Piped into dwelling Bottled water Water tanker trucks Overall 42% 46% 9% Central 52% 32% 13% Western 43% 51% Eastern 33% Southern Northern Table 3.5 URBAN RURAL 77.3 45.6 21.7 50.1 1 4.3 When asked whether the household shares toilet facilities with other households, overall 4.3% mentioned they do share. And this sharing is significantly higher than overall average in Southern region (9.8%). Sanitation facilities by region As shown in Table 3.7, Flush to piped sewer system is significantly higher in Central, Western and Eastern regions. Flush to septic tank is significantly higher for Southern and Northern regions. Incidence of other methods such as flush to unknown, pit latrine, bucket etc) is very low at 1% overall. Table 3.7 Type Flush to piped Flush to of Toilet Facility sewer system septic tank by Region Overall 73% 26% Central 78% 22% Western 81% 17% Others 1% 0% 2% Eastern 4% 95% 5% 0% Southern 37% 60% 3% 55% 11% Northern 55% 42% 2% 18% 72% 9% 55% 20% 13% Significantly higher than overall 9 LIST OF TABLES For more information on environmental risk factors, see the following tables: Table 1: Use of tobacco Table 2: Use of smokeless tobacco Table 3: Use of electronic cigarettes Table 4: Household air pollution Table 5: Household drinking water Table 6: Household sanitation facilities 10 Table 1: Use of tobacco Tobacco use, percent distribution by smoking frequency and average daily consumption, according to age, sex, nationality, residence, marital status, education, wealth and region [Saudi Arabia, 2019]. BACKGROUND CHARACTERISTIC MEDIAN DAILY TOBACCO CONSUMPTION TOBACCO CONSUMPTION NEVER SMOKER2 TOTAL DAILY OCCASIONAL1 NOT CURRENT 15-29 6.9 1.8 1.9 89.4 100.0 30-44 12.2 2.8 1.7 83.3 45-59 10.1 1.9 2.2 85.8 60-69 6.2 0.8 5.3 70-79 1.6 1.7 80+ 0.8 3.2 Male 17.1 Female NUMBER OF RESPONDENTS MEDIAN NUMBER OF RESPONDENTS3 3,353 4 288 100.0 3,755 3 551 100.0 1,256 5 146 87.7 100.0 362 5 23 3.5 93.1 100.0 135 2 4 0.0 96.0 100.0 52 50 2 3.3 2.9 76.7 100.0 4,694 4 933 0.9 1.0 1.0 97.1 100.0 4,218 3 79 Saudi 9.0 2.2 1.7 87.0 100.0 7,777 4 850 Non-Saudi 12.3 2.3 3.6 81.8 100.0 1,135 3 165 Urban 9.8 2.4 1.8 86.0 100.0 7,687 4 913 Rural 7.2 1.3 3.1 88.3 100.0 1,225 4 102 Never married 9.5 2.8 1.6 86.1 100.0 2,250 4 272 Currently married 9.3 2.0 2.2 86.5 100.0 5,982 4 658 Formerly married 10.2 2.7 1.3 85.8 100.0 680 4 85 No formal education 3.7 0.8 1.1 94.4 100.0 490 8 21 Less than secondary school 7.3 0.8 2.3 89.6 100.0 1,338 5 101 Secondary school 9.7 1.4 1.8 87.1 100.0 3,449 5 377 More than secondary school 10.8 3.7 2.2 83.4 100.0 3,635 3 516 Lowest 11.7 1.6 1.7 84.9 100.0 2,169 5 283 Second 9.8 1.8 1.4 87.0 100.0 1,918 3 215 Middle 9.9 2.1 2.6 85.4 100.0 1,694 5 198 Fourth 7.1 2.2 2.2 88.5 100.0 1,626 4 148 Highest 7.7 3.8 2.1 86.4 100.0 1,505 3 171 Riyadh 13.2 3.5 2.0 81.3 100.0 2,345 3 389 Makkah 9.2 2.9 3.5 84.4 100.0 2,257 8 263 Madinah 7.2 1.6 0.9 90.3 100.0 664 10 57 Qasim 3.5 0.4 2.8 93.3 100.0 364 14 14 Eastern Province 6.6 1.6 1.1 90.7 100.0 1,149 4 84 Asir 8.4 0.9 0.9 89.7 100.0 644 2 59 Tabuk 11.0 1.1 0.6 87.3 100.0 300 1 36 Hail 12.6 0.2 2.4 84.8 100.0 179 1 23 Northern Borders 8.2 1.4 0.9 89.5 100.0 87 26 8 Jizan 7.4 1.0 1.1 90.5 100.0 410 5 34 Najran 1.2 2.3 1.3 95.2 100.0 194 15 7 Bahah 9.6 0.1 1.4 89.0 100.0 153 6 15 Jawf 14.6 1.2 0.3 83.9 100.0 165 15 26 Total 9.4 2.2 2.0 86.4 100.0 8,912 4 1,015 Age Sex Nationality Residence Marital Status Education Wealth Quintile Region 1. Occasional refers to less than daily use 2. Includes categories missing, “I do not know” and “refused” 3. Excludes respondents that reported “I do not know” or zero units 11 Table 2: Use of smokeless tobacco Smokeless tobacco use, percentage distribution by frequency of use and average daily consumption, according to age, sex, nationality, residence, marital status, education, wealth and region [Saudi Arabia, 2019]. SMOKELESS TOBACCO CONSUMPTION MEDIAN DAILY TOBACCO CONSUMPTION BACKGROUND CHARACTERISTIC NEVER USED2 TOTAL NUMBER OF RESPONDENTS MEDIAN NUMBER OF RESPONDENTS3 3,353 3 5 3,755 1 20 100.0 1,256 2 4 98.1 100.0 362 1 1 0.0 100.0 100.0 135 0 0 0.0 0.0 100.0 100.0 52 0 0 0.8 0.5 1.2 97.6 100.0 4,694 1 30 0.0 0.1 0.2 99.7 100.0 4,218 1 0 Saudi 0.3 0.3 0.5 99.0 100.0 7,777 1 19 Non-Saudi 1.0 0.6 2.5 95.8 100.0 1,135 1 11 Urban 0.4 0.3 0.6 98.6 100.0 7,687 1 25 Rural 0.2 0.2 1.4 98.2 100.0 1,225 1 5 Never married 0.3 0.5 1.0 98.3 100.0 2,250 2 2 Currently married 0.4 0.2 0.5 98.9 100.0 5,982 1 19 Formerly married 0.7 0.7 1.6 97.0 100.0 680 1 8 No formal educatio n 0.4 0.8 1.2 97.6 100.0 490 1 5 Less than secondary school 0.4 0.1 0.8 98.7 100.0 1,338 2 2 Secondary school 0.4 0.4 0.7 98.5 100.0 3,449 2 13 More than secondary school 0.5 0.2 0.7 98.7 100.0 3,635 1 10 Lowest 0.8 0.5 0.7 97.9 100.0 2,169 1 15 Second 0.2 0.1 1.2 98.5 100.0 1,918 2 2 Middle 0.6 0.5 0.6 98.2 100.0 1,694 1 9 Fourth 0.2 0.3 0.8 98.7 100.0 1,626 3 3 Highest 0.0 0.0 0.1 99.8 100.0 1,505 17 1 Riyadh 0.2 0.4 1.1 98.3 100.0 2,345 1 9 Makkah 0.3 0.4 0.7 98.5 100.0 2,257 1 3 Madinah 0.8 0.0 1.4 97.8 100.0 664 7 2 Qasim 0.0 0.0 0.0 100.0 100.0 364 0 0 Eastern Province 0.1 0.1 0.0 99.8 100.0 1,149 0 0 Asir 1.5 0.8 0.7 97.0 100.0 644 1 8 Tabuk 0.8 0.2 0.6 98.4 100.0 300 3 3 Hail 0.3 0.0 0.0 99.7 100.0 179 0 0 Northern Borders 0.0 0.4 1.6 98.0 100.0 87 1 0 Jizan 1.2 0.2 1.0 97.6 100.0 410 1 4 Najran 0.0 0.2 0.5 99.3 100.0 194 2 0 Bahah 0.0 0.0 0.0 100.0 100.0 153 0 0 Jawf 0.0 0.0 0.0 100.0 100.0 165 0 0 Total 0.4 0.3 0.7 98.6 100.0 8,912 1 30 DAILY OCCASIONAL1 NOT CURRENT 15-29 0.1 0.4 0.8 98.8 100.0 30-44 0.8 0.3 0.7 98.2 100.0 45-59 0.3 0.3 0.4 99.0 60-69 0.3 0.0 1.7 70-79 0.0 0.0 80+ 0.0 Male Female Age Sex Nationality Residence Marital Status Education Wealth Quintile Region 1. Occasional refers to less than daily use 2. Includes categories missing, “I do not know” and “refused” 3. Excludes respondents that reported “I do not know” or zero units 12 Table 3: Use of electronic cigarettes Electronic cigarette use and percentage distribution by frequency of use, according to age, sex, nationality, residence, marital status, education, wealth and region [Saudi Arabia, 2019]. ELECTRONIC CIGARETTE CONSUMPTION BACKGROUND CHARACTERISTIC NEVER USE D2 TOTAL NUMBER OF RESPONDENTS DAILY OCCASIONAL1 NOT CURRENT 15-29 0.2 0.4 0.7 98.7 100.0 3,353 30-44 0.2 0.4 1.3 98.1 100.0 3,755 45-59 0.1 0.0 0.5 99.3 100.0 1,256 60-69 0.0 0.0 0.0 100.0 100.0 362 70-79 0.0 0.0 0.0 100.0 100.0 135 80+ 0.0 0.0 0.0 100.0 100.0 52 Male 0.3 0.4 1.4 97.8 100.0 4,694 Female 0.0 0.3 0.2 99.5 100.0 4,218 Saudi 0.2 0.4 0.8 98.6 100.0 7,777 Non-Saudi 0.1 0.0 1.3 98.6 100.0 1,135 Urban 0.2 0.4 0.9 98.6 100.0 7,687 Rural 0.1 0.0 0.9 99.0 100.0 1,225 Never married 0.2 0.5 1.0 98.2 100.0 2,250 Currently married 0.1 0.2 0.8 98.8 100.0 5,982 Formerly married 0.3 1.0 0.6 98.2 100.0 680 No formal education 0.0 0.0 0.0 100.0 100.0 490 Less than secondary school 0.0 0.0 0.3 99.7 100.0 1,338 Secondary school 0.3 0.4 0.6 98.7 100.0 3,449 More than secondary school 0.2 0.5 1.4 97.9 100.0 3,635 Lowest 0.2 0.3 0.6 99.0 100.0 2,169 Second 0.2 0.3 0.6 98.9 100.0 1,918 Middle 0.3 0.5 1.6 97.7 100.0 1,694 Fourth 0.2 0.1 1.1 98.5 100.0 1,626 Highest 0.0 0.5 0.6 98.8 100.0 1,505 Riyadh 0.0 0.1 1.3 98.5 100.0 2,345 Makkah 0.1 1.0 1.4 97.5 100.0 2,257 Madinah 0.2 0.0 0.8 99.0 100.0 664 Qasim 0.1 0.5 0.2 99.2 100.0 364 Eastern Province 0.6 0.2 0.3 98.8 100.0 1,149 Asir 0.3 0.1 0.3 99.3 100.0 644 Tabuk 0.0 0.0 0.3 99.7 100.0 300 Hail 0.5 0.0 0.0 99.5 100.0 179 Northern Borders 0.0 0.0 1.2 98.8 100.0 87 Jizan 0.0 0.0 0.1 99.9 100.0 410 Najran 0.0 0.0 0.0 100.0 100.0 194 Bahah 0.0 0.0 0.0 100.0 100.0 153 Jawf 0.0 0.0 0.0 100.0 100.0 165 Total 0.2 0.3 0.9 98.6 100.0 8,912 Age Sex Nationality Residence Marital Status Education Wealth Quintile Region 13 Occasional refers to less than daily use Table 4: Household air pollution Percentage distribution of households using solid fuel for cooking and percentage distribution by frequency of smoking and using incense in the home, according to residence and wealth [Saudi Arabia, 2019]. HOUSING CHARACTERISTIC RESIDENCE WEALTH QUINTILE TOTAL URBAN RURAL LOWEST SECOND MIDDLE FOURTH HIGHEST Gas 83.8 91.6 86.2 85.4 84.1 85.2 82.8 84.9 Electricity 16.1 8.2 13.7 14.6 15.7 14.6 16.9 15.0 Kerosene 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.0 Coal/Charcoal 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Other 0.1 0.1 0.1 0.0 0.1 0.3 0.2 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Percentage using solid fuel for cooking1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Percentage using clean fuel for cooking2 99.9 99.8 99.9 100.0 99.9 99.7 99.8 99.9 In the house 99.6 99.9 99.3 100.0 99.8 99.7 99.6 99.7 In a separate building 0.3 0.0 0.2 0.0 0.2 0.3 0.4 0.2 Outdoors 0.0 0.1 0.1 0.0 0.0 0.0 0.0 0.0 Other 0.1 0.0 0.3 0.0 0.0 0.0 0.0 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Cooking fuel Place for cooking Frequency of smoking in the home Daily 31.5 38.0 21.3 29.2 35.8 35.7 45.0 32.4 Weekly 41.5 42.5 36.8 43.0 42.3 44.4 43.4 41.7 Monthly 12.0 8.1 12.2 13.4 11.6 12.0 6.8 11.4 Less often than once a month 6.4 5.7 8.6 8.2 5.3 4.8 3.3 6.3 Never 8.6 5.7 21.1 6.1 4.9 3.1 1.4 8.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Frequency of using incense in the home Daily 19.4 14.1 19.2 18.2 17.3 16.7 22.0 18.6 Weekly 3.1 2.0 2.3 2.5 4.0 2.3 3.8 2.9 Monthly 0.8 0.2 0.5 0.9 0.5 0.9 0.8 0.7 Less often than once a month 1.0 1.1 1.0 1.1 1.3 0.8 0.7 1.0 Never 75.8 82.6 77.0 77.2 77.0 79.3 72.7 76.7 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of households 8,027 1,312 2,266 2,014 1,784 1,699 1,575 9,339 Includes coal/charcoal •Includes gas and electricity 14 Table 5: Household drinking water Percentage distribution of households by source of drinking water, percentage using various methods to treat drinking water and percentage using an appropriate treatment method, according to residence and wealth [Saudi Arabia, 2019]. RESIDENCE CHARACTERISTIC URBAN WEALTH QUINTILE RURAL LOWEST SECOND MIDDLE FOURTH HIGHEST TOTAL Source of drinking water Improved source Piped into dwelling 45.0 21.0 37.4 37.7 38.5 42.9 55.1 41.6 Piped into yard/plot 0.4 0.2 0.9 0.2 0.3 0.1 0.0 0.4 Public tap/standpipe 0.9 3.4 0.7 0.9 1.5 2.8 0.6 1.3 Tubewell/borehole 0.1 0.5 0.5 0.0 0.0 0.0 0.1 0.1 Protected well 0.2 0.8 0.7 0.3 0.3 0.1 0.0 0.3 Protected spring 0.3 0.0 0.1 0.1 0.2 0.7 0.2 0.3 Bottled water 44.2 59.0 46.7 50.0 48.9 45.7 38.9 46.3 Water tanker trucks 8.1 15.1 12.9 10.0 9.0 7.1 4.5 9.1 Rainwater 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Other (unimproved) 0.8 0.0 0.1 0.9 1.3 0.6 0.7 0.7 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 99.2 100.0 99.9 99.1 98.7 99.4 99.3 99.3 Percentage with improved drinking water Water treatment method1 Boil 3.2 2.3 1.5 2.6 3.8 3.9 4.1 3.0 Add bleach/chlorine 0.7 2.0 0.9 0.5 1.0 0.9 1.0 0.9 Strain through a cloth 0.3 0.5 0.4 0.4 0.2 0.3 0.5 0.3 21.5 12.9 12.6 19.1 17.9 23.5 32.2 20.3 Solar disinfection 0.2 0.0 0.2 0.2 0.2 0.1 0.1 0.2 Let it stand and settle 0.3 0.5 0.4 0.1 0.4 0.2 0.5 0.3 Other 0.6 0.6 0.8 0.7 0.5 0.2 0.5 0.6 Percentage using an appropriate treatment method2 23.9 14.5 13.7 21.0 20.9 26.4 35.1 22.5 Percentage with basic drinking water services3 94.2 86.1 93.5 93.1 92.4 90.6 95.6 93.0 Percentage with limited drinking water services4 5.0 13.9 6.4 6.1 6.3 8.8 3.8 6.3 Number of households 8,027 1,312 2,266 2,014 1,784 1,699 1,575 9,339 Use water filter (ceramic, sand, composite) 1. 2. 3. 4. For households that reported using any source of drinking water except bottled water and that reported using a method to make drinking water safe. Households may report multiple treatment methods, so the sum of treatment methods may exceed 100% Appropriate water treatment methods include boiling, filtering and solar disinfection Defined as drinking water from an improved source provided water is on the premises (NOTE: this excludes drinking water that is not on the premises but for which collection time does not exceed 30 minutes) Defined as drinking water from an improved source that is not on the premises (NOTE: this includes drinking water that is not on the premises but for which collection time does not exceed 30 minutes) 15 Table 6: Household sanitation facilities Percentage distribution of household by type of toilet/latrine facilities and percentage distribution with a toilet/latrine facility by location of the facility, according to residence [Saudi Arabia, 2019]. TYPE OF TOILET/ LATRINE FACILITY RESIDENCE URBAN WEALTH QUINTILE RURAL LOWEST SECOND MIDDLE FOURTH HIGHEST TOTAL Improved sanitation facility Flush to piped sewer system 77.3 45.6 61.5 65.9 74.6 82.6 85.6 72.9 Flush to septic tank 21.7 50.1 35.0 32.8 24.4 16.7 14.4 25.7 Flush to pit latrine 0.7 2.2 2.9 0.6 0.5 0.0 0.0 0.9 Flush to unknown 0.0 0.1 0.0 0.1 0.1 0.0 0.0 0.1 Ventilated improved pit (VIP) latrine 0.0 0.8 0.2 0.3 0.1 0.0 0.0 0.1 Pit latrine with slab 0.0 0.9 0.1 0.2 0.4 0.1 0.0 0.2 Unimproved sanitation facility Flush to somewhere else 0.2 0.2 0.2 0.2 0.0 0.4 0.0 0.2 Bucket 0.0 0.0 0.1 0.0 0.0 0.0 0.0 0.0 Other 0.0 0.2 0.0 0.0 0.0 0.1 0.0 0.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 99.8 99.7 99.7 99.8 100.0 99.5 100.0 99.8 Percentage with basic sanitation services1 96.0 92.3 92.6 95.7 97.4 96.7 95.8 95.5 Percentage with limited sanitation services2 3.8 7.5 7.2 4.1 2.6 2.8 4.2 4.3 Number of households 8,027 1,312 2,266 2,014 1,784 1,699 1,575 9,339 Percentage with improved sanitation facility 1. 2. Defined as use of improved facilities that are not shared with other households Defined as use of improved facilities that are shared by two or more households 16 College of Health Sciences Department of Public Health ASSIGNMENT COVER SHEET Course name: Chronic Disease Epidemiology Course Code & CRN: PHC331 -XXXX Assignment title or task: (You can write a question) Paper assignment (2): Tobacco use is a risk factor for many non-communicable diseases. The second round of the World Health Survey-2019, in Saudi Arabia, showed the burden of Tobacco usage in the kingdom. Using this survey results, can you describe the overall use of Tobacco among responders, and then by describe it by the following sociodemographic factors: age group, region, education level, and occupation. Student name: Student ID: Submission date: / 4/ 2022 Instructor name: Dr……………… Grade: ……. Out of 10 College of Health Sciences Department of Public Health Release Date: 12/4/2022 Due Date :23/4/2022 Instructions: • • • • • • • • • Length of the write-up could be more than 500 words. Font should be Times New Roman, and size should be 12. Heading should be Bold The text color should be Black Line spacing should be 1.5. Proper headings with number should be given for each segment Avoid Plagiarism Assignments must be submitted with the filled cover page All assignments must carry the references using APA style.

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