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Investigation of some components of female adolescent health in a school in Riyadh, 2007

Female adolescent's health is an important issue which has not received much attention in Saudi Arabia, therefore we decided to conduct this cross-sectional exploratory study.
Simple random sampling was used to choose one female high school in Riyadh. A total sample size of 276 participants was obtained. Their ages ranged between 15-18 years (mean ± S.D 16.4 ± 0.8 years). Saudi nationality constituted 93.1%. The majority of fathers' and over half the mothers were college graduates (77.9% and 54%, respectively).
Regarding oral health, 55.1% were tooth brushing 2-3 times daily. However, a large proportion had not used either dental floss 64.1 % or mouth wash 56.2%, and 37.7% reported eating sweets 2 times or more per day in the week before the study. 23.9% had not visited the dentist in the previous year.
Always washing hands before eating was reported by 58.3%; 78.6% stated that they always washed their hands after eating; 90.9% always washed hands after using the toilet; 45.3% never washed hands after shaking with others; and 76.1% always used soap when washing hands.
Forty five percent reported taking a shower once daily, and the same proportion reported taking a shower once every 2-4 days. Taking shower during menstruation once daily and once every 2-4 days were equally reported (42%), and only 2.5% reported never taking a shower during menstruation.
More than half had an ideal weight self-image 52.7%, 28.4% thought they were overweight, and 12% thought they were underweight; 60.8% were trying to lose weight, and 19.2% were trying to maintain their weight; 55.1% had used a diet to achieve weight loss.
A large proportion reported always eating breakfast 45.3%, and only 8% reported never eating breakfast. Eating fruits once a week or less was reported by 28.3%, eating vegetables 2-3 times per week was reported by 33%. During the week prior to the study, 39.5% reported drinking milk 1-2 times per day, 7.2% had not drunk milk, 29.7% drank soda 2-3 times per week and 9.8% reported drinking soda 3 times or more per day. In the week prior to the study, 53.6% had eaten fast foods on 1 or 2 days, and 8% on 6 or 7 days; Over half hadn't practiced any physical activity (52.2%).
Reported smoking included 11.6% who had ever smoked, of whom 75% had started smoking at 13-16 years of age. In the week prior to the study, 3.6% had smoked cigarettes, 2.9% had smoked Shisha, and 2.2% had smoked both.
Regarding exposure to violence in the week prior to the study, 34.4% reported being verbally abused at home. Among those, 74.7% had been verbally abused 1-4 times. The most frequent verbally abusive family member was a brother 26.7%. Physical abuse was reported by 9.4%, among who 84.6% had been physically abused 1-4 times. The most frequent physically abusive family member was also a brother (41%). Among all participants, 27.9% reported having been involved in a fight at home in the week prior to the study, among who 80.5% had been involved in a fight at home 1-4 times.
Regarding school violence, 15.2% reported being bullied at school in the week prior to the study, 81% of whom had been bullied 1-4 times. Stated reasons for being bullied were native region 23.1%, skin color 11.6%, nationality 3.8%, body appearance 3.8%, and other reasons 57.7%. Those who reported being physically attacked at school constituted 5.8%, 50% of whom had been physically attacked 1-4 times. Among all participants, 6.5% had ever been involved in a fight at school, among who 83.3% had been involved in a fight at school 1-4 times in the week prior to the study.
Reported received health education was: 29.7% on oral health, 26.8% hand washing, 26.1 % bathing and showering, 39.9% hygiene during menstruation, 55.1% food and eating habits, 37.7% physical activity, 21.7% smoking, and 22.1 % violence. Most health education on all matters was received at home, oral hygiene 63.3%, hand washing Table 1 shows the effect of fathers' education, mothers' education, and Family income on hand washing practices of adolescent females.
Higher mothers education was noticeable among those with good shower taking practices during menstruation, but was not statistically significant (OR= 1.41, 95% CI= 0.74-2.72). Also, those from higher income families showed better shower taking practices during menstruation, but was not statistically significant.
All cigarettes and shisha smokers among our sample belonged to fathers and mothers with higher education but both were not statistically significant.
Adolescents with ideal weight self-image had better breakfast eating practices than both those with underweight self-image (OR= 2.82,95% CI= 1.32-6.07)which was statistically significantly, and those with overweight self-image, but not significant (OR= 1.46, 95% CI= 0.82-2.59).
Poor fruit and vegetables eating habits were common among ideal, underweight, and overweight self-image adolescents, but were not statistically significant.

Editorial note:

Health-risk behaviors developed during adolescence contribute to the leading causes of morbidity and mortality among adults. Female adolescents in particular are a highly vulnerable group, because of tendency for poor nutritional habits and eating disorders, potentially high caries rate, increased esthetic desire, initiation of tobacco use, increased risk for violence and bullying, and unique social and psychological needs.[1]
Regarding oral health practices our study showed that 90.6% of respondents cleaned their teeth once per day or more. This is better than previously reported among intermediate school children in Riyadh (65.5%).[2] The low use of dental floss among the study sample suggests lack of awareness of this procedure and its value in preventing oral diseases.
Overall, 50.7% of girls in our study did not practice good shower taking hygiene during menstruation. A study in Tehran to assess the knowledge, attitudes and behavior of female adolescents regarding dysmenorrhea and hygienic practices during menstruation showed that the vast majority lacked appropriate knowledge about personal hygiene. Only 32% practiced positive health behaviors in this regard.[3] In our study, 83.8% of those with good hygienic practices had mothers with higher educational level. In the same respect, most education in all aspects of adolescent health was received at home. This is similar to the Iranian study, where 61% identified their mothers' as the main health information source.[3] Educating mothers, who are the main source of information to their daughters, should be a main aim in health education.
Adolescents from higher income families had better hygienic practices during menstruation, which is similar to the findings of a study among 664 adolescent girls in Egypt, showing that although use of sanitary pads was increasing, but not among girls from rural and poor families.[4]
In our study, 52.5% of respondents' skipped breakfast; 53.6% ate fast foods at least on 1 or 2 days per week. When teenagers skip meals, they are more likely to consume fast foods high in fat and sugar and of poor nutritional value. Economic changes in Saudi Arabia have influenced the quality and quantity of food intake and predisposed to a sedentary lifestyle. Only 52.2% of the study sample reported physical activity in a typical week. This low level may partially be attributed to lack of sports activities in female schools in the Kingdom. Social beliefs are an important issue in adopting a physical activity program.
The present study showed an 11.6% prevalence of ever smoking. In a study assessing the gender differences in smoking behavior among adolescents in Saudi Arabia, out of 1,505 students studied, 22.3% (34% males, 11.1% females) were current cigarette smokers and 5.8% (11.1% males, 0. 7. females) were daily smokers.[5]
In our study, both verbal (34.4%) and physical abuse (9.4%) were reported and a brother was the predominant abuser. Children who experience both verbal aggression and physical violence exhibit the highest rates of aggression and interpersonal problems.[6]
Considering the limitations of this study, additional studies are needed using a wider geographic scope and a larger sample size.
  1. Overview of CAH, Child and Adolescent Health and Development, [homepage on the Internet]. World Health Organization; 2004 [cited 2007, Feb10]. Available at:URL: adh_ over.htm >.
  2. Al-Sadhan SA. Oral health practices and dietary habits of intermediate school children in Riyadh, Saudi Arabia. Saudi Dental Journal. 2003; 15(2): 81-87.
  3. Poureslami M, Osati-Ashtiani F. Attitudes of female adolescents about dysmenorrheal and menstrual hygiene in Tehran suburbs. Arch Iranian Med 2002; 5(4): 219-24.
  4. El-Gilany A, Badawi K. Menstrual Hygiene among Adolescent Schoolgirls in Mansoura, Egypt. Reproductive Health Matters. 2005; 13 (26): 147-52.
  5. Abdalla AM, Al-Kaabba AF, Saeed AA, Abdulrahman BM, Raat H. Gender differences in smoking behavior among adolescents in Saudi Arabia. Saudi Med J. 2007 Jul;28(7): 1102-8.
  6. Teen Violence [homepage on the internet]. June, 2007 [cited on 2007, May 27], Available at: URL: http://www.nlm.nih. gov/medlineplus/teenviolence.html.
Table 1: Effect of some demographic features on hand washing practices of female adolescents, Riyadh, 2007.
Adolescent female's demographic features
Hand washing practice after eating
Hand washing practice after shaking hands with others
Good No. (%)
No. (%)
95% CI
Good No. (%)
No. (%)
95% CI
Father's education (n=276)
High (high school & above)
24 (70.6)
225 (93)
 Low (below high school)
25 (9.7)
10 (29.4)
Mother's education (n=276)
High (high school &above)
27 (79.4)
197 (81.4)
Low (below high school)
50 (19.4)
7 (20.6)
45 (18.6)
Family monthly income (n=116)
High (> 5000 SR)
105 (99.1)
9 (90)
Fisher exact test P-value 0.17
100 (100)
Fisher exact test P-value 0.02
Low (< 5000 SR)
1 (0.9)
1 (10)
2 (12.5)