Background Prediabetes, a high‐risk state for developing diabetes, has become more prevalent among children and adolescents in recent decades. This study sought to estimate the prevalence of prediabetes and assess its association with adiposity among adolescents in Kuwait. Also, to determine whether maternal and paternal history of diabetes associate with offspring prediabetes in a sex‐specific manner. Methods A cross‐sectional study was conducted by enrolling students (n = 1959; aged 14‐19 years) attending high schools across Kuwait. Body mass index‐for‐age z‐scores were estimated using the World Health Organization growth reference. Glycated hemoglobin A1c (HbA1c) was measured in capillary blood using point‐of‐care testing. Prediabetes was defined according to the diagnostic criteria of the American Diabetes Association (ADA; 5.7 ≤ HbA1c% ≤ 6.4) and the International Expert Committee (IEC; 6.0 ≤ HbA1c% ≤ 6.4). Adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) were estimated using Poisson regression with robust variance estimation. Results According to the ADA criteria, 33.3% (620/1845) of participants had prediabetes; whereas, 8.5% (157/1845) met the IEC definition for prediabetes. Subjects classified as obese had higher prevalence of prediabetes compared to children in the thinness/normal group (aPR = 1.68, 95% CI: 1.44‐1.95). Analysis stratified by offspring sex showed that maternal history of diabetes is associated with prediabetes among male offspring (aPR = 1.29, 95% CI: 1.02‐1.63). In contrast, paternal history of diabetes showed an association with prediabetes among female offspring (aPR = 1.22, 95% CI: 1.01‐1.48). Conclusions Prediabetes affects a substantial proportion of adolescents in Kuwait and adiposity and parental diabetes being the main associated factors with prediabetes.

INTRODUCTION Detrimental effects of secondhand smoke (SHS) exposure are well established; however, data on SHS exposure among adolescents in Kuwait are lacking. Hence, this study sought to estimate the prevalence of household SHS exposure among two samples of adolescents in Kuwait and assess its variation by socioeconomic status and parental education level. METHODS Data from two large school-based cross-sectional studies were analyzed. Adolescents attending public middle (n=3864; aged 11-14 years) and high (n=1959; aged 14-19 years) schools throughout Kuwait were enrolled in 2016-2017, and parental self-reported household SHS exposure was ascertained. Associations were assessed using Poisson regression with robust variance estimation, and adjusted prevalence ratios (APRs) and 95% confidence intervals (CIs) were estimated. RESULTS Overall, 45.8% (1755/3836; 95% CI: 44.2-47.3%) of the enrolled middle school students and 51.6% (998/1936; 95% CI: 49.3-53.8%) of the enrolled high school students were exposed to household SHS. Among middle and high school students, the prevalence of household SHS exposure increased as maternal/ paternal education level and family income decreased. Among middle school students, paternal educational attainment of middle school or less compared to bachelor's degree or higher was associated with 1.60 times (95% CI: 1.44-1.79) higher household SHS exposure. Similarly, in the sample of middle school students, the prevalence of household SHS exposure significantly increased from 35.8% among children from families reporting the highest household income to 50.5% among children from families with the lowest reported household income (p-trend<0.001). CONCLUSIONS Household SHS exposure is substantially high among adolescents in Kuwait. Enrolled adolescents from families with low socioeconomic status or with low parental education level have the highest household SHS exposure. These findings highlight the need for national comprehensive tobacco control policies and increasing parental awareness of the impact of SHS exposure on children.

Background: Health sciences students as future health care providers, can play a valuable role in protecting societies against the spread of COVID-19 through health promotion and lifestyle modification education. Therefore, proper education of these students is essential.Objective: This study sought to assess and measure the change of knowledge of health sciences students regarding healthy lifestyle promotion strategies during the spread of the Covid-19 pandemic, after participation in different types of online and social media educational programs.Methods: In order to serve the purpose of the study, a methodological research design was first used to ensure the validation of the developed scale; the COVID-19 Healthy Lifestyle Promotion Scale (COVID-19 HLPS). The study utilized a four-arm randomized control research design in which the participants were randomly assigned into one of four groups, (1) control group (placebo intervention), (2) brochure group, who received brochures relevant to healthy lifestyle promotion, (3) Instagram group, who received similar information but through Instagram posts, and (4) online interactive educational workshop group, who also received similar information through an online interactive educational workshop.Results: In total, 155 participants participated in the online and social media intervention programs. There was a significant improvement in the intervention groups in the total knowledge subscale of the healthy promotion strategies compared with the control group (p &lt; 0.001). Overall, the workshop group was the most effective group (effect size = 1.54) followed by the Instagram group (effect size = 0.99) and then the brochure group (effect size = 0.91).Conclusions: In order to meet the challenges posed by this pandemic, the use of such online and social media interventions is essential and may be the key for health promotion during this pandemic. Health science students, as future health care professionals, can play a fundamental role during the COVID-19 pandemic in disseminating knowledge relevant to healthy lifestyle to their families and communities thus promoting healthy living and behavioral changes. We propose the development of research initiatives at both national and international levels targeting changes within health science curricula that can meet potential challenges of future pandemics, leading to advancement of health care services globally.

Obesity and prediabetes are common among adolescents; however, it is unclear whether they jointly influence lipid levels. Hence, this study sought to assess whether obesity and prediabetes independently or jointly influence lipid levels among adolescents. Methods: A cross-sectional study enrolled school students aged 14-19 years (n = 1584). Body mass index (BMI)-for-age z-scores were estimated, and glycated hemoglobin A1c (HbA1c) and lipid profile were measured in capillary blood. Prediabetes was defined as 5.7≤ HbA1c% ≤6.4. Geometric means of lipids were calculated, and linear regression was used to estimate the ratio of geometric means (RoGM) and their 95% confidence intervals (CI). All analyses were stratified by sex. Results: Of the total study participants, 52.1% (826/1584) were females and the majority were aged between 14.0 (5th percentile) and 18.0 (95th percentile) years. Based on BMI-forage categories, 356 (22.5%) and 494 (31.2%) participants were classified as overweight and obese, respectively. Moreover, 34.3% (543/1584) of the study participants met the prediabetes definition. Compared to those with normal BMI and no prediabetes (reference category), participants classified as obese and having prediabetes had elevated levels of total cholesterol (TC; RoGM=1.09, 95% CI: 1.06-1.13), low-density lipoprotein cholesterol (LDL-C; 1.21, 1.13-1.29), non-high-density lipoprotein cholesterol (non-HDL-C; 1.20, 1.14-1.26), and triglycerides (TG; 1.18, 1.09-1.27) and reduced HDL-C (0.91, 0.88-0.95) levels. Independent of prediabetes, obesity was associated with all the investigated lipids. Prediabetes alone was associated with reduced levels of LDL-C and increased levels of HDL-C only among females. Conclusion: Obesity independently and in combination with prediabetes demonstrated unfavorable effects on lipids among male and female adolescents, whereas prediabetes independently influenced LDL-C and HDL-C favorably only among females.

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