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We present the design, implementation, and evaluation of an e-service learning course, "Social Marketing for Health Promotion", offered to full-time and part-time students enrolled in the Master of Public Health at our institution. In a quasi-experimental trial, we introduced e-service learning in 2018, comparing a traditional face-to-face section to a blended course (33% online). Based on the positive feedback received, we progressively increased the online component in the following academic years, reaching 100% online in Fall 2020. We compared the quantitative and qualitative indicators evaluating three e-service learning-course iterations with a face-to-face control. The impact indicators included participation and engagement in the course, the attainment of the learning outcomes, satisfaction with the course, instructors and mode of delivery, and the impact of the experience beyond the classroom. Over the years, we trained 73 students whose engagement with the course remained relatively stable. The attainment of the learning outcomes and general course satisfaction steadily increased over time, demonstrating a positive impact on student learning. Qualitative data illustrate the importance of instructors in setting expectations and guiding students and community partners through a remote-learning process.

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Health literacy is an important predictor of health status, health behaviours, and other health outcomes. However, research on health literacy in the Arab world is scarce and no health literacy tool has been validated to test the health literacy level of the Lebanese population so far. The aim of this study was to validate Arabic translations of three commonly used health literacy assessment tools, the S-TOFHLA, the REALM-R, and the Brief Health Literacy Screening items. The tools were linguistically and culturally adapted to the Lebanese context, and 250 face-to-face interviews were conducted in an outpatient clinic in Beirut, Lebanon, between April and June 2015. The General Self-Efficacy Scale and socio-demographic questions such as gender, age, origin, education and chronic condition were included to assess predictive validity. Reliability of the instruments was found to be low to high (Cronbach's α =0 .94 for the S-TOFHLA, Cronbach's α = 0.46 for the REALM-R). Younger and highly educated participants scored higher on the S-TOFHLA. The Brief Health Literacy Screening items were significantly correlated with age, education, self-efficacy and the S-TOFHLA, reinforcing the convergent and predictive validity of the two tools. Results indicate that the S-TOFHLA and the three screening questions are a valuable tool to measure health literacy in Lebanon and, allowing for minimal adaptations according to each country's healthcare system, in the entire Arabic-speaking area.

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BACKGROUND: Early detection of common mental disorders, such as depression and anxiety, among children and adolescents requires the use of validated, culturally sensitive, and developmentally appropriate screening instruments. The Arab region has a high proportion of youth, yet Arabic-language screening instruments for mental disorders among this age group are virtually absent. METHODS: We carried out construct and clinical validation on the recently-developed Arab Youth Mental Health (AYMH) scale as a screening tool for depression/anxiety. The scale was administered with 10-14 year old children attending a social service center in Beirut, Lebanon (N = 153). The clinical assessment was conducted by a child and adolescent clinical psychiatrist employing the DSM IV criteria. We tested the scale's sensitivity, specificity, and internal consistency. RESULTS: Scale scores were generally significantly associated with how participants responded to standard questions on health, mental health, and happiness, indicating good construct validity. The results revealed that the scale exhibited good internal consistency (Cronbach's alpha = 0.86) and specificity (79%). However, it exhibited moderate sensitivity for girls (71%) and poor sensitivity for boys (50%). CONCLUSIONS: The AYMH scale is useful as a screening tool for general mental health states and a valid screening instrument for common mental disorders among girls. It is not a valid instrument for detecting depression and anxiety among boys in an Arab culture.

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A variety of measures of mental health have been used with youth. The reason for choosing one scale over another in any given situation is rarely stated, and cross-cultural validation is scarce. Psychometric testing is crucial before utilizing any measure of mental health with a certain population, due to possible cultural variations in interpreting meaning. The research reported herein describes the development and psychometric testing of the Arab Youth Mental Health Scale. The process included 5 phases: (1) reviewing existing scales leading to the identification of 14 non-clinical and relatively short mental health scales used previously with youth; (2) rating the scales by the researchers and community members leading to the identification of 3 scales with apt structure, and that were judged to be suitable, applicable, and appropriate; (3) soliciting youth input to assess comprehension of each item in the selected 3 scales and to discover context specific mental health related feelings, thoughts, and expressions; (4) seeking expert opinion to classify items remaining after phase 3 that measured common mental disorders, and to limit repetitiveness; and (5) testing for psychometric properties of the 28 items that remained after the previous 4 phases. The contribution of each phase to the process is described separately. Results of the exploratory principal component analysis resulted in one factor which explained 28% of the variance and for which 21 items loaded above an eigenvalue of 0.5. No other factor added significantly to the explanation of variance, nor had items that added theoretical or conceptual constructs. The process of soliciting feedback from youth groups, the community and professionals; and of field testing was challenging; but resulted in a contextually sensitive, culturally appropriate and reliable scale to measure mental health of youth. We recommend that researchers measuring mental health of youth critically analyze the relevance of existing scales to their context; consider using the AYMH scale if appropriate to their target population; and when needed, use a similar methodology to construct a relevant, culturally and contextually sensitive measure.

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Waterpipe or "argileh" is a form of smoking other than cigarettes that is currently spreading among people of all ages. The objective of the present study was to assess tobacco smoking practices (waterpipe and/or cigarette) among public and private adolescent school students in Beirut, Lebanon. A sample of 2,443 students selected from 10 private and 3 public schools with intermediate/secondary classes filled out a self-administered anonymous questionnaire that inquired about sociodemographic characteristics, and behavior about tobacco smoking. Binary analysis was performed as well as three regression models for the relationship between exclusive cigarettes smoking, exclusive waterpipe smoking and both cigarettes and waterpipe as the dependent variables and gender, type of school, and class as the independent variables. The current prevalence of cigarettes smoking was 11.4%, and that of waterpipe smoking was 29.6%. Gender was significantly associated with cigarettes (OR=3.2, 95% CI 1.8-5.6) but not waterpipe smoking. Public school students were, respectively, 3.2 (95% CI 1.8-5.6) and 1.7 (95% CI 1.4-2.1) times more likely to be exclusive cigarettes smokers, and exclusive waterpipe smokers. Class was not significantly associated with exclusive cigarette smoking; however, students attending secondary classes were 1.3 (95% CI 1.1-1.6) times more likely to be exclusive waterpipe smokers. The reasons behind the high prevalence of both types of smoking are presented and discussed. The present study calls for school-based prevention programs and other types of interventions such as tax increases, and age-restrictions on tobacco sales. More aggressive interventions to disseminate education and awareness among parents and students altogether are warranted.

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OBJECTIVES: To determine the prevalence and predictors of smoking nargileh and/or cigarettes among school students in Greater Beirut, Lebanon. METHODS: A proportionate random sample of 2443 students from 13 public and private schools was selected and asked to complete self-administered anonymous questionnaires. RESULTS: The prevalence of smoking cigarettes only, nargileh only, and both was 2.5%, 25.6%, and 6.3%, respectively. Stepwise regression analyses revealed that the predictors of smoking for either type are different, whereby nargileh smoking is more culturally accepted than cigarette smoking. CONCLUSIONS: Design interventions to increase awareness towards the hazards of the misconceived harmless effects of nargileh smoking.

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