Research Projects

  • Adverse childhood experiences, chronic diseases, and risky health behaviors in Saudi Arabian adults Project

  • First Phase

Adverse childhood experiences, chronic diseases, and risky health behaviors in Saudi Arabian adults: a pilot study.

 November 2014

Adverse childhood experiences (ACEs) have been linked with risky health behaviors and the development of chronic diseases in adulthood. This study examined associations between ACEs, chronic diseases, and risky behaviors in adults living in Riyadh, Saudi Arabia in 2012 using the ACE International Questionnaire (ACE-IQ). A cross-sectional design was used, and adults who were at least 18 years of age were eligible to participate. ACEs event scores were measured for neglect, household dysfunction, abuse (physical, sexual, and emotional), and peer and community violence. The ACE-IQ was supplemented with questions on risky health behaviors, chronic diseases, and mood. A total of 931 subjects completed the questionnaire (a completion rate of 88%); 57% of the sample was female, 90% was younger than 45 years, 86% had at least a college education, 80% were Saudi nationals, and 58% were married. One-third of the participants (32%) had been exposed to 4 or more ACEs, and 10%, 17%, and 23% had been exposed to 3, 2, or 1 ACEs respectively. Only 18% did not have an ACE. The prevalence of risky health behaviors ranged between 4% and 22%. The prevalence of self-reported chronic diseases ranged between 6% and 17%. Being exposed to 4 or more ACEs increased the risk of having chronic diseases by 2–11 fold, and increased risky health behaviors by 8–21 fold. The findings of this study will contribute to the planning and development of programs to prevent child maltreatment and to alleviate the burden of chronic diseases in adults.

  • Second Phase

Adverse childhood experiences and association with health, mental health, and risky behavior in the kingdom of Saudi Arabia.

October 2016


The aim of this study is to determine if ACEs impact the health and risk behavior burden among Kingdom of Saudi Arabia (KSA) adults. Methods: In 2013, a cross-sectional study was conducted across KSA to identify the retrospective prevalence of ACEs and their association with high risk behaviors and chronic diseases. Surveys from 10,156 adults in all 13 Saudi regions were obtained using an Arabic version of the WHO ACE-IQ (KSA ACE-IQ).


Compared to respondents reporting no ACEs, even just one ACE contributed significantly to the odds of experiencing diabetes mellitus (OR = 1.3), depression (OR = 1.32), or anxiety (OR = 1.79) outcomes. Two ACEs were necessary for statistically significant, higher odds to emerge for hypertension (OR = 1.46), mental illness (OR = 1.93), smoking (OR = 1.17), alcohol use (OR = 1.75), and drug use (OR = 1.45). Respondents who reported four or more ACEs had greater odds of coronary heart disease (OR = 1.94), and obesity (OR = 2.25). Compared to those reporting no ACEs, respondents reporting four or more ACEs had over four times the odds of Alcohol or Drug Use, Mental Illness, Depression, and/or Anxiety outcomes and more than twice the odds of diabetes, hypertension, obesity, and/or smoking outcomes.


Findings from this analysis underscore the potential benefit of providing focused preventative approaches to mitigating ACEs in KSA in relation to both the specific and cumulative burden of health and risky behavior outcomes.

  • Multidimensional model to assess the readiness of Saudi Arabia to implement evidence based child maltreatment prevention programs Project

  • First Phase

Multidimensional model to assess the readiness of Saudi Arabia to implement evidence based child maltreatment prevention programs at a large scale.


Scientific papers


There has been increased awareness of child maltreatment in Saudi Arabia recently. This study assessed the readiness for implementing large-scale evidence-based child maltreatment prevention programs in Saudi Arabia. Key informants, who were key decision makers and senior managers in the field of child maltreatment, were invited to participate in the study. A multidimensional tool, developed by WHO and collaborators from several middle and low income countries, was used to assess 10 dimensions of readiness. A group of experts also gave an objective assessment of the 10 dimensions and key informants' and experts' scores were compared. On a scale of 100, the key informants gave a readiness score of 43% for Saudi Arabia to implement large-scale, evidence-based CM prevention programs, and experts gave an overall readiness score of 40%. Both the key informants and experts agreed that 4 of the dimensions (attitudes toward child maltreatment prevention, institutional links and resources, material resources, and human and technical resources) had low readiness scores (<5) each and three dimensions (knowledge of child maltreatment prevention, scientific data on child maltreatment prevention, and will to address child maltreatment problem) had high readiness scores (≥5) each. There was significant disagreement between key informants and experts on the remaining 3 dimensions. Overall, Saudi Arabia has a moderate/fair readiness to implement large-scale child maltreatment prevention programs. Capacity building; strengthening of material resources; and improving institutional links, collaborations, and attitudes toward the child maltreatment problem are required to improve the country's readiness to implement such programs.

  • Second Phase

GCC child maltreatment prevention Readiness

Project Status: Under Study


Aim of the study: To assess child maltreatment (CM) prevention readiness for implementation of large-scale evidence-based programs in GCC (Bahrain, Kuwait, Oman, Qatar, KSA and UAE).


Ø  To explore the perception and the level of awareness of CM in GCC.

Ø  To assess the level of readiness to implement large-scale, evidence-based programs to prevent CM in GCC.

Ø  To identify specific measures to increase readiness of CM prevention.

Ø  To identify potential ideas for the development of regional capacity and policy addressing CM prevention.

Ø  To compare the level of awareness in KSA particularly since the last time this study  was conducted 5 years ago in view of changes in knowledge and scientific data on  CM prevention; legislation, mandates, and policies; and institutional links and resources. 

Ø  To raise the level of awareness of CM among the study population and engage them in the future efforts to prevent CAN the GCC.

Ø  To help create a structure and a system of services delivery to prevent CM by implementing large-scale, community-based, evidence-based programs all over GCC.

Research Outcome

The study will inform professionals and decision-makers, influence national policies towards CM prevention, and shift the programs focus toward prevention rather than protection.

  • Determining child maltreatment incidence in Saudi Arabia using the ICAST-CH Project

  • First Phase

Determining child maltreatment incidence in Saudi Arabia using the ICAST-CH: a pilot study.

April 2015

Studies in other countries, including countries with mandated reporting by professionals and a long history of recognition of the problem, have found child abuse to be seriously under reported. This population-based pilot study was conducted to determine the magnitude of adolescents' exposure to CAN at home, and to identify ethical and methodological challenges to conducting a survey on a culturally sensitive subject. This cross-sectional study was carried out in Al-Kharj city in 2011-2012. Through a stratified multistage cluster random sampling of schools, a sample of adolescents (15-18 years) were identified and invited to participate. The ISPCAN Child Abuse Screening Tool-Child: Home version (ICAST-CH) was used for data collection. The previous year's incidence of physical, psychological, and sexual abuse, neglect, and exposure to violence were assessed. A total of 2,043 students participated in the study (mean age, 16.6 years; 58%, female). The incidence of psychological abuse, physical abuse, exposure to violence, neglect, and sexual abuse were 74.9%, 57.5%, 50.7%, 50.2%, and 14.0%, respectively. Female participants were at higher risk for psychological and physical abuse, exposure to violence, and neglect, but not for sexual abuse. The rates and gender distribution of CAN at home differ from findings of health-based records. Our results are comparable to other regional population-based studies. Thus, population-based data are necessary to inform and guide professionals and decision makers for prevention policies and resource allocation. Insights to ethical and methodological challenges surrounding the sensitive nature of this type of study are discussed.

  • Second Phase

Determining prevalence of maltreatment among children in the kingdom of Saudi Arabia.

15 February 2016


The aim of this study is to find out the overall prevalence rates for the major forms of abuse among adolescents in the Kingdom of Saudi Arabia and the differences in prevalence by age, gender and living arrangement.


The cross-sectional study was conducted in secondary high schools in five of the 13 main regions of Kingdom of Saudi Arabia during 2012. Through a multistage stratified sampling technique, a sample (n = 16 939) of adolescents (15-19 years) were identified and invited to participate. The ISPCAN Child Abuse Screening Tool - Child was used for data collection. The previous year's occurrence of violence exposure, psychological, physical and sexual abuse, and neglect were assessed.


Nearly 90% of the adolescents were between 16 and 18 years of age, and over 80% were cared for by both of their biological parents. Annual prevalence of various forms of abuse in the year before the 2012 assessment ranged between 0.10 and 0.65, with the lowest rate for sexual abuse and the highest for psychological abuse. Significantly, greater rates of all forms of abuse/exposure were found when participants lived with their mother or father only (versus with both), and even greater rates for all when they lived with their biological parent and a step-parent. Rates for violence exposure, psychological abuse and neglect were significantly greater for girls, and rate of sexual abuse was greater for boys.


More attention should be given to the effect of adolescent maltreatment particularly among girls. In addition, sexual abuse prevention programme should be targeted among boys.