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Basma Damiri,1 Omar Khatib,2 Zaher Nazzal,3 Diala Sanduka,2 Siwar Igbaria,2 Ammar Thabaleh,2 Ahmad Farhoud,2 Lubna Saudi,3 Souad Belkebir,3 Rayyan Al Ali,4 Mohammed Alili,2 Mahmoud Hamdan,5 Omar A Safarini,2 Omar Younis2 1Medicine & Health Science Faculty, Drug, and Toxicology Division, An-Najah National University, Nablus, 00970, Palestine; 2Medicine & Health Science Faculty, Department of Medicine, An-Najah National University, Nablus, 00970, Palestine; 3Medicine & Health Science Faculty, Family and Community Medicine, An-Najah National University, Nablus, 00970, Palestine; 4Medicine & Health Sciences Faculty, Forensic Medicine Institute, An-Najah National University, Nablus, 00970, Palestine; 5Medicine & Health Science Faculty, Graduate School, Clinical Laboratory Science Program, An-Najah National University, Nablus, 00970, PalestineCorrespondence: Basma DamiriFaculty of Medicine and Health Sciences, Drug and Toxicology Division, An-Najah National University, P.O. Box 7, Nablus, 00970, PalestineTel +972592234270Email bdamiri@najah.eduIntroduction: Due to their stressful lives, Palestinian refugees are prone to use cognitive enhancers (CE) and psychostimulant substances (PS). Recognising health problems associated with CE/PS use can indicate how preventive programs should be directed towards adolescents. Unfortunately, research has not thoroughly investigated the health problems related to tobacco and caffeine products, the most socially acceptable CE/PS among Palestinian refugee adolescents.Methodology: In 2021, schoolchildren from five Palestinian refugee camps (N=271) aged 12-< 16 years agreed to give blood samples and to be interviewed to address the association between metabolic syndrome (MetS) and tobacco smoking, coffee, energy drinks (ED), black tea, and chocolate consumption. MetS was diagnosed based on International Diabetic Federation Criteria. To address the association, we used binary logistic regression models adjusted to age, gender, BMI, and central obesity.Results: The prevalence of MetS was [17 (6.3%)]; (7.4%) in males, (5.1%) in females. The prevalence of substance use was as follows: ED [163 (48.9%)], coffee [255 (76.6%)], black tea [295 (89.1%)], cigarette [35 (10.5%)], waterpipe [59 (17.7%)], and chocolate [309 (93.6%)], with male predominance. Cigarette smokers have increased central obesity (p-value=0.024), and decreased HDL-cholesterol (p-value=0.015) than non-smokers. Similar results were observed for waterpipe smokers besides the increased levels of triglycerides (p-value=0.01). ED consumers have increased central obesity (p-value=0.03) and fast blood sugar (p-value=0.003) than non-consumers. Chocolate consumers have decreased central obesity (p-value=0.008) and increased HDL levels (p-value=0.04) than non-consumers. ED consumers were significantly at higher risk of MetS (OR=9.97, p-value=0.019) than non-consumers and chocolate consumers were at lower risk of MetS (OR=0.14, p-value=0.046) than non-consumers. Waterpipe smokers were at a higher risk of having increased plasma triglycerides than non-consumers (OR=3.4, p-value=0.03).Conclusion: The high prevalence of ED consumption and waterpipe smoking in Palestinian refugee adolescents is problematic. Their use was associated with higher odds of MetS, dyslipidemia, and central obesity, which justifies greater attention.Keywords: refugee adolescents, metabolic syndrome, tobacco smoking, cognitive enhancers and psychostimulants, dyslipidemia, UNRWA

Basma Damiri,1 Omar A Safarini,2 Zaher Nazzal,2 Ahmad Abuhassan,3 Ahmad Farhoud,2 Nesma Ghanim,4 Rayyan Al Ali,5 Mirvat Suhail,2 Mohammad Qino,2 Mohammad Zamareh,2 Ammar Thabaleh,2 Jihad Zahran2 1Medicine & Health Sciences Faculty, Drug, and Toxicology Division, An-Najah National University, Nablus, 00970, Palestine; 2Medicine & Health Sciences Faculty, Department of Medicine, An-Najah National University, Nablus, 00970, Palestine; 3An-Najah National University Hospital, Department of Neurology, An-Najah National University, Nablus, 00970, Palestine; 4Medicine & Health Sciences Faculty, Department of Public Health, An-Najah National University, Nablus, 00970, Palestine; 5Medicine & Health Sciences Faculty, Forensic Medicine Institute, An-Najah National University, Nablus, 00970, PalestineCorrespondence: Basma DamiriFaculty of Medicine and Health Sciences, Drug and Toxicology Division, An-Najah National University, PO Box 7, Nablus, 00970, PalestineTel +972592234270Email bdamiri@najah.eduBackground: University students, who are at risk of eating disorders (ED), are more liable to use cognitive enhancers and psychostimulants to improve their cognitive functions and lose weight. ED in Palestinian male students is a neglected health issue. We aimed to investigate the prevalence and the association between ED and cognitive enhancers, and psychostimulants use among An-Najah National University students (ANNU).Methods: In a cross-sectional study conducted in 2020 at ANNU, 1047 students completed anonymous surveys for cognitive enhancers practice, the Eating Attitude Test-26 (EAT-26), Sick, Control, One, Fat and FOOD (SCOFF) screening tests.Results: The prevalence of ED among ANNU students was 21.2% based on EAT-26 (17.1% in males, 23.8% in females) and 31.5% based on SCOFF (24.0% in males, 36.3% in females). The binary logistic regression revealed that students at risk to have ED were water-pipe smokers (OR: 1.471, p-value 0.047), especially males, while students who were less likely to have ED were males (OR: 0.341, p-value< 0.001), coffee users (OR: 0.581, p-value 0.014) and chocolate users (OR: 0.530, p-value 0.041) than nonusers. Moreover, the risk of ED increased with increasing body mass index (p-value< 0.01). Clinical medical students showed the lowest prevalence (11.1%) compared to preclinical (22.5%), health sciences (23.7%), and non-medical students (20.9%) (p-value 0.059).Conclusion: Our findings highlight water-pipe smoking as a significant health problem in males with ED, which may require unique treatment and prevention strategies. Moreover, coffee and chocolate consumption were associated with decreased risk of ED, only among males. The gender-gap in ED prevalence was very narrow compared to international results. These results prompt the need to focus on both genders in future studies instead of females. They also suggest the urgent need to address ED among Palestinian university students by educating students about mental health, identifying high-risk students, and offering easily accessible psychological help.Keywords: cognitive enhancers, psychostimulants, eating disorders, tobacco smoking, water-pipe smoking