Tobacco Use Among Students Ages 13–15 Years—Baghdad, Iraq, 2008

April 03, 2009 / Vol. 58 / No. 12

MMWR Highlights

• Current/potential smoking:
  • Of students aged 13-15 years
    • 7.4% have ever smoked cigarettes
    • 12.9% have ever smoked shisha
    • 3.2% currently smoked cigarettes
    • 6.3% currently smoked shisha (also known as waterpipes, hookahs, hubble-bubbles, or narghiles)
    • there was no difference by gender in current cigarette or shisha smoking
  • Among never smokers in this age group
    • 13.0% were likely to initiate cigarette smoking in the next year
    • For boys and girls, potential initiation of cigarette smoking was four-fold higher than current cigarette smoking
• Cigarette smoking by gender:
  • Current cigarette smoking in Baghdad is similar to that of World Health Organization's (WHO) 21 member
  • states of the Eastern Mediterranean Region (EMR) (4.9%)
  • Current smoking among boys (3.3%) is lower than the EMR value (7.3%)
  • Current smoking among girls is similar in Baghdad and the EMR (2.7% and 2.0%, respectively)
• Shisha smoking by gender:
  • Boys were 97% more likely to have ever smoked shisha than to have ever smoked cigarettes (14.6% vs. 7.4%, respectively)
  • Girls were 51% more likely to have ever smoked shisha
  • Current use of shisha was two-fold greater than cigarette smoking for boys (6.7% vs. 3.3%) and girls (5.0% vs. 2.7%)
• Secondhand smoke exposure and public smoking:
  • 29.2% of students reported they were exposed to smoke in public places in the week preceding the survey
  • 39.3% reported their parents smoked cigarettes
  • 13.1% reported that their parents smoked shisha
  • 72.6% were in favor of banning smoking in public places
• Exposure to pro- and anti-tobacco messages:
  • 59.6% of students reported having seen an anti-cigarette media message in the past month
  • 67.9% had seen pro-cigarette advertising on billboards
  • 67.6% had seen pro-cigarette advertising at point of sale locations
  • 59.8% had seen pro-cigarette advertising in newspapers or magazines
  • 13.2% reported they had an object with a cigarette brand logo on it
  • 7.3% reported they had been offered free cigarettes by company representatives
  • 41.8% reported having been taught in school during the past year about the dangers of smoking
• Future challenges:
  • The use of shisha—the health effects of which have been shown to be far worse than cigarette smoking—is two-fold higher than cigarette smoking.
  • Current cigarette smoking for girls is twice as high as adult female cigarette smoking rates in Iraq, and likely initiation of cigarette smoking by girls who have never smoked cigarettes (11.8%) is four-fold higher than girls' current cigarette smoking rate (2.7%)—findings may indicate that girls' cigarette use is increasing in Iraq.

Background

As in most Middle East countries tobacco use in Iraq takes the form of cigarettes and shisha (also known as waterpipe, hookahs, hubble-bubble, or narghiles).

In 2008, the Iraqi Parliament ratified the World Health Organization Framework Convention on Tobacco Control (WHO FCTC), which requires governments to develop a comprehensive tobacco control program and establish monitoring, surveillance, and evaluation systems.

WHO has identified six policy areas that countries should include in their tobacco control programs to maximize effect:

• Raising taxes on tobacco
• Banning advertising promotion and sponsorship
• Reducing exposure to secondhand smoke
• Establishing tobacco cessation programs
• Informing the public regarding the dangers of tobacco
• Establishing surveillance programs aimed at monitoring tobacco use and policies

In 2008, the Iraqi Ministry of Health (MOF) developed a number of tobacco-control strategies, including the following:

• Banning smoking in MOH buildings
• Establishing tobacco free health institutes in Baghdad and other governorates
• Collaborating with WHO and the Al-Nahrain medical college in Baghdad to ban smoking in all medical college buildings
• Initiating the "Tobacco Free School Project" in 30 primary schools in Baghdad to raise teacher, student, and family awareness about the dangers of tobacco use
• Establishing a National Tobacco Control Committee to develop new legislation and regulations regarding tobacco control

The Global Youth Tobacco Survey (GYTS) is a school-based survey developed by WHO, CDC, and the Canadian Public Health Association that collects data about students aged 13–15 years using a standardized methodology for constructing the sample frame, selecting schools and classes, and processing data.