Youth knowledge and attitudes towards cigarette and waterpipe use in nine Eastern Mediterranean countries

Introduction
The Eastern Mediterranean Region (EMRO) is one of only two WHO regions in which prevalence of tobacco use is projected to increase by 2025. Evidence shows initiation occurs at an early age, so understanding factors that influence youth tobacco initiation is a high priority.

Material and methods
This study uses Global Youth Tobacco Survey (GYTS) data from Egypt (2009), Jordan (2009), Kuwait (2009), Lebanon (2010), Morocco (2011), Oman (2010), Saudi Arabia (2010), Tunisia (2010) and Turkey (2012). GYTS is a nationally representative survey of 13-15-year-olds using a standardized protocol. Current cigarette smoking status is defined as having smoked at least once in the last 30 days preceding the survey. Current waterpipe smoking status is defined as use of at least one waterpipe rock in the last 30 days preceding the survey.

Results
Of the total sample population, 10.8% were current cigarette smokers, 10.2% were current waterpipe smokers, 23.8% had tried or experimented with cigarettes, and 26.6% had tried or experimented with waterpipe. Male gender and parental smoking were strong predictors of experimentation with both cigarettes and waterpipe when controlling for other variables. In addition, those who believed that waterpipe smoke was not harmful were more likely to experiment with all forms of tobacco. Apart from Lebanon, over 30% of smokers in each country stated that waterpipe smoking is “not harmful to health”.

Conclusions
Low perceptions of harm from waterpipe smoking may be an important contributor to youth tobacco use in the EMRO region. Better understanding of attitudes, knowledge and risk behaviors around youth waterpipe smoking can inform effective interventions in these countries.