Current Addiction Reports

, Volume 5, Issue 1, pp 54–64 | Cite as

Linking Global Youth Tobacco Survey Data to the WHO Framework Convention on Tobacco Control: the Case for Egypt

  • Omar El-Shahawy
  • Nicole E. Nicksic
  • Carolina Ramôa
  • Mohammed Jawad
  • Raymond Niaura
  • David Abrams
  • Scott E. Sherman
Tobacco (S Sussman and R Garcia, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Tobacco



Limited publications from Egypt have focused on prevalence of tobacco use and tobacco control policy. We used four waves of the Egypt Global Youth Tobacco Survey (GYTS) between 2001 and 2014 and a cigarette affordability measure, to evaluate the implementation of the World Health Organization’s MPOWER recommendations.


Despite Egypt’s implementation of several MPOWER recommendations, the enforcement of laws and regulations may be limited, and therefore had little to no impact on youth current smoking prevalence through 2014. Notably, experimentation with cigarette smoking has significantly increased between waves 2001 and 2014.


There is a missed opportunity for implementing evidence-based interventions for youth tobacco control in Egypt. There is a strong need for initiatives aiming at meaningful taxation, enforcement of smoking bans in public places, promoting smoke-free homes, appropriate mass media counter-advertising, and effective cessation activities.


Global Youth Tobacco Survey Youth MPOWER Smoking Tobacco control Egypt 



It was also supported by Partnerships for Enhanced Engagement in Research (PEER) under cooperative agreement number AID-OAA-A-11-00012. NN effort was supported by the National Institute on Drug Abuse of the National Institutes of Health under Award Number P50DA036105 and the Center for Tobacco Products of the U.S. Food and Drug Administration. Research reported in this publication was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under Award Number P50HL120163. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. SS is supported in part by the National Institute on Drug Abuse (1K24DA038345-01), NYU CTSA Grant (UL1TR000038) from the National Center for Advancing Translational Sciences and the NYU Abu Dhabi Public Health Research Center; OS is supported in part by the NYU Abu Dhabi Public Health Research Center.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    US Department of Health Human Services. The health consequences of smoking—50 years of progress: a report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2014. p. 17.Google Scholar
  2. 2.
    Chung T, Lam T, Cheng Y. Knowledge and attitudes about smoking in medical students before and after a tobacco seminar. Med Educ. 1996;30(4):290–5. Scholar
  3. 3.
    World Health Organization. Why is tobacco a public health priority? 2007. Accessed 12 Jul 2007.
  4. 4.
    Islam SMS, Johnson CA. Western media’s influence on Egyptian adolescents’ smoking behavior: the mediating role of positive beliefs about smoking. Nicotine Tob Res. 2007;9(1):57–64. Scholar
  5. 5.
    Framework Convention on Tobacco Control, editor. WHO framework on tobacco control, reprint 20052003. Geneva: WHO Document Production Services.Google Scholar
  6. 6.
    Framework Convention on Tobacco Control. Country data: Egypt. 2007. Accessed 20 Jul 2007.
  7. 7.
    Song Y, Zhao L, Palipudi KM, Asma S, Morton J, Talley B, et al. Tracking MPOWER in 14 countries: results from the Global Adult Tobacco Survey, 2008–2010. Glob Health Promot. 2016;23(2_suppl):24–37. Scholar
  8. 8.
    World Health Organization. WHO report on the global tobacco epidemic, 2008: the MPOWER package. 2008.Google Scholar
  9. 9.
    Dous NM. Report on the result of the global youth tobacco survey in Egypt. Centers for Disease Control and Prevention. 2003. Accessed 12 Jul 2007.
  10. 10.
    Nassar H. The economics of tobacco in Egypt: a new analysis of demind. 2003. Accessed 20 Aug 2007.
  11. 11.
    Ministry of Health and Population. Webpage: tobacco control program. 2007. Accessed 12 Jul 2007.
  12. 12.
    Islam SMS, Johnson CA. Influence of known psychosocial smoking risk factors on Egyptian adolescents’ cigarette smoking behavior. Health Promot Int. 2005;20(2):135–45. Scholar
  13. 13.
    Mohamed MK, Loffredo CA, Israel E, El-Setouhy M, Radwa G, Andel-Rahman R, et al. Monograph. Tobacco use in shisha: studies on water pipe smoking in Egypt. Harmony: WHO, Cairo; 2006.Google Scholar
  14. 14.
    Youssef H. The Egyptian experience with tobacco earmarking. In: Tobacco free initiative. 2003. Accessed 20 Aug 2007.
  15. 15.
    Egyptian Smoking Prevention Research Institute. Five pillars are needed for an effective smoking prevention program in rural Egypt. 2006.Google Scholar
  16. 16.
    U.S. Centers for Disease Control and Prevention. Fact sheet: global youth tobacco surveys (GYTS) Egypt. 2005. Accessed 12 Jul 2017.
  17. 17.
    U.S. Centers for Disease Control and Prevention. Fact sheet: global youth tobacco surveys (GYTS) Egypt. 2014. Accessed 10 Aug 2017.
  18. 18.
    U.S. Centers for Disease Control and Prevention. Fact sheet: global youth tobacco surveys (GYTS) Egypt. 2001. Accessed 30 Sept 2017.
  19. 19.
    U.S. Centers for Disease Control and Prevention. Fact sheet: global youth tobacco surveys (GYTS) Egypt. 2009. Accessed 30 Sept 2017.
  20. 20.
    U.S. Centers for Disease Control and Prevention. Exposure to secondhand smoke among students aged 13–15 years—worldwide, 2000–2007. MMWR Morb Mortal Wkly Rep 2007;56(20):497.Google Scholar
  21. 21.
    Global Tobacco Surveillance System (GTSS), Global Adult Tobacco Survey (GATS): indicator guidelines: definition and syntax. 2009. Accessed 30 Oct 2017.
  22. 22.
    World Bank. GDP per capita (current US$); World Bank national accounts data, and OECD National Accounts data files. 2017. Accessed 30 Oct 2017.
  23. 23.
    Campaign for tobacco free kids. Tobacco control laws: country details for Egypt. 2017.
  24. 24.
    El-Zanaty F, Way AA. Egypt demographic and health survey 2000. 2001.Google Scholar
  25. 25.
    Kostova D, Chaloupka FJ, Shang C. A duration analysis of the role of cigarette prices on smoking initiation and cessation in developing countries. Eur J Health Econ. 2015;16(3):279–88. Scholar
  26. 26.
    Stone E, Peters M. Young low and middle-income country (LMIC) smokers—implications for global tobacco control. Transl Lung Cancer Res. 2017;6(S1):S44–6. Scholar
  27. 27.
    Li DX, Guindon GE. Income, income inequality and youth smoking in low-and middle-income countries. Addiction. 2013;108(4):799–808. Scholar
  28. 28.
    Loffredo CA, Radwan GN, Eltahlawy EM, El-Setouhy M, Magder L, Hussein MH. Estimates of the prevalence of tobacco smoking in Egypt. Open Journal of Epidemiology. 2015;5(02):129–35. Scholar
  29. 29.
    • Arrazola RA. Current tobacco smoking and desire to quit smoking among students aged 13–15 years—global youth tobacco survey, 61 countries, 2012–2015. MMWR Morb Mortal Wkly Rep. 2017;66. This study demonstrates that more than 50% of youth have a desire to quit in 40 low- and middle-income countries, with proportion as high as 90% in the Philippines. With high smoking rates among youth in these countries, implementing effective youth cessation interventions is a considerable challenge. Google Scholar
  30. 30.
    Robinson JN, Wang B, Jackson KJ, Donaldson EA, Ryant CA. Characteristics of Hookah tobacco smoking sessions and correlates of use frequency among US adults: findings from wave 1 of the Population Assessment of Tobacco and Health (PATH) study. Nicotine Tob Res. 2017;
  31. 31.
    Martinasek MP, Haddad LG, Wheldon CW, Barnett TE. Beliefs and attitudes associated with hookah smoking among a United States college population. Respir Care. 2017;62(3):370–9. Scholar
  32. 32.
    Akl EA, Irani J, Jawad M, Obeid R, Lam WY. Motives, beliefs and attitudes towards waterpipe tobacco smoking: a systematic review. Harm Reduction J. 2013;10(1):12. Scholar
  33. 33.
    Kowitt SD, Patel T, Ranney LM, Huang L-L, Sutfin EL, Goldstein AO. Poly-tobacco use among high school students. Int J Environ Res Public Health. 2015;12(11):14477–89. Scholar
  34. 34.
    Lee YO, Hebert CJ, Nonnemaker JM, Kim AE. Youth tobacco product use in the United States. Pediatrics. 2015;135(3):409–15. Scholar
  35. 35.
    Agaku IT, Filippidis FT, Vardavas CI, Odukoya OO, Awopegba AJ, Ayo-Yusuf OA, et al. Poly-tobacco use among adults in 44 countries during 2008–2012: evidence for an integrative and comprehensive approach in tobacco control. Drug Alcohol Depend. 2014;139:60–70. Scholar
  36. 36.
    •• Jawad M, Lee JT, Millett C. Waterpipe tobacco smoking prevalence and correlates in 25 Eastern Mediterranean and Eastern European countries: cross-sectional analysis of the Global Youth Tobacco Survey. Nicotine Tob Res. 2015;18(4):395–402. This study demonstrated that waterpipe is becoming alarmingly high across many Eastern Mediterranean and Eastern European countries. Additionally, dual smoking of cigarette and waterpipe is becoming prevalent, which requires ongoing monitoring of waterpipe as well as designing interventions that are appropriate for youth waterpipe cessation. Scholar
  37. 37.
    • Cavazos-Rehg PA, Krauss MJ, Spitznagel EL, Grucza RA, Bierut LJ. Youth tobacco use type and associations with substance use disorders. Addiction. 2014;109(8):1371–80. This study examined the associations between youth poly-tobacco use and substance use disorders. It found that tobacco use in adolescence was associated with higher rates of substance use disorders (including alcohol, marijuana and other drug use) across all tobacco users, especially among those who use cigarettes plus other tobacco products. Scholar
  38. 38.
    Zaytoun S, Afifi R, Alsenbesy M, Ayoub H. Patterns and distribution of drug dependence and associated risk factors among male youth in upper Egypt. Eur J Sci Res. 2015;131(2):2015.Google Scholar
  39. 39.
    Ali M, Gray TR, Martinez DJ, Curry LE, Horn KA. Risk profiles of youth single, dual, and poly tobacco users. Nicotine Tob Res. 2016;18(7):1614–21. Scholar
  40. 40.
    Abo-Elkheir OI, Sobh E. Knowledge about electronic cigarettes and its perception: a community survey, Egypt. Respir Res. 2016;17(1):58. Scholar
  41. 41.
    •• Weitzman M, Yusufali AH, Bali F, Vilcassim MR, Gandhi S, Peltier R et al. Effects of hookah smoking on indoor air quality in homes. Tob Control. 2016:tobaccocontrol-2016-053165. This study was the first to measure air quality in homes where hookah is smoked. It demonstrated that the air quality at homes remain substantially low for prolonged periods of time after a hookah session and is much more hazardous than the air quality at homes where cigarettes are smoked. Google Scholar
  42. 42.
    Gholamreza Heydari M, Shadmehr MB, Fadaizadeh L. The second study on WHO MPOWER tobacco control scores in Eastern Mediterranean countries based on the 2013 report: improvements over two years. Arch Iran Med. 2014;17(9):621.PubMedGoogle Scholar
  43. 43.
    Heydari G, EbnAhmady A, Lando HA, Chamyani F, Masjedi M, Shadmehr MB, et al. Third study on WHO MPOWER tobacco control scores in Eastern Mediterranean countries 2011–2015. East Mediterr Health J. 2017;23(9):598–603. Scholar
  44. 44.
    Heydari G, Talischi F, Algouhmani H, Lando HA, Ebn Ahmady A. WHO MPOWER tobacco control scores in the Eastern Mediterranean countries based on the 2011 report. 2013.Google Scholar
  45. 45.
    •• Nazar GP, Lee JT, Glantz SA, Arora M, Pearce N, Millett C. Association between being employed in a smoke-free workplace and living in a smoke-free home: evidence from 15 low and middle income countries. Prev Med. 2014;59:47–53. This study replicates the evidence from western countries that working in smoke-free environment in developing countries is associated with establishing smoker-free homes, which is associated with less SHS exposure and smoking initiation among youth. Scholar
  46. 46.
    Wakefield MA, Loken B, Hornik RC. Use of mass media campaigns to change health behaviour. Lancet. 2010;376(9748):1261–71. Scholar
  47. 47.
    Depue JB, Southwell BG, Betzner AE, Walsh BM. Encoded exposure to tobacco use in social media predicts subsequent smoking behavior. Am J Health Promot. 2015;29(4):259–61. Scholar
  48. 48.
    Allen JA, Duke JC, Davis KC, Kim AE, Nonnemaker JM, Farrelly MC. Using mass media campaigns to reduce youth tobacco use: a review. Am J Health Promot. 2015;30(2):e71–82. Scholar
  49. 49.
    Koh HK, Alpert HR, Judge CM, Caughey RW, Elqura LJ, Connolly GN et al. Understanding worldwide youth attitudes towards smoke-free policies: an analysis of the Global Youth Tobacco Survey. Tobacco control. 2011:tc. 2010.038885.Google Scholar
  50. 50.
    Sussman S, Unger J, Rohrbach LA, Johnson CA. School-based smoking prevention research. J Adolesc Health : Off Publ Soc Adolesc Med. 2005;37(1):4; author reply 6-8–4; author reply 8. Scholar
  51. 51.
    Thomas R, Perera R. School-based programmes for preventing smoking. Cochrane Database Syst Rev (Online). 2006;3(Journal Article):CD001293. Scholar
  52. 52.
    Thomas RE, McLellan J, Perera R. School-based programmes for preventing smoking. Evidence-Based Child Health: A Cochrane Review Journal. 2013;8(5):1616–2040. Scholar
  53. 53.
    Peebles K, Hall MG, Pepper JK, Byron MJ, Noar SM, Brewer NT. Adolescents’ responses to pictorial warnings on their parents’ cigarette packs. J Adolesc Health. 2016;59(6):635–41. Scholar
  54. 54.
    •• Nakkash R, Khalil J. Health warning labelling practices on narghile (shisha, hookah) waterpipe tobacco products and related accessories. Tob Control. 2010;19(3):235–9. This study is one of the first studies to evaluate the effectiveness of waterpipe warnings and advocate for adding these warning labels on waterpipe apparatus itself, rather than having earnings only on the packaging where waterpipe café patrons will not be exposed. Scholar
  55. 55.
    Islam F, Salloum RG, Nakkash R, Maziak W, Thrasher JF. Effectiveness of health warnings for waterpipe tobacco smoking among college students. Int J Public Health. 2016;61(6):709–15. Scholar
  56. 56.
    Jawad M, Bakir A, Ali M, Grant A. Impact of waterpipe tobacco pack health warnings on waterpipe smoking attitudes: a qualitative analysis among regular users in London. Biomed Res Int. 2015;2015:1–6. Scholar
  57. 57.
    Jawad M, Darzi A, Lotfi T, Nakkash R, Hawkins B, Akl EA. Waterpipe product packaging and labelling at the 3rd international Hookah Fair; does it comply with Article 11 of the framework convention on tobacco control? J Public Health Policy. 2017;38(3):303–13. Scholar
  58. 58.
    International Agency for Research on Cancer. Methods for evaluating tobacco control policies. World Health Organization; 2008.Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Omar El-Shahawy
    • 1
    • 2
    • 3
    • 4
    • 5
  • Nicole E. Nicksic
    • 6
    • 7
  • Carolina Ramôa
    • 2
  • Mohammed Jawad
    • 8
  • Raymond Niaura
    • 3
  • David Abrams
    • 3
  • Scott E. Sherman
    • 1
    • 2
    • 3
  1. 1.Department of Population HealthNew York University School of MedicineNew YorkUSA
  2. 2.Public Health Research CenterNew York University Abu DhabiAbu DhabiUnited Arab Emirates
  3. 3.College of Global Public HealthNew York UniversityNew YorkUSA
  4. 4.AHA Tobacco Regulation and Addiction CenterAmerican Heart AssociationDallasUSA
  5. 5.Faculty of MedicineAin Shams UniversityCairoEgypt
  6. 6.Department of Health Behavior and PolicyVirginia Commonwealth UniversityRichmondUSA
  7. 7.Center for the Study of Tobacco Products, Department of PsychologyVirginia Commonwealth UniversityRichmondUSA
  8. 8.Public Health Policy Evaluation Unit, School of Public HealthImperial College LondonLondonUK

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