Linking Global Youth Tobacco Survey Data to the WHO Framework Convention on Tobacco Control: the Case for Egypt
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.
KeywordsGlobal 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.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.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. https://doi.org/10.1111/j.1365-2923.1996.tb00831.x.CrossRefPubMedGoogle Scholar
- 3.World Health Organization. Why is tobacco a public health priority? 2007. http://www.who.int/tobacco/health_priority/en/index.html. Accessed 12 Jul 2007.
- 5.Framework Convention on Tobacco Control, editor. WHO framework on tobacco control, reprint 20052003. Geneva: WHO Document Production Services.Google Scholar
- 6.Framework Convention on Tobacco Control. Country data: Egypt. 2007. http://www.fctc.org/index.php?item=countryinfo&code=EGY. Accessed 20 Jul 2007.
- 8.World Health Organization. WHO report on the global tobacco epidemic, 2008: the MPOWER package. 2008.Google Scholar
- 9.Dous NM. Report on the result of the global youth tobacco survey in Egypt. Centers for Disease Control and Prevention. 2003. http://www.cdc.gov/tobacco/global/GYTS/reports/emro/2001/00_pdfs/egypt_intro.pdf. Accessed 12 Jul 2007.
- 10.Nassar H. The economics of tobacco in Egypt: a new analysis of demind. 2003. http://www.mohp.gov.eg/Sec/Services/SmComp1.asp?x=11. Accessed 20 Aug 2007.
- 11.Ministry of Health and Population. Webpage: tobacco control program. 2007. http://www.mohp.gov.eg/Sec/Services/SmComp1.asp?x=11. Accessed 12 Jul 2007.
- 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.Youssef H. The Egyptian experience with tobacco earmarking. In: Tobacco free initiative. 2003. http://www.who.int/tobacco/training/success_stories/TfiR3hrEG.pdf Accessed 20 Aug 2007.
- 15.Egyptian Smoking Prevention Research Institute. Five pillars are needed for an effective smoking prevention program in rural Egypt. 2006.Google Scholar
- 16.U.S. Centers for Disease Control and Prevention. Fact sheet: global youth tobacco surveys (GYTS) Egypt. 2005. https://nccd.cdc.gov/GTSSDataSurveyResources/Ancillary/DownloadAttachment.aspx?ID=216. Accessed 12 Jul 2017.
- 17.U.S. Centers for Disease Control and Prevention. Fact sheet: global youth tobacco surveys (GYTS) Egypt. 2014. https://nccd.cdc.gov/GTSSDataSurveyResources/Ancillary/DownloadAttachment.aspx?ID=1311. Accessed 10 Aug 2017.
- 18.U.S. Centers for Disease Control and Prevention. Fact sheet: global youth tobacco surveys (GYTS) Egypt. 2001. https://nccd.cdc.gov/GTSSDataSurveyResources/Ancillary/DownloadAttachment.aspx?ID=215. Accessed 30 Sept 2017.
- 19.U.S. Centers for Disease Control and Prevention. Fact sheet: global youth tobacco surveys (GYTS) Egypt. 2009. https://nccd.cdc.gov/GTSSDataSurveyResources/Ancillary/DownloadAttachment.aspx?ID=1135. Accessed 30 Sept 2017.
- 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.Global Tobacco Surveillance System (GTSS), Global Adult Tobacco Survey (GATS): indicator guidelines: definition and syntax. 2009. http://www.who.int/tobacco/surveillance/en_tfi_gats_indicator_guidelines.pdf. Accessed 30 Oct 2017.
- 22.World Bank. GDP per capita (current US$); World Bank national accounts data, and OECD National Accounts data files. 2017. https://data.worldbank.org/indicator/NY.GDP.PCAP.CD?locations=EG. Accessed 30 Oct 2017.
- 23.Campaign for tobacco free kids. Tobacco control laws: country details for Egypt. 2017. https://www.tobaccocontrollaws.org/legislation/country/egypt/summary.
- 24.El-Zanaty F, Way AA. Egypt demographic and health survey 2000. 2001.Google Scholar
- 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.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; https://doi.org/10.1093/ntr/ntx060.
- 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. https://doi.org/10.1016/j.drugalcdep.2014.03.003.CrossRefPubMedGoogle Scholar
- 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. https://doi.org/10.1093/ntr/ntv101.CrossRefPubMedGoogle Scholar
- 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. https://doi.org/10.1111/add.12567.CrossRefPubMedPubMedCentralGoogle Scholar
- 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
- 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
- 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.•• 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. https://doi.org/10.1016/j.ypmed.2013.11.017.CrossRefPubMedPubMedCentralGoogle Scholar
- 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
- 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. https://doi.org/10.1136/tc.2009.031773.CrossRefPubMedPubMedCentralGoogle Scholar
- 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. https://doi.org/10.1057/s41271-017-0078-8.CrossRefPubMedGoogle Scholar
- 58.International Agency for Research on Cancer. Methods for evaluating tobacco control policies. World Health Organization; 2008.Google Scholar