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• Tobacco Use Among Students Aged 13--15 Years --- Baghdad, Iraq, 2008 

In 2008, Iraq's parliament ratified the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) (1), which obligates participants to establish tobacco use monitoring, surveillance, and evaluation systems. Lack of data on adolescent tobacco use in Iraq led the Ministry of Health (MOH) to conduct the Global Youth Tobacco Survey (GYTS) in Baghdad in 2008. GYTS is a school-based survey of students aged 13--15 years that is self-administered in classes in selected schools. As in most Middle East countries, tobacco use in Iraq takes the form of cigarettes and shisha (Figure) (2). Based on GYTS results, 7.4% of students aged 13--15 years reported having ever smoked cigarettes, 12.9% had ever smoked shisha, 3.2% currently smoked cigarettes, and 6.3% currently smoked shisha. Among never smokers aged 13--15 years, 13.0% reported they were likely to initiate cigarette smoking in the next year. Future declines in adolescent tobacco use in Iraq (and Baghdad) could be enhanced by expanding existing tobacco control programs to include prevention and cessation of the use of cigarettes and shisha, implementing measures that discourage adolescents who have never smoked from initiating tobacco use, expanding legislation to ban exposure to secondhand smoke in all indoor workplaces, and enacting legislation banning pro-tobacco advertising and sponsorship. . . .

The results from the Baghdad GYTS point to a number of challenges facing MOH tobacco control efforts. First, the use of shisha is twice as prevalent as cigarette smoking. Smoking shisha originated in ancient Persia and India, and spread throughout the Middle East and Asia during the 15th century (5,6). In the 21st century, smoking shisha appears to be a new trend in tobacco use and has recently become a preferred form of tobacco smoking for young persons, specifically women, in the Arabian Peninsula (7). For Arab women, shisha smoking carries less of a cultural stigma than does cigarette smoking (5,6). This is a concern because the harmful health effects of shisha can exceed those of cigarette smoking (2). Some reports indicate that the concentration of nicotine is higher from shisha smoking than from cigarette smoking (5,6). Levels of arsenic, chromium, and lead also are higher in shisha smoking compared to single cigarette use. Additionally, because shisha sessions typically last 45--60 minutes, shisha smokers inhale higher concentrations of these toxic substances (5,6).

A second concern is that the current cigarette smoking rate for girls (2.7%) is twice that for adult female cigarette smokers in Iraq (8). In addition, the likely initiation of cigarette smoking by girls who have never smoked cigarettes (11.8%) is significantly higher than the current cigarette smoking rate for girls (2.7%). These findings might indicate that girls' cigarette use is increasing

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