Correlates of smoking behaviour among Egyptian adolescents

Background. Tobacco use is on the rise in developing countries. One such country is Egypt, which has the highest rate of smoking in the developing Arab world (33.5% are daily smokers, of which 19.6% are under 15 years). Understanding the correlates of smoking behavior among Egyptian adolescents may aid researchers develop effective adolescent smoking prevention programs to help curb the rising smoking epidemic in Egypt. Methods. A school-based cross-sectional survey of 1,930 actively consenting Egyptian adolescents in 7th, 9th and 12th grades, from randomly selected public and private schools, in Alexandria, Egypt. Measures included demographics, smoking behavior, psychosocial, psychological and cultural factors, and exposure/receptivity to western and pro-tobacco media. Results. Overall prevalence of ever, 30-day, current smoking and susceptibility to smoking was 25%, 12%, 6% and 38% respectively, with males having significantly higher smoking rates than females. Adolescent smoking behavior was positively associated with family and peer smoking, perceived social smoking norms, and positive beliefs about smoking. Refusal self efficacy was protective against ever smoking and susceptibility to smoking, while knowledge of the short-term negative consequences of smoking was protective against susceptibility to smoking for females only. Familism/obedience to parents and religious relevance were protective against any smoking behavior, while social conformity and gender specific norms were smoking risk factors for males only. Impulsive behavior was positively associated with smoking behavior across genders, while hostility and sensation seeking were risk factors for ever-smoking and 30-day smoking for males only, but were risk factors for susceptibility to smoking across genders. Exposure and receptivity to pro-tobacco and western media increased the risk of adolescent smoking behavior. Positive beliefs about smoking partially mediated the association between western media and ever smoking and susceptibility to smoking, and completely mediated the relationship between western media and 30-day smoking. Conclusion. Results of this study provide important new information about the correlates of smoking behavior among Egyptian adolescents. Smoking prevention programs targeting Egyptian adolescents should be culturally tailored, gender specific and multicomponent, and should go hand in hand with adult smoking cessation interventions.