The report launched today by the three implementing partners, presents the first comprehensive data on tobacco consumption and control measures in Egypt. It will create an opportunity for policy-makers as well as the tobacco control community at different levels to translate data into action through improved policies and programmes in different areas of tobacco control.

The Global Adult Tobacco Survey (GATS) is a national household survey conducted in 2009 in all of Egypt’s governorates, covering both males and females, aged 15 years and older, in a total sample size of 23 760. The implementation of the survey and the production of its final report were a collaborative effort between the implementing partners: the Ministry of Health, Central Agency for Public Mobilization and Statistics and the World Health Organization.

The report summarizes the major findings of the survey. Results are presented in six chapters that address key survey findings, through topic areas covered by the survey questionnaire, which include: tobacco use, cessation, second-hand smoke, tobacco economics, media, and knowledge, attitudes and perceptions towards tobacco use.

Many previous studies have been published to monitor adult tobacco use but to-date, no single national report has existed containing such comprehensive evidence-based data on tobacco use and control measures in Egypt. This report paves the way for the implementation of evidence-based policies and measures guided by documented facts, a few examples of which are discussed below:

• Egyptian males are the main tobacco consumers; where 38% of Egyptian males use some form of tobacco products. This percentage increases to 46.1% and 48.9% among the most productive age groups 25–44 and 45–64 years, respectively. The most commonly used tobacco product among Egyptian males is cigarettes with a high average consumption rate of one pack per day.

• Exposure to second-hand smoke is high; where nearly 56.2% of shisha users smoke shisha at home, while only 35.9% smoke shisha in cafes. Smoking in public places in Egypt is prevailing where it is estimated that 80.0% of Egyptians are exposed to second-hand smoke in public transportation, more than 70.0% of them are exposed in restaurants, while about 49.0% are exposed to second-hand smoke in health care facilities.

• Emergence of new tobacco products in the Egyptian market; use of smokeless tobacco (chewed tobacco) was uncovered. This is the first time in a national survey that this form of tobacco use has been identified as a public health concern in Egypt. Usage of ‘chewed’ tobacco was shown to be as high as 5.0% among males and 0.3% among females.

• Implementation of an effective cessation programme at national level; which is one of the priority needs. The report showed that more than 41.0% of smokers have attempted to quit at some point. Of those, only 17.9% successfully managed to quit smoking.

The Egypt GATS Country Report is considered to be the official baseline record for the current national tobacco status and tobacco control measures in Egypt. It reflects to-date the status of the implementation and enforcement of: anti-tobacco legislation; articles and guidelines of the WHO Framework Convention on Tobacco Control; and the MPOWER Effective Strategies for Tobacco Control. The government is encouraged to undertake national tobacco control interventions based on findings revealed by the Egypt GATS.

The World Health Organization warns that women are being increasingly targeted by tobacco companies, especially in low-income and middle-income countries. Tobacco companies have a long history of targeting women and girls in their marketing campaigns. After aggressive promotional campaigns targeting women and girls, smoking among women in Japan jumped from 8.6% to 18.2% within a span of five years. The Global Youth Tobacco Survey shows that tobacco use among girls age 13–15 around the world is increasing and the gap between the rates of girls and boys is getting smaller. In some countries, as many girls now smoke as boys.

Tobacco use by women is a serious, growing problem throughout the world. Women comprise about 20% of the world’s more than 1 billion smokers and this figure is rising. Use of other forms of tobacco, such as shisha and smokeless tobacco, is also increasing among women in many countries, particularly in the Eastern Mediterranean Region. The WHO Framework Convention on Tobacco Control expresses alarm at “the increase in smoking and other forms of tobacco consumption by women and young girls worldwide”.

In the Eastern Mediterranean Region, rates of tobacco use among school girls are rising rapidly and have reached as high as 19.5% in the Islamic Republic of Iran, 22.4% in Somalia, 26.8% in the Syrian Arab Republic, 27.7% in the occupied Palestinian territory (West Bank) and 54.1% in Lebanon.

For adult women, smoking rates are high as 10% in Jordan, 7% in Lebanon and 6% in Tunisia and Yemen.

The Region has the second highest rate (9%) in the world of girls’ use of tobacco products other than cigarettes, including shisha and smokeless tobacco, with rates exceeding 30% in Lebanon and 20% in Jordan, Syrian Arab Republic, United Arab Emirates and occupied Palestinian territory (West Bank).

Tobacco use by women is becoming more socially acceptable in many countries as cultural norms change. Women also become more easily addicted to nicotine than men and find it harder to quit.

Tobacco use by mothers also increases the risk of health and behavioural problems in infants and children. Although the majority of smokers are men, many women and children are affected by their second-hand smoke. Worldwide, second-hand smoke causes an estimated 600 000 premature deaths a year, the majority (64%) among women.

How are women targeted?

As potential customers, women present a major marketing opportunity for the tobacco industry, especially in developing countries where rates of tobacco use among women are currently low. Tobacco marketing promotes the belief that smoking is fashionable and keeps women slim, and that tobacco use is a symbol of women’s emancipation and independence. Advertising even links smoking with being a modern liberated woman. They use images of vitality and sophistication, slimness and beauty. Misleading branding terms are used, such as “light”, “ultra-light” and “low tar”. Women are more likely to smoke these brands of cigarette than men in the mistaken belief that they are safer.

The Global Youth Tobacco Survey has found high levels of exposure in the Region to advertising on billboards and in newspapers and magazines. It also found that 15% of 13–15 year olds in the Region own an object with a tobacco company logo or other cigarette branding, while 9% have been offered free cigarettes.

Protection against second-hand smoke

“There is no safe level of exposure to second-hand smoke” remarks the World Health Organization. Women and children need to be protected from second-hand smoke exposure within the home, at school and in the workplace. However, women often do not have the power to negotiate smoke-free spaces, even within their own homes. Protection can be greatly furthered through smoking bans at national level that adhere to the WHO Framework Convention on Tobacco Control.