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A cross sectional study was carried out in two rural secondary schools in Qualyobia governorate in the academic year 2002-2003 in order to assess the students' knowledge, attitudes and practice toward smoking. An anonymous self-administered questionnaire was used. A total of 635 students, 416 males and 219 females were interviewed. The response rate was 100%. The prevalence of ever tried cigarette was 29% (40% among males and 7% among females) with a median age of initiation at 11 years of age. The prevalence of current cigarette smoking among all students was 7.7 (11.5% among males and 0% among females). Waterpipe (Shisha) smoking was reported by 19% (26% among males and 5% among females) with median age of initiation at 12 yearsof age. The risk of smoking is higher among sons of highly educated mothers (OR=3.7, 95% CI=1-12), Boy only school students have almost half the risk of smoking than mixed school male students (OR=0.4, 95% CI=0.2-0.8). On studying the effect of having a smoker family member or friends on students smoking, having a smoker friend increases the risk of male students three time (OR=3, 95%CI=2-5) while others smoking was not statistically significant. More than 90% of the students (both males and females) thought that active and passive smoking are harmful. More females than males thought smoking is addictive (89% of the females and 81% of the males) while more males than females agreed that smokers have more friends (34% of males, 26% of the females) and that smoking makes boys look handsome (8% of males, 3% of females).

An interview survey was carried out in a rural village and two nearby schools in Qalyubia Governorate to assess the pattern of smoking and knowledge about religious ruling (Fatwa) and its impact on the quit attempts. Also, a similar survey was conducted in 6 Shisha cafés in Cairo. The results showed that the majority of respondents (81% among rural adults, 83.2% among Shisha café patrons, 73.3% among rural youth and 81.4% among rural students) knew about the Fatwa on smoking. Higher proportions of all participants thought that smoking is a sin (97.3% among rural adults, 80.8% among Shisha café patrons, 94.4% among rural youth and 98.4% among rural students). There was a significantly higher knowledge about Fatwa on smoking among men than women. This indicates a successful outreach program targeted mainly to men through mosques. Knowledge about Fatwa on smoking increased significantly with increased exposure to antismoking messages from religious leader. Knowledge about the Fatwa on smoking or belief that smoking is a sin had no significant effect on quit attempts. Our results point to the need for intensive efforts on the part of religious leaders to translate the current belief that smoking is a sin into quitting among smokers. Better results may be achieved through personal interactions in small groups rather than in mosque settings.

Nicotine dependence is a significant public health problem. This study describes the nicotine dependence status among male adults in rural communities in Egypt. A survey was carried out in five rural villages in Egypt to study the smoking prevalence. A total of 938 current smokers were identified and their nicotine dependence status was studied. About 9% of all smokers in the studied villages were found to have heavy dependence to nicotine. Heavy dependence was associated with younger age of smoking initiation (p0.05) and more smoking in the first hours of the day (p0.001). Heavy dependent smokers are less likely to quit smoking (p0.001), lack the confidence to quit by themselves (p0.001) and less likely to have tried to quit earlier (p0.001). Dependent smokers are more likely to smoke in the presence of their children (p0.001). Reasons for smoking included the habit of smoking helping them to keep them going when tired, to make them alert and not knowing what to do with their hands without a cigarette. The main reasons they identified for restarting smoking after quitting were the signs of withdrawal namely headaches, irritability and difficulty in concentration. Nicotine dependence status and attributes were comparable to studies reported in other countries around the world. Enhanced behavioral and medical intervention strategies are needed to motivate helping both low and heavy nicotine dependent smokers to increase the number and effectiveness of quit attempts.

Shisha café patrons in Cairo, Egypt were interviewed to assess their knowledge, attitudes and practices regarding smoking and health. The median age of initiation of Shisha smoking is 20 years. Shisha smokers know about the hazards of smoking and believe that Shisha smoking is less dangerous than cigarette smoking. Over half the Shisha smokers have tried to quit in the past year. The younger adults who smoke Shisha also tend to smoke more often with friends, smoke cigarettes in addition to Shisha and prefer fruit flavored tobacco as compared to tobacco mixed with molasses favored by Shisha smokers who are older. Heavy Shisha smoking was not related to age.