Editor,—As cigarette consumption in the US has fallen, and tobacco companies have come under criticism for allegedly targeting youth in their advertising, many companies have focused more on overseas markets to maintain their profits. Egypt, with the highest tobacco consumption in the Arab world, appears to be a lucrative market for cigarette manufacturers. While adult cigarette consumption is declining or stagnant in the US, it is growing in Egypt at a rate of 4–5% a year.1 In the US smoking typically starts during adolescence: 89% of daily smokers tried their first cigarette on or before age 18 years, and 71% of those who have ever smoked daily have also initiated smoking by 18.2 This trend appears to hold true in Egypt as well: the modal age for onset of smoking is 14–15 years old.3 The purpose of our survey was to examine the level of tobacco education in Egyptian schools and to determine whether exposure to the health risks of tobacco is related to smoking prevalence.

Mr Mohamed Helml Abd Raboh, an inspector general in the Egyptian Ministry of Education, conducted a survey of secondary students (ages 14–18 years) to obtain information on both the prevalence of adolescent smoking in Egypt and the level of student knowledge of tobacco health risks. The survey was conducted in 1998 on a convenience sample of 302 students from Cairo and the surrounding cities of Giza and Kalyoub.

The overall prevalence of current smoking was 8.3%, with significant sex differences (13.2% males, 3.3% females). Important predictors of current smoking were peer norms, perceived benefits of smoking, and knowledge that smoking is addictive. Furthermore, exposure to extensive education on the health risks of smoking was the most important predictor of knowledge of addiction. The effect of an extensive school tobacco education is shown in fig 1. For each risk factor and smoking behaviour, having an extensive tobacco health education had a beneficial effect.

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Figure 1

Effectiveness of tobacco health education class on related knowledge, attitudes, beliefs, and smoking behaviour.

Most of the Egyptian students surveyed in this study reported having some level of tobacco education, yet there was great variability in the extent of this education among the respondents. It appears that education on tobacco risk has an indirect role on smoking prevalence among Egyptian adolescents. Tobacco education was shown to be the most important factor in determining the students' knowledge that smoking is addictive, while this knowledge was the strongest predictor of whether or not the students were current smokers. Efforts to standardise educational outreach between males and females, in addition to increasing the level of exposure to information on the health risks of smoking, may help diminish the smoking prevalence among Egyptian adolescents.