The Prevalence of Tobacco Smoking among Secondary School Students in Babil Governorate, Iraq, 2014

Background: Tobacco smoking among adolescents remains a critical public health issue globally, with significant long-term health and socioeconomic consequences.Despite Iraq's ratification of the WHO Framework Convention on Tobacco Control (FCTC), data on youth smoking in regions like Babil Governorate are limited.This study assessed the prevalence and determinants of tobacco use among secondary school students in Babil Governorate, Iraq, in 2014.Methods: A cross-sectional study was conducted among 1,390 students (934 males, 456 females) from 13 randomly selected urban and rural schools.Data were collected via an anonymous, selfadministered questionnaire adapted from the Global Youth Tobacco Survey (GYTS). Descriptive statistics, chi-square tests, and logistic regression were used to analyze smoking prevalence and associated factors (p < 0.05). Results: The study found an overall smoking prevalence of 16.4% among secondary school students, with significantly higher rates among males (21.1%) compared to females (6.8%). Smoking prevalence showed a clear age-related pattern, rising to 32.4% among 19-year-olds. Urban students reported nearly twice the smoking rate of their rural counterparts (19.2% vs 10.2%). Several key factors emerged as significant predictors of smoking behavior: academically struggling students smoked at higher rates (21.7%) than their successful peers (11.3%), while parental employment status showed notable associations -students with unemployed fathers (20.2%) or housewife mothers (20.5%) were more likely to smoke. Social influences proved particularly strong, with students exposed to smoking classmates (26.2%) or teachers (28.0%) showing elevated smoking rates. The data revealed that most smokers (62.7%) began tobacco use before entering secondary school, with friends being the most common source of first cigarettes (38.2%). While awareness of smoking's link to lung cancer was relatively high (72.7%), knowledge about other health risks like cardiovascular (8.5%) and digestive (1.6%) consequences remained alarmingly low among respondents. Conclusion: Smoking prevalence among Babil adolescents is alarmingly high, driven by peer pressure, stress, and urban residence. Gender disparities and low quit intentions (26.3%) underscore the need for targeted school-based interventions, stricter tobacco sales regulations, and enhanced health education. Policymakers should prioritize enforcement of FCTC measures and parental engagement to reduce youth smoking in Iraq.