The Healthy Mother/Healthy Child Results Package (HM/HC RP) carried out qualitative research on beliefs and attitudes associated with adolescent smoking in Egypt to provide the basis for development of a school-based smoking prevention campaign for Upper Egypt. This information was also used to guide the development of a complementary media strategy that can be used in other parts of the country. This activity was conducted under the Ministry of Health and Population, Primary Health Care, and in coordination with the Healthy Egyptians 2010 Initiative.
Communication Strategies: 

The HM/HC RP team will focus on the promotion of smoking prevention messages through school-based activities and media advocacy. These activities will primarily target boys aged 10-13 years, but will include all preparatory and secondary boys and girls.

As this smoking prevention campaign is the first of its kind in Egypt, the first step in the creative development of the campaign was concept testing. Based on this research, the concepts of addiction and having a strong personality (making your own decision) are emphasized in the campaign, and statements about curiosity and independence will also be mentioned.

School-based Programme

Research has shown that, for many reasons, teachers are not a credible source of smoking prevention education. Therefore, the school-based effort will build on the existing anemia prevention health education activities that are being implemented by HM/HC RP. Classroom activities will be offered during school by health educators trained in behavior change.

Many adolescents try cigarettes because of curiosity or in imitation, without any intention of making it a habit. Therefore, a draft curriculum has been designed to present smoking as a conscious and logical decision for adolescents, rather than something to slide into. Students are guided through a step-by-step decision-making process, through which they become aware of the decision and consider the costs and benefits of smoking. The objective of this programme is to assist students in making their own decisions to remain smoke-free. Therefore, they are encouraged to research and analyze the facts as well as weigh emotional reasons on their own. The educator's role is to lead the students through this process and assist them in collecting and discussing information relevant to their decision about smoking.

The programme is broken down into 4 steps, including activities, assignments, and worksheets for each step:

1. Define the decision. Recognize the choice.

2. Collect information you need to make your decision.

3. Consider the information and evaluate the benefits and harm.

4. Take action. Take responsibility.

At the end of the programme, students are asked to sign a contract with themselves about their smoking decision. This well-informed decision and very personal commitment is designed to result in sustained smoke free behavior.

Media Materials

A local advertising agency was contracted to design and produce the media materials under the guidance of HM/HC RP and an independent research agency was contracted to pretest the materials among the primary target audience. The creative, research, and technical teams worked together to develop the most appropriate and effective media materials based on qualitative research, concept testing results, and implementation research.

HM/HC RP has developed, pretested, and produced 2 TV spots, 1 poster, and 1 workbook.

1. "Just the One" - this spot focuses on the role of trial as a first step to (unintended) addiction and the consequences or "costs" of smoking on health and popularity.

2. "I Bet You" - this spot emphasizes the strong personality needed to remain smoking prevention and portrays the weakness and frustration of addiction. It also touches on the role of peer pressure and the bad health effects of smoking.

Posters, with the message "Cigarettes have no friends, only victims", will be displayed in classrooms and depict the same youth as one of the TV spots. The workbook will be used as part of the school-based curriculum.

Development Issues: 

Tobacco, Children, Youth.

Key Points: 

Adolescent smoking is a serious public heath concern in Egypt with the potential to negatively impact 16 million youth. Statistics from various surveys indicate that between 5% and 20% of the country's youth (10 - 19-year-olds) smoke. However, because a significantly higher number of boys reported that their peers smoke, the prevalence is believed to be much higher. A study conducted by the Population Council in 1997 suggests that the incidence among some groups of boys could be as high as 77%. Many youth start at a young age and become lifetime smokers. Experts believe that school-based smoking prevention programmes can be very successful in target youth and deterring them from tobacco use.

A review of the existing information on adolescents revealed that very little research has been done on their attitudes, knowledge and motivations related to smoking. In order to develop an effective smoking prevention campaign, a qualitative research study was designed to collect this information from adolescents themselves, as well as their fathers and teachers. The qualitative research study was conducted by a local Egyptian firm, with technical assistance from the HM/HC RP in study design and development of the data collection instruments. Data results analyzed by the HM/HC RP provided a solid basis for designing the school-based intervention and media activities to encourage adolescents to remain tobacco-free.

The research suggests that smoking is strongly associated with "growing up," separating from one's parents and becoming an adult. While Egyptian youth have fairly sophisticated knowledge about the negative health outcomes related to smoking, this knowledge does not act as a deterrent; addiction is poorly understood. Many youth also believe that smoking plays a role in stress and problem reduction. Although the family does not seem to play a major role in youths' decisions to smoke or not smoke, the data suggest that the prevalence of adult smoking in the home is the biggest factor in this lack of parental influence. Adolescents in this study were unwilling to abandon or strongly sanction friends who are smokers, and they express great willingness to apply reasoning, support, "love" and help to friends in order to help them quit.

Teachers do not emerge from this data as positive role models or as potentially effective agents for changing youth attitudes about smoking. These data suggest that a school-based intervention strategy will need some careful planning and should include work with classroom teachers to change at least their public smoking personae. Although tradition, religion and sports are all cited in the research data as important mechanisms for promoting smoking prevention in Egyptian youth, there is not much evidence that these could realistically be used as a primary motivator for not smoking. "Role model" questions in the study instruments elicited strong negative comments about this concept, but popular culture figures were occasionally mentioned as positive models and many youth said that there are individuals whose behavior could and should be emulated.

Partner Text: 

John Snow, Inc., The Manoff Group, GOE Ministry of Health and Population, Healthy Egyptians 2010.


Letter from Aparna Ramakrishnan, Manoff Group to The Communication Initiative 9/26/01.