Prevalence of Tobacco Use and Smoking-Related Knowledge Among Pilgrims of the Arbaeen Mass Gathering in Iraq, 2022

Abstract

Background: Tobacco use remains one of the most serious global public health challenges, causing more than 8 million deaths annually. The Arbaeen pilgrimage in Iraq is one of the world’s largest recurring religious mass gatherings; however, data on the prevalence of tobacco use and related knowledge among its attendees are absent from the literature. Objectives: This study aimed to estimate the prevalence of tobacco use among Arbaeen pilgrims in 2022, assess their knowledge of smoking-related health hazards, and identify independent sociodemographic predictors of current tobacco use through multivariable logistic regression. Methods: A cross-sectional study was conducted from September 10 to 17, 2022, among 509 Arbaeen pilgrims recruited through convenience sampling. The prevalence and patterns of tobacco use, as well as smoking-related knowledge, were assessed using a validated electronic questionnaire adapted from the World Health Organization Global Adult Tobacco Survey. Multivariable binary logistic regression was performed to identify independent predictors of current tobacco use. Results: The overall prevalence of current tobacco use was 61% (n = 309). In multivariable logistic regression, male sex (adjusted odds ratio [aOR] = 10.87; 95% CI, 6.36 - 18.58), wage-earner occupation (aOR = 4.77; 95% CI, 2.49 - 9.13), and younger age were significant independent predictors of smoking. Housewife status (aOR = 0.20) and student status (aOR = 0.17) were significantly protective. Education level, marital status, and rural or urban residence were not independently associated with smoking after adjustment. Conclusions: The prevalence of tobacco use among Arbaeen pilgrims was alarmingly high, particularly among young men and manual workers. Targeted smoking cessation interventions and stronger enforcement of smoke-free legislation during mass gathering events are urgently needed.