Abstract

BackgroundThere is growing concern about the impacts of war on unhealthy substance use in Iraq. However, little is known about the country's current substance use trends.ObjectivesTo investigate gender differences in cigarette and water-pipe use, to examine trends of unhealthy alcohol consumption in men and women, and to examine trends of illicit and prescription drug misuse in Muslim men and its relation to residing in ISIL-targeted governorates.Study Design and PopulationThe population included participants from the Iraqi National Household Survey of Alcohol and Drug Use, who were not displaced and non-institutionalized adult Iraqi residents. This survey was cross-sectional and sampled 911 women and 2,289 men from all 18 Iraqi governorates, using a multi-stage cluster sampling approach. The response rate was 91.6%. MethodsSubstance use indicators included cigarette smoking, water-pipe smoking, at-risk drinking, and binge drinking, in the past month, in addition to past-year illicit drug use and prescription drug misuse. Covariates included sex, age, education, employment, marital status, ethnicity, religion and residency in ISIL-targeted governorates. For every substance use indicator, weighted prevalence and adjusted odds ratios, with corresponding 95% confidence intervals, were estimated.ResultsMen were at greater odds for smoking cigarettes, and using water-pipes, compared to women. Age and college education were positively associated with tobacco use in women, but the opposite was observed in men. Overall alcohol use was low, however, most men who reported past-month drinking were at-risk and binge drinkers. Muslim men reported past-year prescription drug misuse more frequently than illicit drug use. The odds for past-year prescription drug misuse was lower in ISIL-targeted governorates compared to untargeted governorates, and no men reported using Illicit drugs in ISIL-targeted governorates. Conclusions The current focus on substance use prevention in Iraq should be on tobacco use, especially in young men. Awareness should be raised about unhealthy alcohol consumption and its complications, and the harms associated with prescription drug misuse.