This report focuses on change over time in tobacco use among adolescents in countries included in the Eastern Mediterranean Region (EMR) of the World Health Organization. The Global Youth Tobacco Survey (GYTS) was conducted in each site at least twice between 1999 and 2007. Results indicate that for students aged 13–15 years tobacco use is a major public health problem. Increase in the use of water pipe, the likely initiation of smoking by never smokers, and a potential increase in tobacco use among young girls was found in most of the EMR sites. The results from the GYTS can be used by all of the EMR countries involved to set their tobacco control programme and policy agenda.