Prevalence of cigarette and waterpipe tobacco smoking among adults in three Eastern Mediterranean countries: a cross-sectional household survey

Abstract

ObjectivesTobacco smoking is on the rise in the Eastern Mediterranean region. In light of limited surveillance of smoking in the region, this study sought to understand the prevalence of cigarette and waterpipe smoking among adults and the factors associated with smoking in Lebanon, Jordan and Palestine (West Bank only).Design, setting and participantsHousehold surveys were conducted with participants over the age of 18 in Lebanon (n=1680), Jordan (n=1925) and Palestine (n=1679) between June and August 2019. A multistage cluster sampling approach with probability-proportional-to-size random selection method was followed in the three countries.Primary and secondary outcome measuresGender-specific prevalence rates for cigarette and waterpipe smoking were estimated. Multivariable logistic regression was used to examine factors associated with current cigarette and waterpipe tobacco smoking.ResultsThe prevalence of cigarette smoking among males and females respectively was 48.6% and 21.5% in Lebanon, 50.4% and 9.1% in Jordan, and 53.4% and 3.1% in Palestine. The prevalence of waterpipe smoking among males and females respectively was 32.7% and 46.2% in Lebanon, 13.4% and 7.8% in Jordan, and 18.0% and 7.9% in Palestine. Cigarette smokers were significantly (p<0.05) more likely to be male, younger and with lower educational attainment across the three countries. Waterpipe smokers were more likely to be young adults across the three countries (p<0.001). They were more likely to be male in Jordan and Palestine, and more likely to be female in Lebanon.ConclusionsThe high prevalence rates of smoking in Lebanon, Jordan and Palestine are concerning. Continued surveillance is key to monitor smoking patterns and inform stronger tobacco control measures.

Impact of pictorial health warning labels on smoking beliefs and perceptions among waterpipe smokers: an online randomised cross-over experimental study

“…However, study participants were allowed to forward the email to their friends outside the university, who also participated in this study. This helped include a large sample of young adults representing a high-risk group of waterpipe smoking in Lebanon and globally 1 4 62. In addition, the main focus in an experimental design is to provide evidence for a potential effect of this novel approach to HWLs in waterpipe smokers based on within-subject comparisons that can inform further real-world testing using representative samples.…”

“…Waterpipe tobacco smoking (WTS) has witnessed alarming popularity among young people in the Eastern Mediterranean Region (EMR), particularly Lebanon 1–3. The prevalence of current WTS among adults (18 years and older) in Lebanon was 39.5% in 2019 4. Accumulating evidence suggests that WTS is associated with adverse health outcomes, including cardiovascular diseases, respiratory illness and cancer 5–7.…”

Economic research in waterpipe tobacco smoking: reflections on data, demand, taxes, equity and health modelling

“…Additionally, waterpipe tobacco use was self-reported and not biochemically verified, which may have resulted in under-reported prevalence. Current waterpipe tobacco smoking was reported by only a small proportion of women in two of the countries, which suggests a potential for social desirability bias resulting in unreliable estimates 13…”

“…Assessments included current waterpipe smoking, as well as details regarding the number of heads per session, amounts paid and venue (ie, commercial establishments—as cafés and restaurants, and home—whether prepared at home or ordered through delivery service). Survey results revealed high prevalence rates for current waterpipe smoking in all three countries (39.5% in Lebanon, 11.0% in Jordan and 12.9% in Palestine) 13. In waterpipe tobacco smoking research, assessing lifetime, past-year or past 30-day waterpipe tobacco smoking, while ignoring measures of quantity and frequency, may be insufficient.…”

“…In our research, we conducted in-person nationally representative household surveys in Jordan, Lebanon, and Palestine between June and August 2019 using standardised questionnaires 13. One strength of standardised questionnaires is that they allow for valid cross-country comparisons.…”