Tobacco in the Arab world: old and new epidemics amidst policy paralysis

Abstract

The Arab world is comprised of 22 countries with a combined population of ∼360 million. The region is still at the initial stages of the tobacco epidemic, where it is expected to witness an increase in smoking levels and mounting tobacco-related morbidity and mortality in the future. Still, the bleak outlook of the tobacco epidemic in the Arab world continues to be faced with complacency in the form of underutilization of surveillance systems to monitor the tobacco epidemic and prioritize action, and failure to implement and enforce effective policies to curb the tobacco epidemic. Understandably, the focus on the Arab world carries the risk of trying to generalize to such a diverse group of countries at different level of economic and political development. Yet, tobacco control in the Arab world faces some shared patterns and common challenges that need to be addressed to advance its cause in this region. In addition, forces that promote tobacco use, such as the tobacco industry, and trends in tobacco use, such as the emerging waterpipe epidemic tend to coalesce around some shared cultural and socio-political features of this region. Generally, available data from Arab countries point at three major trends in the tobacco epidemic: (1) high prevalence of cigarette smoking among Arab men compared with women; (2) the re-emergence of waterpipe (also known as hookah, narghile, shisha, arghile) smoking as a major tobacco use method, especially among youth and (3) the failure of policy to provide an adequate response to the tobacco epidemic. In this review, we will discuss these trends, factors contributing to them, and the way forward for tobacco control in this unstable region.

Benzene Uptake in Hookah Smokers and Non-smokers Attending Hookah Social Events: Regulatory Implications

“…Packages of charcoal, a unique toxicant source in hookah smoking, contain misleading statements as well, such as "environmentally friendly," "natural," or "smokeless, odorless, and free of chemicals" (73,74). In hookah lounges, customers are served hookah already packed with tobacco, and therefore are possibly not aware of health warnings that are displayed on the hookah tobacco packages (76). Regulations are needed to require hookah lounge owners to display health warnings on the harms of smoking hookah tobacco in their venues and on the hookah tobacco menus that are provided to their customers.…”

Predictors of Cigarette Smoking Progression Among a School-Based Sample of Adolescents in Irbid, Jordan: A Longitudinal Study (2008–2011)

“…For example, girls (12-17 years old) have been shown to be at higher risk of addiction to nicotine once they start smoking, compared with boys. 8,9 Additionally, since cigarette smoking is generally a socially unacceptable habit for girls in the EMR, 10,11 gender roles may influence cigarette smoking progression differentially by gender. 10 Evidence from developed countries showed the strength of the longitudinal study designs in gaining valuable information about determinants of cigarette smoking progression.…”

Water Pipe Tobacco Smoking among Females: A Middle Eastern or a Global Epidemic?

“…[7,[9][10][11][12]. This is partly attributed to the prevention and control measures that focused on cigarette rather than tobacco smoking, the belief that shisha smoking is not as harmful as that of cigarettes and in being perceived as an acceptable alternative for those who wish to smoke tobacco or those who want to quit cigarette smoking.…”