The tobacco epidemic in Syria
- K D Ward1,*,
- T Eissenberg1,†,
- S Rastam1,
- T Asfar1,
- F Mzayek1,‡,
- M F Fouad1,
- F Hammal1,
- J Mock2,
- W Maziak1,§
- 1Syrian Center for Tobacco Studies, Aleppo, Syria
- 2Department of Psychiatry, University of California San Francisco, California, USA
- Correspondence to: Dr Wasim Maziak PO Box 16542, Aleppo, Syria;
Background: The Syrian Center for Tobacco Studies (SCTS) was established in response to the smoking epidemic in Syria and lack of local knowledge and expertise to confront it.
Objectives: To (1) study tobacco use and local smoking practices using both qualitative and quantitative research methods; (2) develop and test an effective smoking cessation intervention for the Syrian environment; and (3) train Syrian researchers.
Methods and results: The Aleppo Household Survey involved a representative sample of adults in Aleppo (2038 subjects, 45.2% men, mean age 35.3 years, response rate 86%). The prevalence of cigarette smoking was 56.9% among men and 17.0% among women, while the prevalence of waterpipe smoking was 20.2% among men and 4.8% among women. Daily use predominated for cigarettes (29.0%), while the opposite was seen in waterpipe use with 10.6% smoking occasionally. Interest in quitting was greater for cigarette than waterpipe smokers (74.0% v 48.6%), while quit rates were higher for waterpipe compared to cigarettes (28.2% v 16.5%). In-depth ethnographic interviews with smokers show that smoking waterpipe is often viewed as an aesthetic enjoyable experience, while smoking cigarettes is viewed as a mundane anxiety-relieving addiction. Clinical laboratory studies reveal that both waterpipe and cigarette smokers in Syria are exposed to smoke toxicants and exhibit dependence symptoms.
Conclusions: All these data have been used iteratively to adapt smoking cessation interventions from developed countries to suit the local Syrian environment. Research conducted in the SCTS to date has provided a fertile training ground for Syrian researchers, as well as for the building of regional collaborations.
- AHS, Aleppo Household Survey
- EMR, Eastern Mediterranean Region
- NRT, nicotine replacement therapy
- PPS, probability proportional to size
- QSU, Tiffany-Drobes Questionnaire of Smoking Urges
- RAM, Research Assistance Matching Project
- SCTS, Syrian Center for Tobacco Studies
- SES, socioeconomic status
↵* Also Department of Health and Sport Sciences, and Center for Community Health, University of Memphis, Memphis, Tennessee, USA;
↵ † Also Department of Psychology and Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, Virginia, USA;
↵‡ Also Tulane University School of Public Health and Tropic Medicine, New Orleans, Louisiana, USA;
↵§ Also Institute of Epidemiology and Social Medicine, Muenster, Germany
Competing interests: none declared