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The tobacco epidemic in Syria
  1. K D Ward1,*,
  2. T Eissenberg1,,
  3. S Rastam1,
  4. T Asfar1,
  5. F Mzayek1,,
  6. M F Fouad1,
  7. F Hammal1,
  8. J Mock2,
  9. W Maziak1,§
  1. 1Syrian Center for Tobacco Studies, Aleppo, Syria
  2. 2Department of Psychiatry, University of California San Francisco, California, USA
  1. Correspondence to:
 Dr Wasim Maziak
 PO Box 16542, Aleppo, Syria; maziak{at}


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
  • capacity building
  • smoking
  • Syria
  • Syrian Center for Tobacco Studies
  • waterpipe

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  • * 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