Joanna Khalil

Health warning labelling practices on narghile (shisha, hookah) waterpipe tobacco products and related accessories

Background Waterpipe tobacco smoking prevalence is increasing around the globe despite current evidence that smoke emissions are toxic and contain carcinogenic compounds. Objective To evaluate current health warning labelling practices on waterpipe tobacco products and related accessories. Methods All waterpipe tobacco products, as well as waterpipe accessories, were purchased from Lebanon and a convenience sample was obtained from Dubai (United Arab Emirates), Palestine, Syria, Jordan, Bahrain, Canada, Germany and South Africa. Findings Of the total number of waterpipe tobacco products collected from Lebanon, the majority had textual health warning labels covering on average only 3.5% of total surface area of the package. Misleading descriptors were commonplace on waterpipe tobacco packages and related accessories. Conclusions There are no WHO FCTC compliant waterpipe-specific health warning labels on waterpipe tobacco products and related accessories. Introducing health warnings on waterpipe tobacco products and accessories will probably have worldwide public health benefits.

The rise in narghile (shisha, hookah) waterpipe tobacco smoking: A qualitative study of perceptions of smokers and non smokers

BackgroundThe prevalence of waterpipe tobacco smoking (WTS) in the Middle East region and worldwide is increasing. There is evidence to indicate both short term and long term health effects of WTS, resulting in the issuance of an advisory note by the World Health Organization.MethodsThis research aimed at gaining an in-depth understanding of the factors contributing to the rise in WTS in Lebanon. Qualitative focus groups (25) and in-depth interviews (9) were conducted with adults in Lebanon in 2007. Participants were recruited to represent diversity in smoking status, gender, age groups and urban/rural residence. The interviews and focus groups were thematically analyzed, and recurrent themes noted and summarized.ResultsThe main themes identified were availability, affordability, innovation, influence of media, lack of a policy framework, and the sensory characteristics evoked from WTS. Men and women, smokers and non-smokers, and younger and older participants differed in their emphases on the above themes. These themes, though specific to waterpipe, are similar to themes manipulated by the cigarette industry, and eventually controlled through tobacco control policies.ConclusionsUnderstanding reasons behind the rise in waterpipe tobacco use is important if appropriate prevention, cessation, and policy interventions are to be formulated. Strict adherence to the FCTC is warranted, with careful and vigilant attention that all tobacco products are covered by laws in both high as well as middle to lower income countries.

The tobacco health nexus? Health messages in narghile advertisements

In many parts of the world, cigarettes are not the only form of tobacco smoked.1 2 In the eastern Mediterranean region, narghile (water pipe) is a more traditional form of tobacco consumption. The Lebanon Global Youth Tobacco Survey (GYTS), conducted among schoolchildren in 2005, indicated that 61% were current users of tobacco and 33.9% currently smoked narghile.3 Research on the narghile smoke constituents suggest it is as harmful—if not more harmful—than cigarettes.4 5 Recently, narghile smoking has become “big business” and a variety of marketing techniques are being used to emphasise the enjoyable facet of smoking while disregarding its detrimental health effects. One interesting marketing technique has …

Social norms and attitudes linked to waterpipe use in the Eastern Mediterranean Region.

Waterpipe tobacco smoking (WTS) is on the rise globally, particularly among vulnerable populations such as youth and women. Increasing knowledge about toxicant yield from waterpipe tobacco and deleterious health effects points to the potential for a health epidemic. WTS is often viewed as a safe alternative to cigarette smoking. Though the original objective of the research was to explore the social norms and attitudes that lead to waterpipe being a more acceptable form of tobacco smoking for women than cigarettes in the Eastern Mediterranean Region, the use of a qualitative research methodology resulted in rich data that helped to understand more generally the phenomenon of waterpipe smoking. Both focus group discussions (FGDs) and key informant interviews were used. Participants were recruited to represent genders, various age groups, socioeconomic status, waterpipe smoking status, and residents of urban and rural areas. A total of 81 FGDs and 38 in-depth interviews were conducted in 2007. Thematic analysis was used to analyze the transcripts. A total of ten themes emerged: socio-cultural norms, gender differences, motivation to smoke, sensory characteristics of waterpipe, metaphors, consumerism, indicators of dependence, comparison between cigarettes and waterpipe, health effect of smoking, and intervention. Results indicated that WTS has socio-cultural dynamics associated with it that are far more pronounced than health considerations. An increased socio-cultural acceptability, the perceived reduced harm and the advent of the fruity Moassel tobacco are among the many reasons for WTS acceptability. Findings point to the need for a unified strategy to address this health issue at all levels of the ecological framework and have important implications for future policy and practice.

Women and Waterpipe Tobacco Smoking in the Eastern Mediterranean Region: Allure or Offensiveness

The prevalence of waterpipe tobacco smoking is increasing worldwide, despite evidence indicating its adverse health effects. Women and young people seem more likely to be choosing waterpipe tobacco smoking over cigarettes. The objective of this qualitative study was to understand better whether and why waterpipe smoking is a more acceptable form of tobacco use than cigarettes for women in the Eastern Mediterranean Region, and to understand whether the strategies used by multi-national corporations to attract women to cigarette smoking were perceived to be relevant in the context of waterpipe tobacco use. Focus groups (n = 81) and in-depth interviews (n = 38) were conducted with adults in Lebanon, Egypt, Palestine, and Syria. Discussions were thematically analyzed and recurrent themes identified. One of the themes which emerged was the negative image of women smoking waterpipes. Moreover, the sexual allure conveyed through waterpipe smoking as well as waterpipe tobacco smoking as a symbol of emancipation was illustrated. The latter was mainly expressed in Lebanon, in contrast with Egypt where traditional gender roles depict women smoking waterpipes as disrespectful to society. Understanding the social aspects of waterpipe tobacco smoking is crucial to planning future interventions to control waterpipe tobacco smoking among women and in society at large.

Building Research Evidence for Policy Advocacy: A Qualitative Evaluation of Existing Smoke-Free Policies in Lebanon

Secondhand smoke is harmful to smokers and nonsmokers, and smoke-free legislation worldwide improves health status. Lebanon has one of the weakest tobacco control regulatory environments in the Eastern Mediterranean region. However, several Lebanese workplaces and hospitality venues have chosen to implement such policies on their own. The objective of this study was to document their experiences. Qualitative interviews and focus group discussions were conducted with management, employees, and clients. Thematic analysis was used to identify recurrent themes. Results describe the types of bans implemented; the reasons for adopting a policy; and the barriers and facilitators to implementation, enforcement, and compliance. A main facilitator was management support, whereas a main barrier was prosmoking norms. This analysis provides insight and lessons learned that can aid in scaling up tobacco control efforts in Lebanon and the Eastern Mediterranean region.