Friday, December 22, 2006

The Alarming Facts of Smoking in Lebanon

“No! Really? You don’t smoke?! You look like someone who smokes!” This is the reaction I almost always get when people find out that I do not smoke. In a nutshell, to most people, smoking is prestige, power, sex appeal, and fun!

Smoking prevalence in the adult population in Lebanon of 53.6% by contrast, the reported prevalence of smoking in the USA is 25.6% and is continuing to decline emphasizing just how unacceptable is the Lebanese prevalence. (It is interesting to note that the prevalence of smoking among Lebanese immigrants living in the Detroit area is higher than that for the US population overall!) .

Intensity of smoking is also comparatively high in the Lebanese population. The average daily number of cigarettes smoked daily is 23, compared to 15 in France. Furthermore, 67.4% of Lebanese smoke more than 20 cigarettes/day compared to 27% in the USA (R. Baddoura, C. Wehbeh-Chidiac, 2001)

Following the war period that extended from 1975 until 1990, cigarette smoking has increased (Karam et al. 2000). An estimated 52.6% of individuals 19 years and above are current smokers (National Tobacco Information Online System of CDC, 2003).

Anti-smoking legislation in Lebanon is effectively non-existent. The Lebanese economy is significantly boosted through the trading and advertising (which is completely unrestricted) of tobacco products. The lack of restriction is due to the fact that the country’s mass media organizations are affiliated to the different political parties and they derive substantial revenues from tobacco and alcohol advertising. Political leaders and social figures smoke during television interviews without any post-production editing. Schools seldom or almost never focus on educational programs aimed at smoking prevention and control. Astonishingly enough, schools are not smoke-free areas, and neither are most hospitals. Smoking-related-health-hazards public campaigns are singled out one-day annually activities. Research is fundamentally carried out by nongovernmental organizations, which lack adequate support. The medical community is poorly committed to smoking prevention and awareness policies and medical curricula do not include the community dimension of tobacco-related diseases (R. Baddoura, C. Wehbeh-Chidiac, 2001)

Moreover, there has been a revival of old methods of tobacco use known to have bad health consequences, as exemplified by argileh smoking(H. Tamim et al. 2003). The popularity of argileh smoking has risen in the last decade, among both genders and among practically all age groups. Argileh is rapidly becoming the new ‘‘hip’’ smoking device among all society in Lebanon, where argileh is commonly viewed as ‘‘healthy’’ compared with cigarette smoking (M. Chaaya et al., 2004).

There is, however, increasing evidence of the harmful health effects of argileh smoking. Most notable are the pulmonary effects with reduced ventilatory capacity (lung capacity) such as emphysema and chronic bronchitis. Others include cancer and coronary heart diseases. Argileh contains the same toxic chemicals present in a cigarette only nicotine is less filtered compared to the cigarette. Tar, a carcinogenic agent, is not soluble in water and hence it is saturated in higher concentrations in blood leading to higher cancer probabilities. Carbon monoxide which could lead to mental problems such as psychosis is also present in higher concentrations. (Al-Fayez, Salleh et al., 1988, El Hakim&Uthman, 1999, Radwan, 1999, Shihadeh, 2003).

In a study by M. Chaaya et al. published in Elsevier Ltd. 2004, relatively few Lebanese women answered correctly on all knowledge questions for argileh (9%) and cigarettes (13%). Knowledge about harm to participant’s fetus and newborn from smoking was also slight.
Attitudes of participants towards smoking were not generally expressed in strong terms, particularly regarding argileh. Consequently, several issues arise such as concerns on the influence of cultural norms, whether women in Lebanon have adequate awareness about their own health rights, and whether they have the power to protect these rights in a ‘‘heavy-smoking’’ society, and the need to upgrade women’s knowledge of and attitudes toward both forms of smoking especially argileh. (M.Chaaya et al., 2004).

While the common norm in the developed world is the decreased smoking and increased smoking risks awareness among the middle and upper classes as compared to lower and less privileged classes (Malmstadt et al . 2001), the opposite is the case in Lebanon. (Papazian, 1993, World Health Organization: Regional Office for the Eastern Mediterranean, 2002).60% of the young Lebanese who smoked belonged to the upper middle class while 22.5% belonged to the lower class.

This was not the case with argileh smoking, which was not significantly different among the different educational levels; argileh smoking is now an activity that cuts across social groupings, and people from all positions in society practice this type of smoking (H.Tamim et al. 2003, Kandela 2000) and hence the greater danger and the pressing need to implicate special educational awareness programs.


A strong relation has been documented between cigarette smoking and excessive alcohol consumption and extreme weight reduction methods, thus suggesting the ‘risk behavior syndrome’ in Lebanese youth (H. Tamim et al. 2003, Robinson et al. 1997). As cigarette smoking has been used as a means to control weight (French et al. 1994), anti-smoking programs should also take into consideration this fact and address both issues together. In contrast to cigarette smoking, argileh smoking and weight concerns were not related, indicating that argileh may be associated with a tradition-oriented social profile rather than being clustered with adolescent risky behaviors and hence more stress should be on social morality. Nevertheless, argileh smoking was significantly associated with excessive alcohol drinking as well. (H. Tamim et al. 2003).

This alarming trend should be tackled very soon and effectively. Interventions should start at assessing the vulnerabilities of smokers especially adolescents particularly targeting extreme weight control measures, alcohol drinking, peer pressure and accepting society trends. ( J. Yeretzian, R. Afifi- Soweid et al. 2004). Effective strategies to control and prevent smoking are essential to improving health outcomes of populations, particularly in Lebanon where other factors such as poverty, poor nutrition, polluted cities, and diversion of resources to armed conflict predispose to less than optimal health. Anti-smoking initiatives such as those taken by the Council of State and Territorial Epidemiologists in the USA in June 1996 whereby they agreed to add smoking to the list of reportable diseases to the Centers for Disease Control and Prevention should be obtained, thereby requiring the involvement of health professionals in anti-smoking public health policies (R. Baddoura, C. Wehbeh-Chidiac, 2001).

140 comments:

Anonymous said...

Nancy, thanks for a sobering post. The data you present speak for themselves.

Sam said...

do you really think that you're not a smoker? well think again!! 2nd hand smoking is even worse.. and for ppl who try not to smoke for several reasons including health ones (like myself) it's really frustrating how no1 really gives a hoot about us minorities who prefere to stay smoke free.. not the rules nor the smokers really care to think of us one bit..
dont tell me you dont love it when someone enters your overcrowded elevator with a cigarette in his hand.. or maybe the cab?!
we surely need miracles..

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