title: 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.
authors: Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8 St, Miami, 33199 FL, USA, Syrian Center for Tobacco Studies, Sheehan St, Aleppo, Syria, Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Riad El Solh St, 1107 2020 Beirut, Lebanon, Department of Social Medicine and Public Health, Faculty of Medicine and Health Sciences, University of Aden, Aden, Yemen, Institute of Community and Public Health, Birzeit University, PO Box 14 Birzeit, Occupied Palestinian Territory and Department of Psychology and Institute for Drug and Alcohol Studies, Virginia Commonwealth University, 1112 East Clay St, Richmond, 23298 VA, USA Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8 St, Miami, 33199 FL, USA, Syrian Center for Tobacco Studies, Sheehan St, Aleppo, Syria, Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Riad El Solh St, 1107 2020 Beirut, Lebanon, Department of Social Medicine and Public Health, Faculty of Medicine and Health Sciences, University of Aden, Aden, Yemen, Institute of Community and Public Health, Birzeit University, PO Box 14 Birzeit, Occupied Palestinian Territory and Department of Psychology and Institute for Drug and Alcohol Studies, Virginia Commonwealth University, 1112 East Clay St, Richmond, 23298 VA, USA wmaziak@fiu.edu.
authors: Wasim
authors: W
authors: Maziak
authors: Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8 St, Miami, 33199 FL, USA, Syrian Center for Tobacco Studies, Sheehan St, Aleppo, Syria, Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Riad El Solh St, 1107 2020 Beirut, Lebanon, Department of Social Medicine and Public Health, Faculty of Medicine and Health Sciences, University of Aden, Aden, Yemen, Institute of Community and Public Health, Birzeit University, PO Box 14 Birzeit, Occupied Palestinian Territory and Department of Psychology and Institute for Drug and Alcohol Studies, Virginia Commonwealth University, 1112 East Clay St, Richmond, 23298 VA, USA.
authors: Rima
authors: R
authors: Nakkash
authors: Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8 St, Miami, 33199 FL, USA, Syrian Center for Tobacco Studies, Sheehan St, Aleppo, Syria, Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Riad El Solh St, 1107 2020 Beirut, Lebanon, Department of Social Medicine and Public Health, Faculty of Medicine and Health Sciences, University of Aden, Aden, Yemen, Institute of Community and Public Health, Birzeit University, PO Box 14 Birzeit, Occupied Palestinian Territory and Department of Psychology and Institute for Drug and Alcohol Studies, Virginia Commonwealth University, 1112 East Clay St, Richmond, 23298 VA, USA Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8 St, Miami, 33199 FL, USA, Syrian Center for Tobacco Studies, Sheehan St, Aleppo, Syria, Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Riad El Solh St, 1107 2020 Beirut, Lebanon, Department of Social Medicine and Public Health, Faculty of Medicine and Health Sciences, University of Aden, Aden, Yemen, Institute of Community and Public Health, Birzeit University, PO Box 14 Birzeit, Occupied Palestinian Territory and Department of Psychology and Institute for Drug and Alcohol Studies, Virginia Commonwealth University, 1112 East Clay St, Richmond, 23298 VA, USA.
authors: Raed
authors: R
authors: Bahelah
authors: Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8 St, Miami, 33199 FL, USA, Syrian Center for Tobacco Studies, Sheehan St, Aleppo, Syria, Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Riad El Solh St, 1107 2020 Beirut, Lebanon, Department of Social Medicine and Public Health, Faculty of Medicine and Health Sciences, University of Aden, Aden, Yemen, Institute of Community and Public Health, Birzeit University, PO Box 14 Birzeit, Occupied Palestinian Territory and Department of Psychology and Institute for Drug and Alcohol Studies, Virginia Commonwealth University, 1112 East Clay St, Richmond, 23298 VA, USA.
authors: Abdullatif
authors: A
authors: Husseini
authors: Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8 St, Miami, 33199 FL, USA, Syrian Center for Tobacco Studies, Sheehan St, Aleppo, Syria, Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Riad El Solh St, 1107 2020 Beirut, Lebanon, Department of Social Medicine and Public Health, Faculty of Medicine and Health Sciences, University of Aden, Aden, Yemen, Institute of Community and Public Health, Birzeit University, PO Box 14 Birzeit, Occupied Palestinian Territory and Department of Psychology and Institute for Drug and Alcohol Studies, Virginia Commonwealth University, 1112 East Clay St, Richmond, 23298 VA, USA.
authors: Nadia
authors: N
authors: Fanous
authors: Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8 St, Miami, 33199 FL, USA, Syrian Center for Tobacco Studies, Sheehan St, Aleppo, Syria, Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Riad El Solh St, 1107 2020 Beirut, Lebanon, Department of Social Medicine and Public Health, Faculty of Medicine and Health Sciences, University of Aden, Aden, Yemen, Institute of Community and Public Health, Birzeit University, PO Box 14 Birzeit, Occupied Palestinian Territory and Department of Psychology and Institute for Drug and Alcohol Studies, Virginia Commonwealth University, 1112 East Clay St, Richmond, 23298 VA, USA.
authors: Thomas
authors: T
authors: Eissenberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000352:Africa, Northern / Q000453:epidemiology; D018643:Arab World; D005260:Female; D014943:Global Health; D006801:Humans; D008297:Male; D008877:Middle East / Q000453:epidemiology; D015995:Prevalence; D011634:Public Health; D011640:Public Policy; D017678:Sex Distribution; D012907:Smoking / Q000453:epidemiology* / Q000331:legislation & jurisprudence / Q000639:trends; D019460:Tobacco Industry / Q000331:legislation & jurisprudence*; D055815:Young Adult
keywords: Arab world; hookah; policy; tobacco industry; waterpipe
references: Tob Control. 2000 Jun;9(2):206-16
references: 10841858
references: Nicotine Tob Res. 2005 Feb;7(1):149-56
references: 15804687
references: Atmos Environ (1994). 2010 Jan 1;44(1):8-14
references: 20161525
references: Toxicol Lett. 2011 Sep 10;205(3):279-84
references: 21712083
references: BMC Public Health. 2013 Jun 03;13:534
references: 23731766
references: Br Med Bull. 1996 Jan;52(1):206-21
references: 8746308
references: Nicotine Tob Res. 2009 Jun;11(6):591-9
references: 19380383
references: Prev Med. 2003 Mar;36(3):272-81
references: 12634018
references: J Med Liban. 1997;45(1):19-20
references: 9421941
references: Tob Control. 2009 Oct;18(5):420-1
references: 19779065
references: BMC Public Health. 2011 May 14;11:315
references: 21569577
references: Tob Control. 2004 Dec;13(4):433-7
references: 15564631
references: Emerg Med J. 2010 May;27(5):406
references: 20442182
references: Am J Prev Med. 2012 Feb;42(2):150-6
references: 22261211
references: Tob Control. 2006 Jun;15 Suppl 1:i24-9
references: 16723671
references: Pharmacol Biochem Behav. 2005 Jan;80(1):173-9
references: 15652393
references: Am J Health Behav. 2007 Jan-Feb;31(1):56-63
references: 17181462
references: Nicotine Tob Res. 2008 Mar;10(3):519-23
references: 18324571
references: Eur J Public Health. 2013 Oct;23(5):862-7
references: 24078649
references: MMWR Morb Mortal Wkly Rep. 2009 Apr 3;58(12):305-8
references: 19343010
references: Tob Control. 2009 Aug;18(4):310-6
references: 19633145
references: Food Chem Toxicol. 2008 May;46(5):1582-90
references: 18308445
references: Addict Behav. 2011 Jan-Feb;36(1-2):1-5
references: 20888700
references: Am J Public Health. 2012 Sep;102(9):e47-51
references: 22827447
references: East Mediterr Health J. 2010 Mar;16(3):266-73
references: 20795439
references: Tob Control. 2008 Apr;17(2):e3
references: 18375726
references: Tob Control. 2010 Jun;19(3):235-9
references: 20501497
references: J Sch Health. 2005 Jan;75(1):15-24
references: 15779140
references: Food Chem Toxicol. 2008 Sep;46(9):2991-5
references: 18573302
references: Addiction. 2013 Feb;108(2):394-403
references: 22882805
references: Respiration. 2012;83(5):423-32
references: 22487605
references: Am J Health Behav. 2008 Mar-Apr;32(2):146-56
references: 18052855
references: BMC Public Health. 2011 Apr 19;11:244
references: 21504559
references: Tob Control. 2004 Dec;13(4):327-33
references: 15564614
references: Nicotine Tob Res. 2011 Feb;13(2):78-87
references: 21127030
references: Int J Epidemiol. 2010 Jun;39(3):834-57
references: 20207606
references: Tob Control. 2007 Dec;16(6):390-3
references: 18048615
references: Am J Health Behav. 2010 May-Jun;34(3):275-85
references: 20001185
references: Clin Toxicol (Phila). 2011 Aug;49(7):697-8
references: 21819288
references: Health Educ Res. 2008 Aug;23(4):709-22
references: 17947246
references: Int J Public Health. 2009;54(5):349-55
references: 19662333
references: Lancet. 2006 Mar 4;367(9512):749-53
references: 16517275
references: Tob Control. 2008 Oct;17(5):324-31
references: 18818226
references: Curr Probl Pediatr Adolesc Health Care. 2011 Feb;41(2):34-57
references: 21232693
references: Am J Addict. 2014 Mar-Apr;23(2):103-7
references: 25187045
references: Inhal Toxicol. 2010 Nov;22(13):1101-9
references: 21062108
references: J Sch Health. 2008 Jun;78(6):337-43
references: 18489467
references: Nicotine Tob Res. 2012 Apr;14(4):448-54
references: 22140149
references: BMC Public Health. 2004 Aug 04;4:32
references: 15294023
references: Cancer Epidemiol. 2013 Feb;37(1):1-4
references: 23196170
references: Bull World Health Organ. 2010 Feb;88(2):83
references: 20428359