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Nakkash R, Tleis M, Khalil J, Romani M, Salloum RG. A qualitative study on tobacco use during the COVID-19 pandemic in Lebanon: Waterpipe and cigarette smokers' views, risk perceptions, and behaviors. Tob Prev Cessat 2024; 10:TPC-10-27. [PMID: 38938265 PMCID: PMC11209738 DOI: 10.18332/tpc/189770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 01/26/2024] [Accepted: 06/06/2024] [Indexed: 06/29/2024]
Abstract
INTRODUCTION Since the beginning of the COVID-19 pandemic, a growing number of studies have documented more severe COVID-19 symptoms and worse outcomes among smokers compared to non-smokers. The aim of this research is to understand the views, risk perceptions, and behaviors of Lebanese adult smokers during the pandemic. METHODS We conducted 18 qualitative online structured interviews with adults who smoke cigarettes and waterpipe tobacco residing in Lebanon from November 2020 through April 2021. Participants were recruited predominantly via paid social media ads. Interviews were audio-recorded using Zoom software then transcribed verbatim. Data were analyzed thematically. RESULTS The findings showed three main themes: changes to smoking behaviors, concerns over the susceptibility and severity of COVID-19, and using coping methods to protect smokers from COVID-19. Although there was an increased risk perception of COVID-19 in relation to smoking, most participants reported an increase in smoking. Instead of being encouraged to quit, participants developed coping strategies against COVID-19 while smoking. CONCLUSIONS Smoking behavior did not seem to decrease during the COVID-19 pandemic. To support cessation initiatives and raise awareness, effective health messaging aimed at smokers is pivotal. Smoking cessation programs need to be better equipped at supporting people who smoke in finding healthier coping mechanisms during a pandemic. Moreover, policies to regulate the propagation of misinformation are required to prevent the development of a false sense of safety and protection from COVID-19.
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Affiliation(s)
- Rima Nakkash
- Global and Community Health Department, College of Public Health, George Mason University, Fairfax, Virginia, United States
| | - Malak Tleis
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Joanna Khalil
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Maya Romani
- Department of Family Medicine, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ramzi G. Salloum
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, United States
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Villalobos Dintrans P, Alliende T, Palacios J, Contrucci I, Browne J. Long-term Care in the Agenda: The Case of Chile. Health Syst Reform 2023; 9:2163470. [PMID: 36696684 DOI: 10.1080/23288604.2022.2163470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
The Chilean presidential elections of 2021 included an unprecedented topic in the country's political debate: long-term care (LTC). Although some public policies and programs have been in place for at least 20 years, during this 2021 presidential election LTC was mentioned for the first time in a political campaign. Five out of seven candidates highlighted the importance of LTC in their proposals and designed policies to address it. Why did this topic gain momentum as a campaign topic in 2021? What can explain the sudden inclusion of a new topic on the Chilean political agenda? Using Kingdon's multiple streams framework this article aims to understand the factors explaining the inclusion of LTC in the Chilean political agenda during the past presidential elections. A two-step qualitative research design was performed using a case study approach. As a first step, a documentary analysis of the campaign programs was conducted searching for references to LTC proposals. In a second step, semi-structured interviews were carried out with representatives from three of the seven campaign teams, including the teams that reached the ballotage. Data were analyzed using Kingdon's multiple streams framework. Results showed that the availability of national data on LTC needs helped highlight the problem and acted as a facilitator for advocacy; international organizations and other countries' experiences in implementing LTC systems served as policy entrepreneurs; and four events-the feminist movement, the social outbreak with the constitutional process, and the COVID-19 pandemic-pushed LTC forward on the political agenda. The case of Chile illustrates how Kingdon's framework can be used to identify facilitators for LTC inclusion on the political agenda, serving as an example for other countries facing similar issues and fostering the global debate around the increase in LTC needs.
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Affiliation(s)
- Pablo Villalobos Dintrans
- Programa Centro Salud Pública, Facultad de Ciencias Médicas, Universidad de Santiago, Santiago, Chile.,Millennium Institute for Care Research (MICARE), Santiago, Chile.,African Health and Ageing Research Centre (AHaARC), Winneba, Ghana
| | | | | | | | - Jorge Browne
- Millennium Institute for Care Research (MICARE), Santiago, Chile.,Sección de Geriatría, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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Bou-Orm IR, Loffreda G, Diaconu K, Witter S, deVos P. Political Economy of Non-Communicable Disease (NCD) prevention and control in Lebanon: identifying challenges and opportunities for policy change and care provision reforms. BMC Public Health 2023; 23:2526. [PMID: 38110967 PMCID: PMC10726601 DOI: 10.1186/s12889-023-17357-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 11/28/2023] [Indexed: 12/20/2023] Open
Abstract
INTRODUCTION Lebanon is a middle-income country facing substantial fragility features. Its health profile shows a high burden of NCD morbidity and mortality. This paper intends to analyse the political economy of NCD prevention and control in Lebanon. METHODS This study adopted a literature-based case study research design using a problem-driven political economy analysis framework. A total of 94 peer-reviewed articles and documents from the grey literature published before June 2019 were retrieved and analysed. RESULTS Lebanon's political instability and fragile governance negatively affect its capacity to adapt a Health-in-All-Policies approach to NCD prevention and enable the blocking of NCD prevention policies by opposed stakeholders. Recent economic crises limit the fiscal capacity to address health financing issues and resulting health inequities. NCD care provision is twisted by powerful stakeholders towards a hospital-centred model with a powerful private sector. Stakeholders like the MOPH, UN agencies, and NGOs have been pushing towards changing the existing care model towards a primary care model. An incremental reform has been adopted to strengthen a network of primary care centres, support them with health technologies and improve the quality of primary care services. Nevertheless, outpatient services that are covered by other public funds remain specialist-led without much institutional regulation. CONCLUSION Our study revealed a locked equilibrium in NCD prevention policymaking in Lebanon, but with an incremental progress in service delivery reforms towards a primary care model. Advocacy and close monitoring by policy entrepreneurs (such as civil society) could initiate and sustain the implementation of policy change and care model reforms.
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Affiliation(s)
- Ibrahim R Bou-Orm
- NIHR Global Health Research Unit on Health in Situations of Fragility, Institute for Global Health and Development, Queen Margaret University, Edinburgh, EH21 6UU, UK.
- Higher Institute of Public Health, Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon.
| | - Giulia Loffreda
- NIHR Global Health Research Unit on Health in Situations of Fragility, Institute for Global Health and Development, Queen Margaret University, Edinburgh, EH21 6UU, UK
| | - Karin Diaconu
- NIHR Global Health Research Unit on Health in Situations of Fragility, Institute for Global Health and Development, Queen Margaret University, Edinburgh, EH21 6UU, UK
| | - Sophie Witter
- NIHR Global Health Research Unit on Health in Situations of Fragility, Institute for Global Health and Development, Queen Margaret University, Edinburgh, EH21 6UU, UK
| | - Pol deVos
- NIHR Global Health Research Unit on Health in Situations of Fragility, Institute for Global Health and Development, Queen Margaret University, Edinburgh, EH21 6UU, UK
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Townsend B, Johnson TD, Ralston R, Cullerton K, Martin J, Collin J, Baum F, Arnanz L, Holmes R, Friel S. A framework of NGO inside and outside strategies in the commercial determinants of health: findings from a narrative review. Global Health 2023; 19:74. [PMID: 37817196 PMCID: PMC10565967 DOI: 10.1186/s12992-023-00978-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 10/02/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Public health scholarship has uncovered a wide range of strategies used by industry actors to promote their products and influence government regulation. Less is known about the strategies used by non-government organisations to attempt to influence commercial practices. This narrative review applies a political science typology to identify a suite of 'inside' and 'outside' strategies used by NGOs to attempt to influence the commercial determinants of health. METHODS We conducted a systematic search in Web of Science, ProQuest and Scopus. Articles were eligible for inclusion if they comprised an empirical study, explicitly sought to examine 'NGOs', were in English, and identified at least one NGO strategy aimed at commercial and/or government policy and practice. RESULTS One hundred forty-four studies met the inclusion criteria. Eight industry sectors were identified: extractive, tobacco, food, alcohol, pharmaceuticals, weapons, textiles and asbestos, and a small number of general studies. We identified 18 types of NGO strategies, categorised according to the target (i.e. commercial actor or government actor) and type of interaction with the target (i.e. inside or outside). Of these, five NGO 'inside' strategies targeted commercial actors directly: 1) participation in partnerships and multistakeholder initiatives; 2) private meetings and roundtables; 3) engaging with company AGMs and shareholders; 4) collaborations other than partnerships; and 5) litigation. 'Outside' strategies targeting commercial actors through the mobilisation of public opinion included 1) monitoring and reporting; 2) protests at industry sites; 3) boycotts; 4) directly engaging the public; and 5) creative use of alternative spaces. Four NGO 'inside' strategies directly targeting government actors included: 1) lobbying; 2) drafting legislation, policies and standards; 3) providing technical support and training; and 4) litigation. NGO 'outside' strategies targeting government included 1) protests and public campaigns; 2) monitoring and reporting; 3) forum shifting; and 4) proposing and initiating alternative solutions. We identified three types of NGO impact: substantive, procedural, and normative. CONCLUSION The analysis presents a matrix of NGO strategies used to target commercial and government actors across a range of industry sectors. This framework can be used to guide examination of which NGO strategies are effective and appropriate, and which conditions enable NGO influence.
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Affiliation(s)
- Belinda Townsend
- Australian Research Centre for Health Equity, School of Regulation and Global Governance, Australian National University, Canberra, Australia.
| | - Timothy D Johnson
- Australian Research Centre for Health Equity, School of Regulation and Global Governance, Australian National University, Canberra, Australia
| | - Rob Ralston
- Global Health Policy Unit, Social Policy, School of Social and Political Science, University of Edinburgh, Edinburgh, UK
| | | | - Jane Martin
- Obesity Policy Coalition, Melbourne, Australia
| | - Jeff Collin
- Global Health Policy Unit, Social Policy, School of Social and Political Science, University of Edinburgh, Edinburgh, UK
| | - Fran Baum
- Stretton Health Equity & School of Social Science, University of Adelaide, Adelaide, Australia
| | | | - Rodney Holmes
- Foundation for Alcohol Research and Education, Canberra, Australia
| | - Sharon Friel
- Australian Research Centre for Health Equity, School of Regulation and Global Governance, Australian National University, Canberra, Australia
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Salloum RG, Romani M, Bteddini DS, El-Jardali F, Lee JH, Theis R, LeLaurin JH, Hamadeh R, Osman M, Abla R, Khaywa J, Ward KD, Shelley D, Nakkash R. An effectiveness-implementation hybrid trial of phone-based tobacco cessation interventions in the Lebanese primary healthcare system: protocol for project PHOENICS. Implement Sci Commun 2023; 4:72. [PMID: 37365656 PMCID: PMC10294351 DOI: 10.1186/s43058-023-00456-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 06/17/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Tobacco use remains the leading cause of preventable disease, disability, and death in the world. Lebanon has an exceptionally high tobacco use burden. The World Health Organization endorses smoking cessation advice integrated into primary care settings as well as easily accessible and free phone-based counseling and low-cost pharmacotherapy as standard of practice for population-level tobacco dependence treatment. Although these interventions can increase access to tobacco treatment and are highly cost-effective compared with other interventions, their evidence base comes primarily from high-income countries, and they have rarely been evaluated in low- and middle-income countries. Recommended interventions are not integrated as a routine part of primary care in Lebanon, as in other low-resource settings. Addressing this evidence-to-practice gap requires research on multi-level interventions and contextual factors for implementing integrated, scalable, and sustainable cessation treatment within low-resource settings. METHODS The objective of this study is to evaluate the comparative effectiveness of promising multi-component interventions for implementing evidence-based tobacco treatment in primary healthcare centers within the Lebanese National Primary Healthcare Network. We will adapt and tailor an existing in-person smoking cessation program to deliver phone-based counseling to smokers in Lebanon. We will then conduct a three-arm group-randomized trial of 1500 patients across 24 clinics comparing (1) ask about tobacco use; advise to quit; assist with brief counseling (AAA) as standard care; (2) ask; advise; connect to phone-based counseling (AAC); and (3) AAC + nicotine replacement therapy (NRT). We will also evaluate the implementation process to measure factors that influence implementation. Our central hypothesis is that connecting patients to phone-based counseling with NRT is the most effective alternative. This study will be guided by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework, supported by Proctor's framework for implementation outcomes. DISCUSSION The project addresses the evidence-to-practice gap in the provision of tobacco dependence treatment within low-resource settings by developing and testing contextually tailored multi-level interventions while optimizing implementation success and sustainability. This research is significant for its potential to guide the large-scale adoption of cost-effective strategies for implementing tobacco dependence treatment in low-resource settings, thereby reducing tobacco-related morbidity and mortality. TRIAL REGISTRATION ClinicalTrials.gov, NCT05628389, Registered 16 November 2022.
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Affiliation(s)
- Ramzi G Salloum
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, 2004 Mowry Road, Gainesville, FL, USA.
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
| | - Maya Romani
- Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Dima S Bteddini
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, 2004 Mowry Road, Gainesville, FL, USA
| | - Fadi El-Jardali
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Knowledge to Policy (K2P) Center, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Ji-Hyun Lee
- Department of Biostatistics, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
- Division of Quantitative Sciences, University of Florida Health Cancer Center, University of Florida, Gainesville, FL, USA
| | - Ryan Theis
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, 2004 Mowry Road, Gainesville, FL, USA
| | - Jennifer H LeLaurin
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, 2004 Mowry Road, Gainesville, FL, USA
| | | | - Mona Osman
- Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ruba Abla
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Jihan Khaywa
- Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Kenneth D Ward
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, TN, USA
| | - Donna Shelley
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, NY, USA
| | - Rima Nakkash
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Department of Global and Community Health, College of Public Health, George Mason University, Fairfax, VA, USA
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Matthes BK, Kumar P, Dance S, Hird T, Carriedo Lutzenkirchen A, Gilmore AB. Advocacy counterstrategies to tobacco industry interference in policymaking: a scoping review of peer-reviewed literature. Global Health 2023; 19:42. [PMID: 37344818 DOI: 10.1186/s12992-023-00936-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 05/09/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND There has been remarkable tobacco control progress in many places around the globe. Tobacco industry interference (TII) has been identified as the most significant barrier to further implementation of the World Health Organization Framework Convention on Tobacco Control (WHO FCTC). Civil society has been recognised as a key actor in countering TII. While TII has been extensively studied for several decades now, there is little research that focuses on counteractions to limit it and their effectiveness to do so. This scoping review seeks to map the peer-reviewed literature on civil society's activities of countering TII in policymaking to identify common counterstrategies and assess their effectiveness. METHODS Data sources: We searched Embase, IBSS, JSTOR, PubMed, Science Direct, Scopus and Web of Science using the following terms: ("Tobacco industry" OR "Tobacco compan*") AND. ("corporate political activity" OR "CPA" OR "lobbying" OR "interference") AND ("advoca*" OR "counter*" OR "activi*"), without time or language restrictions. STUDY SELECTION Our selection criteria included peer-reviewed studies that were written in English, German, or Spanish that drew on primary data and/or legal and policy documents and reported at least one specific example of civil society members or organisations countering tobacco industry action-based strategies. DATA EXTRACTION Advocates' counterstrategies were analysed inductively and countered industry strategies were analysed using the Policy Dystopia Model (PDM). Perceptions of effectiveness of countering attempts were analysed descriptively. RESULTS We found five common counterstrategies among 30 included papers covering five WHO regions; 1. Exposing industry conduct and false claims; 2. Accessing decision-makers; 3. Generating and using evidence; 4. Filing a complaint or taking legal action; 5. Mobilising coalition and potential supporters. These counterstrategies were used to work against a wide range of industry strategies, which are captured by five action-based strategies described in the PDM (Coalition Management, Information Management, Direct Access and Influence, Litigation, Reputation Management). While some studies reported the outcome of the countering activities, their impact remained largely underexplored. CONCLUSION The review shows that peer-reviewed literature documenting how civil society actors counter TII is scarce. It suggests that advocates employ a range of strategies to counter TII in its different forms and use them flexibly. More work is needed to better understand the effects of their actions. This could stimulate discussions about, and facilitate learning from, past experiences and help to further enhance advocates' capacity.
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Affiliation(s)
- Britta K Matthes
- Department for Health, University of Bath, Claverton Down, Bath, BA27AY, UK.
| | | | - Sarah Dance
- Department for Health, University of Bath, Claverton Down, Bath, BA27AY, UK
| | - Tom Hird
- Department for Health, University of Bath, Claverton Down, Bath, BA27AY, UK
| | | | - Anna B Gilmore
- Department for Health, University of Bath, Claverton Down, Bath, BA27AY, UK
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Zheng Y, Shi Y, Ji Y, Chang C. Multiple streams approach to tobacco control policymaking in the capital city of the world's largest tobacco consuming country. Health Policy Plan 2023; 38:321-329. [PMID: 36639931 PMCID: PMC10019569 DOI: 10.1093/heapol/czad004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 11/25/2022] [Accepted: 01/13/2023] [Indexed: 01/15/2023] Open
Abstract
The aim of this study was to analyse the policymaking process of Beijing tobacco control regulations based on a multiple streams framework to provide a reference for other cities, at the national level and for the international community to promote the development of tobacco control policy. Twenty-one documents related to tobacco control in Beijing were collected, nine informants were interviewed and the interview data were analysed by a thematic framework method. It was found that indicators, feedback and a focus event in the problem stream drew the attention of policymakers and the society for tobacco control. In 2011, Ying Songnian, a representative of the Beijing Municipal People's Congress, put forward tobacco control legislation, which was just in time for the legislative reform of the Congress. The proposal was studied by the Congress, and a strategy of 'social co-governance' was founded. In the political stream, the government actively promoted tobacco control and social organizations extensively participated in it. In 2013, the General Office of the Central Committee of the Chinese Communist Party and the General Office of the State Council issued a notice on matters related to leading cadres taking the lead in banning smoking in public places, which opened a policy window for decision-makers who were hesitatant. The issue of tobacco control was successfully put on the policy agenda and contributed to the introduction of the Beijing Municipal Regulations on Smoking Control. Development of the factors in problem stream, policy stream and political stream promoted the setting up of the tobacco control policy agenda in Beijing. It is suggested that more cities should learn from the experience of Beijing, seize the opportunity of the ideological change of the ruling party, actively identify the problems, mobilize and advocate for representatives and introduce the concept of 'social co-governance' to promote tobacco control legislation.
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Affiliation(s)
- Yunting Zheng
- School of Health Management, Fujian Medical University, NO. 1 Xue Yuan Road, University Town, FuZhou, Fujian 350122, China
- School of Public Health, Peking University, NO. 38 Xue Yuan Road, Haidian District, Beijing 100191, China
| | - Yuhui Shi
- School of Public Health, Peking University, NO. 38 Xue Yuan Road, Haidian District, Beijing 100191, China
| | - Ying Ji
- School of Public Health, Peking University, NO. 38 Xue Yuan Road, Haidian District, Beijing 100191, China
| | - Chun Chang
- School of Public Health, Peking University, NO. 38 Xue Yuan Road, Haidian District, Beijing 100191, China
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Jalal Eddine R, Moacdieh NM. Bilingual Cigarette Warning Labels: Effects on Young People's Recall and Attention in Lebanon. JOURNAL OF DRUG EDUCATION 2023; 52:30-44. [PMID: 37858924 DOI: 10.1177/00472379231209313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
The goal was to determine the effects of bilingual cigarette warning labels on the recall performance and attention of young bilingual Lebanese college students. Forty-eight students were shown English-only, Arabic-only, or bilingual cigarette warning labels in 2020. Participants recalled as many of the labels as they could after the experiment and then two weeks later. Eye tracking was used to determine attention to the label and subjective data were collected. Results showed that bilingual labels did not lead to better recall; participants needed more time to extract data from bilingual labels and first looked at them later in time, although bilingual labels were revisited more. However, participants believed that bilingual labels were better. It appeared that bilingual labels led to clutter rather than helped recall.
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Affiliation(s)
- Reem Jalal Eddine
- Department of Industrial Engineering and Management, American University of Beirut, Beirut, Lebanon
| | - Nadine Marie Moacdieh
- Department of Industrial Engineering and Management, American University of Beirut, Beirut, Lebanon
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Mugharbil S, Tleis M, Romani M, Salloum RG, Nakkash R. Understanding Determinants of Electronic Cigarette and Heated Tobacco Product Use among Young Adults in Lebanon: Prevention and Policy Implications. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4273. [PMID: 36901283 PMCID: PMC10001978 DOI: 10.3390/ijerph20054273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 02/22/2023] [Accepted: 02/24/2023] [Indexed: 06/18/2023]
Abstract
In line with the global trends, electronic cigarettes (e-cigarettes) and heated tobacco products (HTPs) have found their way to the Lebanese market. The present study aims to explore the determinants of e-cigarette and HTP use among young adults in Lebanon. Convenience and snowball sampling were used to recruit participants aged 18-30 residing in Lebanon, who were familiar with e-cigarettes products. Twenty-one consenting participants were interviewed via Zoom and the verbatim transcriptions were analyzed thematically. The outcome expectancy theory was used to categorize the results into determinants and deterrents of use. HTPs were viewed by participants as another mode of smoking. The results showed that most participants perceived e-cigarettes and HTPs to be healthier alternatives to cigarettes/waterpipes and to be used as smoking cessation tools. Both e-cigarettes and HTPs were found to be easily accessible in Lebanon; although, in the recent economic crisis, e-cigarettes have become unaffordable. More research is needed to investigate the motivations and behaviors of e-cigarette and HTP users if effective policies and regulations are to be developed and enforced. Furthermore, greater public health efforts need to be made to increase awareness of the harmful impacts of e-cigarettes and HTPs and to implement evidence-based cessation programs tailored to those modes of smoking.
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Affiliation(s)
- Sanaa Mugharbil
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut 11-0236, Lebanon
| | - Malak Tleis
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut 11-0236, Lebanon
| | - Maya Romani
- Department of Family Medicine, Faculty of Medicine, American University of Beirut Medical Center, Beirut 11-0236, Lebanon
| | - Ramzi G. Salloum
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut 11-0236, Lebanon
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32611, USA
| | - Rima Nakkash
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut 11-0236, Lebanon
- Global and Community Health Department, College of Public Health, George Mason University, Fairfax, VA 22030, USA
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10
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Alaouie H, Branston JR, Bloomfield MJ. The Lebanese Regie state-owned tobacco monopoly: lessons to inform monopoly-focused endgame strategies. BMC Public Health 2022; 22:1632. [PMID: 36038852 PMCID: PMC9421117 DOI: 10.1186/s12889-022-13531-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 05/23/2022] [Indexed: 11/25/2022] Open
Abstract
Background Many countries have started pursuing tobacco ‘endgame’ goals of creating a ‘tobacco-free’ country by a certain date. Researchers have presented models to attain this goal, including shifting the supply of tobacco to a monopoly-oriented endgame model (MOEM), wherein a state-owned entity controls the supply and distribution of tobacco products. Although not designed to end tobacco use, the Regie in Lebanon exhibits some of the key features identified in MOEM and hence can serve as a practical example from which to draw lessons. Methods We comprehensively review previous literature exploring tobacco endgame proposals featuring a MOEM. We distil these propositions into core themes shared between them to guide a deductive analysis of the operations and actions of the Regie to investigate how it aligns (or does not) with the features of the MOEM. Results Analysing the endgame proposals featuring MOEM, we generated two main themes: the governance of the organisation; and its operational remit. In line with these themes, the investigation of the Regie led to several reflections on the endgame literature itself, including that it: (i) does not seem to fully appreciate the extent to which the MOEM could end up acting like Transnational Tobacco Companies (TTC); (ii) has only vaguely addressed the implications of political context; and (iii) does not address tobacco growing despite it being an important element of the supply chain. Conclusion The implementation of tobacco endgame strategies of any type is now closer than ever. Using the Regie as a practical example allows us to effectively revisit both the potential and the pitfalls of endgame strategies aiming to introduce some form of monopoly and requires a focus on: (i) establishing appropriate governance structures for the organisation; and (ii) adjusting the financial incentives to supress any motivation for the organisation to expand its tobacco market.
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Affiliation(s)
- Hala Alaouie
- Department of Social and Policy Sciences, University of Bath, Bath, UK. .,Department for Health, Tobacco Control Research Group, University of Bath, Bath, UK.
| | - J Robert Branston
- Department for Health, Tobacco Control Research Group, University of Bath, Bath, UK.,School of Management, University of Bath, Bath, UK
| | - Michael John Bloomfield
- Department of Social and Policy Sciences, University of Bath, Bath, UK.,Department for Health, Tobacco Control Research Group, University of Bath, Bath, UK
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Mialon M, Fooks G, Cullerton K, Gómez-Donoso C, Fidalgo HS, Nakkash R, Lacy-Nichols J. Corporations and Health: The Need to Combine Forces to Improve Population Health. Int J Health Policy Manag 2022; 11:871-873. [PMID: 35596271 PMCID: PMC9808186 DOI: 10.34172/ijhpm.2022.6687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 05/10/2022] [Indexed: 01/12/2023] Open
Abstract
The recent concerns raised about commercial determinants of health (CDoH) are not new. Numerous organizations around the world are working on these issues. These groups have emerged in response to specific issues and contexts and bring with them a diversity of interests, worldviews and strategies for change. In creating the 'Governance, Ethics and Conflicts of Interest in Public Health' network in 2018, our hope was to broaden our engagement with other actors advocating for change and strengthen our collective efforts. For academics, this requires moving further beyond the collective comfort zone of peer-reviewed publications, working with the media and those with political expertise, and learning from and supporting other stakeholders with a common vision.
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Affiliation(s)
| | | | | | | | | | - Rima Nakkash
- Health Promotion and Community Health Department, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Global and Community Health Department, College of Health and Human Services, George Mason University, Fairfax, VA, USA
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Abu-Rmeileh NME, Khader YS, Abdul Rahim H, Mostafa A, Nakkash RT, Hamadeh RR, Ben Romdhane H, Salloum RG. Tobacco control in the Eastern Mediterranean region: implementation progress and persisting challenges. Tob Control 2022; 31:150-152. [PMID: 35241580 DOI: 10.1136/tobaccocontrol-2021-056539] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Niveen M E Abu-Rmeileh
- Institute of Community and Public Health, Birzeit University, Birzeit, Palestine, State of
| | - Yousef Saleh Khader
- Epidemiology and Biostatistics, Jordan University of Science and Technology, Irbid, Jordan
| | - Hanan Abdul Rahim
- College of Health Sciences, QU Health, Qatar University, Doha, Ad Dawhah, Qatar
| | - Aya Mostafa
- Department of Community, Environmental, and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Rima T Nakkash
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Randah R Hamadeh
- College of Medicine and Medical Sciences (CMMS), Arabian Gulf University, Manama, Bahrain
| | | | - Ramzi George Salloum
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Health Outcomes and Policy, University of Florida, Gainesville, Florida, USA
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Chaaya M, Farran D, Saab D, Al-Hindi M, Romani M, Khairallah M, Nakkash R. Influence of a University Tobacco-Free Policy on the Attitudes, Perceptions of Compliance, and Policy Benefit Among the University Students: A Pre-Post Investigation. Int J Public Health 2021; 66:614602. [PMID: 34744578 PMCID: PMC8565293 DOI: 10.3389/ijph.2021.614602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 02/11/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To evaluate the effectiveness of a university tobacco-free policy by examining differences in students' attitudes, perceptions of compliance and policy benefits, after one year of the policy's implementation. Methods: Cross-sectional studies were undertaken to collect data pre- and 1 year post-policy implementation. The two samples were selected using stratified random sampling. Results: The prevalence of smoking decreased from 26% pre-policy implementation to 21% 1 year after (p = 0.035). The proportion of smokers who thought the policy had contributed to a reduction in smoking frequency increased from 10% to 70% (p < 0.001). Smokers' support for the policy rose from 42 to 58% (p = 0.007). Conclusion: Against the background of a strongly pro-tobacco environment in Lebanon, it is possible to create a positive change in the mindset of smokers at the levels of the education and smoking cessation and more efforts should be expended to bring it about.
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Affiliation(s)
- Monique Chaaya
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Dina Farran
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Dahlia Saab
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Mahmoud Al-Hindi
- Department of Mechanical Engineering, Maroun Semaan Faculty of Engineering and Architecture, American University of Beirut, Beirut, Lebanon
| | - Maya Romani
- Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mary Khairallah
- Human Resources Department, American University of Beirut, Beirut, Lebanon
| | - Rima Nakkash
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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Ebrahimi Kalan M, Bahelah R, Bursac Z, Ward KD, Ben Taleb Z, Tleis M, Jebai R, Asfar T, Eissenberg T, Maziak W. A Group-Based Modeling Approach to Identify Developmental Trajectories of Nicotine Dependence Among Lebanese Adolescents Waterpipe Smokers. Nicotine Tob Res 2021; 23:2056-2064. [PMID: 34125916 PMCID: PMC8825565 DOI: 10.1093/ntr/ntab128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 06/11/2021] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Adolescence represents a critical period in which nicotine dependence (ND) symptoms are developing. Little is known about waterpipe (WP) smoking and developmental trajectories of ND criteria across adolescence. AIMS AND METHODS Here, we aimed to identify ND trajectories from early- to late-adolescence in current (past 30 days) WP smokers and examine baseline correlates of each identified trajectory, using the International Classification of Diseases, 10th Revision (ICD-10). The analytical sample consisted of 278 current WP smokers from eight waves of an ongoing longitudinal cohort of eighth to ninth graders in Lebanon. Group-based trajectory modeling was estimated to identify trajectory classes for ICD-10-ND criteria over ages 11-18. RESULTS A group-based modeling approach yielded a four-class solution that best fit the data and reflected differences in the timing of ND onset during adolescence: no-onset of ND (43.9%), early-onset (16.2%), mid-onset (26.6%), and late-onset (13.3%) of ND criteria. Having a less-educated mother (adjusted odds ratio [aOR] = 4.08, 95% confidence interval [95% CI] = 1.01% to 16.53%) and siblings who smoke WP (aOR = 3.95, 95% CI = 1.08% to 14.42%), exposure to favorite WP-specific advertisements (aOR = 3.33, 95% CI = 1.03% to 10.85%), and being a novelty seeker (aOR = 1.12, 95% CI = 1.02% to 1.23%) were associated with early-onset of ND. Daily (aOR = 3.48, 95% CI = 1.08% to 11.23%) or weekly (aOR = 2.20, 95% CI = 1.05% to 4.62%) WP smokers (vs. monthly) and having higher stress level (aOR = 1.07, 95% CI = 1.00% to 1.14%) were associated with mid-onset trajectory. Believing that WP smoking is not harmful to health (aOR = 0.11, 95% CI = 0.02% to 0.82%) and spending less than 60 minutes on a WP smoking session (aOR = 5.62, 95% CI = 1.20% to 26.44%) were associated with late-onset ND trajectory class. CONCLUSIONS Monitoring the development of ND trajectories among WP smokers may identify an individual as belonging to one of these four groups with distinct individual and socioenvironmental factors and allow the individual and health care providers opportunities to inform initiate on-time WP-specific tailored prevention and cessation interventions. IMPLICATIONS The results from this study showed a four-class trajectory of ICD-10-ND criteria and suggested that every ND trajectory class during adolescence could have distinctive characteristics and therefore provides new insights into the process of ND in terms of when and what specific interventions are needed to curb the development of ND and long-term WP smoking among youth.
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Affiliation(s)
- Mohammad Ebrahimi Kalan
- Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, FL, USA
| | - Raed Bahelah
- School of Health Sciences, Baldwin Wallace University, Berea, OH, USA
| | - Zoran Bursac
- Department of Biostatistics, Robert Stempel College of Public Health, Florida International University, Miami, FL, USA
| | - Kenneth D Ward
- School of Public Health, University of Memphis, Memphis, TN, USA
| | - Ziyad Ben Taleb
- Department of Kinesiology, College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, USA
| | - Malak Tleis
- Health Promotion and Community Health Department, Faculty of Health Sciences, American University of Beirut, Miami, FL, USA
| | - Rime Jebai
- Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, FL, USA
| | - Taghrid Asfar
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Thomas Eissenberg
- Center for the Study of Tobacco Products, Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Wasim Maziak
- Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, FL, USA
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15
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Goel S, Kar SS, Verma M, Sivanantham P, Naik BN, Gupta D. Evidence on article 5.3 of FCTC (tobacco industry interference in tobacco control activities) in India- a qualitative scoping study. BMC Public Health 2021; 21:1855. [PMID: 34649546 PMCID: PMC8515702 DOI: 10.1186/s12889-021-11773-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 09/10/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The Tobacco Industry (henceforth TI) yearns to portray itself as being "socially responsible" and fights for the decision-making positions; that are it used to deter, delay or dilute tobacco control measures. There is little documented evidence of Tobacco Industry Interference (henceforth TII) from India, the scope of their interference and challenges faced by the experts for effective tobacco control. This research study seeks to cover this significant gap in the literature on the TI of India. METHODS A cross-sectional qualitative research design, based upon in-depth interviews (N = 26), was used to explore the key stakeholders' opinions regarding TII in India. The interviews used a set of questions to collect information about the participant's roles and responsibilities in tobacco control, the nature of TII faced by the participants, means of influence by TI, barriers and challenges to tobacco control efforts. RESULTS Most of the respondents were engaged in tobacco control, training, advocacy and awareness generation activities for 5-10 years or more. The respondents defined the TI and its scope as per their experience with the help of the power ranking methodology. Most of them perceived TI as 'manufacturers' while others consider them as 'advertisers', 'public relation companies', 'wholesalers', 'vendors', and 'Government firms with TI stocks. The research team identified six significant domains: influencing the policy and administrative decisions, Interference in the implementation of tobacco control laws and activities, false propaganda and hiding the truth, manipulating front action groups (FAG), rampant tobacco advertising and promotion activities and others under which TII activities were classified. Most respondents believed that TI players were interfering in the policy decisions, implementing the tobacco control laws and activities and manipulating the FAG. A detailed taxonomic classification of the TII strategies that emerged from our analysis was linked to article 5.3 of FCTC. CONCLUSIONS The study documented a significant level of TII in different domains, with stakeholders acting at various hierarchical levels. Thus providing insight into the tactics of the TI in order to enable stakeholders to anticipate and pre-empt the kinds of alliances the TI may attempt to build; stimulating academicians and researchers to undertake in-depth analysis into various strategies and therefore underscoring the need to ensuring transparency in official interaction with the TI and its representatives.
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Affiliation(s)
- Sonu Goel
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012 India
- Public Health Masters Program at School of Medicine, University of Limerick, Limerick, Ireland
- Faculty of Human and Health Sciences, Swansea University, Swansea, United Kingdom
| | - Sitanshu Sekhar Kar
- Department of Preventive & Social Medicine, Jawaharlal Institute of Postgraduate Institute of Medical Education & Research, Puducherry, India
| | - Madhur Verma
- Department of Community and Family Medicine, All India Institute of Medical Sciences Bathinda, Bathinda, Punjab India
| | - Parthibane Sivanantham
- Department of Preventive & Social Medicine, Jawaharlal Institute of Postgraduate Institute of Medical Education & Research, Puducherry, India
| | - Bijay Nanda Naik
- Community & Family Medicine, All India Institute of Medical Sciences Patna, Patna, India
| | - Deepti Gupta
- Department of English and Cultural Studies, Panjab University, Chandigarh, India
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Nakkash R, Tleis M, Chehab S, Wensong W, Schmidt M, Ward KD, Maziak W, Asfar T. Novel Insights into Young Adults' Perceived Effectiveness of Waterpipe Tobacco-Specific Pictorial Health Warning Labels in Lebanon: Implications for Tobacco Control Policy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7189. [PMID: 34281125 PMCID: PMC8296856 DOI: 10.3390/ijerph18137189] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 11/30/2022]
Abstract
This study aims to explore the perceived effectiveness of waterpipe (WP) tobacco specific health warning labels (HWLs) among young adult WP smokers and nonsmokers in Lebanon. Before participating in focus group discussions, participants (n = 66; WP smokers n = 30; nonsmokers n = 36; age 18-33) completed a brief survey to rate the effectiveness of 12 HWLs' and rank them according to four risk themes (WP health effects, WP harm to others, WP-specific harm, and WP harm compared to cigarettes). Differences in HWLs ratings by WP smoking status were examined and the top-ranked HWL in each theme were identified. HWLs depicting mouth cancer and harm to babies were rated as the most effective by both WP smokers and non-smokers. WP smokers rated HWLs which depicted harm to children and infants as more effective than non-smokers. The top-ranked HWLs for perceived overall effectiveness were those depicting "oral cancer", "harm to babies", "orally transmitted diseases" and "mouth cancer". HWLs depicting oral lesions and harm to babies were rated as most effective, while HWLs showing the harmful effects of WP secondhand smoke on infants and children were rated as less effective by nonsmokers compared to smokers. Our study provides evidence on the potential effectiveness of HWLs for further evaluation in Lebanon and the Eastern Mediterranean region. The results will inform and guide the development and implementation of tobacco control policy.
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Affiliation(s)
- Rima Nakkash
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut 1103, Lebanon; (R.N.); (M.T.); (S.C.)
| | - Malak Tleis
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut 1103, Lebanon; (R.N.); (M.T.); (S.C.)
| | - Sara Chehab
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut 1103, Lebanon; (R.N.); (M.T.); (S.C.)
| | - Wu Wensong
- Department of Mathematics and Statistics, Florida International University, Miami, FL 33199, USA;
| | - Michael Schmidt
- Department of Art, University of Memphis, Memphis, TN 38152, USA;
| | - Kenneth D. Ward
- School of Public Health, University of Memphis, Memphis, TN 38152, USA;
| | - Wasim Maziak
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL 33199, USA;
- Syrian Center for Tobacco Studies, Aleppo 2203, Syria
| | - Taghrid Asfar
- Syrian Center for Tobacco Studies, Aleppo 2203, Syria
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL 33124, USA
- Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, FL 33124, USA
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El Achi N, Honein-Abouhaidar G, Rizk A, Kobeissi E, Papamichail A, Meagher K, Ekzayez A, Abu-Sittah GS, Patel P. Assessing the capacity for conflict and health research in Lebanon: a qualitative study. Confl Health 2020; 14:59. [PMID: 32821269 PMCID: PMC7432458 DOI: 10.1186/s13031-020-00304-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 08/08/2020] [Indexed: 01/08/2023] Open
Abstract
Background Conflicts pose new challenges for health systems, requiring rapid and practical approaches to meet emerging needs on the ground. Lebanon has been highly influenced by surrounding conflicts in the Middle East and North Africa (MENA) region, especially the Syrian crisis. Strengthening research capacity to collect evidence on conflict in the MENA region and beyond is crucial to inform healthcare policy and practice. For targeted capacity strengthening interventions, the main objective of this paper is to present key findings of a needs assessment of conflict and health research in Lebanon. This will support recent efforts to scale up context-specific policies, interventions to strengthen the country’s health system, and research capacity. Methods The study is based on 30 semi-structured interviews with key informants such as specialist academics, humanitarian workers and public sector officials. Results Despite being ranked third in the number of publications on biomedical and health research per capita in MENA and in hosting reputable universities which are considered central academic hubs in the region, lack of nationwide research culture, insufficient funding and limited access to data were reported to be major challenges for health researchers in Lebanon. Even with the ongoing efforts, poor impact of research on policy continues to be a persistent gap. Large disparities in research capacities and taught skills were reported between different universities in Lebanon, with a disproportionate emphasis on quantitative over qualitative skills. Most medical students are not trained to conduct research or to practice in conflict settings. Concerns were also expressed regarding the ethics of research conducted, specifically by local non-governmental organizations. Recommendations To conduct contextualized trainings on research skills with a stronger focus on qualitative approaches, medical practice, and ethical research in conflict. To better involve policymakers in designing research agendas by organizing multiple stakeholder meetings. Conclusion The study indicates that health research in Lebanon is characterized by considerable strengths in terms of human capital and research capacities of certain universities. However, the Lebanese research infrastructure needs further development in terms of ensuring sustainable funding, providing access to data, teaching qualitative research skills, conducting ethical and multidisciplinary research, and promoting cross-sectoral knowledge transfer.
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Affiliation(s)
- Nassim El Achi
- R4HC-MENA, Conflict Medicine Program, Global Health Institute, American University of Beirut, Beirut, 1107 2020 Lebanon
| | - Gladys Honein-Abouhaidar
- Hariri School of Nursing, Global Health Institute, American University of Beirut, Beirut, 1107 2020 Lebanon
| | - Anthony Rizk
- R4HC-MENA, Conflict Medicine Program, Global Health Institute, American University of Beirut, Beirut, 1107 2020 Lebanon
| | - Elsa Kobeissi
- Conflict Medicine Program, Global Health Institute, American University of Beirut, Beirut, 1107 2020 Lebanon
| | - Andreas Papamichail
- School of Politics & International Relations, Queen Mary University of London, London, E1 4NS UK
| | - Kristen Meagher
- R4HC-MENA, Conflict and Health Research Group, Department of War Studies, King's College London, London, WC2R 2LS UK
| | - Abdulkarim Ekzayez
- R4HC-MENA, Conflict and Health Research Group, Department of War Studies, King's College London, London, WC2R 2LS UK
| | - Ghassan S Abu-Sittah
- R4HC-MENA, Conflict Medicine Program, Global Health Institute, American University of Beirut, Beirut, 1107 2020 Lebanon
| | - Preeti Patel
- R4HC-MENA, Conflict and Health Research Group, Department of War Studies, King's College London, London, WC2R 2LS UK
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Chaaya M, Nakkash R, Saab D, Kadi L, Afifi R. Effect of tobacco control policies on intention to quit smoking cigarettes: A study from Beirut, Lebanon. Tob Induc Dis 2019; 17:63. [PMID: 31582952 PMCID: PMC6770611 DOI: 10.18332/tid/111128] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 07/19/2019] [Accepted: 07/23/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION In Lebanon, the tobacco control policy, Law 174, became effective in 2011. Using the International Tobacco Control Policy Evaluation Project (ITC) conceptual model, this study aims to assess the association between exposure to control measures related to the policy and the intention to quit, which is a mediator in the pathway leading to behavioral change (quitting). METHODS This is a secondary data analysis of 154 cigarette smokers from a cross-sectional survey that assessed compliance with Law 174 among Beirut residents aged 15–65 years. Data were collected face-to-face, three months after the implementation of indoor public places and tobacco advertisement/promotion bans. Intention to quit smoking was the main outcome. Exposure to policy control measures such as seeing smokers in restaurants, and noticing warning labels on cigarette packs were the explanatory variables. Sociodemographics, past smoking behavior, and psychosocial variables were also considered for their moderating and mediating effects, respectively. Crude and adjusted odds ratios (ORs) were generated. Sobel test was used to check for possible mediation. RESULTS Intention to quit was reported by 24% of cigarette smokers. The association between noticing warning labels and having intentions to quit was statistically significant (adjusted OR=6.27). Concerns about influencing children’s smoking behavior had a statistically significant mediation effect on the relationship. After adding the interaction term between noticing the warnings and previous quit attempts, the OR was inflated to 12.92, suggesting a possible interaction. CONCLUSIONS This study offers preliminary insight into how Lebanese smokers are influenced by policy related control measures like health warning labels on cigarette packs. Tobacco control policy advocates should push for stronger enforcement of public smoking bans in general. Behavioral intervention should work on the mediator variables to influence smoking behavior and encourage quitting. Further prospective studies modelling quitting as outcome are needed.
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Affiliation(s)
- Monique Chaaya
- Department of Epidemiology and Population Health, American University of Beirut, Beirut, Lebanon
| | - Rima Nakkash
- Department of Health Promotion and Community Health, American University of Beirut, Beirut, Lebanon
| | - Dahlia Saab
- Department of Epidemiology and Population Health, American University of Beirut, Beirut, Lebanon
| | - Lina Kadi
- Department of Epidemiology and Population Health, American University of Beirut, Beirut, Lebanon
| | - Rima Afifi
- Department of Community and Behavioral Health, The University of Iowa, Iowa City, United States
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Nakkash RT, Ghandour LA, Yassin N, Anouti S, Chalak A, Chehab S, El-Aily A, Afifi RA. "Everyone Has the Right to Drink Beer": A Stakeholder Analysis of Challenges to Youth Alcohol Harm-Reduction Policies in Lebanon. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E2874. [PMID: 31408935 PMCID: PMC6719017 DOI: 10.3390/ijerph16162874] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 08/03/2019] [Accepted: 08/05/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Alcohol use is a major risk factor in premature death and disability, especially among youth. Evidence-based policies to prevent and control the detrimental effect of alcohol use have been recommended. In countries with weak alcohol control policies-such as Lebanon, stakeholder analysis provides critical information to influence policy interventions. This paper assesses the views of stakeholders regarding a national alcohol harm reduction policy for youth. METHODS We interviewed a total of 22 key stakeholders over a period of 8 months in 2015. Stakeholders were selected purposively, to include representatives of governmental and non-governmental organizations and industry that could answer questions related to core intervention areas: affordability, availability, regulation of marketing, and drinking and driving. We analyzed interview transcripts using thematic analysis. RESULTS Three themes emerged: Inadequacy of current alcohol control policies; weak governance and disregard for rule of law as a determinant of the status quo; and diverting of responsibility towards 'other' stakeholders. In addition, industry representatives argued against evidence-based policies using time-worn strategies identified globally. CONCLUSIONS Our findings indicate that alcohol harm reduction policies are far from becoming a policy priority in Lebanon. There is a clear need to shift the narrative from victim blaming to structural conditions.
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Affiliation(s)
- Rima T Nakkash
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut 1107-2020, Lebanon
| | - Lilian A Ghandour
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut 1107-2020, Lebanon
| | - Nasser Yassin
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut 1107-2020, Lebanon
| | - Sirine Anouti
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut 1107-2020, Lebanon
| | - Ali Chalak
- Department of Agriculture, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut 1107-2020, Lebanon
| | - Sara Chehab
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut 1107-2020, Lebanon
| | - Aida El-Aily
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut 1107-2020, Lebanon
| | - Rima A Afifi
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, IA 52242, USA.
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