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Jawad M, Awawda S, Abla R, Chalak A, Khader YS, Nakkash RT, Mostafa A, Salloum RG, Abu-Rmeileh NME. Impact of waterpipe tobacco taxation on consumption, government revenue and premature deaths averted in Jordan, Lebanon and Palestine: a simulation study. Tob Control 2024; 33:e85-e90. [PMID: 36601792 PMCID: PMC10958304 DOI: 10.1136/tc-2022-057284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 11/18/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Despite the high prevalence of waterpipe tobacco smoking in the Eastern Mediterranean region, evidence supporting its fiscal measures is limited. We modelled the impact of waterpipe tobacco-specific excise taxes on consumption, government revenue and premature deaths averted in Jordan, Lebanon and Palestine. METHODS We developed a simulation model using country-specific and market share-specific price, consumption and price elasticity data from WHO, UN Comtrade and nationally representative surveys. We modelled increases to specific excise taxes to meet a 35.9% tax burden on 20 g of waterpipe tobacco in Lebanon and Jordan, in line with the global average, and to double government revenues from excise duties in Palestine, which has surpassed this average. RESULTS Specific excise tax was raised by $1.14 ($0.18-$1.32) in Jordan, $2.41 ($0.03-$2.44) in Lebanon (alongside removal of ad valorem taxes) and $2.39 ($1.72-$4.11) in Palestine per 20 g of waterpipe tobacco. Government revenue increased by $126.3 million in Jordan, $53.8 million in Lebanon and $162.4 million in Palestine while waterpipes smoked decreased by 32.4% in Jordan, 71.0% in Lebanon and 16.3% in Palestine. The corresponding numbers of premature deaths averted annually were approximately 162 000; 1 000 000; and 52 000. DISCUSSION Increases in waterpipe tobacco-specific excise taxes substantially reduce smoking and increase government revenue and averted premature deaths in Jordan, Lebanon and Palestine. This has positive implications for both public health and financing and should be considered a policy priority.
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Affiliation(s)
- Mohammed Jawad
- Public Health Policy Evaluation Unit, Imperial College London, London, UK
| | - Sameera Awawda
- Department of Economics and Institute of Community and Public Health, Birzeit University, Birzeit, Palestine
| | - Ruba Abla
- Department of Health Promotion and Community Health, American University of Beirut, Beirut, Lebanon
| | - Ali Chalak
- Department of Agriculture, American University of Beirut, Beirut, Lebanon
| | - Yousef S Khader
- Epidemiology and Biostatistics, Jordan University of Science and Technology, Irbid, Jordan
| | - Rima T Nakkash
- Health Behaviour and Education Department, American University of Beirut, Beirut, Lebanon
| | - Aya Mostafa
- Department of Community, Environmental, and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ramzi G Salloum
- Health Outcomes and Policy, University of Florida, Gainesville, Florida, USA
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Farran D, Salloum RG, El Jardali F, Abla R, Abu Rmeileh N, Al Sheyab N, Awaw-da S, Chalak A, Jawad M, Khader Y, Mostafa A, Nakkash R. From knowledge production to knowledge translation: Waterpipe tobacco control research in the Eastern Mediterranean Region. Tob Prev Cessat 2024; 10:TPC-10-03. [PMID: 38250221 PMCID: PMC10797642 DOI: 10.18332/tpc/175953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/24/2023] [Accepted: 11/27/2023] [Indexed: 01/23/2024]
Abstract
Waterpipe tobacco smoking (WTS) rates in the Eastern Mediterranean Region (EMR) are the highest worldwide, particularly among young people. Although fiscal policies to curb tobacco use have been recommended by the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC), implementation has been suboptimal. The Eastern Mediterranean Consortium on the Economics of Waterpipe Tobacco Smoking (ECON-WTS) was formed in response to this need to produce knowledge on the economics of WTS in the EMR and apply a comprehensive Knowledge translation (KT) framework. The KT framework comprised priority setting, evidence synthesis, knowledge translation, and knowledge uptake. In this article, we discuss the approaches followed in applying the KT framework to WTS control, providing examples and noting challenges and lessons learned where possible.
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Affiliation(s)
- Dina Farran
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Ramzi G. Salloum
- Department of Health Outcomes & Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Fadi El Jardali
- Health Management and Policy Department, Faculty of Health Sciences, American University of Beirut, Lebanon
| | - Ruba Abla
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Lebanon
| | - Niveen Abu Rmeileh
- Institute of Community and Public Health, Birzeit University, Birzeit, Palestine
| | - Nihaya Al Sheyab
- Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Sameera Awaw-da
- Institute of Community and Public Health, Birzeit University, Birzeit, Palestine
- Economics Department, Faculty of Business and Economics, Birzeit University, Birzeit, Palestine
| | - Ali Chalak
- Department of Agriculture, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Mohammed Jawad
- Public Health Policy Evaluation Unit, Imperial College London School of Public Health, London, UK
| | - Yousef Khader
- Department of Community Medicine, Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Aya Mostafa
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Rima Nakkash
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Lebanon
- Global and Community Health Department, George Mason University, Virginia, USA
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Farran D, Abla R, Nakkash R, Abu Rmeileh N, Jawad M, Khader Y, Mostafa A, Salloum RG, Chalak A. Factors associated with intentions to quit tobacco use in Lebanon: A cross-sectional survey. Prev Med Rep 2024; 37:102572. [PMID: 38186664 PMCID: PMC10767259 DOI: 10.1016/j.pmedr.2023.102572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/16/2023] [Accepted: 12/19/2023] [Indexed: 01/09/2024] Open
Abstract
Introduction The prevalence of tobacco smoking in Lebanon is among the highest globally. This study aims to determine past attempts to quit smoking among adults and identify factors associated with intentions to quit. Methods A nationally representative telephone survey was conducted between June and August 2022. Eligibility criteria included people aged >=18 years residing in Lebanon. The questionnaire was divided into three components: socio-demographic characteristics, cigarette and waterpipe tobacco use behaviours. Binary logistic regression was used to examine factors associated with intention to quit cigarette and waterpipe tobacco use. Results A total of 2003 respondents were included in the study. The prevalence of any tobacco product use was 41%, the prevalence of current cigarette smoking was 41% and the prevalence of current waterpipe tobacco use was 20%. Approximately 24% of adults who smoke cigarettes and 26% of those who use waterpipe tobacco had previous quit attempts mainly due to health concerns. Intentions to quit smoking within the next 6 months were reported among 12% of survey respondents. Among adults who smoke, past quit attempts increased the likelihood of intentions to quit cigarette smoking by 5-fold (OR: 5.11; 95% CI: 1.80-14.47, p = 0.002) and waterpipe tobacco use by 7-fold (OR: 6.98, 95% CI: 2.63-18.51, p = <0.001). Age and income were associated with intentions to quit cigarette but not waterpipe tobacco use. Conclusion Intention to quit smoking was strongly associated with past quitting attempts. Understanding factors associated with intentions to quit can help inform the development of context specific smoking cessation interventions.
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Affiliation(s)
- Dina Farran
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Ruba Abla
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Lebanon
| | - Rima Nakkash
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Lebanon
- Global and Community Health Department, George Mason University, VA, USA
| | - Niveen Abu Rmeileh
- Institute of Community and Public Health, Birzeit University, Birzeit, Palestine
| | - Mohammed Jawad
- Public Health Policy Evaluation Unit, Imperial College London School of Public Health, London, UK
| | - Yousef Khader
- Department of Community Medicine, Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Aya Mostafa
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ramzi G. Salloum
- Department of Health Outcomes & Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL, USA
| | - Ali Chalak
- Department of Agriculture, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
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Bteddini D, Nakkash RT, Chalak A, Jawad M, Khader Y, Abu-Rmeileh NME, Mostafa A, Abla R, Awawda S, Salloum RG. Economic research in waterpipe tobacco smoking: reflections on data, demand, taxes, equity and health modelling. Tob Control 2023; 33:116-121. [PMID: 35902224 DOI: 10.1136/tc-2022-057383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 07/22/2022] [Indexed: 11/03/2022]
Abstract
Economic evaluation of tobacco control policies is common in high-income settings and mainly focuses on cigarette smoking. Evidence suggests that increasing the excise tax of tobacco products is a consistently effective tool for reducing tobacco use and is an efficient mechanism for increasing government revenues. However, less research has been conducted in low/middle-income countries where other tobacco forms are common. This paper presents insights from our work on the economics of waterpipe tobacco smoking conducted in the Eastern Mediterranean Region where waterpipe smoking originated and is highly prevalent. The specific areas related to economics of waterpipe smoking considered herein are: price elasticity, taxation, government revenue, expenditure and healthcare costs. This paper aims to provide practical guidance for researchers investigating the economics of waterpipe tobacco with potential implications for other novel tobacco products. We present lessons learnt across five thematic areas: data, demand, taxes, equity and health modelling. We also highlight knowledge gaps to be addressed in future research. Research implications include designing comprehensive assessment tools that investigate heterogeneity in waterpipe smoking patterns; accounting for cross-price elasticity of demand with other tobacco products; exploring the change in waterpipe tobacco smoking in response to a tax increase and analysing the equity impact of waterpipe tobacco control interventions.
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Affiliation(s)
- Dima Bteddini
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
| | - Rima T Nakkash
- Department of Health Promotion and Community Health, American University of Beirut, Beirut, Lebanon
- Department of Global and Community Health, George Mason University College of Health and Human Services, Fairfax, Virginia, USA
| | - Ali Chalak
- Department of Agriculture, American University of Beirut, Beirut, Lebanon
| | - Mohammed Jawad
- Public Health Policy Evaluation Unit, Imperial College London, London, UK
| | - Yousef Khader
- Department of Community Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | | | - Aya Mostafa
- Department of Community, Environmental, and Occupational Medicine, Ain Shams University Faculty of Medicine, Cairo, Egypt
| | - Ruba Abla
- Department of Health Promotion and Community Health, American University of Beirut, Beirut, Lebanon
| | - Sameera Awawda
- Institute of Community and Public Health, Birzeit University, Birzeit, Palestine
| | - Ramzi G Salloum
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
- Department of Health Promotion and Community Health, American University of Beirut, Beirut, Lebanon
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Mostafa A, Chalak A, Nakkash R, Abla R, Khader YS, Abu-Rmeileh NM, Salloum RG, Jawad M. Health and economic impacts of introducing specific excise tax to waterpipe tobacco in Egypt: a simulation model of simple and mixed tax policy approaches. BMJ Glob Health 2023; 8:e012048. [PMID: 37813447 PMCID: PMC10565201 DOI: 10.1136/bmjgh-2023-012048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 07/31/2023] [Indexed: 10/13/2023] Open
Abstract
INTRODUCTION Waterpipe tobacco is taxed at half the rate of cigarettes in Egypt and, unlike cigarettes, does not have a specific excise component. We aimed to simulate the introduction of a specific excise tax on waterpipe tobacco consumption, premature deaths and government waterpipe tobacco revenue in Egypt. METHODS We took model inputs from the latest available data on consumption, market shares and market share prices, price elasticities of demand, tax structure and from discussions with government officials. We modelled increases to specific excise to produce a 45%, 55%, 65% and 75% tax burden and compared a simple (specific only) structure with a mixed (specific and ad valorem) structure. RESULTS Under the simple approach, introducing a US$2.1 specific tax would result in a 75% tax burden with 67% fewer waterpipe tobacco units smoked, 1 004 604 averted premature deaths and a 236% increase in government revenue relative to the current tax structure. At the 75% tax burden, the simple approach resulted in 1.5% fewer waterpipe tobacco units consumed, 9000 more averted premature deaths and 12.7% more government revenue compared with the mixed approach. Results for other tax burdens are presented and remained robust to sensitivity analyses. CONCLUSIONS Introducing a specific excise tax on waterpipe tobacco in Egypt can yield considerable government revenue and public health gains. We recommend the simple approach, in line with the WHO recommendations, which produces greater economic and public health gains than the mixed approach and is easier to administer for the Egyptian government.
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Affiliation(s)
- Aya Mostafa
- Department of Community, Environmental and Occupational Medicine, Ain Shams University Faculty of Medicine, Cairo, Egypt
| | - Ali Chalak
- Department of Agriculture, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Rima Nakkash
- Global and Community Health Department, George Mason University, Fairfax, Virginia, USA
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Ruba Abla
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Yousef S Khader
- Department of Community Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Niveen Me Abu-Rmeileh
- Institute of Community and Public Health, Birzeit University, Birzeit, State of Palestine
| | - Ramzi G Salloum
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Mohammed Jawad
- Public Health Policy Evaluation Unit, Imperial College London School of Public Health, London, UK
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Saad RK, Maiteh A, Nakkash R, Salloum RG, Chalak A, Abu-Rmeileh NME, Khader Y, Al Nsour M. Monitoring and Combating Waterpipe Tobacco Smoking Through Surveillance and Taxation. JMIR Public Health Surveill 2023; 9:e40177. [PMID: 36951907 PMCID: PMC10132023 DOI: 10.2196/40177] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 01/31/2023] [Accepted: 02/14/2023] [Indexed: 02/16/2023] Open
Abstract
Waterpipe tobacco smoking (WTS) is a traditional tobacco use method that originated in the Eastern Mediterranean Region (EMR) and has resurged in recent decades. WTS rates in the EMR are the highest worldwide, especially among youth, exceeding cigarette-smoking rates in select jurisdictions. Despite its documented harm, the growing prevalence of WTS has been met with a poor regulatory response globally. At the epicenter of the WTS epidemic, countries in the EMR are in urgent need of effective tobacco control strategies that consider the particularities of WTS. A roundtable session, titled "Monitoring and Combating WTS Through Taxation and the Global Tobacco Surveillance System (GTSS)," was held as part of the 7th Eastern Mediterranean Public Health Network's regional conference. The session provided an overview of evidence to date about WTS policy control, the taxation of WTS, volumetric choice experiments for tobacco control research, and monitoring WTS patterns and control policies among adults and youth through the GTSS. The session highlighted the need to update the regulation of WTS in the current global tobacco control policy frameworks and the need for developing tailored, evidence-based, and WTS-specific regulations to complement current tobacco control policy frameworks. Raising taxes to increase the price of tobacco products is the single most effective tobacco control measure, and these taxes can fund expanded government health programs. The effectiveness of taxation can be measured via volumetric choice experiments, which allow for the estimation of a complete set of own-price and cross-price elasticities that are instrumental for fiscal policy simulations. Finally, the surveillance of WTS (for example, through the GTSS) is critical to informing policy and decision makers. The Global Youth Tobacco Survey (GYTS) and Global Adult Tobacco Survey (GATS) are 2 GTSS products that provide nationally representative data among students aged 13-15 years and persons ≥15 years, respectively.
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Affiliation(s)
- Randa K Saad
- Global Health Development | Eastern Mediterranean Public Health Network, Amman, Jordan
| | - Adna Maiteh
- Global Health Development | Eastern Mediterranean Public Health Network, Amman, Jordan
| | - 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 Health and Human Services, George Mason University, Fairfax, VA, United States
| | - Ramzi G Salloum
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Florida, FL, United States
| | - Ali Chalak
- Department of Agriculture, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Niveen M E Abu-Rmeileh
- Institute of Community and Public Health, Birzeit University, Birzeit, Occupied Palestinian Territory
| | - Yousef Khader
- Public Health, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohannad Al Nsour
- Global Health Development | Eastern Mediterranean Public Health Network, Amman, Jordan
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Chalak A, Nakkash R, Abu-Rmeileh NME, Khader YS, Jawad M, Mostafa A, Abla R, Louviere J, Salloum RG. Own-price and cross-price elasticities of demand for cigarettes and waterpipe tobacco in three Eastern Mediterranean countries: a volumetric choice experiment. Tob Control 2023; 32:86-92. [PMID: 34193608 PMCID: PMC9763177 DOI: 10.1136/tobaccocontrol-2021-056616] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/11/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Waterpipe tobacco smoking rates in the Eastern Mediterranean region are among the highest worldwide, yet little evidence exists on its economics. Estimates of demand elasticities for tobacco products are largely limited to cigarettes. This study aimed to estimate own-price and cross-price elasticities of demand for cigarettes and waterpipe tobacco products in Lebanon, Jordan and Palestine. METHODS A volumetric choice experiment was conducted using nationally representative household surveys. The choice experiment elicited respondents' stated purchases of eight cigarette and waterpipe tobacco product varieties by hypothetically varying prices. Data were analysed using zero-inflated Poisson models that yielded demand elasticity estimates of cigarette and waterpipe tobacco consumption. RESULTS The study included 1680 participants in Lebanon (50% female), 1925 in Jordan (44.6% female) and 1679 in Palestine (50% female). We found the demand for premium cigarettes to be price elastic (range, -1.0 to -1.2) across all three countries, whereas the demand for discount cigarettes was less elastic than premium cigarettes in Lebanon (-0.6) and Jordan (-0.7) and more elastic in Palestine (-1.2). The demand for premium waterpipe tobacco was highly elastic in Lebanon (-1.9), moderately elastic in Jordan (-0.6) and inelastic in Palestine (0.2). The cross-price elasticity between cigarettes and waterpipe tobacco was near zero, suggesting that the two products are not considered to be close substitutes by consumers. CONCLUSIONS These results serve as a strong evidence base for developing and implementing fiscal policies for tobacco control in the Eastern Mediterranean region that address cigarettes and waterpipe tobacco products.
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Affiliation(s)
- Ali Chalak
- Department of Agriculture, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Rima Nakkash
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | | | - Yousef S Khader
- Department of Community Medicine, Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammed Jawad
- Public Health Policy Evaluation Unit, Imperial College London, London, UK
| | - Aya Mostafa
- Department of Community, Environmental, and Occupational Medicine, Faculty of Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ruba Abla
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | | | - Ramzi G Salloum
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon,Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
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Hassan HF, Ghandour LA, Chalak A, Aoun P, Reynolds CJ, Abiad MG. The influence of religion and religiosity on food waste generation among restaurant clienteles. Front Sustain Food Syst 2022. [DOI: 10.3389/fsufs.2022.1010262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
IntroductionFood waste is a global issue of primary concern due to its repercussions on the environment, food security, and the economy. Our study aimed to explore the impact of religion and religiosity on food waste generation among restaurant clienteles in Lebanon, a religiously diverse country.MethodsA convenient sample of 927 restaurant patrons dining out in Greater Beirut was interviewed face-to-face, and leftovers at each table were collected and weighed.ResultsChristian diners were found to waste significantly less (p < 0.05) than Druze and Muslim patrons in restaurants serving Lebanese and non-Lebanese food. Individuals (19.1% of respondents) from both religions who reported that their relationship with God is the priority in life waste similarly compared to those who claimed to have other priorities. The higher the religiosity score among both Christians and Muslims/Druze groups was, the lower the food waste quantity got, highlighting the reduced wasteful behavior among highly religious people.DiscussionBased on these findings, including religious cues in consumer-based interventions to reduce food waste can be more effective. This can be achieved through marketing campaigns that communicate religious-based messages to trigger religious beliefs that reduce food waste, using physical spaces and rituals of mosques and churches.
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Ghattas H, Jamaluddine Z, Semaan A, El-Helou N, Safadi G, Elghossain T, Akl C, Elbassuoni S, Chalak A, El Ati J. School and community drivers of child diets in two Arab cities: The SCALE protocol and innovative tools to assess children’s food environments. PLoS One 2022; 17:e0264963. [PMID: 35857785 PMCID: PMC9299321 DOI: 10.1371/journal.pone.0264963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 02/21/2022] [Indexed: 11/18/2022] Open
Abstract
Background In the context of the rapid nutrition transition experienced by middle-income countries of the Arab region, children and adolescent’s food choices and dietary behaviors are early risk factors for the development of non-communicable diseases. Assessment of factors influencing food choices among this age group is challenging and is usually based on self-reported data, which are prone to information and recall bias. As the popularity of technologies and video gaming platforms increases, opportunities arise to use these tools to collect data on variables that affect food choice, dietary intake, and associated outcomes. This protocol paper describes the SCALE study (School and community drivers of child diets in Arab cities; identifying levers for intervention) which aims to explore the environments at the level of households, schools and communities in which children’s food choices are made and consequently identify barriers and enablers to healthy food choices within these environments. Methods Field studies are being conducted in primary schools, among children aged 9–12 years, in Greater Beirut, Lebanon and Greater Tunis, Tunisia. A stratified random sample of 50 primary schools (public and private) are selected and 50 children are randomly selected from grades 4-5-6 in each school. The study includes surveys with children, parents/caregivers, school directors, teachers, and nutrition/health educators to assess individual diets and the contextual factors that influence children’s food choices. Innovative locally adapted tools and methods such as game-based choice experiments, wearable cameras and neighborhood mapping are used to describe the environments in which children’s food choices are made. Discussion The SCALE study will generate contextual knowledge on factors in school and neighborhood environments that influence child dietary behaviors and will inform multi-level interventions and policies to address childhood malnutrition (under-and over-nutrition). By integrating methods from various disciplines, including economics, data science, nutrition, and public health and by considering factors at various levels (home, school, and neighborhood), the study will identify levers for intervention with the potential to improve children’s dietary behaviors. This will help fill existing gaps in research on food systems and consequently guide positive change in Lebanon and Tunisia, with the potential for replicability in other contexts.
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Affiliation(s)
- Hala Ghattas
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- * E-mail:
| | - Zeina Jamaluddine
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Aline Semaan
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Nehmat El-Helou
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Gloria Safadi
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Tatiana Elghossain
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Christelle Akl
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Shady Elbassuoni
- Department of Computer Science, Faculty of Arts and Sciences, American University of Beirut, Beirut, Lebanon
| | - Ali Chalak
- Department of Agriculture, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Jalila El Ati
- INNTA (National Institute of Nutrition and Food Technology), SURVEN (Nutrition Surveillance and Epidemiology in Tunisia) Research Laboratory, Tunis, Tunisia
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Awawda S, Chalak A, Khader Y, Mostafa A, Abla R, Nakkash R, Jawad M, Salloum RG, Abu-Rmeileh NM. Gender differences in the price elasticity of demand for waterpipe and cigarette smoking in Lebanon, Jordan and Palestine: a volumetric choice experiment. BMJ Open 2022; 12:e058495. [PMID: 35851023 PMCID: PMC9297203 DOI: 10.1136/bmjopen-2021-058495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES This study assessed the extent to which the elasticity of cigarette and waterpipe tobacco products differs between men and women. We also explored the levels of substitution and complementarity in tobacco products among men and women. SETTING The study examines tobacco elasticities in three Arab countries: Lebanon, Jordan and the West Bank of Palestine. PARTICIPANTS We used data from nationally representative surveys of adults aged ≥18 years in Lebanon (n=1680), Jordan (n=1925) and Palestine (n=1679). The proportion of women was 50.0% of the sample in Lebanon and Palestine, and 44.6% in Jordan. PRIMARY AND SECONDARY OUTCOME MEASURES A zero-inflated Poisson regression model estimated own-price and cross-price elasticities for two variations of cigarettes and five variations of waterpipe tobacco products. Elasticities were measured based on eight scenarios of prices. RESULTS Demand for waterpipe tobacco products was elastic for both men and women. The cross-price elasticities in the three countries indicate the existence of substitution between cigarettes and waterpipe products and by different varieties within each of the two tobacco products. Gender differences varied across the three countries whereby higher cross-price elasticities were observed for women in Jordan and Palestine. For example, the price elasticity for discount waterpipe was -1.4 and -0.6 for women and men in Jordan, respectively. CONCLUSIONS Results on the elasticity of demand for tobacco products and the existence of substitution between tobacco products reveal the higher responsiveness of men and women to changes in tobacco prices. This should be taken into consideration in tobacco control strategies particularly when reducing tobacco consumption via taxation policies.
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Affiliation(s)
- Sameera Awawda
- Economics Department, Birzeit University, Ramallah, Palestine, State of
- Institute of Community and Public Health, Birzeit University, Ramallah, Palestine, State of
| | - Ali Chalak
- Department of Agriculture, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon, Beirut, Lebanon
| | - Yousef Khader
- Department of Community Medicine, Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Aya Mostafa
- Department of Community, Environmental, and Occupational Medicine, Faculty of Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ruba Abla
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - 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 Health and Human Services, George Mason University, Fairfax, VA, USA
| | - Mohammed Jawad
- Public Health Policy Evaluation Unit, Imperial College London, London, UK
| | - Ramzi G Salloum
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Niveen Me Abu-Rmeileh
- Institute of Community and Public Health, Birzeit University, Ramallah, Palestine, State of
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11
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Chalak A, Haddad J, Jawad M, Nakkash R, M. N, Khader Y, Mostafa A, Abla R, Salloum R. Estimating the impacts of waterpipe tobacco
taxation on demand: Evidence from a
subgroup analysis in Lebanon. Tob Prev Cessat 2022. [DOI: 10.18332/tpc/150961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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12
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Jomaa L, Diab-El-Harake M, Chalak A, Abiad M. Unravelling the Relationship Between Food Security, Financial Management and Household Food Waste: The Case of Lebanon During the COVID-19 Pandemic. Curr Dev Nutr 2022. [PMCID: PMC9193989 DOI: 10.1093/cdn/nzac065.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
To explore associations between household food security (HFS), household financial management (HFM) skills, and food literacy (FL) with household food waste (HFW) generation during the COVID-19 crisis.
Methods
Data were collected through online surveys and face-to-face interviews with a random sample of households in Lebanon (n = 323, January-May2021). HFI and HFM were assessed using the previously validated food insecurity experience scale and a 14-item food literacy behavior checklist, respectively. HFW and FL measures were constructed based on validated tools. Multiple tobit regression was conducted to examine the relationship of HFS, HFM and FL with HFW adjusting for other socioeconomic variables.
Results
Overall, 50.5% (n = 163) of the study population reported experiencing moderate to severe FI during the pandemic. Approximately one-third of participants had low FL score (29.7%) and HFM (34.1%). University education and being employed were both associated with increased HFW (β = 1.730 and β = 1.246; P < 0.10). Multiple linear regression model showed that participants with high HFM skills score had significantly higher HFW compared to those with lower HFM scores, even after adjusting for significant correlates including education, employment, and crowding (β = 3.758, P < 0.01). However, participants with highest FL score had lower HFW scores (i.e., less food to be discarded) compared to their counterparts (β = −1.652, P < 0.05). Specifically, tobit regression revealed that participants with highest FL score had lower expected waste behavior scores compared to those with lowest FL scores (mean = 13.8[90%CI:13.0, 14.7] vs. mean = 15.5[90%CI:14.6, 16.4]). Severe HFI was also shown to be associated with increased HFW (β = 2.799, P < 0.01).
Conclusions
Improved FL may lead to better cooking and eating practices that are less wasteful (e.g., plan meals, cook on budget, estimate portion sizes, etc.). Findings highlight the need to develop interventions addressing FL and better HFM practices to help improve HFS and reduce HFW.
Funding Sources
The present study was funded by the University Research Board at the American University of Beirut.
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13
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Chaaban J, Haddad J, Ghandour L, Chalak A. Impact of minimum unit pricing on youth alcohol consumption: insights from Lebanon. Health Policy Plan 2022; 37:760-770. [PMID: 35353893 DOI: 10.1093/heapol/czac021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 01/21/2022] [Accepted: 03/10/2022] [Indexed: 11/12/2022] Open
Abstract
This paper analyses the impact of introducing an alcohol minimum unit pricing policy on youth's off-premise alcohol consumption. We rely on price elasticities derived using stated preference alcohol purchase data from a survey of 1024 university students in Lebanon. Selectively targeting drinks with high ethanol concentration by applying a minimum unit pricing (MUP) corresponding to the maximum price that respondents are willing to pay per beverage achieves a reduction in ethanol intake close to 0.23 l/month (∼28% of pre-MUP ethanol intake). Imposing a flat MUP corresponding to the average price respondents are willing to pay for all alcoholic beverages decreases ethanol intake by nearly half the reduction from the previous targeted MUP. This work provides evidence in favour of MUP in conjunction with taxation capable of substantially reducing alcohol consumption. We also document a positive welfare benefit of MUP.
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Affiliation(s)
- Jad Chaaban
- Department of Agriculture, Faculty of Agricultural and Food Sciences, American University of Beirut, P.O. Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon
| | - Joanne Haddad
- ECARES, Université Libre de Bruxelles, Ave. F.D. Roosevelt 50, CP114/04, Brussels 1050, Belgium
| | - Lilian Ghandour
- Department of Epidemiology and Population Health, Faculty of Agricultural and Food Sciences, American University of Beirut, P.O. Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon
| | - Ali Chalak
- Department of Agriculture, Faculty of Agricultural and Food Sciences, American University of Beirut, P.O. Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon
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14
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Nakkash R, Khader Y, Chalak A, Abla R, Abu-Rmeileh NME, Mostafa A, Jawad M, Lee JH, Salloum RG. Prevalence of cigarette and waterpipe tobacco smoking among adults in three Eastern Mediterranean countries: a cross-sectional household survey. BMJ Open 2022; 12:e055201. [PMID: 35246419 PMCID: PMC8900030 DOI: 10.1136/bmjopen-2021-055201] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 01/06/2022] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES Tobacco smoking is on the rise in the Eastern Mediterranean region. In light of limited surveillance of smoking in the region, this study sought to understand the prevalence of cigarette and waterpipe smoking among adults and the factors associated with smoking in Lebanon, Jordan and Palestine (West Bank only). DESIGN, SETTING AND PARTICIPANTS Household surveys were conducted with participants over the age of 18 in Lebanon (n=1680), Jordan (n=1925) and Palestine (n=1679) between June and August 2019. A multistage cluster sampling approach with probability-proportional-to-size random selection method was followed in the three countries. PRIMARY AND SECONDARY OUTCOME MEASURES Gender-specific prevalence rates for cigarette and waterpipe smoking were estimated. Multivariable logistic regression was used to examine factors associated with current cigarette and waterpipe tobacco smoking. RESULTS The prevalence of cigarette smoking among males and females respectively was 48.6% and 21.5% in Lebanon, 50.4% and 9.1% in Jordan, and 53.4% and 3.1% in Palestine. The prevalence of waterpipe smoking among males and females respectively was 32.7% and 46.2% in Lebanon, 13.4% and 7.8% in Jordan, and 18.0% and 7.9% in Palestine. Cigarette smokers were significantly (p<0.05) more likely to be male, younger and with lower educational attainment across the three countries. Waterpipe smokers were more likely to be young adults across the three countries (p<0.001). They were more likely to be male in Jordan and Palestine, and more likely to be female in Lebanon. CONCLUSIONS The high prevalence rates of smoking in Lebanon, Jordan and Palestine are concerning. Continued surveillance is key to monitor smoking patterns and inform stronger tobacco control measures.
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Affiliation(s)
- Rima Nakkash
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Yousef Khader
- Department of Community Medicine, Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Ali Chalak
- Department of Agriculture, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Ruba Abla
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | | | - Aya Mostafa
- Department of Community, Environmental and Occupational Medicine, Ain Shams University Faculty of Medicine, Cairo, Egypt
| | - Mohammed Jawad
- Public Health Policy Evaluation Unit, Imperial College London School of Public Health, London, UK
| | - Ji-Hyun Lee
- Department of Biostatistics and UF Health Cancer Center, University of Florida, Gainesville, Florida, USA
| | - Ramzi G Salloum
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, USA
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15
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Khauli N, Ghandour LA, Anouti S, Afifi RA, Nakkash R, Chalak A, Yassin N, Martins SS. Does knowing about the long-term health effects of alcohol matter? Evidence from a university sample in Lebanon. East Mediterr Health J 2021; 27:336-343. [PMID: 33955529 DOI: 10.26719/emhj.20.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 04/28/2020] [Indexed: 11/09/2022]
Abstract
Background Research linking awareness of health effects of alcohol and harmful alcohol drinking status is limited. Aims To investigate the association between awareness of long-term alcohol effects and alcohol use disorders. Methods University students aged 18-25 years (n = 1155) completed a self-filled survey. Participants were asked if they knew that alcohol causes: (1) problems in the liver; (2) cancers of the mouth, throat, oesophagus and breast; (3) damage to the heart; and (4) weakening of the immune system. Multinomial regression analyses were conducted to assess the association between awareness of long-term alcohol effects and alcohol drinking status, including Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) alcohol use disorders. Results One third (32.8%) were past-year drinkers and 18% screened positive for DSM-5 alcohol use disorders. Compared to past-year drinkers with no alcohol use disorders, non-past-year ever drinkers were twice as likely to know about the link between alcohol and cancers of the mouth, throat, oesophagus and breast. Past-year drinkers with an alcohol use disorders were less likely to know about this association. Non-past-year ever drinkers (vs past-year drinkers with no alcohol use disorders) were also 2.6 times more likely to know the alcohol liver risks. Conclusions There is a strong inverse relationship between awareness of the effects of alcohol and harmful consumption among young people, providing preliminary support for the protective nature of knowledge on alcohol drinking status. Efforts to increase public awareness of the long-term health effects of alcohol may be useful in reducing alcohol-related harm.
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Affiliation(s)
- Nicole Khauli
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, United States of America
| | - Lilian A Ghandour
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Sirine Anouti
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Rima A Afifi
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.,Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, United States of America
| | - Rima Nakkash
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Ali Chalak
- Department of Agriculture, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Nasser Yassin
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Silvia S Martins
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, United States of America
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16
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Mardigian P, Chalak A, Fares S, Parpia A, El Asmar K, Habib RR. Pesticide practices in coastal agricultural farms of Lebanon. Int J Environ Health Res 2021; 31:132-147. [PMID: 31311292 DOI: 10.1080/09603123.2019.1634797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 06/12/2019] [Indexed: 06/10/2023]
Abstract
The agricultural sector in Lebanon relies heavily on agrochemicals for crop protection; thus exposing humans and the environment to the harmful effects of pesticides. This study investigated Lebanese farmers' pesticide use practices and explored the underlying factors associated with farmers' choices. Of the 104 surveyed farmers, around 87% were willing to use pesticides that are less toxic to humans and the environment than those currently using, if available. The majority of these farmers (92%) planted their crops in greenhouses. Willingness to use less toxic pesticides was significantly associated with farmers using greenhouses as opposed to open fields, after adjusting for demographic and behavioural characteristics (OR = 7.50; p = 0.010). There was no association between willingness to use less toxic pesticides and perceptions of pesticides' health effects. Policies banning the import and sale of internationally banned pesticides must be enforced. Farmers must be supported to make informed choices about pesticides and their use.
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Affiliation(s)
- Patil Mardigian
- Department of Environmental Health, Faculty of Health Sciences, American University of Beirut , Beirut, Lebanon
| | - Ali Chalak
- Department of Agriculture, Faculty of Agricultural and Food Sciences, American University of Beirut , Beirut, Lebanon
| | - Souha Fares
- Hariri School of Nursing, Faculty of Medicine, American University of Beirut , Beirut, Lebanon
| | - Alyssa Parpia
- Dalla Lana School of Public Health, The University of Toronto , Toronto, Canada
| | - Khalil El Asmar
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut , Beirut, Lebanon
| | - Rima R Habib
- Department of Environmental Health, Faculty of Health Sciences, American University of Beirut , Beirut, Lebanon
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17
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Abed Al Ahad M, Chalak A, Fares S, Mardigian P, Habib RR. Decentralization of solid waste management services in rural Lebanon: Barriers and opportunities. Waste Manag Res 2020; 38:639-648. [PMID: 32090703 DOI: 10.1177/0734242x20905115] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Rapid urbanization, closure of dumps, and insufficient infrastructure funding in Lebanon have resulted in improper municipal solid waste management (MSWM), creating a continuing trash crisis in recent years. In Beirut and Mount Lebanon, MSWM was carried out in centralized waste processing and disposal facilities operated by the government. The trash crisis and failure of the centralized system prompted several municipal authorities to decentralize MSWM by establishing local facilities, paid by the council taxes charged to beneficiary households. To study the feasibility of decentralized MSWM, a survey of 228 households in a rural village in Lebanon explored households' willingness to pay (WTP) for a local MSWM service. For data analysis, a multivariate Tobit model was used to examine the determinants of the WTP amount. Results showed that 79% of surveyed households in the studied village were willing to support local MSWM improvements by contributing an average yearly fee of US$48, representing a 30% increase in their current council taxes. Analysis showed a significant positive association between the WTP amount and the household monthly income level, the residents perceived needs for urgency to act on solid waste management, and the households' responsibility to be involved in MSWM. An interview with the municipality mayor later revealed that financial, technical, and land resources are lacking to enable consideration of a decentralized project for MSWM in the village. Municipalities in rural areas have limited resources and are unable to sustain a decentralized MSWM service unless adjacent towns join effort in supporting and financing MSWM initiatives.
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Affiliation(s)
- Mary Abed Al Ahad
- Department of Environmental Health, American University of Beirut, Beirut, Lebanon
| | - Ali Chalak
- Department of Agriculture, American University of Beirut, Beirut, Lebanon
| | - Souha Fares
- Hariri School of Nursing, American University of Beirut, Beirut, Lebanon
| | - Patil Mardigian
- Department of Environmental Health, American University of Beirut, Beirut, Lebanon
| | - Rima R Habib
- Department of Environmental Health, American University of Beirut, Beirut, Lebanon
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18
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Chalak A, Ghandour L, Anouti S, Nakkash R, Yassin N, Afifi R. The impact of broad-based vs targeted taxation on youth alcohol consumption in Lebanon. Health Policy Plan 2020; 35:625-634. [DOI: 10.1093/heapol/czaa018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2020] [Indexed: 11/15/2022] Open
Abstract
Abstract
This study aims to model youth’s off-premise alcohol demand and forecasts ethanol intake responsiveness to alcohol taxes. Using stated preference alcohol purchase data from a survey of 1024 university students in Lebanon, we derive price elasticities that we use to forecast the effects of two excise tax scenarios on overall ethanol intake. The first scenario imposes a broad-based 20% tax on all types of alcoholic beverages, and the second scenario imposes a targeted 20% tax only on the high ethanol content, while exempting the lower ethanol beverages. Overall, targeted taxes are found to achieve a reduction in ethanol intake that is nearly three times that achieved by broad taxes (15.7% vs 5.3%). For ‘past-month binge drinkers’, targeted taxes would decrease alcohol intake by 16.3%, while broad taxes increase it by 3.3%. Finally, ethanol intake among participants who prefer low ethanol content would decrease under targeted taxes by more than five times as much as under broad taxes. For ‘high-ethanol drinkers’, targeted taxes decrease alcohol intake by an even larger proportion than for ‘low-ethanol drinkers’ (19.0% vs 15.6%), while broad taxes increase their ethanol intake by ∼16.0%. This study contributes evidence that taxation policy substantially reduces alcohol consumption and that alcohol consumption patterns should be accounted for when designing taxes.
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Affiliation(s)
- Ali Chalak
- Department of Agriculture, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut 1107-2020, Lebanon
| | - Lilian Ghandour
- Department of Epidemiology and Population Health, 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
| | - Rima Nakkash
- Department of Health Promotion and Community 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
| | - Rima Afifi
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut 1107-2020, Lebanon
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, IA 52246, USA
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Abebe GK, Bahn RA, Chalak A, Yehya AAK. Drivers for the implementation of market-based food safety management systems: Evidence from Lebanon. Food Sci Nutr 2020; 8:1082-1092. [PMID: 32148817 PMCID: PMC7020299 DOI: 10.1002/fsn3.1394] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 12/11/2019] [Accepted: 12/13/2019] [Indexed: 11/12/2022] Open
Abstract
The food safety landscape continues to evolve across time, geography, and supply chains. This research seeks to analyze the determinants of market-based food safety management systems (FSMSs) implementation in the Middle Eastern context. Primary data were collected from food safety managers representing 94 processors across Lebanon. We found food processors having implemented ISO 22000 (50%), HACCP (40%), and ISO 9001 (25.5%); however, none of the processors implemented industry-based FSMSs. Although ISO 22000 was mostly implemented by large (85%) and medium (67%) processors, the uptake of ISO 22000 by small processors has picked up (29%). Economic incentives (market orientation) and firm-specific factors (organizational readiness, product/process characteristics, company size, and ownership structure) are the key drivers for the increased implementation of market-based FSMSs. Predominantly export-oriented processors had the odds of implementing ISO 22000 5.5 times more than the domestically oriented processors. Firms with a quality assurance (QA) unit had 15 times higher chance of implementing ISO 22000 than otherwise. Finally, processors engaged in fresh produce had 4.9 times higher chance of implementing ISO 22000 than those engaged in dry goods. The study establishes that the dominance of public-based FSMSs in the governance of food safety is a strategic choice (economic incentives) more than statutory requirements.
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Affiliation(s)
- Gumataw Kifle Abebe
- Faculty of Agricultural and Food SciencesThe American University of BeirutBeirutLebanon
| | - Rachel Anne Bahn
- Faculty of Agricultural and Food SciencesThe American University of BeirutBeirutLebanon
| | - Ali Chalak
- Faculty of Agricultural and Food SciencesThe American University of BeirutBeirutLebanon
| | - Abed Al Kareem Yehya
- Faculty of Agricultural and Food SciencesThe American University of BeirutBeirutLebanon
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20
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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. Int J Environ Res Public Health 2019; 16:ijerph16162874. [PMID: 31408935 PMCID: PMC6719017 DOI: 10.3390/ijerph16162874] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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21
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Affiliation(s)
- Ali Chalak
- Department of AgricultureAmerican University of Beirut Beirut Lebanon
| | - Mohammad Diab
- Department of Nutrition and Food ScienceAmerican University of Beirut Beirut Lebanon
| | - Issmat I. Kassem
- Department of Nutrition and Food ScienceAmerican University of Beirut Beirut Lebanon
| | - Mohamad G. Abiad
- Department of Nutrition and Food ScienceAmerican University of Beirut Beirut Lebanon
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Nakkash R, Ghandour LA, Anouti S, Nicolas J, Chalak A, Yassin N, Afifi R. Surveying Alcohol Outlet Density in Four Neighborhoods of Beirut Lebanon: Implications for Future Research and National Policy. Int J Environ Res Public Health 2018; 15:ijerph15092006. [PMID: 30223460 PMCID: PMC6164322 DOI: 10.3390/ijerph15092006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/02/2018] [Accepted: 09/05/2018] [Indexed: 11/16/2022]
Abstract
Underage drinking among youth in Lebanon is increasing. Regulating availability is one of the best buy policies recommended by the World Health Organization. To quantitatively document the current status of alcohol availability to youth in Lebanon, we used GPS technology to survey alcohol outlet density in four highly populated neighborhoods in Beirut, Lebanon, and to estimate their proximity to educational institutions. The density of alcohol outlets ranged from 18.30 to 80.95 per km2 (average of 39.6 alcohol outlets/km2). The highest number of total alcohol outlets was in the “Hamra & Jamiaa” area, which includes one of the largest private universities in the country. Thirteen out of 109 (12%) alcohol outlets (on and off-premise) were located less 100 m away from educational institutions, in violation of the current licensing law. None of the off-premise and the majority (94%) of on-premise alcohol outlets displayed the “no sale for <18” sign. Findings were indicative of an environment conducive to increased access and availability of alcohol among youth in Lebanon probably attributed to the prevailing weak alcohol policies and their enforcement. Systematic collection and reporting of alcohol outlet densities is critical to understand the alcogenic environment and guide local harm reduction policies.
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Affiliation(s)
- Rima 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.
| | - Sirine Anouti
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut 1107-2020, Lebanon.
| | - Jessika Nicolas
- Department of Geology, Faculty of Arts and 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.
| | - Nasser Yassin
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut 1107-2020, Lebanon.
| | - Rima Afifi
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut 1107-2020, Lebanon.
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, IA 52242, USA.
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Abebe GK, Chalak A, Abiad MG. The effect of governance mechanisms on food safety in the supply chain: Evidence from the Lebanese dairy sector. J Sci Food Agric 2017; 97:2908-2918. [PMID: 27804134 DOI: 10.1002/jsfa.8128] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 10/25/2016] [Accepted: 10/27/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Food safety is a key public health issue worldwide. This study aims to characterise existing governance mechanisms - governance structures (GSs) and food safety management systems (FSMSs) - and analyse the alignment thereof in detecting food safety hazards, based on empirical evidence from Lebanon. RESULTS Firm-to-firm and public baseline are the dominant FSMSs applied in a large-scale, while chain-wide FSMSs are observed only in a small-scale. Most transactions involving farmers are relational and market-based in contrast to (large-scale) processors, which opt for hierarchical GSs. Large-scale processors use a combination of FSMSs and GSs to minimise food safety hazards albeit potential increase in coordination costs; this is an important feature of modern food supply chains. The econometric analysis reveals contract period, on-farm inspection and experience having significant effects in minimising food safety hazards. However, the potential to implement farm-level FSMS is influenced by formality of the contract, herd size, trading partner choice, and experience. CONCLUSION Public baseline FSMSs appear effective in controlling food safety hazards; however, this may not be viable due to the scarcity of public resources. We suggest public policies to focus on long-lasting governance mechanisms by introducing incentive schemes and farm-level FSMSs by providing loans and education to farmers. © 2016 Society of Chemical Industry.
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Affiliation(s)
- Gumataw K Abebe
- Department of Agricultural Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, P.O. Box 11-0236 Riad El Solh, Beirut, 1107-2020, Lebanon
| | - Ali Chalak
- Department of Agricultural Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, P.O. Box 11-0236 Riad El Solh, Beirut, 1107-2020, Lebanon
| | - Mohamad G Abiad
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, P.O. Box 11-0236 Riad El Solh, Beirut, 1107-2020, Lebanon
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Chalak A, Abou-Daher C, Chaaban J, Abiad MG. The global economic and regulatory determinants of household food waste generation: A cross-country analysis. Waste Manag 2016; 48:418-422. [PMID: 26680687 DOI: 10.1016/j.wasman.2015.11.040] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 11/10/2015] [Accepted: 11/24/2015] [Indexed: 06/05/2023]
Abstract
Food is generally wasted all along the supply chain, with an estimated loss of 35percent generated at the consumer level. Consequently, household food waste constitutes a sizable proportion of the total waste generated throughout the food supply chain. Yet such wastes vary drastically between developed and developing countries. Using data collected from 44 countries with various income levels, this paper investigates the impact of legislation and economic incentives on household food waste generation. The obtained results indicate that well-defined regulations, policies and strategies are more effective than fiscal measures in mitigating household food waste generation.
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Affiliation(s)
- Ali Chalak
- Department of Agriculture, Faculty of Agricultural and Food Sciences, American University of Beirut, P.O. Box 11-0236 Riad El Solh, Beirut 1107-2020, Lebanon
| | - Chaza Abou-Daher
- Department of Agriculture, Faculty of Agricultural and Food Sciences, American University of Beirut, P.O. Box 11-0236 Riad El Solh, Beirut 1107-2020, Lebanon
| | - Jad Chaaban
- Department of Agriculture, Faculty of Agricultural and Food Sciences, American University of Beirut, P.O. Box 11-0236 Riad El Solh, Beirut 1107-2020, Lebanon
| | - Mohamad G Abiad
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, P.O. Box 11-0236 Riad El Solh, Beirut 1107-2020, Lebanon.
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Ghandour L, Chalak A, El-Aily A, Yassin N, Nakkash R, Tauk M, El Salibi N, Heffron M, Afifi R. Alcohol consumption in the Arab region: What do we know, why does it matter, and what are the policy implications for youth harm reduction? International Journal of Drug Policy 2016; 28:10-33. [DOI: 10.1016/j.drugpo.2015.09.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 07/14/2015] [Accepted: 09/28/2015] [Indexed: 11/16/2022]
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Chalak A, Abiad M. How effective is information provision in shaping food safety related purchasing decisions? Evidence from a choice experiment in Lebanon. Food Qual Prefer 2012. [DOI: 10.1016/j.foodqual.2012.04.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Crane M, Norton A, Leaman J, Chalak A, Bailey A, Yoxon M, Smith J, Fenlon J. Acceptability of pesticide impacts on the environment: what do United Kingdom stakeholders and the public value? Pest Manag Sci 2006; 62:5-19. [PMID: 16261541 DOI: 10.1002/ps.1134] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
EU Directive 91/414/EEC requires there to be no unacceptable effects on the environment from the use of pesticides. This paper reports the views of direct stakeholder groups and results from an opinion survey of more than 2000 members of the general public on what in practice should constitute acceptable and unacceptable effects of pesticides. Stakeholders in focus groups were concerned with the potential effects of pesticides on animal and plant population viability and micro-organism function but recognized that a trade-off exists between the potential economic advantages of responsible pesticide use and the potential disadvantages of individual poisoning events. The public opinion survey showed that although pesticides are widely used in homes and gardens, their use on farm crops remains of concern to the public. Concerns are greatest on issues of human health and food quality but potential environmental effects are also an issue for a substantial number of people, particularly if attractive species could be affected.
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Affiliation(s)
- Mark Crane
- Watts & Crane Associates, 23 London Street, Faringdon SN7 7AG, UK.
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Vo Van JM, Le Bervet JY, Nguyen NQ, Chalak A. [Tetracaine with the addition of metaraminol in spinal anesthesia]. Cah Anesthesiol 1985; 33:361-2. [PMID: 4052858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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