The past decade has seen unprecedented increases in the usage of hookah smoking among young adults in the Eastern Mediterranean Region. Hookah smoking originated in ancient Persia, Iran, and India around 500 years ago. Spreading through Middle Eastern and Asian countries, hookah smoking has become embedded in their cultures of these areas and has become a prominent component in social gatherings.1 The Middle East has an increased prevalence of smoking, Jordan (35.0%), Saudi Arabia (30.4%), and Lebanon (26.3%), respectively.2
Lebanon and Tunisia suffer from considerable hookah smoking among youth. For example, a new study of 3384 students from 17 universities in Lebanon, showed that 23% were current hookah smokers compared to 19.2% for cigarettes.3 Among 13–15-year-old, current hookah smoking in Lebanon according to the Global Youth Tobacco Survey (GYTS, 2011) was 34.8% compared to 11.3% for cigarettes.5 Tunisia, in particular, has weak tobacco control research (Zyoud et al., 2014), but earlier results from the GYTS show an increasing trend in non-cigarette use; an indicator of hookah smoking (7.2% in 2001 to 13.9% in 2007).7 Both countries have ratified the FCTC but are struggling with implementation. In a recent analysis of FCTC policy implementation in the EMR, Tunisia ranked 17 and Lebanon 15 out of 22 countries.8 This demonstrates the need for translational research to help Tunisia and Lebanon respond to the hookah epidemic, and strengthen their national tobacco control capacity.
References
- Montazeri Z, Nyiraneza C, El-Katerji H, Little J. Waterpipe smoking and cancer: systematic review and meta-analysis. Tob Control. 2017 Jan;26(1):92-97. Doi: 10.1136/tobaccocontrol-2015-052758. Epub 2016 May 10. PMID: 27165994.
- Nasser, A. M., Geng, Y., & Al-Wesabi, S. A. (2020). The prevalence of smoking (cigarette and waterpipe) among university students in some Arab countries: a systematic review. Asian Pacific journal of cancer prevention: APJCP, 21(3), 583.
- Salameh, P., Salamé, J., Waked, M., Barbour, B., Zeidan, N., & Baldi, I. (2014). Waterpipe dependence in university students and effect of normative beliefs: a cross-sectional study. BMJ open, 4(2), e004378.
- Centers for Disease Control and Prevention. (2011). Global tobacco surveillance system data (GTSSData). Saudi Arabia GYTS Factsheet. Received from: http://nccd. cdc. gov/GTSSData/default/CountryResults. aspx.
- Maziak, W., Taleb, Z. B., Bahelah, R., Islam, F., Jaber, R., Auf, R., & Salloum, R. G. (2015). The global epidemiology of waterpipe smoking. Tobacco control, 24(Suppl 1), i3-i12.
- Zyoud SH, Al-Jabi SW, Sweileh WM, Awang R. A Scopus-based examination of tobacco use publications in Middle Eastern Arab countries during the period 2003–2012. Harm Reduct J. 2014;11:14
- Elawa, F., Warren, C. W., & Jones, N. R. (2010). Changes in tobacco use among 13-15-year-olds between 1999 and 2007: findings from the Eastern Mediterranean Region. EMHJ-Eastern Mediterranean Health Journal, 16 (3), 266-273, 2010
- Heydari, G., Talischi, F., Algouhmani, H., Lando, H. A., & Ebn Ahmady, A. (2013). WHO MPOWER tobacco control scores in the Eastern Mediterranean countries based on the 2011 report. EMHJ-Eastern Mediterranean Health Journal, 19 (4), 314-319, 2013.
