This international project will help Tunisia and Lebanon develop effective health warning labels for the waterpipe and equip them with the means to implement them successfully. 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 4 was 34.8% compared to 11.3% for cigarettes. 5 Tunisia, in particular, has weak tobacco control research, 6 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.
Hookah Smoking in the Middle East
This study is funded by the Fogarty International Center of the National Institutes of Health, R01 TW010654.
Dr. Asfar has extensive experience in tobacco control research nationally and internationally. Since 2001, her tobacco control work has been funded continuously by the NIH and conducted both in the United States and the Eastern Mediterranean Region, including Syria, Lebanon, and Tunisia. This work involves epidemiological and qualitative studies of tobacco use, randomized clinical trials of smoking cessation interventions, and tobacco regulatory research in health communication approaches targeting emerging tobacco products such as e-cigarettes and hookahs. She has two overarching aims in her research: (1) improving smoking cessation treatment among socially disadvantaged and high-risk populations (i.e., low-income adults, ethnic minorities, HIV patients, cancer survivors); and (2) preventing tobacco use among youth and young adults by advancing health communication strategies, such as health warning labels. She has more than 60 peer-reviewed publications (Asfar T - Search Results - PubMed) and many of these are in leading, high impact journals in this field (i.e., Tobacco Control; Nicotine and Tobacco Research; Addiction; and the Cochrane Tobacco Addiction Group). Dr. Asfar has currently five active grants as PI including: Rima Nakkash is a distinguished Professor in the Global and Community Health Department, renowned for her international leadership in tobacco control research, prevention, and policy evaluation. Her expertise extends to community-based participatory research, with a focus on mental health promotion among youth and disadvantaged populations. Nakkash is deeply engaged in civic and citizen involvement in health policy making, translating evidence-based public health for interventions and policy, and advocating for health. Notably, she played a pivotal role in the passage of Lebanon's comprehensive tobacco control law in 2011 and received the WHO World No Tobacco Day Award in 2013. Dr. Michael Schmidt is a social and behavioral research scientist in the field of public health, graphic designer, associate professor of design in the Department of Art, and affiliate faculty member in the School of Public Health at the University of Memphis. Dr. Schmidt's research areas include substance use disorders, intimate partner violence, and child and family wellbeing. Wensong Wu attained her Bachelor's degree in Computational Mathematics from Nanjing University, China in 2004 and her Master's degree in Mathematics from the University of South Carolina in 2007. In 2011, under the guidance of Dr. Edsel Pena, she completed her PhD in Statistics at the University of South Carolina, subsequently joining Florida International University as an assistant professor. Her research focuses on Bayesian methodologies for multiple hypothesis testing and classification, model selection and averaging for high- dimensional data, as well as statistical learning theory and its applications. Dr. Wasim Maziak is a professor of Epidemiology, Director of the Clinical Research Lab for Tobacco Smoking at Florida International University, and Founder of the Syrian Center for Tobacco Studies. Dr. Maziak has extensive experience in tobacco control research and has published over 200 peer-reviewed scientific reports, including contributions in Science, Nature, Lancet, and British Medical Journal. His focus has been on emerging tobacco products such as e-cigarettes and hookah (Waterpipe), especially risk communication strategies targeting young users. He has been continuously funded by NIH since 2001 for tobacco control research. Dr. Maziak’s Clinical Research Laboratory is located at the Academic Health Center 4 at FIU MMC campus. This state-of-the-art facility is fully equipped with five computer stations, blood drawing and specimen processing areas, fully furnished physical examination station, real-time monitoring equipment for vital signs, subjective measures assessment capability, and the latest in smoking topography technology (i.e., puff count, puff volume, average flow, puff duration, interpuff interval). This laboratory is devoted to assessing the impact of emerging tobacco products among young people such as waterpipe (hookah) and electronic nicotine delivery systems (i.e., ENDS, e-cigarettes). The research team is the first to evaluate this highly addictive and misperceived tobacco use method in a clinical lab setting, as its popularity grows statewide and nationally—especially among youth Kenneth D. Ward, PhD is a Professor and Director of the Division of Social and Behavioral Sciences at the University of Memphis as well as Adjunct Professor of Preventive Medicine at the University of Tennessee College of Medicine. Dr. Ward’s research focuses on community, healthcare system, and population level approaches to reduce the burden of tobacco use. He is particularly interested in improving methods to help smokers quit and is a Certified Tobacco Treatment Specialist and holds a National Certificate in Tobacco Treatment Practice. Currently, Dr. Ward’s research projects include: (1) Epidemiology, prevention, and treatment of waterpipe ("hookah") and cigarette smoking in the U.S. and Middle East; (2) effects of stress and tobacco use on birth outcomes; and (3) use of tobacco and other substances in the aftermath of a disaster. He is also a Research Laureate the American Academy of Health Behavior and a fellow of AAHB, the Society for Research on Nicotine and Tobacco, and Society of Behavioral Medicine. Habiba Zehi Ben Romdhane attained a public health degree from the Faculty of Medicine at the University of Tunis in 1978. She furthered her training in public health at Laval University in 1979, the University of Chicago in 1981, and the University of Tokyo in 1988. Currently serving Formatted: Font color: Text 1 Formatted: Line spacing: single Commented [AC5]: Newly added, no need to include a picture as a professor of preventive medicine within the Faculty of Medicine at the University of Tunis, she also leads the Laboratory for Research on the Epidemiology and Prevention of Cardiovascular Diseases. Additionally, she has collaborated with the World Health Organization and was Tunisia’s health minister.Collaborators
Taghrid Asfar, M.D., M.S.P.H.
Rima Nakkash, Ph.D.
Michael Schmidt, Ph.D., M.G.D.
Wu Wensong, Ph.D.
Wasim Maziak, M.D., Ph.D.
Kenneth D. Ward, Ph.D.
Habiba Zehi Ben Romdhane