AUB research collaboration toward tobacco control

​Safa Jafari Safa <ss152@aub.edu.lb> Office of Communications

Two consecutive workshops were held at AUB by the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) Waterpipe Tobacco Smoking Knowledge Hub (WTS-KH) and the Framework Convention Alliance (FCA) to examine the global perspective on tobacco control and work to enrich the scientific program. The “Waterpipe tobacco smoking (WTS) regulations and challenges” workshop and the “Regional workshop on illicit tobacco trade and taxation in the Eastern Mediterranean” were held with technical support from the World Health Organization Regional Office for the Eastern Mediterranean (WHO EMRO). 

On January 15, 2016, AUB signed a memorandum of understanding with the Convention Secretariat of the WHO Framework Convention on Tobacco Control making AUB the global knowledge hub for waterpipe smoking, particularly with respect to education, research, and the dissemination of information that contributes to the implementation of the convention.

Challenges to regulation
Representatives from government and civil society organizations, as well as academics and policymakers in the region, shared their experience and expertise to identify the challenges associated with the enactment and enforcement of WTS control legislation in the context of different countries. Speakers discussed individual experiences of countries including Egypt, Iran, Jordan, Kuwait, Lebanon, Oman, Qatar, Pakistan, Saudi Arabia, Syria, and Turkey, and analyzed a number of themes, drawing a set of recommendations for future action. 

“Experience gained from fighting the tobacco epidemic to date, which is mostly cigarette-focused, has taught researchers, policymakers, and governments that fast action is needed to curb the waterpipe epidemic,” said Dr. Ghazi Zaatari, director of the WHO FCTC Global Knowledge Hub on Waterpipe Tobacco Smoking at AUBMC, who gave an overview on current global tobacco control laws and policies as they relate to WTS and the extent of implementation by parties of the FCTC articles for that purpose. “Sufficient scientific evidence has been generated about the toxicology and harmful health effects of waterpipe smoking to justify swift action. What remains lacking is the strong implementation, monitoring, and enforcement of laws, policies, interventions, and rigorous evaluation pertaining specifically to waterpipe control.”

WHO country representative in Lebanon, Dr. Iman Shankti, expressed intent to continue to work with the AUB team to enforce legislation regarding waterpipe, as did Dr. Tibor Szilagyi of the WHO FCTC Convention Secretariat who explained implementation challenges in different societies and the enforcement of various measures, including those regulating health warnings on waterpipe tobacco packages and waterpipe use bans, and the promotion and sponsorship of waterpipe tobacco. 

Dr. Alan Shihadeh, dean of the Maroun Semaan Faculty of Engineering and Architecture, clarified in his presentation the contribution of charcoal to CO and toxicant emissions of waterpipes as contributors of carcinogens. Dr. Najat Saliba, AUB professor of chemistry and director of the Nature Conservation Center, spoke about the role of the Tobacco Free Initiative (TFI) in supporting waterpipe regulations and the concern of prevalence of waterpipe use among students, sources of waterpipe smoke, and ways to regulate them in addition to regulating the emissions. Dr. Rima Nakkash, professor at the Health Promotion and Community Health Department at AUB who also coordinates the AUB-Tobacco Control Research Group (AUB-TCRG) and chairs the Tobacco Free AUB Taskforce, discussed demand reduction measures and gave an overview of countries that have health warning labels on waterpipe tobacco/accessories, and presented a review of existing literature on the effectiveness of health warnings on waterpipe tobacco products and accessories. 

Toward a global strategy for tobacco control
Participants from ten countries in the region engaged in group work with eight international experts on tobacco control from various convention alliances, FCTC secretariat, WHO headquarters, and knowledge hubs to exchange information and knowledge on how to better address tobacco illicit trade and tobacco taxation. The Eastern Mediterranean region has the second lowest average tobacco prices and the third lowest average excise tax per pack. Many non-cigarette forms of tobacco are often only minimally taxed or are not covered by tobacco taxation at all. To prevent a further increase in tobacco consumption or switching between various forms of tobacco use, comprehensive taxation strategies were studied and called for across all products.

A global strategy is pending, with follow up on the different stages of ratification or implementation that various countries are in. Reports of analyses are expected to further inform policy and the participating entities were encouraged to continue to play a leading role in collecting, exchanging, generating, and coordinating collaborations.