The State of Tobacco Use Cessation in the Arab World

Abstract

In this dissertation we analyzed the state of tobacco cessation in the Arab World on multiple levels using the socio-ecological model (SEM). We painted a clearer picture on the tobacco cessation status in the Arab World and identified challenges and opportunities in the implementation of demand reduction measures. On the individual and interpersonal levels, we utilized the Global Youth Tobacco Survey to study the smoking cessation behaviors of the youth. We focused on youth for two reasons: (1) the Arab world is relatively young with a third of its population below the age of 15 and (2) national surveillance for adults were lacking; Global Adult Tobacco Surveys were only available for Egypt, 2009 and Qatar 2013. In Study I, we found that most Arab schoolchildren have the desire to quit smoking and have attempted to do so. There was a strong relationship between receiving professional cessation help and positive cessation behavior. We found that receiving cessation help and being taught the dangers of tobacco use in school, were associated with cessation attempts. Conversely, variables such as being a female, a child who smokes five or more cigarettes a day, or being exposed to secondhand smoke at home or school were associated with negative smoking cessation behaviors. We believe that policymakers and researchers could focus on improving the availability and demand for professional cessation services and equip parents with tools to facilitate informed cessation conversation with their youth. On the national policy and organizational levels, we used the latest World Health Organization framework convention on tobacco control (WHO FCTC) reports to assess the national implementation of WHO FCTC Article 14 (key demand reduction measures) in the Arab countries. Additionally, we reviewed the regional and local reports of health professionals from 2012 to 2022, to provide a qualitative summary of the tobacco use cessation services in healthcare settings and tobacco use cessation training in academic institutions. In Study II, we found major inadequacies in the provision of telephone quit lines, the accessibility of nicotine replacement therapy and the inclusion of tobacco dependence treatment curricula in healthcare education. Bahrain, Tunisia, and Sudan received the highest implementation score for WHO FCTC Article 14, among high-income, middle-income, and low-income countries, respectively. A closer look using the regional and local reports found that most healthcare schools do not include tobacco cessation counseling, the 5As or nicotine replacement therapy in their clinical training. These inadequacies were extended to healthcare professionals in their practice where the majority did not provide tobacco use cessation counseling to their patients. Therefore, we urge Arab countries to: 1- Fully implement FCTC Article 14 as a pressing step to reduce the smoking-attributable morbidity and mortality in Arab population. 1- Continuously monitor smoking prevalence and smoking cessation services. 2- Design youth-centered and culturally adapted tobacco cessation programs. 3- Develop and adapt a national strategy for tobacco cessation. 4- Integrate tobacco dependence treatment training in health professional education as part of the national standards of healthcare school accreditation. 5- Utilize existing infrastructure of primary health centers to provide cost-effective, broad-reaching tobacco cessation activities.