AUB team conduct research to help snuff out nargileh and cigarette smoking

Published March 25th, 2009 - 04:37 GMT

AUB team conduct research to help snuff out nargileh and cigarette smoking


A team of AUB faculty members and researchers have been all fired up about the pioneering studies they have been conducting to help snuff out the unhealthy habit of smoking in Lebanon.

In particular, the team has spearheaded studies on the health effects and mechanism of nargileh smoking, and on the importance of warning labels on water-pipe tobacco.

Under the umbrella of AUB's Tobacco Control Research Group, which was established in 1999, academics from a variety of disciplines, including public health, engineering, medicine, and chemistry, have been producing top-notch research material to help policy-makers in Lebanon enhance the effectiveness of their policies on tobacco control.

"Through our research projects, we hope to help policy-makers identify and overcome local barriers to implementing non-smoking policies," said Assistant Research Professor Rima Nakkash from the Department of Public Health and a member of the group. "We have now compiled enough research data to allow us to move into disseminating information and raising awareness as well as policy advocacy."

According to established research, tobacco smoking is responsible for five million deaths every year worldwide, the great majority of which are in the third world.  It is also the only consumer product that harms every person exposed to it and kills half of its regular lifetime users.  Tobacco is found in a variety of products smoked in Lebanon including cigarettes, nargileh, cigars, and pipes.

What worries AUB public health experts is that the international tobacco industry is continuing to target people – especially youth and women, in the low and middle-income countries such as Lebanon, to increase its sales as it loses markets in high-income countries. One way of doing that is by marketing for "Light" cigarettes and smokeless tobacco, both of which are not considered safer alternatives to regular cigarettes by researchers.


Lebanon ratified the World Health Organization Framework Convention on Tobacco Control (FCTC) in 2005, which suggests a variety of policies necessary to protect the health of citizens.

 "To date Lebanon has shown little commitment towards the implementation of the FCTC, although the majority of Lebanese support smoking bans and regulation of tobacco advertising and sales," according to the AUB Tobacco Research Group.  FCTC policies include implementing complete bans on smoking in public places, and printing picture warnings on tobacco products.

The FCTC targets tobacco control through policies aimed at four issues: preventing uptake of smoking, protecting from second-hand smoke, promoting cessation, and regulating products.

The AUB team has been working on all these issues, but their latest work focused on proposals to improve regulation and prevent uptake. In particular, water-pipe tobacco has captured the attention of researchers, as it has up till now escaped regulation forcing it to display warning labels, which would quash prevailing misconceptions that nargileh smoking is a relatively harmless activity.

"There is a smoking epidemic," said Dr. Ghazi Zaatari, who heads the department of pathology and laboratory medicine and is a member of the AUB tobacco group, noting that there are currently 1.3 billion smokers worldwide. In other words, 1 in 5 people in the world are smokers.

Cigarettes contain 4600 chemical toxicants, said Zaatari, who is also the chair of the WHO Study Group on Tobacco Product Regulation. These include rat poison, arsenic, ammonia, which is a toilet cleaner, industrial solvents, formaldehyde, which is used to make paint, and explosives, in addition to tar, nicotine and carbon monoxide, which is a component of car exhaust.

Health professionals and researchers are lobbying to increase the number of substances that are regulated in cigarette smoke, only a fraction of which are currently regulated. Tobacco control advocates are pushing to increase the number that is regulated to at least 44 chemicals.

"Although there is no such thing as a safe cigarette, by regulating chemicals, we hope to reduce harm to consumers," said Zaatari.

"The industry is capable and has the technology to reduce the level of harmful carcinogens, but they refuse to do it," said Zaatari. "Why? Because it will affect the taste of the cigarette, which may cause people to quit."

Scientists have found that additives in tobacco can increase the addictive effect of nicotine and thus make cigarettes a harder habit to kick.

That's tobacco control advocates are pressuring the tobacco industry through the FCTC to disclose all the contents of cigarettes, said Zaatari. In parallel stricter content regulation should be imposed.

What's more the FTCT will not allow manufacturers to list the contents of the cigarette as a means to market them as safer products.

Zaatari said that although in the 1960s and 1970s efforts were made to produce a "safer" cigarette with a lower tar content, the result was cigarettes with more additives, designed to deliver toxins into the lower lungs instead the upper lungs, and thus cause cancer deeper in the lungs. They were marketed as "Light" or "Ultra Light" cigarettes, which researchers have proved to be just as harmful as regular cigarettes.

Zaatari also explained that researchers have managed to push for stricter criteria for smoking machines that are used to set smoke content levels. 
"The current testing method is controlled by the tobacco industry," said Zaatari.

The AUB team is also simultaneously working on introducing warning labels to waterpipe smoking, which has been proven to be as harmful, if not more, than cigarette smoking, contrary to popular perception. But since the habit is often practiced in restaurants and cafes that prepare the waterpipe for the consumer, researchers had to come up with creative methods to deliver their message about the harms of nargileh smoking.
Unlike cigarette smokers, nargileh smokers don't necessarily buy the tobacco or even the pipe itself, so warnings on the tobacco pack might not be seen by consumers.

Rima Nakkash, who researched this topic, found that pictorial warnings on restaurant menus and waterpipe accessories, such as the mouthpiece and the hose, might prove more effective.

In any case, currently, not only do waterpipe tobacco products not bear any warnings, but they in fact display misleading information, about tar and nicotine content, noted Nakkash.


The AUB team is hard at work to promote effective and implementable non-smoking policy making. Team members Alan Shihadeh and Najat Saliba, from engineering and chemistry, respectively, have already identified the complex mechanism by which a waterpipe delivers chemicals to smokers, while Professors Rima Afifi and Monique Chaaya have been studying public perception and behavior with respect to smoking-related topics.

Most recently on March 7-12, six faculty members participated in the 14th World Conference on Tobacco or Health in Mumbai, India, which was attended by about 2500 scientists, government officials, and health organizations from 130 countries. There, they shared their latest findings with top researchers in the field.

Moreover, the International Development Research Center, a Canadian government-affiliated body, has granted about $37,000 to allow Nakkash and her colleagues, Professors Rima Afif and Monique Chaaya, to evaluate the implementation and enforcement of smoke-free policies in Lebanon.


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