Translating evidence and building capacity to support waterpipe control in the Eastern Mediterranean

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Abstract: In the past decade waterpipe smoking (WP; hookah) has become the No. 1 tobacco use method among youth in the Eastern Mediterranean Region (EMR), yet evidence-based solutions to the WP epidemic continue to lag behind. This is mainly due to 2 factors; 1) the mismatch of policy solutions derived from cigarettes to local tobacco use methods such as the WP; and 2) the lack of understanding of local tobacco control (TC) policy environment and challenges to implementation. On the other hand, the WHO’s Framework Convention on Tobacco Control (FCTC) ratified by most countries in the EMR provides an opportunity to address WP smoking in the region. Supported by program TOBAC since its beginning in 2002, our team at the Syrian Center for Tobacco Studies (SCTS) has been on the forefront of characterizing the WP epidemic and its health and addictive properties. Such groundwork has prepared us to plan for the next stage of translating evidence into policy to support EMR efforts to control the WP epidemic. Given the widespread misperceptions that WP is less harmful and addictive than cigarettes, and the value of health warning labels (HWLs) in communicating smoking-related risks, the development of HWLs is a priority for WP control. Developing HWLs for the WP however, requires their adaptation to its unique multi-part context comprised of tobacco, device and charcoal, while implementation of WP-HWLs requires an understanding of the local policy environment, and strong national partnerships. Building on our ongoing collaboration with Lebanon (American University of Beirut) and Tunisia (University of Tunis), we want to assist these countries in developing and implementing effective HWLs for the WP and in building their national capacity in TC policy research. We will apply a mixed method approach to develop and test HWLs with the involvement of members of the target population comprised mostly of young adults (18-25 years). We will also study the structure and functioning of local health systems in Tunisia and Lebanon, so we can propose a clear roadmap for the implementation of WP-HWLs, and establish partnerships among researchers and policymakers than can facilitate such implementation. This application represents our team’s continuing leadership in responding to the WP epidemic, and in strengthening TC capacity in the EMR. It will help Tunisia and Lebanon, and perhaps other countries develop effective HWLs for WP, and equip them with the means to implement them successfully.