Responding to the changing tobacco epidemic in the Eastern Mediterranean Region

描述（由申请人提供）： 烟草使用每年造成490万人死亡，2020年预计死亡1000万人，其中70%发生在发展中国家。这一令人震惊的预测凸显了发展中国家需要检查烟草使用的模式和决定因素，了解当地的烟草使用方法，制定有效的戒烟干预措施，并培训自己的烟草控制科学家。2002年，在NIH/FIC的支持下，叙利亚烟草研究中心（SCTS）在东地中海地区（EMR）开始了这项工作。与此同时，叙利亚和其他EMR国家批准了《烟草控制框架公约》（FCTC）。这一对SCTS持续支持的申请建立在四年的研究和培训势头的基础上，并为叙利亚和EMR履行FCTC义务做好准备。有四个具体目标。首先，我们试图了解青少年烟草使用的模式和决定因素：一项以学校为基础的纵向研究将研究4000名叙利亚青年的烟草使用趋势。其次，我们将在一项实验室研究中检查水管有毒物质的暴露、依赖性和风险，该研究将240名水管使用者根据上个月的使用频率分为三组。所有使用者将在0小时和72小时禁欲条件下接受测试。对非使用者构成风险的颗粒物排放也将进行评估。第三，我们将在250名吸烟者中进行一项戒烟干预的随机临床试验（多中心，双盲，安慰剂对照），同时研究近端（例如，患者）和远端（卫生保健中心，工作人员，政策）的因素，可以影响干预的成功融入叙利亚公共卫生保健系统。第四，我们将继续建设区域烟草控制能力：我们培训叙利亚研究人员的成功计划将得到维持，我们还将在第一年、第三年和第五年组织和资助三个为期一周的培训课程，并开发和利用我们的研究援助匹配项目。SCTS研究和《烟草控制框架公约》义务指出，需要了解烟草使用的决定因素、水管使用、戒烟效果和整合，以及在整个EMR中培训烟草控制研究人员。该申请旨在巩固SCTS过去的成功，同时帮助叙利亚和EMR履行其FCTC义务。这项研究与公共卫生的相关性：拟议的工作将有助于了解烟草使用的决定因素，水管使用，戒烟效果和整合，这将有助于为叙利亚和EMR的预防和干预工作提供信息。拟议的研究和培训活动将有助于专业能力建设，从而有助于在环境管理报告中成功实施《烟草控制框架公约》。

DESCRIPTION (provided by applicant): Tobacco use accounts for 4.9 million deaths annually, with 70% of 2020's 10 million predicted deaths occurring in developing nations. This shocking prediction highlights the need for developing nations to examine patterns and determinants of tobacco use, understand local tobacco use methods, develop effective cessation interventions, and train their own tobacco control scientists. In 2002, with NIH/FIC support, the Syrian Center for Tobacco Studies (SCTS) began this effort in the Eastern Mediterranean Region (EMR). Meanwhile, Syria and other EMR nations ratified the Framework Convention on Tobacco Control (FCTC). This application for continued SCTS support builds on four years of research and training momentum, and prepares Syria and the EMR to meet FCTC obligations. There are four specific aims. First, we seek to understand adolescent tobacco use patterns and determinants: a school-based longitudinal study will examine trends in tobacco use in 4000 Syrian youth. Second, we will examine waterpipe toxicant exposure, dependence, and risk in a laboratory study of 240 waterpipe users placed in three groups based on past-month use frequency. All users will be tested under conditions of 0- and 72-hour abstinence. Particulate matter emissions, a risk for non-users, will also be assessed. Third, we will conduct a randomized clinical trial (multi-site, double blind, placebo-controlled) of a smoking cessation intervention in 250 smokers, while simultaneously studying proximal (e.g., patient) and distal (health care center, staff, policy) factors that can influence the intervention's successful integration within the Syrian public health care system. Fourth, we will continue to build regional tobacco control capacity: our successful program of training Syrian researchers will be maintained, as we also organize and fund three, 1-week, training courses in years 1, 3, and 5 and develop and capitalize on our Research Assistance Matching project. SCTS research and FCTC obligations point to the need for understanding tobacco use determinants, waterpipe use, and cessation efficacy and integration, as well as training of tobacco control researchers across the EMR. This application seeks to build on the past success of the SCTS while helping Syria and the EMR meet their FCTC obligations. Relevance of this research to public health: The proposed work will help understand tobacco use determinants, waterpipe use, and cessation efficacy and integration, which will be instrumental in informing prevention and intervention efforts in Syria and the EMR. Research and training activities proposed will contribute to the building of professional capacity that can aid the successful implementation of the FCTC in the EMR.