A qualitative study on tobacco use during the COVID-19 pandemic in Lebanon: Waterpipe and cigarette smokers' views, risk perceptions, and behaviors.

INTRODUCTION: Since the beginning of the COVID-19 pandemic, a growing number of studies have documented more severe COVID-19 symptoms and worse outcomes among smokers compared to non-smokers. The aim of this research is to understand the views, risk perceptions, and behaviors of Lebanese adult smokers during the pandemic. METHODS: We conducted 18 qualitative online structured interviews with adults who smoke cigarettes and waterpipe tobacco residing in Lebanon from November 2020 through April 2021. Participants were recruited predominantly via paid social media ads. Interviews were audio-recorded using Zoom software then transcribed verbatim. Data were analyzed thematically. RESULTS: The findings showed three main themes: changes to smoking behaviors, concerns over the susceptibility and severity of COVID-19, and using coping methods to protect smokers from COVID-19. Although there was an increased risk perception of COVID-19 in relation to smoking, most participants reported an increase in smoking. Instead of being encouraged to quit, participants developed coping strategies against COVID-19 while smoking. CONCLUSIONS: Smoking behavior did not seem to decrease during the COVID-19 pandemic. To support cessation initiatives and raise awareness, effective health messaging aimed at smokers is pivotal. Smoking cessation programs need to be better equipped at supporting people who smoke in finding healthier coping mechanisms during a pandemic. Moreover, policies to regulate the propagation of misinformation are required to prevent the development of a false sense of safety and protection from COVID-19.

Genodermatoses with behavioural sequelae.

Children with genodermatoses are at an increased risk of developing behavioural disorders which may impart lasting damage on the individual and their family members. As such, early recognition of childhood mental health disorders via meticulous history taking, thorough physical examination, and disorder-specific testing is of paramount importance for timely and effective intervention. If carried out properly, prompt psychiatric screening and intervention can effectively mitigate, prevent or even reverse, the psychiatric sequela in question. To that end, this review aims to inform the concerned physician of the manifestations and treatment strategies relevant to the psychological sequelae of genodermatoses.

Follicular mucinosis: a review.

Follicular mucinosis (FM) is an epithelial reaction pattern characterized by follicular mucin accumulation. It has been described in association with various inflammatory and neoplastic cutaneous disorders. FM is generally divided into a primary benign idiopathic form and a secondary form usually occurring in association with cutaneous lymphomas (especially mycosis fungoides), among other entities. Distinction between the two forms can be challenging as they share many overlapping features and the lack of a single diagnostic tool to differentiate between the two. Making the distinction may require evaluating and correlating the clinical, histologic, immunohistochemical, and molecular studies together. Long-term clinical follow-up also remains very important. In this review, we describe the different entities associated with FM, its pathogenesis, and possible therapeutic options.

Social norms and attitudes linked to waterpipe use in the Eastern Mediterranean Region.

Waterpipe tobacco smoking (WTS) is on the rise globally, particularly among vulnerable populations such as youth and women. Increasing knowledge about toxicant yield from waterpipe tobacco and deleterious health effects points to the potential for a health epidemic. WTS is often viewed as a safe alternative to cigarette smoking. Though the original objective of the research was to explore the social norms and attitudes that lead to waterpipe being a more acceptable form of tobacco smoking for women than cigarettes in the Eastern Mediterranean Region, the use of a qualitative research methodology resulted in rich data that helped to understand more generally the phenomenon of waterpipe smoking. Both focus group discussions (FGDs) and key informant interviews were used. Participants were recruited to represent genders, various age groups, socioeconomic status, waterpipe smoking status, and residents of urban and rural areas. A total of 81 FGDs and 38 in-depth interviews were conducted in 2007. Thematic analysis was used to analyze the transcripts. A total of ten themes emerged: socio-cultural norms, gender differences, motivation to smoke, sensory characteristics of waterpipe, metaphors, consumerism, indicators of dependence, comparison between cigarettes and waterpipe, health effect of smoking, and intervention. Results indicated that WTS has socio-cultural dynamics associated with it that are far more pronounced than health considerations. An increased socio-cultural acceptability, the perceived reduced harm and the advent of the fruity Moassel tobacco are among the many reasons for WTS acceptability. Findings point to the need for a unified strategy to address this health issue at all levels of the ecological framework and have important implications for future policy and practice.

Students' attitude and smoking behaviour following the implementation of a university smoke-free policy: a cross-sectional study.

OBJECTIVE: In view of the high-smoking rate among university students in Lebanon and the known adverse effects of second-hand smoking, the American University of Beirut (AUB) decided to implement a non-smoking policy on campus. This study sought to examine the students' compliance and attitudes following the ban. DESIGN: Cross-sectional study. SETTING: A private university in Lebanon. PARTICIPANTS: 545 randomly selected students were approached. A stratified cluster sample of classes offered in the spring semester of the 2008/2009 academic year was selected. Students completed a self-administered paper and pencil survey during class time. PRIMARY AND SECONDARY OUTCOME MEASURES: The main outcomes were compliance with and attitudes towards the ban. Other secondary outcomes were the perception of barriers to implementation of the ban and attitudes towards tobacco control in general. RESULTS: 535 students participated in the study. Smokers were generally compliant with the ban (72.7%) and for some (20%) it led to a decrease in their smoking. Students' attitude towards the ban and the enforcement of a non-smoking policy in public places across Lebanon varied according to their smoking status whereby non-smokers possessed a more favourable attitude and strongly supported such policies compared with smokers; overall, the largest proportions of students were satisfied to a large extent with the ban and considered it justified (58.6% and 57.2%, respectively). While much smaller percentages reported that the ban would help in reducing smoking to a large extent (16.7%) or it would help smokers quit (7.4%). Perceived barriers to implementation of the non-smoking policy in AUB included the lack of compliance with and strict enforcement of the policy as well as the small number and crowdedness of the smoking areas. CONCLUSIONS: An education campaign, smoking cessation services and strict enforcement of the policy might be necessary to boost its effect in further reducing students' cigarette use.

Women and waterpipe tobacco smoking in the eastern mediterranean region: allure or offensiveness.

The prevalence of waterpipe tobacco smoking is increasing worldwide, despite evidence indicating its adverse health effects. Women and young people seem more likely to be choosing waterpipe tobacco smoking over cigarettes. The objective of this qualitative study was to understand better whether and why waterpipe smoking is a more acceptable form of tobacco use than cigarettes for women in the Eastern Mediterranean Region, and to understand whether the strategies used by multi-national corporations to attract women to cigarette smoking were perceived to be relevant in the context of waterpipe tobacco use. Focus groups (n = 81) and in-depth interviews (n = 38) were conducted with adults in Lebanon, Egypt, Palestine, and Syria. Discussions were thematically analyzed and recurrent themes identified. One of the themes which emerged was the negative image of women smoking waterpipes. Moreover, the sexual allure conveyed through waterpipe smoking as well as waterpipe tobacco smoking as a symbol of emancipation was illustrated. The latter was mainly expressed in Lebanon, in contrast with Egypt where traditional gender roles depict women smoking waterpipes as disrespectful to society. Understanding the social aspects of waterpipe tobacco smoking is crucial to planning future interventions to control waterpipe tobacco smoking among women and in society at large.

The rise in narghile (shisha, hookah) waterpipe tobacco smoking: a qualitative study of perceptions of smokers and non smokers.

BACKGROUND: The prevalence of waterpipe tobacco smoking (WTS) in the Middle East region and worldwide is increasing. There is evidence to indicate both short term and long term health effects of WTS, resulting in the issuance of an advisory note by the World Health Organization. METHODS: This research aimed at gaining an in-depth understanding of the factors contributing to the rise in WTS in Lebanon. Qualitative focus groups (25) and in-depth interviews (9) were conducted with adults in Lebanon in 2007. Participants were recruited to represent diversity in smoking status, gender, age groups and urban/rural residence. The interviews and focus groups were thematically analyzed, and recurrent themes noted and summarized. RESULTS: The main themes identified were availability, affordability, innovation, influence of media, lack of a policy framework, and the sensory characteristics evoked from WTS. Men and women, smokers and non-smokers, and younger and older participants differed in their emphases on the above themes. These themes, though specific to waterpipe, are similar to themes manipulated by the cigarette industry, and eventually controlled through tobacco control policies. CONCLUSIONS: Understanding reasons behind the rise in waterpipe tobacco use is important if appropriate prevention, cessation, and policy interventions are to be formulated. Strict adherence to the FCTC is warranted, with careful and vigilant attention that all tobacco products are covered by laws in both high as well as middle to lower income countries.

Building research evidence for policy advocacy: a qualitative evaluation of existing smoke-free policies in Lebanon.

UNLABELLED: Secondhand smoke is harmful to smokers and nonsmokers, and smoke-free legislation worldwide improves health status. Lebanon has one of the weakest tobacco control regulatory environments in the Eastern Mediterranean region. However, several Lebanese workplaces and hospitality venues have chosen to implement such policies on their own. The objective of this study was to document their experiences. Qualitative interviews and focus group discussions were conducted with management, employees, and clients. Thematic analysis was used to identify recurrent themes. RESULTS: describe the types of bans implemented; the reasons for adopting a policy; and the barriers and facilitators to implementation, enforcement, and compliance. A main facilitator was management support, whereas a main barrier was prosmoking norms. This analysis provides insight and lessons learned that can aid in scaling up tobacco control efforts in Lebanon and the Eastern Mediterranean region.

Health warning labelling practices on narghile (shisha, hookah) waterpipe tobacco products and related accessories.

BACKGROUND: Waterpipe tobacco smoking prevalence is increasing around the globe despite current evidence that smoke emissions are toxic and contain carcinogenic compounds. OBJECTIVE: To evaluate current health warning labelling practices on waterpipe tobacco products and related accessories. METHODS: All waterpipe tobacco products, as well as waterpipe accessories, were purchased from Lebanon and a convenience sample was obtained from Dubai (United Arab Emirates), Palestine, Syria, Jordan, Bahrain, Canada, Germany and South Africa. FINDINGS: Of the total number of waterpipe tobacco products collected from Lebanon, the majority had textual health warning labels covering on average only 3.5% of total surface area of the package. Misleading descriptors were commonplace on waterpipe tobacco packages and related accessories. CONCLUSIONS: There are no WHO FCTC compliant waterpipe-specific health warning labels on waterpipe tobacco products and related accessories. Introducing health warnings on waterpipe tobacco products and accessories will probably have worldwide public health benefits.