Tobacco is a threat to the environment and human health.

The 2022 World No-Tobacco Day campaign focuses on tobacco's threat to the environment. It aims to raise awareness on the environmental impact of tobacco throughout its lifecycle, demonstrating its destructive impact not only on human health, but also on the environment and the planet. It also aims to expose efforts of the tobacco industry to "greenwash" their reputation and products by increasingly portraying their activities as environmentally friendly.The campaign messages demonstrate the varied ways that tobacco cultivation, production, distribution, consumption, and post-consumer waste threaten the environment. Tobacco destroys forests, harms the soil, affects water supply, pollutes the air, and contributes to other types of unsustainable environmental damage.

Estimated and projected prevalence of tobacco smoking in males, Eastern Mediterranean Region, 2000-2025.

BACKGROUND: Three global reports published by the World Health Organization (WHO) report trends in the prevalence of tobacco smoking from 2000 to 2025 based on data from national surveys. AIMS: The is study aimed to: (i) compare current and projected prevalence rates of tobacco smoking presented in these reports for males ≥ 15 years in countries of the Eastern Mediterranean Region; and (ii) assess changes in the prevalence rates in the context of changes in tobacco monitoring and control policies in these countries. METHODS: Regional and country-level data on tobacco smoking were extracted from the trend reports. Percentage point differences between the estimated prevalence of tobacco smoking in 2010 and the projected prevalence in 2025 were calculated for countries with available data. Data on implementation of national surveys and policies on tobacco use were obtained from relevant WHO reports. RESULTS: In the latest trend report (2019), the prevalence of male current tobacco smoking is projected to decrease by less than 2 percentage points in the Region (from 33.1% in 2010 to 31.2% in 2025). The projections for male tobacco smoking for 2025 in the 2019 report are more encouraging than in the 2015 report in seven of the eight countries of the Region. For five of these seven countries, implementation of tobacco monitoring and tobacco control policies improved over the same period. CONCLUSIONS: Countries of the Region need to conduct additional national tobacco-use surveys to improve the accuracy of prevalence estimates and projections. Such data can help guide policy-makers to implement policies to control tobacco smoking.

Full implementation of the WHO Framework Convention on Tobacco Control in the Eastern Mediterranean Region is the responsibility of all.

Although the World Health Organization Framework Convention on Tobacco Control (FCTC) came into force in 2005, the tobacco control challenge continues to escalate. Despite the fact that tobacco use is finally projected to decrease in the Eastern Mediterranean Region (EMR), as indicated in the WHO Global Report on Trends in the Prevalence of Tobacco Use, the tobacco epidemic is still far from over.The challenges facing the Region do not have a single source; the tobacco epidemic started as a multi-faceted problem and remains so today. The emergency situation in several EMR countries is pushing tobacco control down the list of priorities for decision-makers, whether directly or indirectly affected by regional conflict. The existence of unregulated and novel tobacco products, such as e-cigarettes, in many EMR countries complicates the situation further. Such products allow affordable access to tobacco products for young people, which consequently increases nicotine dependence and thus worsens the tobacco epidemic.

Smoking prevalence in the Eastern Mediterranean Region.

BACKGROUND: Three global reports issued by the World Health Organization (WHO) track and report on trends in the prevalence of tobacco smoking from 2000 to 2025 based on data from national surveys. AIMS: This review aimed to compare regional and country-level projections for current tobacco smoking as presented in the WHO trend reports. These changes were considered in the context of improved monitoring and tobacco control policies. METHODS: Regional and country-level results in the WHO trend reports were considered in terms of the projected percentage point increase of current tobacco smoking between 2000 and 2025. Data on national surveys and policy implementation came from the relevant WHO reports. RESULTS: In the 2019 trend report, the prevalence of current tobacco smoking among males is projected to decrease by less than 2 percentage points by 2025. Eight countries featured in both the 2015 and 2019 WHO trend reports. Seven of these countries indicated a more encouraging projection (a decline in their projected increase between 2000 and 2025) for current male tobacco smoking in the 2019 report than in the 2015 report. For five out of these seven countries, their monitoring and tobacco control policy implementation improved over the same period. CONCLUSION: Countries in the Region should implement additional national surveys to improve the accuracy of prevalence estimates, allow further projections to be performed and motivate policy-makers to make positive policy changes. Solutions to under-reporting biases during surveys should be considered. Governments should use trend projections to guide effective tobacco control policies to reduce tobacco use in the Region.

The status of tobacco control in the Eastern Mediterranean Region: progress in the implementation of the MPOWER measures.

BACKGROUND: The World Health Organization (WHO) MPOWER measures are a set of highly effective tobacco control measures drawn from the WHO Framework Convention on Tobacco Control (FCTC), designed to help countries reduce the prevalence of tobacco use. The WHO Report on the Global Tobacco Epidemic is published biennially to monitor global implementation of these measures. AIMS: This review aimed to critically assess the status of MPOWER implementation in the Eastern Mediterranean Region. METHODS: Data were collected for WHO Reports on the Global Tobacco Epidemic, focusing on the most recent 2019 edition. Regional population coverage figures were calculated using this data and population figures for the countries of the Region. RESULTS: Between 2007 and 2018, for any MPOWER measure, there were 29 cases of countries progressing to the highest level of achievement; 23 cases of countries progressing to the intermediate levels from the lowest level; 12 cases of countries falling from the highest level; and 18 cases of countries falling to the lowest level. 57.7% of people are covered at the highest level for the monitoring measure; 63.7% for the smoke-free policies measure; 6.7% for the cessation measure; 60.7% for the health warnings measure; 37.4% for the mass media measure; 29.4% for the advertising bans measure; and 16.1% for the taxation measure. CONCLUSIONS: Countries must work comprehensively to improve tobacco control. Regional priorities should include lifting more people out of lowest level coverage for the health warnings and mass media measures, increasing taxation on tobacco products and improving access to cessation services.

Smoking cessation services in the Eastern Mediterranean Region: highlights and findings from the WHO Report on the Global Tobacco Epidemic 2019.

The report aimed to review and assess the status of tobacco cessation services in the Eastern Mediterranean Region (EMR). Nearly 70% of people in the Region have legal access to nicotine-replacement therapy but for 77% of these people the costs of the treatment are not covered. Bupropion and Varenicline are legally available in 10 and 11 EMR countries respectively. Just under 50% of people in the Region have access to at least some cessation support in primary health care facilities. Around 32% of people have access to a national toll-free quit line. Costs for cessation services are fully covered in few EMR countries; however, cessation services in the Region must be improved. Member States should aim to increase the availability of, and financial support for, cessation treatments and support, which should be prioritized in primary health care facilities.

Implementation of the WHO Framework Convention on Tobacco Control in Tunisia: Progress and challenges.

INTRODUCTION: The World Health Organization Framework Convention on Tobacco Control (WHO FCTC) was the first health treaty that requires state parties to adopt and implement the MPOWER package. The aim of this study is to review the current status of tobacco control policies in Tunisia according to the WHO FCTC recommendations. METHODS: This paper is a critical narrative literature review in which information was obtained from peer-reviewed articles, official government documents, reports, decrees and grey literature in French, Arabic and English. RESULTS: Modest progress in FCTC implementation in Tunisia was noted. The smoking ban in public places is not regularly or largely enforced. The advertising and promotion for tobacco and its products is prohibited by law, but, the ban does not cover the display and visibility of tobacco products at points-of-sale, through the internet, and the depiction of tobacco or tobacco use in entertainment media products. Health warnings on tobacco products consist only of text and do not exceed 30% of the main display areas but are expected to increase to 70% with graphics and text when the new law is passed. CONCLUSIONS: Effective intervention efforts are urgently required. These actions should include accelerating the adoption of a new law, enforcing the present law and the new one once adopted, developing an advocacy and argument about the positive impact on state budget balance, increasing taxes, combating smuggling and illicit manufacturing and counterfeiting, increased education, increased smoking cessation support and implementing periodic surveillance.

Lung health in the Eastern Mediterranean Region: the need to end designated smoking areas in public places (Editorial).

Tobacco use is a fatal habit that causes harm to almost all organs of the human body and kills up to half of its users. Studies have shown that tobacco contains a poisonous mix of more than 7000 chemicals that have major consequences, including heart attacks and strokes , and are considered major risk factors for many types of cancer (4) and the leading cause of lung cancer. Moreover, tobacco use dramatically affects the respiratory system, damaging its airways and alveoli, and leading to chronic obstructive lung diseases1 including emphysema and chronic bronchitis.

World No Tobacco Day 2018: towards a sustainable campaign involving the cardiovascular community (Editorial).

The movement to reduce tobacco use has been gathering pace in the Eastern Mediterranean Region (EMR), as governments aim at implementing legislation to encourage populations to turn away from tobacco consumption and avoid the associated health risks. Indeed, within the Region it was in 2007 that Egyptian cardiologist Prof. Hamdi El Sayed, former member of parliament and former head of the Medical Syndicate, successfully proposed legislation for the implementation of graphic health warnings on tobacco packets covering 50% of visible packaging. In 2011, cardiologist Dr George Saade, former focal point of tobacco control in the Lebanese Ministry of Health, proposed banning tobacco use in all public places in Lebanon - a country coined a "paradise for smokers" in local media - and witnessed the implementation of this ground-breaking legislation. Meanwhile, in 2013, cardiologist Dr Sania Nishtar, Pakistan, stood strongly in support of the tobacco control movement with regard to the adoption of legislation comprehensively banning tobacco advertising in Pakistan.

MPOWER, needs and challenges: trends in the implementation of the WHO FCTC in the Eastern Mediterranean Region.

BACKGROUND: WHO MPOWER aims to help countries prioritize tobacco control measures in line with the WHO Framework Convention on Tobacco Control. OBJECTIVES: This paper assessed the progress and challenges in implementing the 6 priority policies of MPOWER in countries of the WHO Eastern Mediterranean Region since 2011. METHODS: A checklist was developed and scores assigned based on the MPOWER indicators (maximum score 37). MPOWER data for the Region in the 2015 and 2017 tobacco control reports were extracted and scored. Data from similar analyses for 2011 and 2013 were also included. Countries were ranked by scores for each indicator for 2015 and 2017 and for overall scores for 2011 to 2017. RESULTS: The Islamic Republic of Iran, Egypt and Pakistan had the highest scores in 2015 (33, 29 and 27 respectively) and the Islamic Republic of Iran, Pakistan and Yemen had the highest scores in 2017 (34, 31 and 27 respectively). The indicators with the highest and lowest combined score for all countries were for advertising bans and compliance with smoke-free policies: 67 and 18 respectively in 2015, and 73 and 15 respectively in 2017. Most countries (15/22) had higher total scores in 2017 than 2015: Afghanistan, Bahrain and Syrian Arab Republic had the greatest increases. The total score for the Region increased from 416 out of a maximum score of 814 in 2011 to 471 in 2017. CONCLUSIONS: Although notable achievements have been made in the Region, many challenges to policy implementation remain and require urgent action by governments of the countries of the Region.

Tobacco advertising, promotion and sponsorship in entertainment media: a phenomenon requiring stronger controls in the Eastern Mediterranean Region.

Tobacco use and placement of tobacco products in television (TV) productions and movies is a way to promote tobacco use while avoiding tobacco advertising bans that exist in most countries. The fact that such productions are broadcast widely and viewed by millions, including children and young people, is of concern. This paper reviews the evidence on the use of tobacco advertising, promotion and sponsorship (TAPS) in TV and films in the Eastern Mediterranean Region and the ways to combat it. Evidence from Egypt shows considerable and increasing use of tobacco products by actors on screen, including female actors, in programmes aired during Ramadan in 2015-2017. A study of Iranian movies in 2015 showed that tobacco scenes in Iranian movies were increasing. In 2014, the WHO Regional Office for the Eastern Mediterranean held a consultative meeting on TAPS in drama. The consultation recommended regulating the tobacco presence in movies and TV through complete implementation of Article 13 of the WHO FCTC, and raising the issue to the WHO FCTC Conference of the Parties. In 2016, the Conference of the Parties called on parties to consider scaling up the implementation of WHO FCTC Article 13 and monitoring the use of TAPS in entertainment media in accordance with national legislation. A comprehensive approach is essential to end the tobacco industry's use of TV productions and movies to promote their products.

Moving away from the comfort zone of tobacco control policies to the highest level of implementation (Editorial).

The year 2015 marked the 10th anniversary of the entry into force of the WHO Framework Convention on Tobacco Control (FCTC). Following this, in the same year, the 18th comprehensive national tobacco control law(s) was adopted in the WHO Eastern Mediterranean Region (EMR). Member countries of the EMR have come a long way in tobacco control legislation since the entry into force of the WHO FCTC, with 19 of the 22 countries now party to it (except Morocco, Palestine and Somalia). But has this legal movement really succeeded in changing the prevalence of tobacco use in the Region?

The WHO Framework Convention on Tobacco Control as a tool for advancing health promotion: perspective from the Eastern Mediterranean Region.

The paper addresses the impact of the adoption and implementation of the WHO Framework Convention on Tobacco Control (FCTC) in the Eastern Mediterranean Region, and how successful the FCTC is as a tool for health promotion. The FCTC implementation has impacted areas such as surveillance systems for tobacco control, increasing political commitment, development of legislation and addressing new social norms in tobacco consumption. These developments help to overcome many challenges for better health promotion in the region. However, there are still other challenges such as the tobacco industry influence, but those challenges will not undermine the gains already achieved through both the negotiation process and implementation process of the FCTC. In conclusion, implementation of the FCTC has contributed positively to advancing health promotion in the region, and the continuation of strong implementation will lead to even better outcomes.

Tobacco use among Palestine refugee students (UNRWA) aged 13-15.

OBJECTIVE: The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) has made tobacco use prevention a primary health issue. UNRWA provides education, health, relief and social services in five fields of operation: Jordan, Lebanon, Syria, Gaza Strip and the West Bank. The purpose of this paper is to compare tobacco use among Palestine refugee students and students in the general population of the five fields of operation. METHODS: Global Youth Tobacco Survey (GYTS) data were collected from representative samples of students in UNRWA schools in each of the five fields of operation in 2008. For comparison, previous data are included from GYTS conducted in Gaza Strip, Lebanon, and the West Bank (2005) and in Jordan and Syria (2007). Data are presented for three groups of students: refugees attending schools within and outside the camps and non-refugee students in the general population. RESULTS: In each of the five fields of operation, there was no difference in current cigarette smoking, current use of shisha, or susceptibility to initiate smoking among the three groups of students. Cigarette smoking and susceptibility was lowest in the Gaza Strip and highest in the West Bank; shisha use was lowest in the Gaza Strip but over 30% in Lebanon, Syria, and the West Bank. Exposure to secondhand smoke in public places was greater than 60% in almost all sites. Exposure to indirect advertising was almost 10%. CONCLUSIONS: The similarity in tobacco use among the three groups of students suggests that a coordinated plan between the UNRWA and the governmental authority could be most beneficial in reducing the burden of tobacco-related morbidity and mortality.

Prevalence of tobacco use among students aged 13-15 years in Health Ministers' Council/Gulf Cooperation Council Member States, 2001-2004.

BACKGROUND: This article examines differences and similarities in adolescent tobacco use among Member States of the Health Ministers' Council for the Gulf Cooperation Council (HMC/GCC) using Global Youth Tobacco Survey (GYTS) data. METHODS: Nationally representative samples of students in grades associated with ages 13-15 in Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, United Arab Emirates, and Yemen. Schools were selected proportional to enrollment size, classes were randomly selected within participating schools, and all students in selected classes were eligible to participate. RESULTS: GYTS results confirmed that boys are significantly more likely than girls to smoke cigarettes or use shisha (water pipe). Students had higher rates of tobacco use than adults in Bahrain, Oman, and United Arab Emirates. For boys and girls, shisha use was higher than cigarette smoking in almost all countries. Susceptibility to initiate smoking among never smokers was higher than current cigarette smoking in all countries. Exposure to secondhand smoke in public places was greater than 30%, direct protobacco advertising exposure was greater than 70% on billboards and in newspapers, and more than 10% of students were influenced by indirect advertising. Finally, less than half of the students were taught in school about the dangers of tobacco use in the past year. CONCLUSIONS: For boys and girls, high prevalence of cigarette smoking, high prevalence of shisha use, and high susceptibility of never smokers to initiate smoking in the next year are troubling indicators for the future of chronic disease and tobacco-related mortality in the Member States of the HMC/GCC.

Global youth tobacco surveillance, 2000-2007.

PROBLEM: Tobacco use is a major contributor to deaths from chronic diseases. The findings from the Global Youth Tobacco Survey (GYTS) suggest that the estimate of a doubling of deaths from smoking (from 5 million per year to approximately 10 million per year by 2020) might be an underestimate because of the increase in smoking among young girls compared with adult females, the high susceptibility of smoking among never smokers, high levels of exposure to secondhand smoke, and protobacco indirect advertising. REPORTING PERIOD COVERED: This report includes GYTS data collected during 2000-2007 from 140 World Health Organization (WHO) member states, six territories (American Samoa, British Virgin Islands, Guam, Montserrat, Puerto Rico, and the U.S. Virgin Islands), two geographic regions (Gaza Strip and West Bank), one United Nations administered province (Kosovo), one special administrative region (Macau), and one Commonwealth (Northern Mariana Islands). For countries that have repeated GYTS, only the most recent data are included. For countries with multiple survey sites, only data from the capital or largest city are presented. DESCRIPTION OF SYSTEM: GYTS is a school-based survey of a defined geographic site that can be a country, a province, a city, or any other geographic entity. GYTS uses a standardized methodology for constructing sampling frames, selecting schools and classes, preparing questionnaires, conducting field procedures, and processing data. GYTS standard sampling methodology uses a two-stage cluster sample design that produces samples of students in grades associated with students aged 13-15 years. Each sampling frame includes all schools (usually public and private) in a geographically defined area containing any of the identified grades. In the first stage, the probability of schools being selected is proportional to the number of students enrolled in the specified grades. In the second sampling stage, classes within the selected schools are selected randomly. All students in selected classes attending school the day the survey is administered are eligible to participate. Student participation is voluntary and anonymous using self-administered data collection procedures. The GYTS sample design produces independent, cross-sectional estimates that are representative of each site. RESULTS: The findings in this report indicate that the level of cigarette smoking between boys and girls is similar in many sites; the prevalence of cigarette smoking and use of other tobacco products is similar; and susceptibility to initiate smoking among never smokers is similar among boys and girls and is higher than cigarette smoking in the majority of sites. Approximately half of the students reported that they were exposed to secondhand smoke in public places during the week preceding the survey. Approximately eight in 10 favor a ban on smoking in public places. Approximately two in 10 students own an object with a cigarette brand logo on it, and one in 10 students have been offered free cigarettes by a tobacco company representative. Approximately seven in 10 students who smoke reported that they wanted to stop smoking. Approximately seven in 10 students who smoked were not refused purchase of cigarettes from a store during the month preceding the survey. Finally, approximately six in 10 students reported having been taught in school about the harmful effects of smoking during the year preceding the survey. INTERPRETATION: The findings in this report suggest that interventions that decrease tobacco use among youth (e.g., increasing excise taxes, media campaigns, school programs in conjunction with community interventions, and community interventions that decrease minors' access to tobacco) must be broad-based, focused on boys and girls, and have components directed toward prevention and cessation. If effective programs are not developed and implemented soon, future morbidity and mortality attributed to tobacco probably will increase. PUBLIC HEALTH ACTION: The synergy between countries in passing tobacco-control laws, regulations, or decrees; ratifying the WHO Framework Convention on Tobacco Control; and conducting GYTS offers a unique opportunity to develop, implement, and evaluate comprehensive tobacco-control policy that can be helpful to each country. The challenge for each country is to develop, implement, and evaluate a tobacco-control program and make changes where necessary.