115 results found
Mostafa A, Chalak A, Nakkash R, et al., 2023, Health and economic impacts of introducing specific excise tax to waterpipe tobacco in Egypt: A simulation model of simple and mixed tax policy approaches, BMJ Global Health, ISSN: 2059-7908
Introduction: Waterpipe tobacco is taxed at half the rate of cigarettes in Egypt and, unlike cigarettes, does not have a specific excise component. We aimed to simulate the introduction of a specific excise tax on waterpipe tobacco consumption, premature deaths, and government waterpipe tobacco revenue in Egypt.Methods: We took model inputs from the latest available data on consumption, market shares and market share prices, price elasticities of demand, tax structure, and from discussions with government officials. We modelled increases to specific excise to produce a 45%, 55%, 65%, and 75% tax burden and compared a simple (specific only) structure to a mixed (specific and ad valorem) structure.Results: Under the simple approach, introducing a $2.1 (USD) specific tax would result in a 75% tax burden with 67% fewer waterpipe tobacco units smoked, 1,004,604 averted premature deaths, and a 236% increase in government revenue relative to the current tax structure. At the 75% tax burden, the simple approach resulted in 1.5% fewer waterpipe tobacco units consumed, 9,000 more averted premature deaths, and 12.7% more government revenue compared to the mixed approach. Results for other tax burdens are presented and remained robust to sensitivity analyses.Conclusions: Introducing a specific excise tax on waterpipe tobacco in Egypt can yield considerable government revenue and public health gains. We recommend the simple approach, in line with the WHO recommendations, which produces greater economic and public health gains than the mixed approach and is easier to administer for the Egyptian government.
Jawad M, Awawda S, Abla R, et al., 2022, Impact of waterpipe tobacco taxation on consumption, government revenue and premature deaths averted in Jordan, Lebanon and Palestine: a simulation study, TOBACCO CONTROL, ISSN: 0964-4563
Abu Hamad B, Jamaluddine Z, Safadi G, et al., 2022, The hypertension cascade of care in the midst of conflict: the case of the Gaza Strip, Journal of Human Hypertension, ISSN: 0950-9240
Although hypertension constitutes a substantial burden in conflict-affected areas, little is known about its prevalence, control, and management in Gaza. This study aims to estimate the prevalence and correlates of hypertension, its diagnosis and control among adults in Gaza. We conducted a representative, cross-sectional, anonymous, household survey of 4576 persons older than 40 years in Gaza in mid-2020. Data were collected through face-to-face interviews, anthropometric, and blood pressure measurements. Hypertension was defined in anyone with an average systolic blood pressure ≥140 mmHg or average diastolic blood pressure ≥90 mmHg from two consecutive readings or a hypertension diagnosis. The mean age of participants was 56.9 ± 10.5 years, 54.0% were female and 68.5% were Palestinian refugees. The prevalence of hypertension was 56.5%, of whom 71.5% had been diagnosed. Hypertension was significantly higher among older participants, refugees, ex-smokers, those who were overweight or obese, and had other co-morbidities including mental illnesses. Two-thirds (68.3%) of those with hypertension were on treatment with one in three (35.6%) having their hypertension controlled. Having controlled hypertension was significantly higher in females, those receiving all medications for high blood pressure and those who never or rarely added salt to food. Investing in comprehensive but cost-effective initiatives that strengthen the prevention, early detection and timely treatment of hypertension in conflict settings is critical. It is essential to better understand the underlying barriers behind the lack of control and develop multi-sectoral programs to address these barriers.
Bteddini D, Nakkash RT, Chalak A, et al., 2022, Economic research in waterpipe tobacco smoking: reflections on data, demand, taxes, equity and health modelling, TOBACCO CONTROL, ISSN: 0964-4563
Awawda S, Chalak A, Khader Y, et al., 2022, Gender differences in the price elasticity of demand for waterpipe and cigarette smoking in Lebanon, Jordan and Palestine: a volumetric choice experiment, BMJ OPEN, Vol: 12, ISSN: 2044-6055
Radó MK, Laverty AA, Hone T, et al., 2022, Cigarette taxation and neonatal and infant mortality: a longitudinal analysis of 159 countries, PLOS Global Public Health, Vol: 2, ISSN: 2767-3375
Previous studies on the associations between cigarette taxes and infant survival have all been in high-income countries and did not examine the relative benefits of different taxation levels and structures. We evaluated longitudinal associations of cigarette taxes with neonatal and infant mortality globally. We applied country-level panel regressions using 2008–2018 annual mortality and biennial WHO tobacco taxation data. Complete data was available for 159 countries. Outcomes were neonatal and infant mortality. We conducted analyses by type of taxes (i.e. specific cigarette taxes, ad valorem taxes, and other taxes, import duties and VAT) and the income group classification of countries. Covariates included scores for other WHO recommended tobacco control policies, socioeconomic, health-care, and air quality measures. Secondary analyses investigated the associations between cigarette tax and cigarette consumption. We found that a 10 percentage-point increase in total cigarette tax as a percentage of the retail price was associated with a 2.6% (95% Confidence Interval [CI]: 1.9% to 3.2%) decrease in neonatal mortality and a 1.9% (95% CI: 1.3% to 2.6%) decrease in infant mortality globally. Estimates were similar for both excise and ad valorem taxes. We estimated that 231,220 (95% CI: 152,658 to 307,655) infant deaths could have been averted in 2018 if all countries had total cigarette tax at least 75%. 99.2% of these averted deaths would have been in low- and middle-income countries (LMICs). The secondary analysis supported causal interpretation of results by finding that a 10 percentage-point increase in taxes was associated with a reduction of 94.6 (95% CI: 32.7 to 156.5) in annual cigarette consumption per capita. Although causal inference is precarious due to the quasi-experimental design, we used a robust analytical approach and focused on within-country changes. Limitations include an inability to include data on roll-your-own tobacco, other forms of toba
Nakkash R, Khader Y, Chalak A, et al., 2022, Prevalence of cigarette and waterpipe tobacco smoking among adults in three Eastern Mediterranean countries: a cross-sectional household survey, BMJ OPEN, Vol: 12, ISSN: 2044-6055
Coley-Grant D, Jawad M, Ashby HL, et al., 2021, The Relationship Between Intact Parathyroid Hormone and 25-Hydroxyvitamin D in United Kingdom Resident South Asians and Whites: A Comparative, Cross-Sectional Observational Study., Horm Metab Res, Vol: 53, Pages: 672-675
Ethnic differences in intact parathyroid hormone (iPTH) at similar total 25 hydroxyvitamin D [25(OH)D] concentrations have been reported between US resident Whites, Blacks, and Hispanics, but this has not been studied between South Asians and Whites. We, therefore, compared the iPTH relationship to 25(OH)D in UK resident South Asians and Whites. A comparative, cross-sectional observational study in which demographic and laboratory data on South Asian and White residents of Wolverhampton, UK were analyzed. Log-log models measured the association between 25(OH)D and the interaction term of ethnicity and iPTH. Seven hundred and seventy-two patients consisting of 315 white subjects (208 women) and 457 South Asian subjects (331 women) were studied. Compared to South Asians, White subjects were older, had higher serum concentrations of 25(OH)D, creatinine (lower eGFR), adjusted calcium and magnesium, but similar concentrations of iPTH and phosphate. In an adjusted model, variables significantly associated with 25(OH)D included age, creatinine, adjusted calcium and ethnicity; but not iPTH and the interaction term of ethnicity and iPTH (beta coefficient -0.071, 95% CI -0.209, 0.067, p=0.32). In our study cohort, iPTH was not, per se, influenced by 25 (OH)D. We found no ethnic differences in the association between iPTH and 25(OH)D between South Asians and White UK residents.
Jawad M, Hone T, Vamos EP, et al., 2021, Implications of armed conflict for maternal and child health: A regression analysis of data from 181 countries for 2000-2019, PLoS Medicine, Vol: 18, ISSN: 1549-1277
BACKGROUND: Armed conflicts have major indirect health impacts in addition to the direct harms from violence. They create enduring political instability, destabilise health systems, and foster negative socioeconomic and environmental conditions-all of which constrain efforts to reduce maternal and child mortality. The detrimental impacts of conflict on global maternal and child health are not robustly quantified. This study assesses the association between conflict and maternal and child health globally. METHODS AND FINDINGS: Data for 181 countries (2000-2019) from the Uppsala Conflict Data Program and World Bank were analysed using panel regression models. Primary outcomes were maternal, under-5, infant, and neonatal mortality rates. Secondary outcomes were delivery by a skilled birth attendant and diphtheria, pertussis, and tetanus (DPT) and measles vaccination coverage. Models were adjusted for 10 confounders, country and year fixed effects, and conflict lagged by 1 year. Further lagged associations up to 10 years post-conflict were tested. The number of excess deaths due to conflict was estimated. Out of 3,718 country-year observations, 522 (14.0%) had minor conflicts and 148 (4.0%) had wars. In adjusted models, conflicts classified as wars were associated with an increase in maternal mortality of 36.9 maternal deaths per 100,000 live births (95% CI 1.9-72.0; 0.3 million excess deaths [95% CI 0.2 million-0.4 million] over the study period), an increase in infant mortality of 2.8 per 1,000 live births (95% CI 0.1-5.5; 2.0 million excess deaths [95% CI 1.6 million-2.5 million]), a decrease in DPT vaccination coverage of 4.9% (95% CI 1.5%-8.3%), and a decrease in measles vaccination coverage of 7.3% (95% CI 2.7%-11.8%). The long-term impacts of war were demonstrated by associated increases in maternal mortality observed for up to 7 years, in under-5 mortality for 3-5 years, in infant mortality for up to 8 years, in DPT vaccination coverage for up to 3 years, and in
Habib RR, Mikati D, Al-Barathie J, et al., 2021, Work-related injuries among Syrian refugee child workers in the Bekaa Valley of Lebanon: A gender-sensitive analysis, PLOS ONE, Vol: 16, ISSN: 1932-6203
Jawad M, Shihadeh A, Nakkash RT, 2021, Philip Morris patents 'harm reduction' electronic waterpipe, TOBACCO CONTROL, Vol: 30, Pages: 473-473, ISSN: 0964-4563
Chalak A, Nakkash R, Abu-Rmeileh NME, et al., 2021, Own-price and cross-price elasticities of demand for cigarettes and waterpipe tobacco in three Eastern Mediterranean countries: a volumetric choice experiment, TOBACCO CONTROL, Vol: 32, Pages: 86-92, ISSN: 0964-4563
Jawad M, Millett C, Nakkash R, 2021, Tobacco-control challenges among adolescents in the Eastern Mediterranean region Comment, LANCET CHILD & ADOLESCENT HEALTH, Vol: 5, Pages: 234-235, ISSN: 2352-4642
Flecknoe MD, Jawad M, Latif S, et al., 2021, Communicable and Noncommunicable Diseases in Conflict Zones, Handbook of Healthcare in the Arab World, Pages: 699-723, ISBN: 9783030368104
Modern armed conflict represents a significant risk to global health. This risk is partly inherent in the use of mass violence to advance political goals but also arises in large part from the contemporary trend of warring parties failing in their duty to abide by International Humanitarian Law. The deliberate targeting (or negligent destruction) of civilian and health infrastructure, the endangerment of health workers, and the subjection of a civilian population to starvation, unnecessary forced displacement, and other cruelties are war crimes which should not be normalized. As well as the direct toll of morbidity and mortality that they bring in the form of short-term injuries and deaths, these actions dramatically increase the risk of communicable and noncommunicable disease incidence and simultaneously reduce the ability of a society to prevent and control such risks. Armed conflict degrades the capacity of health systems to gather vital data and plan effectively for future emergencies, and all of these impacts can persist long after the guns have fallen silent. A fuller understanding of the many and various ways in which warfare affects public health (in the separate but linked senses of the professional discipline and the collective health and well-being of the public) would be highly beneficial to international policy-makers, humanitarian workers, and health professionals of whatever background who work (or are planning to work) in or near conflict zones.
Abdul-Khalek R, Kayyal W, Akkawi AR, et al., 2020, Health-related articles on Syria before and after the start of armed conflict: a scoping review for The Lancet-American University of Beirut Commission on Syria, Conflict and Health, Vol: 14, ISSN: 1752-1505
IntroductionArmed conflict may influence the size and scope of research in Arab countries. We aimed to assess the impact of the 2011 Syrian conflict on health articles about Syria published in indexed journals.MethodsWe conducted a scoping review on Syrian health-related articles using seven electronic databases. We included clinical, biomedical, public health, or health system topics published between 1991 and 2017. We excluded animal studies and studies conducted on Syrian refugees. We used descriptive and social network analyses to assess the differences in rates, types, topics of articles, and authorship before and after 2011, the start of the Syrian conflict.ResultsOf 1138 articles, 826 (72.6%) were published after 2011. Articles published after 2011 were less likely to be primary research; had a greater proportion reporting on mental health (4.6% vs. 10.0%), accidents and injuries (2.3% vs. 18.8%), and conflict and health (1.7% vs. 7.8%) (all p < 0.05); and a lower proportion reporting on child and maternal health (8.1 to 3.6%, p = 0.019). The proportion of research articles reporting no funding increased from 1.1 to 14.6% (p < 0.01). While international collaborations increased over time, the number of articles with no authors affiliated to Syrian institutions overtook those with at least one author affiliation to a Syrian institution for the first time in 2015.ConclusionTo our knowledge, this is the first study to examine the impact of armed conflict on health scholarship in Syria. The Syrian conflict was associated with a change in the rates, types, and topics of the health-related articles, and authors’ affiliations. Our findings have implications for the prioritization of research funding, development of inclusive research collaborations, and promoting the ethics of conducting research in complex humanitarian settings.
Jawad M, Hone T, Vamos E, et al., 2020, Estimating indirect mortality impacts of armed conflict in civilian populations: panel regression analyses of 193 countries, 1990-2017, BMC Medicine, Vol: 266, Pages: 1-11, ISSN: 1741-7015
BackgroundArmed conflict can indirectly affect population health through detrimental impacts on political and social institutions and destruction of infrastructure. This study aimed to quantify indirect mortality impacts of armed conflict in civilian populations globally, and explore differential effects by armed conflict characteristics and population groups.Methods We included 193 countries between 1990 and 2017 and constructed fixed effects panel regression models using data from the Uppsala Conflict Data Program and Global Burden of Disease study. Mortality rates were corrected to exclude battle-related deaths. We assessed separately four different armed conflict variables (capturing binary, continuous, categorical and quintile exposures) and ran models by cause-specific mortality stratified by age groups and sex. Post-estimation analyses calculated the number of civilian deaths. ResultsWe identified 1,118 unique armed conflicts. Armed conflict was associated with increases in civilian mortality - driven by conflicts categorised as wars. Wars were associated with an increase in age-standardised all-cause mortality of 81.5 per 100.000 population (β 81.5, 95% CI 14.3-148.8) in adjusted models contributing 29.4 million civilian deaths (95% CI 22.1-36.6) globally over the study period. Mortality rates from communicable, maternal, neonatal, and nutritional diseases (β 51.3, 95% CI 2.6-99.9), non-communicable diseases (β 22.7, 95% CI 0.2-45.2) and injuries (β 7.6, 95% CI 3.4-11.7) associated with war increased, contributing 21.0 million (95% CI 16.3-25.6), 6.0 million (95% CI 4.1-8.0), and 2.4 million deaths (95% CI 1.7-3.1) respectively. War-associated increases in all-cause and cause-specific mortality were found across all age groups and both genders, but children aged 0-5 years had the largest relative increases in mortality. Conclusions Armed conflict, particularly war, is associated with a substantial indirect mortality impact among civilians
Jawad M, Blanchet K, Leaning J, 2020, Editorial: Revisiting public health response in times of war, JOURNAL OF PUBLIC HEALTH, Vol: 42, Pages: E285-E286, ISSN: 1741-3842
Al Oweini D, Jawad M, Akl EA, 2020, The association of waterpipe tobacco smoking with later initiation of cigarette smoking: a systematic review and meta-analysis exploring the gateway theory, TOBACCO CONTROL, Vol: 29, Pages: 577-584, ISSN: 0964-4563
Habib RR, Ziadee M, Abi Younes E, et al., 2020, The association between living conditions and health among Syrian refugee children in informal tented settlements in Lebanon, Journal of Public Health (Oxford), Vol: 42, Pages: e323-e333, ISSN: 1741-3842
BACKGROUND: This cross-sectional study explores the relationship between housing, social wellbeing, access to services and health among a population of Syrian refugee children in Lebanon. METHODS: We surveyed 1902 Syrian refugee households living in informal tented settlements in Lebanon in 2017. Logistic regressions assessed relationships between housing problems, socioeconomic deprivation, social environment and health. RESULTS: Of the 8284 children in the study, 33.0% had at least one health problem. A considerable number of households (43.1%) had > 8 housing problems. Children in these households had higher odds to have three or more health problems compared to children in households with < 6 housing problems (adjusted odds ratio [AOR], 2.39; confidence interval [CI], 1.50-3.81). Nearly three-quarters (74.3%) of households were severely food insecure. Children in these households had higher odds to have one health problem than those in food secure households (AOR, 1.75; CI, 1.11-2.76). There was a significant positive association between households that reported being unhappy with their neighbourhood and the number of children with health problems in those households. CONCLUSIONS: This study highlights the association between the physical and social living conditions and refugee children's health. Without multidimensional interventions that consider improvements to living conditions, the health of young Syrian refugees will continue to worsen.
Jawad M, Millett C, Sullivan R, et al., 2020, The impact of armed conflict on cancer among civilian populations in low- and middle-income countries: a systematic review, Ecancermedicalscience, Vol: 14, ISSN: 1754-6605
Commitee On Publication EthicsecancermedicalscienceSubmit articleArticlesEditorialsSpecial issuesAuthor interviewsCategorySub-categoryArticle typeVolumeKeywordBookmark and ShareArticle metrics: 204 viewshttps://doi.org/10.3332/ecancer.2020.1039Abstract | Full Article | PDFReviewThe impact of armed conflict on cancer among civilian populations in low- and middle-income countries: a systematic reviewMohammed Jawad1, Christopher Millett1, Richard Sullivan2, Fadel Alturki3, Bayard Roberts4 and Eszter P Vamos11Public Health Policy Evaluation Unit, Imperial College London, Hammersmith, London W6 8RP, UK2Institute of Cancer Policy, Cancer Epidemiology, Population and Global Health, King's College London and Guy's & St Thomas' NHS Trust, London, UK3Faculty of Medicine, American University of Beirut, Lebanon4Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UKAbstractBackground: Armed conflicts are increasingly impacting countries with a high burden of cancer. The aim of this study is to systematically review the literature on the impact of armed conflict on cancer in low- and middle-income countries (LMICs).Methods: In November 2019, we searched five medical databases (Embase, Medline, Global Health, PsychINFO and the Web of Science) without date, language or study design restrictions. We included studies assessing the association between armed conflict and any cancer among civilian populations in LMICs. We systematically re-analysed the data from original studies and assessed quality using the Newcastle-Ottawa Scale. Data were analysed descriptively by cancer site.Results: Of 1,543 citations screened, we included 20 studies assessing 8 armed conflicts and 13 site-specific cancers (total study population: 70,172). Two-thirds of the studies were of low methodological quality (score <5) and their findings were often conflicting. However, among outcomes assessed by three or more studies, we found some evi
Jawad M, Dogar O, Kanaan M, et al., 2020, Factors associated with dual use of waterpipe tobacco and cigarettes among adults in Pakistan, EASTERN MEDITERRANEAN HEALTH JOURNAL, Vol: 26, Pages: 47-54, ISSN: 1020-3397
Singh N, Jawad M, Darzi A, et al., 2019, Features of the waterpipe tobacco industry: A qualitative study of the third International Hookah Fair [version 2; peer review: 2 approved; 1 approved with reservations], F1000Research, Vol: 7, Pages: 247-247, ISSN: 2046-1402
Background: Little research has been done to uncover the features of the waterpipe tobacco industry, which makes designing effective interventions and policies to counter this growing trend challenging. The objective of this study is to describe the features of the waterpipe industry. Methods: In 2015, we randomly sampled and conducted semi-structured interviews with 20 representatives of waterpipe companies participating in a trade exhibition in Germany. We used an inductive approach to identify emerging themes. Results: We interviewed representatives and four themes emerged: industry globalisation, cross-industry overlap, customer-product relationship, and attitude towards policy. The industry was described as transnational, generally decentralized, non-cartelized, with ad hoc relationships between suppliers, distributors and retailers. Ties with the cigarette industry were apparent. The waterpipe industry appeared to be in an early growth phase, encroaching on new markets, and comprising of mainly small family-run businesses. Customer loyalty appears stronger towards the waterpipe apparatus than tobacco. There was a notable absence of trade unionism and evidence of deliberate breaches of tobacco control laws. Conclusion: The waterpipe industry appears fragmented but is slowly growing into a mature, globalized, and customer-focused industry with ties to the cigarette industry. Now is an ideal window of opportunity to strengthen public health policy towards the waterpipe industry, which should include a specific legislative waterpipe framework.
Jawad M, Vamos E, Najim M, et al., 2019, Impact of armed conflict on cardiovascular disease risk: a systematic review, Heart, Vol: 105, Pages: 1388-1394, ISSN: 1355-6037
ObjectivesProlonged armed conflict may constrain efforts to address non-communicable disease in some settings. We assessed the impact of armed conflict on cardiovascular disease (CVD) risk among civilians in low- and middle-income countries (LMICs).MethodsIn February 2019 we performed a systematic review (Prospero ID: CRD42017065722) searching Medline, Embase, PsychINFO, Global Health, and Web of Science without language or date restrictions. We included adult, civilian populations in LMICs. Outcomes included CVDs and diabetes, and eight clinical and behavioural factors (blood pressure, blood glucose, lipids, tobacco, alcohol, body mass index, nutrition, physical activity). We systematically re-analysed data from original papers and presented them descriptively.ResultsSixty-five studies analysed 23 conflicts, and 66% were of low quality. We found some evidence that armed conflict is associated with an increased coronary heart disease, cerebrovascular, and endocrine diseases, in addition to increased blood pressure, lipids, alcohol, and tobacco use. These associations were more consistent for mortality from chronic ischaemic heart disease or unspecified heart disease, systolic blood pressure, and tobacco use. Associations between armed conflict and other outcomes showed no change, or had mixed or uncertain evidence. We found no clear patterning by conflict type, length of follow up, and study quality, nor strong evidence for publication bias.ConclusionsArmed conflict may exacerbate CVDs and their risk factors, but the current literature is somewhat inconsistent. Post-conflict reconstruction efforts should deliver low resource preventative interventions through primary care to prevent excess CVD-related morbidity and mortality.
Arshad A, Matharoo J, Arshad E, et al., 2019, Knowledge, attitudes, and perceptions towards waterpipe tobacco smoking amongst college or university students: a systematic review, BMC Public Health, Vol: 19, ISSN: 1471-2458
BackgroundDespite evidence for the harms of waterpipe tobacco smoking (WTS), its use is increasing amongst college and university students worldwide. This systematic review aims to assess the knowledge of, attitudes towards and perceptions of WTS among college or university students.MethodsWe electronically searched MEDLINE, EMBASE, CINAHL, PSYCHINFO and ISI the Web of Science in October 2018, restricting our search to studies published since January 1990. We included studies among university or college students that used qualitative or quantitative methods, and addressed either knowledge, attitudes, or perceptions towards WTS. We excluded studies where WTS could not be distinguished from other forms of tobacco use and studies reported as abstracts where the full text could not be identified. Data were synthesised qualitatively and analysed data by region (global north/ south), and by reasons for use, knowledge of health hazards, how knowledge influences use, perceptions towards dependence, and policy knowledge.ResultsEighty-six studies were included; 45 from the global north and 41 from the global south. Socio-cultural and peer influences were major contributing factors that encouraged students to initiate WTS. Furthermore, WTS dependence had two components: psychological and social. This was compounded by the general perception that WTS is a less harmful, less addictive and more sociable alternative to cigarette smoking. Knowledge of WTS harms failed to correlate with a reduced risk of WTS use, and some students reported symptoms of WTS addiction. A large proportion of students believed that quitting WTS was easy, yet few were able to do so successfully. Finally, students believed current public health campaigns to educate on WTS harms were inadequate and, particularly in the global north, were not required.ConclusionReasons for WTS amongst university students are multi-faceted. Overall, interventions at both the individual and community level, but also policy mea
Jawad M, Al-Houqani M, Ali R, et al., 2019, Prevalence, attitudes, behaviours and policy evaluation of midwakh smoking among young people in the United Arab Emirates: Cross-sectional analysis of the Global Youth Tobacco Survey, PLOS ONE, Vol: 14, ISSN: 1932-6203
Filippidis FT, Jawad M, Vardavas CI, 2019, Trends and correlates of waterpipe use in the European Union: analysis of selected Eurobarometer surveys (2009-2017)., Nicotine and Tobacco Research, Vol: 21, Pages: 469-474, ISSN: 1462-2203
Introduction: To assess the trends and correlates of waterpipe use between 2009 and 2017 in the 28 European Union (EU) member states. Methods: We analysed data from wave 72.3 (2009, n=27,788); wave 77.1 (2012, n=26,751); wave 82.4 (2014, n=27,801); and wave 87.1 (2017, n=27,901) of the Eurobarometer survey. Representative samples of EU residents aged ≥15 years were asked to report ever use of waterpipe. Regular waterpipe use, i.e. at least once a month was also assessed in 2017. Associations of ever and current use with sociodemographic factors were assessed with multi-level logistic regression. Results: The prevalence of ever waterpipe use in the EU increased from 11.6% in 2009 to 16.3% in 2014 before dropping to 12.9% in 2017, but there was wide variation between EU member states, ranging from 2.3% (Croatia, 2009) to 41.7% (Latvia, 2017). Regular waterpipe use was highest in Austria (3.6%), Latvia (2.5%) and Belgium (2.0%) in 2017. Respondents aged 15-24 years were 11.43 times more likely (95% Confidence Interval [CI]: 10.71-12.21) to have ever used waterpipe compared to those 55 years and older. Regular and ever waterpipe use were also more likely among current and former cigarette smokers. Males (adjusted Odds Ratio [aOR]=1.64; 95% CI: 1.58-1.70) and those living in urban areas (aOR=1.36; 95% CI: 1.30-1.42) were more likely to have ever used waterpipe. Conclusion: A substantial proportion of EU citizens, especially young men, have tried waterpipe. Regular use is relatively limited, but more systematic surveillance is required to monitor trends across the EU. Implications: Data on waterpipe use in the European Union (EU) are scarce. The prevalence of ever waterpipe use in the EU increased from 11.6% in 2009 to 16.3% in 2014 before dropping to 12.9% in 2017, with wide variation between EU member states. Males, those living in urban areas, younger respondents and current or former cigarette smokers were more likely to be ever or regular users of waterpipe.
Jawad M, Eissenberg T, Salman R, et al., 2019, Toxicant inhalation among singleton waterpipe tobacco users in natural settings, TOBACCO CONTROL, Vol: 28, Pages: 181-188, ISSN: 0964-4563
Habib RR, Ziadee M, Younes EA, et al., 2019, Displacement, deprivation and hard work among Syrian refugee children in Lebanon, BMJ GLOBAL HEALTH, Vol: 4, ISSN: 2059-7908
Jawad M, Millett C, 2019, Waterpipe tobacco smoking: prevalence, health effects and interventions to reduce use, WHO STUDY GROUP ON TOBACCO PRODUCT REGULATION: REPORT ON THE SCIENTIFIC BASIS OF TOBACCO PRODUCT REGULATION: SEVENTH REPORT OF A WHO STUDY GROUP, Publisher: WORLD HEALTH ORGANIZATION, Pages: 233-255
Hussain Z, van Schalkwyk MC, Alkateb L, et al., 2018, Assessing the advertisement of waterpipe tobacco on eBay in the UK, Tobacco Control, Vol: 29, ISSN: 0964-4563
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