SMOKING CESSATION IN SYRIA, A DEVELOPING COUNTRY’S PERSPECTIVE
Taghrid Asfar MD, Researcher - Smoking Cessation Intervention Program, Syrian Center for Tobacco Studies (SCTS), Aleppo - Syria
A descriptive picture of the spread, and patterns of smoking in Syria.
In 2004, The prevalence of current smoking
among adults was 60% for men, 23% for women.
Generally, men in Syria smoke more than
women and consume more cigarettes daily.
Male smokers in Syria are more likely to show
signs of addiction and nicotine dependence.
Quitting
Syrian smokers have less success in their quitting
efforts compared to smokers in developed countries. (62% of smoker schoolteachers wanted to quit, but the prevalence of ex-smokers was 12%).
This lack of success may be attributable to the fact
that most Syrians quit on their own.
Identify obstacles for the
application of smoking cessation in Syria
1- Lack of pharmacological agents for smoking cessation.
in Syria neither bupropion nor NRT are
currently available.
The price of these drug even in neighboring
countries is high.
Financial constraints may prevent the
government from supporting free cessation services and medications.
2- Smoking behaviour and attitude of health care professional.
In 1999, the prevalence of smoking among doctors was
(40.7% for men, 11.4% women).
Although doctors were aware of the health
consequences of tobacco use, this knowledge seems to have little effect on their smoking behavior.
Physicians, often do not seriously address the issue of
smoking, or smoke themselves, which makes it difficult to take an active role in anti-smoking efforts.
3- Deficiency in the health care system.
The health care system in Syria is more treatment oriented than
prevention.
Tobacco control interventions judged by the lack of cessation
services within the health care system seems to be a low priority.
Currently, there are no local clinical practice guidelines for
smoking cessation in Syria, and no cessation counseling training opportunities.
The transferability of effective interventions from other
countries has not been tested.
Strategies used by the SCTS to overcome these obstacles
1- Increase access to pharmacological agents used in smoking cessation interventions.
Lobby with main stakeholders about the
importance of providing pharmacological agents used in smoking cessation treatment.
Try to involve some local pharmacological
companies to provide these drugs.
Negotiate with policy makers the importance of
delivering free cessation services and medications.
2- Involve physicians in cessation efforts.
Increase physicians awareness about tobacco, its health
consequences, and the need for concerted efforts to curb the epidemic.
Train physicians to assess tobacco use at each visit,
provide a brief intervention based on the ‘5 A’s’, and provide effective behavioral and pharmacological intervention.
Emphasize physicians professional responsibility to take
a leadership role in advocating for comprehensive tobacco control efforts.
3- Develop and implement effective and cost-effective interventions that can be integrated into the existing health care structure in Syria.
1- Study of local tobacco use patterns and cessation options.
Study of regional tobacco use patterns and cessation
options using qualitative and quantitative methods.
Study of nicotine exposure and abstinence effects using
clinical laboratory methods.
Integration of information from Steps 1 and 2 to aid
development and implementation of a primary care based smoking cessation intervention.
focus on other tobacco use methods that are popular in
the region (e.g., narghile).
Waterpipe use needs to be considered in developing effective tobacco use cessation programs in the Middle East.
In Syria, current waterpipe smoking among University
students (25% men, 5% women, in 2003), and among adults (20% men, 5% women, in 2004).
Primarily evidence shows that waterpipe use is associated with
serious health consequences similar to cigarette smoking.
There is evidence of misperception by waterpipe users that this
product is less lethal than cigarettes. This misperception should be addressed to prevent switching to waterpipe after cessation of cigarette use.
2- Pilot test of the developed cessation program in a randomized controlled trial.
Validated smoking cessation programs and supplementary
materials will be adapted for the Syrian environment.
Analysis of outcome measures will help understanding the
addictive process of smokers in Syria.
Analysis of abstinence according to demographic and
socioeconomic characteristics will detect factors contribute to success or failure of the cessation intervention.
Sub analysis of attrition across intervention conditions and other
sociodemographics factors will help modifying our cessation approach.
3- implement and test a primary care based cessation intervention.
Primary care centers are easy access to smokers, and
variety of health care professionals are available to provide smoking cessation.
Trained Physicians will assess tobacco use and
deliver the brief interventions, or the effective behavioral/pharmacological intervention.
This trial will test the feasibility of pharmacologic
interventions, and the characteristics of behavioral intervention likely to be optimal for the setting.