Self-rated health and its determinants among adults in Syria: a model from the Middle East

<p>Abstract</p> <p>Background</p> <p>Self-rated health (SRH) has been widely used to research health inequalities in developed western societies, but few such studies are available in developing countries. Similar to many Arab societies, little research has been conducted in Syria on the health status of its citizens, particularly in regards to SRH. This Study aims to investigate and compare determinants of SRH in adult men and women in Aleppo, Syria.</p> <p>Methods</p> <p>A cross-sectional survey of adults 18 to 65 years old residing in Aleppo (2,500,000 inhabitants), Syria was carried out in 2004, involving 2038 household representatives (45.2% men, age range 18–65 years, response rate 86%). SRH was categorized as excellent, normal, and poor. Odds ratios for poor and normal SRH, compared to excellent, were calculated separately for men and women using logistic regression.</p> <p>Results</p> <p>Women were more likely than men to describe their health as poor. Men and women were more likely to report poor SRH if they were older, reported two or more chronic health problems, or had high self perceived functional disability. Important gender-specific determinants of poor SRH included being married, low socioeconomic status, and not having social support for women, and smoking, low physical activity for men.</p> <p>Conclusion</p> <p>Women were more likely than men to describe their health as poor. The link with age and pre-existing chronic conditions seems universal and likely reflects natural aging process. Determinants of SRH differed between men and women, possibly highlighting underlying cultural norms and gender roles in the society. Understanding the local context of SRH and its determinants within the prevailing culture will be important to tailor intervention programs aimed at improving health of the Syrian and similar Arab societies.</p

Novel insights into young adults’ perceived effectiveness of waterpipe tobacco-specific pictorial health warning labels in lebanon: Implications for tobacco control policy

This study aims to explore the perceived effectiveness of waterpipe (WP) tobacco specific health warning labels (HWLs) among young adult WP smokers and nonsmokers in Lebanon. Before participating in focus group discussions, participants (n = 66; WP smokers n = 30; nonsmokers n = 36; age 18–33) completed a brief survey to rate the effectiveness of 12 HWLs’ and rank them according to four risk themes (WP health effects, WP harm to others, WP-specific harm, and WP harm compared to cigarettes). Differences in HWLs ratings by WP smoking status were examined and the top-ranked HWL in each theme were identified. HWLs depicting mouth cancer and harm to babies were rated as the most effective by both WP smokers and non-smokers. WP smokers rated HWLs which depicted harm to children and infants as more effective than non-smokers. The top-ranked HWLs for perceived overall effectiveness were those depicting “oral cancer”, “harm to babies”, “orally transmitted diseases” and “mouth cancer”. HWLs depicting oral lesions and harm to babies were rated as most effective, while HWLs showing the harmful effects of WP secondhand smoke on infants and children were rated as less effective by nonsmokers compared to smokers. Our study provides evidence on the potential effectiveness of HWLs for further evaluation in Lebanon and the Eastern Mediterranean region. The results will inform and guide the development and implementation of tobacco control policy

“Waterpipe Is Like a Wife”: Qualitative Assessment of Perspectives on Waterpipe Smoking Dependence

Background: Waterpipe (WP) smoking has become a global public health problem in recent decades and growing evidence indicates that it can cause nicotine dependence. Most evidence on WP dependence to date has been derived from survey- or laboratory based studies. This study employed qualitative methods to explore WP users’ perceptions of dependence in Aleppo, Syria.Methods: A total of 15 focus groups were conducted with 64 adult WP smokers (51 males and 13 females) using a semi-structured interview. All focus group discussions were audiotaped, transcribed, and coded using directed content analysis. Findings: Several WP dependence features were consistent with those commonly reported by cigarette smokers. These included positively reinforced features, such as smoking’s association with social gatherings and cultural connectedness, and negatively reinforced features including relief of withdrawal symptoms, stress, and boredom. Although interest in quitting was low, many users perceived quitting WP to be difficult and an indicator of loss of control over smoking, a common marker of dependence. Several observed dependence features were specific to WP, including transitioning from social smoking to smoking alone, and adapting one’s behavior to the considerable effort normally required to engage in WP smoking despite inconvenience or cost, and often atthe expense of other reinforcers such as social interaction.Conclusion: The general and specific features of WP dependence need to be considered in developing instruments to measure WP dependence, in clinical assessment of WP dependence, and in developing cessation programs

Comparison of patterns of use, beliefs, and attitudes related to waterpipe between beginning and established smokers

BACKGROUND: To compare patterns of use, beliefs, and attitudes related to waterpipe smoking between university students (beginning smokers) and café customers (established smokers) in Aleppo Syria, in order to explore the evolution of this smoking method. METHODS: Two cross-sectional surveys were conducted among representative samples of university students (total 587, 48.4% men, mean age 22 years), and waterpipe users among cafe' customers (total 268, 60% men, mean age 30 years) in Aleppo, Syria. We used interviewer-administered questionnaire inquiring about pattern of waterpipe smoking (initiation, frequency), situational characteristics of use (partner, place, sharing), beliefs related to waterpipe smoking (harmful/addictive properties of waterpipe), attitudes related to waterpipe smoking (confidence in quitting, will to quit, motivation for quitting, past year quit attempt), and cigarette smoking. RESULTS: Daily and regular patterns of smoking become more prevalent with increased duration of smoking, but intermittent smoking remains the predominant pattern of waterpipe use. Women seem to be drawn later to the habit, which seem to escape the usual taboo against women's cigarette smoking. Patterns and context of waterpipe use tend to change with progress of the practice affecting frequency, setting, and sharing of waterpipe. Unlike beginners, established waterpipe smokers seem more smoking-method oriented, more hooked on the habit, less willing to quit, and less likely to foresee challenges to quitting. CONCLUSION: Use patterns and attitudes related to waterpipe smoking evolve to accommodate the change in dependence and life circumstances of the smoker. Most of use features, beliefs, attitudes, as well as time-course seem unique to this smoking method requiring novel approach to intervention

PHYSICAL ABUSE IN LOW-INCOME WOMEN IN ALEPPO, SYRIA

Violence against women is a vicious practice present in all societies. Yet data about its occurrence and associated factors are scarce in the Arab world. In this study, we attempt to determine the spread of physical abuse and its sociodemographic correlates among low-income women in Aleppo, Syria. A sample of 411 women was recruited from 8 randomly selected primary care centers in Aleppo. Response rate was 97%, mean age of participants 28 ± 8 years, and most women (88%) were married. A special questionnaire was used including questions about physical abuse, the self-reporting questionnaire (SRQ-20), and questions about relevant sociodemographic information. Current physical abuse (battering at least 3 times during the previous year) was found in 23% of the investigated and among 26% of married women, while regular abuse (battering at least once weekly) was found in 3.3% of married women. Correlates of physical abuse were women's education, religion, age, marital status, economic status, mental distress, smoking, and residence. Our data show that physical abuse is prevalent in this population and that women's education is the most important modifiable factor

Graphic Design in Public Health Research: A Multiyear Pictorial Health Warning Label Initiative and Recommendations for Sustained Interdisciplinary Collaboration

Schmidt et al discuss their study on graphic design in public health research. Graphic design is often deployed in public health research, intervention, and dissemination of information. In some cases, graphic design artifacts are the public health intervention, developed and tested within a series of scientific study designs involving research teams with wide-ranging expertise. Relatively little attention has been paid, however, to the role graphic design plays in public health research or how graphic designers may contribute to the conduct of research beyond a production services role. Even within the health communication field, the benefits for scientific knowledge and public health emerging from interactions with graphic designers remain understudied

Waterpipe smoking: the pressing need for risk communication

Introduction: Waterpipe (WP) smoking is an important public health problem that is rapidly evolving globally. Much of WP spread among youth is perpetuated by a misperception of reduced harms compared to cigarettes. Increasing awareness about WP smoking harms through health warning labels (HWLs) represents a promising policy and regulatory strategy to curb WP smoking. Areas covered: Peer-reviewed publications indexed in PubMed and CINAHL were searched in March 2019. This review focuses on the current knowledge of WP smoking characteristics, its spread and patterns of use globally, and some of the major WP-related health effects. This knowledge is utilized to advance a promising policy and regulatory avenue to curb WP smoking by increasing awareness of its potential harms through HWLs. It also addresses product configuration and unique features that influence the adaptation of HWLs for WP smoking. Expert opinion: HWLs are effective in communicating smoking-related risks to WP smokers in a way that affects their smoking behavior and experience as well as interest in quitting. Although based on limited data, the WP device appears to be a promising location for HWLs as it offers prolonged contact with smokers and those surrounding them

Why most women in Syria do not smoke: can the passive barrier of traditions be replaced with an information-based one?

To explore the subjective motivations why most Syrian women do not smoke, we performed a cross-sectional survey among primary healthcare patients in Aleppo using an interviewer-administered questionnaire with motivations categorized as traditions and norms, family values, health concerns, personal conviction, economic, religious and other. Study participants ( n=240) had a mean age of 29 years. Among non-smokers, traditions and norms, and health concerns were the main reasons for not smoking, followed by family values, husband's views about smoking, personal conviction, economic reasons and religious reasons. Motivations differed according to the participants' previous smoking, marital and educational status. Better-educated women tended to have their own motives based on a more complete awareness of the smoking problem. Tobacco control efforts should aim at replacing the passive barrier of traditions with a well-informed positive one

Smoking causes blindness: time for eye care professionals to join the fight against tobacco

Sight is an important indicator of health and quality of life. Approximately, 3.4 million Americans 40 years of age and older are visually impaired or blind. Evidence suggests that smoking increases the risk of the most common sight-threatening conditions of eye disease. Half a century after the release of the 1964 landmark Surgeon General's report on smoking and health, tobacco smoking continues to be the leading public health problem in the United States, and nearly half a million adults annually die prematurely from smoking-related diseases. On the historic occasion of the 50(th) anniversary of the 1964 report, the 2014 Surgeon General's report is devoted to smoking and health. This report provides new evidence about the link between cigarette smoking and eye disease, which signifies a new role for eye-care professionals in tobacco control on two levels. First, on a clinical level, eye care professionals should integrate smoking cessation treatment in the standard care of patients' management in eye-care settings in order to motivate and help smoking patients in quitting smoking. Second, on a political level, eye care providers can serve as powerful public advocates against tobacco use, thereby significantly enhancing public awareness about the link between smoking and eye disease