Can vapes stop Lebanon smoking?

Only 32% of Lebanese smokers surveyed reported ever having tried to quit


BEIRUT: A self-described anti-tobacco organization that warned Lebanon is among the world’s most addicted tobacco consumers is recommending that smokers trying to quit turn to “reduced-risk” products such as e-cigarettes. The survey of more than 17,000 people from 13 countries was released Monday by Foundation for a Smoke-Free World, a group funded by an American multinational cigarette company currently marketing its brand of e-cigarettes.

FSFW’s survey included 726 smokers, ex-smokers and non-smokers in Lebanon, who detailed the thought processes and patterns behind their habits. For example, 68 percent of people surveyed said they smoke every time they drink coffee or tea. Separately, 63 percent reported smoking after they eat a meal.

Only 32 percent of Lebanese smokers surveyed reported ever having tried to quit – the lowest number out of any of the 13 countries included in the study, despite nearly all of the respondents saying they agreed smoking is bad for their health. Those who did attempt to quit said they wanted to give up tobacco for their “personal health.”

Results of the survey were announced during a web conference run by FSFW, an organization founded in 2017 with funding from one of the world’s largest tobacco companies, Philip Morris International. Despite getting its funds from the tobacco giant, FSFW claimed the survey results would help “accelerate the end of smoking” worldwide.

With regards to Lebanon, the survey’s findings aren’t necessarily new – Lebanon already has the third most smokers per capita, according to data released by the World Health Organization last year.

A series of anti-smoking regulations in recent years have meanwhile done little to stop Lebanese smokers from lighting up both at home and in public spaces.

The solution, according to Monday’s conference panelists, is electronic cigarettes, or e-cigarettes, which manufacturers claim are a safer alternative to the traditional cigarettes and nargileh water pipes popular in Lebanon.

The electronic devices often resemble traditional boxed cigarettes, but contain flavored, nicotine-laced liquid instead of tobacco. E-cigarettes, or “vapes,” remain banned in Lebanon, but are sold underground.

Despite anecdotal evidence of e-cigarettes and similar “vaping” products helping smokers quit traditional tobacco, Lebanon’s Health Ministry opposes legalizing the devices. Fadi Sanan, director of the National Tobacco Control Program told The Daily Star he distrusted e-cigarettes, saying there were “no good studies” on its potential health benefits.

But FSFW president Dr. Derek Yach told The Daily Star Monday that Lebanon could lower its tobacco reliance if the country were “given the chance to introduce” such products into the market. FSFW did not respond to a question regarding the conflict of interest of being funded by tobacco company Philip Morris.

Tobacco experts in Lebanon criticize FSFW’s source of funding as less than ideal for an organization purporting to improve public health.

The foundation received its “initial funding” of $80 million annually for its first twelve years, beginning in 2018, from Philip Morris International, a multinational American tobacco company, according to the FSFW’s website.

Philip Morris meanwhile sells its products, including the Marlboro cigarettes found in thousands of Lebanese convenience stores, in more than 180 countries worldwide.

The tobacco company is currently marketing its e-cigarette, called iQOS, which it claims “heats” tobacco rather than burning it as with traditional boxed cigarettes, apparently lowering the amount of carcinogens released. A film screened during Monday’s conference portrayed dozens of smokers using similar devices as a path to quit tobacco smoking.

But Philip Morris has yet to obtain approval from the U.S. Food and Drug Administration for the iQOS device, due to irregularities during clinical trials, Reuters reported in December.

“The tobacco industry continues to come up with new tobacco products as long as it can perpetuate nicotine addiction and induct new users,” Dr. Ghazi Zaatari, a pathologist and professor at the American University of Beirut told The Daily Star. Zaatari also serves as a chair of the World Health Organization’s Tobacco Regulation Study Group.

Zaatari cited flavored products such as e-cigarettes as particularly dangerous to Lebanese youth, who may get hooked on smoking through vaping.

The biggest barrier to curbing tobacco use in general is “tobacco industry interference,” AUB’s Dr. Rima Nakkash told The Daily Star, citing the FSFW as an example.

“We already know effective ways to reduce smoking: full implementation of the policy measures of the FCTC,” Nakkash added, referencing the WHO’s Framework Convention on Tobacco Control.

Lebanon signed the FCTC in 2005, and although it was ratified, Beirut has done little to enforce it. In fact, Lebanon risks failing to meet the convention’s obligations.

Article 11 – which states that within three years of adopting the convention, countries must implement effective health warning labels on tobacco products – has not been put into effect. Nor has Article 8, which obligates Lebanon to “strive to provide universal protection” within five years.

And nearly seven years after Parliament passed Law 174, which demanded an end to smoking in enclosed public places tobacco use remains virtually universal in Lebanese cafes, bars and restaurants.

The Daily Star previously reported that smokers in Lebanon – who have little government help they can rely on to quit – are increasingly choosing e-cigarettes as an alternative they believe is improving their health.

But to “bring Lebanon to comply” with wide-scale smoking regulation, it must begin fully “implementing FCTC articles,” Zaatari said.

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