Lebanon’s tobacco addiction comes with a medical bill

Recent studies indicated that most shisha smokers in Lebanon are women and young Lebanese are among the heaviest shisha smokers in the world.
Sunday 17/03/2019
A Lebanese man smokes shisha in Sidon. (Reuters)
Epidemical trend. A Lebanese man smokes shisha in Sidon. (Reuters)

BEIRUT - “It is a nice pastime, especially when we sit with friends in cafes, chatting while having a smoke,” said Nada Cherif.

Cherif said she was never enticed to smoke cigarettes but she is a regular user of nargile — also known as shisha, hookah or water pipe — which has become an epidemical trend in Lebanon.

Cherif insisted that she is not a tobacco addict. “I have friends who smoke the nargile more than once a day and alternate with cigarettes,” she said.

Lebanon has been ranked among the world’s highest tobacco-consuming countries in recent years. In 2015, a report by the World Health Organisation (WHO) put Lebanon third for the highest cigarette consumption per capita.

“It is no surprise that we have the highest cancer rate in the region,” said Nadine Chatila, director of communications at the American University of Beirut Medical Centre (AUBMC). “The problem is that indoor smoking is allowed in many public places. Shisha is easily accessible and you can even have it delivered to your home at a very cheap price.”

AUBMC’s cancer department estimates that 8,000 cases of cancer are reported in Lebanon annually. Dr Nagi Saghir, professor of haematology-oncology and director of the breast cancer centre at AUBMC, has stated that cases are divided equally between the sexes and that, among the 4,000 cases of cancer in women, 1,700 are breast cancer.

Oncologist Dr Joseph Makdessi noted that cancer prevalence has risen globally, not only in Lebanon, with lung cancer being the most common type of the disease.

“Almost 90% of lung cancer cases are related directly to smoking,” Makdessi said. “Among females, cases of breast cancer are the highest, whereas prostate cancer is the most common among men.”

While smoking could be one of the main causes for lung cancer, other factors are relevant for the increase in cancer cases, Makdessi said.

“There is no single cause of cancer,” he said. “The cause is multifactorial. You cannot blame it exclusively on smoking, or pollution or diet, et cetera. It is a combination of several factors and people with a predisposition to genetic mutation are at higher risk.

“Also, people today have a longer life expectancy and it is natural that in view of the population growth you would have an increase in cancer cases. What is important to assess here is the age of the patients. Is it mostly affecting the elderly or is it increasing among the youth?”

The Lebanese Ministry of Health stated that the rate of cancer diagnoses in Lebanon increased 5.5% yearly in 2015 and 2016. It said the figure was based on statistics of people who register at the Health Ministry for treatment. Since not all resort to the ministry for assistance, the real number is probably higher.

With the widespread use of the nargile, in addition to the high consumption of cigarettes, Makdessi said he expected not only cancer but cardiovascular diseases to increase in the next decades.

“Nargile is a very dangerous trend whose effects will appear in 10 or 15 years,” he said. “The rate will increase alarmingly because the majority of shisha smokers today are the young and they will be prone to develop lung cancer in the future because of their history of smoking nargile.”

Recent studies indicated that most shisha smokers in Lebanon are women and young Lebanese are among the heaviest shisha smokers in the world.

There is a common misconception that water pipe smoking is less harmful than cigarette smoking because the water filters the smoke. However, the WHO said a nargile smoking session that lasts one hour involves inhaling 100-200 times the volume of smoke inhaled with a single cigarette and exposes the smoker to higher amounts of toxic materials than found in cigarettes.

AUBMC has begun a social media campaign to raise awareness about the link between smoking tobacco from a water pipe, also known as “hubbly bubbly,” and cancer. The campaign’s video was shared on Facebook to mark World Cancer Day on February 4.

AUBMC offers a smoking cessation programme that costs $166 and includes eight 45-minute sessions of counselling and therapy.

In 2012, Lebanon enacted a law intended to limit cigarette and tobacco consumption. However, Law 174 outlawing smoking in closed public places has been notoriously disregarded, especially in pubs, nightclubs and cafes.

The legislation also introduced the concept of displaying health warnings on all tobacco product packaging in hopes that the messages would deter people from smoking.