Professor Rima Nakkash Awarded

Professor Rima Nakkash

Rima Nakkash, DrPH, assistant research professor in the Department of Health Behavior and Education in the Faculty of Health Sciences, recently won a 45,000 CAD award from the International Development Research Center-Research in International Tobacco Control (IDRC-RITC) in Canada to lead a study analyzing smoke-free policies in Lebanon in coordination with co-investigators Rima Afifi, PhD and Monique Chaaya, DrPh under the banner of the AUB Tobacco Control Research Group (TCRG). The unique goal of the study, set to be completed over the coming year, is to publicize and disseminate its findings on a large scale to influence attitudes and decisions of policy-makers and the general public.

“If India, if Italy can do it, then why not Lebanon?” Nakkash asks. Highlighting the need for local evidence to convince decision-makers to introduce smoke-free policies in Lebanon, Nakkash asserted that previous research showed that public support in Lebanon for banning smoking in public spaces is high among smokers as well as non-smokers.  “It is not impossible to do, with political will, enforcement, and respect,” she said.

“The best way to protect the public is with complete bans; there is no safe level of exposure,” Nakkash insisted, citing health statistics. According to the 2009 edition of “The Tobacco Atlas,” evidence shows that second-hand smoke (SHS) can cause coronary artery disease, lung cancer in adults, reproductive effects in women, respiratory symptoms, impaired lung function, and sudden infant death syndrome in children. In a Global Youth Tobacco Survey conducted in 2005 addressing Lebanese seventh, eighth, and ninth graders, it was found that 78.9 percent lived in homes where others smoked in their presence; 77.1 percent thought others’ smoke was harmful to them, and 84.6 percent  thought smoking should be banned in public places.

Lebanon lags miserably far behind other countries in the Arab world in taking action on the World Health Organization Framework Convention for Tobacco Control (FCTC) signed in 2005. Today Egypt has implemented multiple package health warnings as required by the international convention. Lebanon has yet to apply such a policy, and should have complied by a March deadline.

“There is substantive evidence that the tobacco industry has made efforts in Lebanon to prevent tobacco control from moving forward,” Nakkash said, underlining the need for Lebanon to begin complying with banning tobacco advertising, implementing graphic package health warning labels, and banning smoking in public places, all three being basic pillars of the FCTC. The fourth is increasing taxes on tobacco products.

“There are institutions in Lebanon that have imposed bans willingly, and we will explore why and how this is working,” Nakkash added. Establishments fear losing business if they impose bans, but if a ban is enforced everywhere this argument crumbles. Second hand smoke is  an occupational health risk for employees who “have a right to breathe’ clean air,” she insisted, adding that this argument had convinced policy-makers in Italy to adopt bans.

Complete bans would not only reduce SHS risks, but the tendency for smokers to continue puffing on a product that kills half of its lifetime users. Nakkash said environment was also a key factor. “To quit definitively, people need an enabling environment . . . if they see others smoking they will be more likely to give in to their craving.”

Nakkash sees the study as an exciting contribution to knowledge that could impact health policy, and an opportunity for AUB to continue its participation in the policy debate. Nakkash remains optimistically realistic about results, hoping for “smoke-free places,” protection of “the right of citizens to breathe clean air,” and policy change.