Tobacco use is becoming epidemic in developing countries. Unless current trends are reversed, tobacco will kill 10 million people annually by the decade of 2020-2030, with a staggering 70% of these deaths in developing countries. This epidemic has been curbed in the US and other developed countries with intensive scientific study of tobacco use, but developing nations often lack the capacity and infrastructure for such scientific efforts. This is especially true in the Eastern Mediterranean (EM) region, where the tobacco epidemic is largely unchecked in countries such as Syria, Jordan, and Lebanon. This application's overarching goal is to establish a center for the study, treatment, and prevention of tobacco dependence in the EM. The Syrian Center for Tobacco Studies will serve as a national and regional resource for tobacco control efforts, including epidemiological study, clinical research, and prevention and cessation intervention development. The Center also will serve as a focal point for dissemination of information relevant to tobacco control efforts in the EM region. In its first five years, the specific aims of the Center are to: 1. Learn methods for studying tobacco use and local smoking practices using key informant interviews and focus groups to guide the development of epidemiological, clinical laboratory, and treatment strategies. This Year 1 effort will provide the SCTS's foundation. Second, an epidemiological study during Years 1 and 2 will detail the patterns and determinants of tobacco use and cessation in Aleppo (Syria's second-largest city), focusing on cigarette and narghile (water pipe) use. 2. Describe, in a clinical laboratory established in Aleppo, the subjective, physiological, and behavioral effects of smoking systems that are popular in, and in some cases unique to, the EM. This laboratory will be established in the first 12 months of the project and two detailed studies of tobacco use will occupy the laboratory during Years 2-5 of the funding period. 3. Test a primary-care based smoking cessation intervention tailored to the Syrian setting based on data from epidemiological and clinical laboratory results. This intervention will be developed during Year 2 and implemented and tested in Years 3-5. 4. Train Syrian tobacco researchers so that the expertise and resources necessary for sustaining and expanding the SCTS will be in place locally at project's end. Training components will include a fellowship program for study in the United States, sponsorship of an annual regional tobacco control conference, and expert consultation and resource-sharing via Internet for other researchers and institutions in the EM.

National Institute of Health (NIH)
Fogarty International Center (FIC)
Research Project (R01)
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Special Emphasis Panel (ZCA1-SRRB-Q (M1))
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Primack, Aron
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University of Memphis
Other Health Professions
Schools of Arts and Sciences
United States
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Ward, Kenneth D (2017) Reflections on 15 Years in the Global Tobacco Trenches. Health Behav Res 1:
Ward, Kenneth D (2016) Tobacco intervention research in low- and middle-income countries: lessons learned and future directions. J Smok Cessat 11:61-64
Maziak, Wasim; Jawad, Mohammed; Jawad, Sena et al. (2015) Interventions for waterpipe smoking cessation. Cochrane Database Syst Rev :CD005549
Ward, Kenneth D; Ahn, SangNam; Mzayek, Fawaz et al. (2015) The relationship between waterpipe smoking and body weight: population-based findings from Syria. Nicotine Tob Res 17:34-40
Cobb, Caroline; Ward, Kenneth D; Maziak, Wasim et al. (2010) Waterpipe tobacco smoking: an emerging health crisis in the United States. Am J Health Behav 34:275-85
Albache, Nizar; Al Ali, Radwan; Rastam, Samer et al. (2010) Epidemiology of Type 2 diabetes mellitus in Aleppo, Syria. J Diabetes 2:85-91
Kilzieh, Nael; Rastam, Samer; Ward, Kenneth D et al. (2010) Gender, depression and physical impairment: an epidemiologic perspective from Aleppo, Syria. Soc Psychiatry Psychiatr Epidemiol 45:595-602
Hammal, F; Mock, J; Ward, K D et al. (2008) A pleasure among friends: how narghile (waterpipe) smoking differs from cigarette smoking in Syria. Tob Control 17:e3
Smith-Simone, Stephanie; Maziak, Wasim; Ward, Kenneth D et al. (2008) Waterpipe tobacco smoking: knowledge, attitudes, beliefs, and behavior in two U.S. samples. Nicotine Tob Res 10:393-8
Asfar, Taghrid; Weg, Mark Vander; Maziak, Wasim et al. (2008) Outcomes and adherence in Syria's first smoking cessation trial. Am J Health Behav 32:146-56

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