Smoking is still a big deal in the Middle East. Tel Aviv smokes like Paris in the 80s, and the hookah and shisha pipe is going strong in every city where the taste of apple tobacco makes you forget that the smoke is bad for your lungs. Vaping is pretty much everywhere in the world. Parents typically shoo the kids outside or smoke on the balcony but the residue from smoking can also do harm, finds a new study, citing third-hand smoke.

Thirdhand smoke is the presence of toxic tobacco by-products that remain on surfaces such as furniture, décor, walls and floors. It does not matter of the tobacco is organic. Some cultures like Native Americans may use tobacco for ceremonial purposes. 

In a new study, published in the Journal of Exposure Science & Environmental Epidemiology, researchers tested the surfaces in smoking households where children reside and found troubling results, says Ashley Merianos, a tobacco researcher at the University of Cincinnati who led the study.

Researchers found nicotine on surfaces in all of the children’s homes and detected the presence of a tobacco-specific carcinogen (called NNK) in nearly half of the homes, she says.  The study reported that the NNK levels on surfaces and vacuumed dust were similar, which Merianos says indicates that surfaces and dust can be similar reservoirs and sources of thirdhand smoke exposure for children.

“This is critically important and concerning, since NNK is considered the most potent carcinogen for tobacco-induced cancers,” says Merianos, an associate professor in UC’s School of Human Services.

Nicotine affects poorer families

• Children living in lower-income households had higher levels of NNK and nicotine found on home surfaces.
• Children living in homes that did not ban indoor smoking had higher levels of NNK and nicotine found on surfaces.

Merianos says that NNK and nicotine were still detected in homes with voluntary indoor smoking bans, which highlights the persistence of thirdhand smoke pollutants on surfaces in children’s homes: “This research highlights that home smoking bans do not fully protect children and their families from the dangers of tobacco,” she adds.

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Translated from a poster in Jordan: “Smoking for a long period of time affects marital relations.”

I’m not “blowing smoke” when I rave about Amman. No need, because Amman generates enough smoke on its own. This city rivals onions in making eyes water. Blame diesel fuel. Trucks, cars, buses blast chewy plumes of black exhaust. Heavy equipment on uncontrolled worksites add to the smog. Now introduce the smokers of cigarettes, cigars and arghileh.

Smoking’s entrenched in Arab culture. (My doctor lit up during our consult.) Cabbies puff with abandon, businessmen chainsmoke through meetings. Tobacco’s cheap in Jordan, a virtual give-away. A pack of smokes costs under 3 bucks (compared to $8 in NYC,  $12 in Dublin). Hookah – or hubbly-bubbly – is an essential part of Ammanian café culture; patrons flock to restaurants offering unique settings for enjoying the pipe. Arghileh is on most menus.

In 2005,  Jordan and Egypt ratified the World Health Organization (WHO) Framework Convention on Tobacco Control, a treaty aimed at nipping tobacco use . Follow-on action has been at a slow drag. Jordan’s Public Health Law incorporated anti-smoking controls in 2008, but enforcement didn’t start until 2009. Smoking was banned in fast-food restaurants in 2010, but other businesses in the public realm were given a grace period to adapt. Smoking is now taboo in all public areas. Airport terminals in Cairo and Amman are no-smo-zones: but smoke rings their entry points (drivers, passengers, meeters and greeters cluster outside to light up).  

Non-compliance can result in fines, but enforcement is problematic.

In August, to comply with WHO treaty obligations, packaging on cigarettes sold in Jordan and Egypt will feature vivid photos of smoking health risks. It’s a big step for countries where public discussion on the evils of tobacco is nearly nonexistent.

Anti-smoking campaigns are timid in this slice of the globe. Smoking in developed countries declined in the ‘90s, but the American Cancer Society says it grew 8.6 percent in the Middle East.

Lebanon leads in the smoking Olympics: a breathtaking 58.8% light up daily. Over 60% of Egyptian men use tobacco (no reliable statistics for women) whereas fewer than 25% of American men smoke. The National Jordanian Anti-Smoking Society asserts that 21% of students aged 13-18 smoke cigarettes or hookah, despite it being illegal to sell tobacco products to kids!  Jordanians spend half a billion US dollars annually on tobacco. This, in a nation where 25% of households earn less than $6,000 per year.

“The objective of the ban is to maintain public health,” said Jordanian Health Ministry spokesperson Hatem Azruie. “Non-smokers have the right to breathe clean air.” The ministry offers free consultations and nicotine substitutes to city smokers who are trying to kick the habit, and plans to expand the program to rural locations to help smokers quit throughout the Kingdom.

Meanwhile, Egypt’s Ministry of Health released new warning labels featuring a coughing child, a cartoon fetus, and a limp cigarette implying impotence. The accompanying Arabic messages advise:

“Smoking around pregnant women harms the fetus and causes miscarriage.’

“Smoking affects children – protect your children from smoking.”

“I would like to quit but I just can’t,” said Osama Sabri Mohammed, a 39-year-old civil servant, between cigarette drags outside his Cairo office. “This one specifically will have an effect on Egyptians, since we’re  really concerned about that,” he said, awkwardly tapping the image of the limp cigarette. A stack of studies, including a 2003 Tulane University report, have proven smoking to be a major cause of erectile disfunction.

Warnings that link tobacco with premature death have been shown as ineffectual, as health researchers concluded that most Egyptians perceive death as “inevitable”.  Emphasizing negative impacts such as diminished sexual performance is expected to provide new motivation to kick the habit, especially among young smokers. “We need something to give smokers a shock,” said Dr. Mohammed Mehrez, head of the Egyptian tobacco control department. Wide cultural acceptance of die-hard smoking presents real challenges to these campaigns.

I don’t smoke.  But I can empathize. See there’s no easy substitute for the habit. I applaud this somewhat grisly/yet kinda comical effort to curb smoking,  but will it work?  History shows people  simply ignore warning labels.  Or maybe a new niche market will arise:   custom covers for cigarette packs to mask the offending images – monogrammed, or sporting a favorite team logo – call it an iSmoke? – maybe coming soon to a mall near you.

(Note: Images Egyptian Ministry of Health)

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