The Prevalence of Smoking and the Use of Different Types of Tobacco Products Among Adult Syrians
Authors: Labban Louay 
Published: November 2021

Abstract
Background: In recent years, smoking has been identified as a major cause of sickness and the most pressing public health issue. There is no confirmed number of smoking-related deaths around the world, and there is no safe level of tobacco smoking for both regular and occasional smokers or users of tobacco products. Smoking tobacco raises the risk of lung cancer, mouth cancer, heart disease, and blood clots. Tobacco usage also raises the likelihood of a woman having an abortion. A single study in Syria found the prevalence of smoking to be 56.9% among men and 17.0% among women. The study's goal was to determine the prevalence of cigarette smoking and tobacco product usage among Syrians following the conflict, as well as the association between smoking and age, gender, social status, education, and economic status.Methods: 2847 individuals (aged between 18 - 80 years) have responded to the questionnaires which were distributed through many groups on Whatsapp. The response rate was 91%, 51 participants (1.3 %) individuals were excluded from the study because they were under 18 years of age which is the legal age to buy cigarettes in Syria. Therefore, 2796 participants enrolled in this study (61.7 % Males and 38.3 % Females). Questionnaire was distributed through Whatsapp groups. Regular smoker was defined as the person who smokes at least one cigarette per day or who uses any type of tobacco products once a day. Whereas occasional smoker can be defined as the person who smoked one cigarette at least once during the past week or used any other types of tobacco such as hookah, cigar, vape or pipe.Results: The overall prevalence of smoking among Syrians was 58.3 % and they were mostly regular smokers. More smoked ready imported cigarettes. The prevalence of smoking among men was higher compared with females (61.7 % males vs 38.3 % females). The prevalence of smoking among pregnant women was 33.4% which is still low comparing with other countries. Syrians smokes primarily at homes (41%) followed by public places such as restaurants and cafeterias. The highest %age of smokers was in the age groups 18-30 and 51-60 years old (26.4 %) (22.9 %) respectively whereas the lowest smoking %age was in the age groups over 70 years and 41-50 (5.5%). More smokers were in country-sides comparing with city residents (58.2 % vs 41.8). The prevalence of smoking in under-graduate students and individuals with no education was almost similar 24.1 % and 23.9 % respectively. More smokers were singles 39.1% followed by widowed 22.9 % and lowest were divorced18.7%. With reference to profession, the highest prevalence was among governmental workers 35.9 % followed by health workers 27.1 %, self – employed and engineers 22.5 % and 12.1% respectively. More smokers made less than 20,000 SP/month (31.2%) whereas only 4% of the smokers made over 200,000 SP /month. The majority of smokers smoked less than 5 years (44.2) whereas 8.9% and 9.1% smoked for 20-25 and more than 25 years. The majority of Syrian smokers started smoking at early age about 15-20 years old (66.3%) followed by age 20-30 years old (2,4%) and only 0.7 % started smoking after 60 years old. Unfortunately, only 3.1 % of the smokers were healthy. The rest have had respiratory diseases (32.5%), diabetes (24.1%), kidney diseases (10.8%) and liver diseases (9.3%). With regards to expenditure on smoking 28.8% spent more than 5000 SP daily on smoking, 23.7 % spent 3000-4000 SP/day and only 5.1% spent less than 1000 SP/day.Conclusion: The prevalence of smoking among Syrians males and females is on the rise maybe due to the current conflict. Smoking start at early ages and other tobacco products such as water-pipe smoking is becoming the popular trend among young generation. Syrians smoke more imported cigarettes than locally produced ones despite their cheaper prices. Several diseases have been recorded among Syrian smokers which will be an economic burden on them and on their families. Education has limited effect on smoking practices as the highest prevalence was seen among under – graduate students.