MAY/JUNE 2006
Volume 12 - No. 2

SRNT Newsletter

May/June 2006, Volume 12, Number 2

Profile: The Syrian Center for Tobacco Studies

by Wasim Maziak

The Syrian Center for Tobacco Studies (SCTS) was established in response to the smoking epidemic in Syria and to address the lack of local knowledge and expertise to confront it. The project is an international collaboration of multiple institutions and scientists including the University of Memphis (Ken Ward), Virginia Commonwealth University (Tom Eissenberg), the University of Muenster (Ulrich Keil and Wasim Maziak), and local Syrian partners led by the Syrian Society Against Cancer in Aleppo (Photo 1). The Center was established with a five year grant within the "Tobacco Research and Capacity Building Program" of NIH's Fogarty International Center. The main aims of the SCTS are to

Study tobacco use and local smoking practices using qualitative and quantitative research methods.
Develop and test an effective smoking cessation intervention for the Syrian environment.
Train Syrian researchers.

Figure 1: Profile of smoking among adults
(18-65) in Aleppo-Syria.

To achieve these aims the SCTS applies epidemiological, clinical laboratory, behavioral, and anthropological research methods, capitalizing on the strengths of its multi-disciplinary team. Substantial progress has been made in accomplishing all of these aims. For example, SCTS recently provided the first population-based estimates of the spread of cigarette and waterpipe smoking among adults in Aleppo, Syria (Figure 1). It also examined exposure to tobacco smoke among non-smoking adults using salivary cotinine as a marker of this exposure. Alarmingly, the majority of adult non-smokers (97%) in Aleppo, Syria had detectable levels (exposed) of cotinine in their saliva. What is encouraging, however, was that even with this widespread exposure to tobacco smoke, homes that applied restrictions on smoking indoors achieved partial protection from exposure to secondhand smoke (Figure 2).

Figure 2: Saliva cotinine levels of non-smokers
according to the application of indoor smoking
restrictions among households.

The center also undertook a pioneering research project to investigate the spread and use characteristics of waterpipe smoking; a tobacco use method that is showing dramatic increase all over the world, but particularly among Arab communities. This multi-faceted research helped characterize use/quitting features, health effects (Figure 3), and dependence potential. Waterpipe research completed by the SCTS formed an essential part of a WHO's advisory note about waterpipe smoking (www.who.int/tobacco/global_interaction/tobreg/waterpipe/en/index.html ).

Figure 3: Changes in breath CO and heart rate pre
and post waterpipe smoking in 26 waterpipe users.

Because of a near total lack of cessation services and experience in Syria and most Arab countries, the SCTS undertook the task of developing and testing effective smoking cessation interventions that suit the local environment and smokers. Both laboratory and formative work provided the guiding principles to develop effective and culturally sensitive smoking cessation interventions. Preparations are underway for the first randomized clinical trial of a cigarette smoking cessation intervention using behavioral and pharmaceutical components.

Our team at the Syrian Center for
Tobacco Studies in Aleppo, Syria

Training is another essential part of work at SCTS and is intended to create a local base of tobacco control researchers who can respond to the tobacco epidemic in Syria and the Arab World. This training includes hands-on applied training, short training periods at advanced centers of research (University of Memphis, Virginia Commonwealth University, and the University of Muenster), ongoing distance-learning and mentorship, and financial support for Syrian and Arab researchers to attend important scientific conferences. Most recently, the SCTS teamed up with colleagues at Johns Hopkins Bloomberg School of Public Health to launch the Research Assistance Matching Project (RAM, tobaccoresearch.net/ram.html ), an innovative online program designed to help researchers in developing countries find peer experts ready to help them in their research activities. Additionally, the SCTS has been able to establish scientific exchanges with researchers from many other nations, including Lebanon, Egypt, Yemen, Japan, and the United Kingdom, and "give back" in terms of providing data, methodologies, and expertise.

The SCTS represents a successful model of international partnership to advance tobacco control research in developing countries. It exemplifies the potential for developed/developing countries partnerships to surpass the restricted scope of pure academic research in developing countries by establishing a permanent research base with its own momentum for expansion and growth. Continuous support of such projects will reap the full benefits of collaborative tobacco control research initiatives.

About the Author: Wasim Maziak, Ph.D., is the Director of the Syrian Center for Tobacco Studies Note new email address: maziak@scts-sy.org