Waterpipe tobacco smoking (WTS) is a traditional tobacco use method that originated in the Eastern Mediterranean Region (EMR) and has resurged in recent decades. WTS rates in the EMR are the highest worldwide, especially among youth, exceeding cigarette-smoking rates in select jurisdictions. Despite its documented harm, the growing prevalence of WTS has been met with a poor regulatory response globally. At the epicenter of the WTS epidemic, countries in the EMR are in urgent need of effective tobacco control strategies that consider the particularities of WTS. A roundtable session, titled “Monitoring and Combating WTS Through Taxation and the Global Tobacco Surveillance System (GTSS),” was held as part of the 7th Eastern Mediterranean Public Health Network’s regional conference. The session provided an overview of evidence to date about WTS policy control, the taxation of WTS, volumetric choice experiments for tobacco control research, and monitoring WTS patterns and control policies among adults and youth through the GTSS. The session highlighted the need to update the regulation of WTS in the current global tobacco control policy frameworks and the need for developing tailored, evidence-based, and WTS-specific regulations to complement current tobacco control policy frameworks. Raising taxes to increase the price of tobacco products is the single most effective tobacco control measure, and these taxes can fund expanded government health programs. The effectiveness of taxation can be measured via volumetric choice experiments, which allow for the estimation of a complete set of own-price and cross-price elasticities that are instrumental for fiscal policy simulations. Finally, the surveillance of WTS (for example, through the GTSS) is critical to informing policy and decision makers. The Global Youth Tobacco Survey (GYTS) and Global Adult Tobacco Survey (GATS) are 2 GTSS products that provide nationally representative data among students aged 13-15 years and persons ≥15 years, respectively.

BACKGROUND A better understanding of knowledge, attitude, practices (KAP) in the community and other issues related to Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) can help in implementing evidence-driven activities to control HIV/AIDS in Jordan. With a prevalence rate of 0.02% among the overall population and a prevalence rate of roughly 0.05% among important populations, Jordan is recognized as a country with a low HIV pandemic. The absence of cases could be attributed to underreporting, inaccurate information, and a dearth of efficient organizations to reach the most vulnerable and at-risk group. No systematic HIV surveillance studies have been carried out among the general population or particular most-at-risk populations, with the exception of a few small-scale studies among particular subgroups of the Jordanian population. OBJECTIVE This study aimed to assess HIV/AIDS-related knowledge, attitude, and behaviors among refugees, migrants, and the general population, as well as assess their stigmatizing and discrimination attitudes toward HIV/AIDS patients, their social behavior towards HIV/AIDS, and their healthcare-seeking behaviors. METHODS A cross-sectional study was conducted among Jordanians, Syrian refugees (both urban and camp refugees), and migrants living in four governorates including Amman, Zarqa, Mafraq, and Irbid during the study period June-September 2021. A structured questionnaire was developed and used to collect the data via face-to-face interviews. RESULTS A total of 2276 persons (674 Jordanians, 591 urban refugees, 500 camp refugees, and 511 migrants) participated in this study. The majority of participants (70.8% of Jordanians, 75.2% of urban refugees, 51.3% of the camp refugees, and 65.0% of migrants) had a low level of HIV/AIDS-related knowledge. More than half of the Jordanian, urban refugees and migrants had a positive attitude toward HIV/AIDS and patients with HIV/AIDS, while only 39.5% of camp refugees had a positive attitude. HIV/AIDs stigma levels varied significantly among migrants, Jordanians, urban and camp refugees. Almost 52.1% of Jordanians, 55.9% of urban refugees, 58.1% of camp refugees, and 50.9% of migrants had moderate to high stigma levels. Almost 57.4% of Jordanians, 62.2% of urban refugees, 57.1% of camp refugees, and 66.1% of migrants had moderate to high discrimination levels. About 30.9% of Jordanians, 26.7% of urban refugees, 35.6% of camp refugees, and 37.3% of migrants stated that they feel compassion and desire to help people with HIV/AIDS. Almost one-third of participants reported that the community mostly supports and helps patients with HIV/AIDS. CONCLUSIONS The study populations had significant gaps in HIV/AIDS-related knowledge. Moderate to a high level of stigmatizing attitude was reported by a considerable proportion of the study participants. The poor knowledge of HIV/AIDS, negative attitude, and high level of stigmatizing attitude varied between the studied groups, level of education, and employment status. It is of paramount importance to implement public health education programs to increase the community’s awareness of HIV/AIDS and address HIV/AIDS-related stigma.

BACKGROUND Public health has a pivotal role in strengthening resilience at individual, community and system levels and building healthy communities. During crises, resilient health systems can effectively adapt in response to evolving situations and reduce vulnerability across and beyond the systems. OBJECTIVE To provide expert viewpoint/perspective on the recent lessons learned on the Health Systems Resilience in the Eastern Mediterranean Region METHODS Discussion Areas: In a moderated discussion, experts provided their viewpoints on the matter by providing an introduction to health systems resilience, national public health institutes and their role in health systems resilience, the contribution of the health workforce to health system’s resilience with some empirical and personal experiential examples, building resilient health systems and the role of the Field Epidemiology Training Program (FETPs), with an example from Yemen FETP experience, and an overall reflection on the matter and lessons learned. RESULTS Continuous support is needed for FETP graduates to work toward strengthening surveillance systems and investigating outbreaks and to participate in regional and global efforts in response to COVID-19. CONCLUSIONS Lessons learned from the current situation in the Eastern Mediterranean Region (EMR) and the response to strengthen both pandemic preparedness and health systems, as well as the importance of investing in the essential public health functions (EPHFs), including those required for all-hazards emergency risk management, and institutionalized mechanisms for whole-of-society engagement, as well as strengthening the primary health care (PHC) approach for health security and universal health coverage (UHC), and promoting enabling environments for research, innovation, and learning.

UNSTRUCTURED Waterpipe tobacco smoking (WTS) is a traditional tobacco use method that originated in the Eastern Mediterranean Region (EMR) and has resurged in recent decades. WTS rates in the EMR are the highest worldwide, especially among youth, exceeding cigarette smoking rates in select jurisdictions. Despite its documented harm, the growing prevalence of WTS has been met with a poor regulatory response globally. At the epicenter of the WTS epidemic, countries in the EMR are in urgent need of effective tobacco control strategies that consider the particularities of WTS. A roundtable session titled “Monitoring and Combating WTS Through Taxation and the Global Tobacco Surveillance System (GTSS)”, was held as part of the 7th Eastern Mediterranean Public Health Network’s (EMPHNET) Regional Conference. The session provided an overview of evidence to date about WTS policy control, taxation of WTS, volumetric choice experiments (VCEs) for tobacco control research, and monitoring WTS patterns and control policies among adults and youth through the GTSS. The session highlighted the need to update the regulation of WTS in the current global tobacco control policy frameworks and the need for developing tailored and evidence based WTS specific regulations to complement current tobacco control policy frameworks. Raising taxes to increase the price of tobacco products is the single most effective tobacco control measure, and these taxes can fund expanded government health programs. The effectiveness of taxation can be measured via VCEs, which allow for the estimation of a complete set of own-price and cross-price elasticities that are instrumental for fiscal policy simulations. Finally, surveillance of WTS (for example, through the GTSS) is critical to informing policy and decision makers. The Global Youth Tobacco Survey (GYTS) and Global Adult Tobacco Survey (GATS) are two GTSS products that provide nationally representative data among students aged 13-15 years, and persons ≥15 years, respectively.