Effect of tobacco control policies on intention to quit smoking cigarettes: A study from Beirut, Lebanon

Abstract

INTRODUCTIONIn Lebanon, the tobacco control policy, Law 174, became effective in 2011. Using the International Tobacco Control Policy Evaluation Project (ITC) conceptual model, this study aims to assess the association between exposure to control measures related to the policy and the intention to quit, which is a mediator in the pathway leading to behavioral change (quitting).METHODSThis is a secondary data analysis of 154 cigarette smokers from a cross-sectional survey that assessed compliance with Law 174 among Beirut residents aged 15–65 years. Data were collected face-to-face, three months after the implementation of indoor public places and tobacco advertisement/promotion bans. Intention to quit smoking was the main outcome. Exposure to policy control measures such as seeing smokers in restaurants, and noticing warning labels on cigarette packs were the explanatory variables. Sociodemographics, past smoking behavior, and psychosocial variables were also considered for their moderating and mediating effects, respectively. Crude and adjusted odds ratios (ORs) were generated. Sobel test was used to check for possible mediation.RESULTSIntention to quit was reported by 24% of cigarette smokers. The association between noticing warning labels and having intentions to quit was statistically significant (adjusted OR=6.27). Concerns about influencing children’s smoking behavior had a statistically significant mediation effect on the relationship. After adding the interaction term between noticing the warnings and previous quit attempts, the OR was inflated to 12.92, suggesting a possible interaction.CONCLUSIONSThis study offers preliminary insight into how Lebanese smokers are influenced by policy related control measures like health warning labels on cigarette packs. Tobacco control policy advocates should push for stronger enforcement of public smoking bans in general. Behavioral intervention should work on the mediator variables to influence smoking behavior and encourage quitting. Further prospective studies modelling quitting as outcome are needed.

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“…quit lines) should be considered in this regard, as they are a recommended solution for delivering population-based smoking cessation support, especially in low-resource settings 13 . In addition, while the vast majority of patients in the program were cigarette smokers, the prevalence of waterpipe smoking in Lebanon is comparable to the prevalence of cigarette smoking 1 . There are many patient-level barriers to waterpipe smokers seeking cessation support, including misperceptions about harm, as well as the social and cultural norms associated with the practice.…”

“…Lebanon has high smoking prevalence rates of combustible tobacco use compared to other middleincome countries, reaching 34% in males and 21% in females for daily cigarette smoking, and 26% and 24%, respectively, for waterpipe smoking 1 . The incidence of lung cancer in Lebanon is highest among females and second highest among males in the Eastern Mediterranean Region 2 .…”

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