Impact of COVID-19 lockdown on smoking (waterpipe and cigarette) and participants' BMI across various sociodemographic groups in Arab countries in the Mediterranean Region

Abstract

INTRODUCTION Tobacco smokers are at high risk of developing severe COVID-19. Lockdown was a chosen strategy to deal with the spread of infectious diseases; nonetheless, it influenced people's eating and smoking behaviors. The main objective of this study is to determine the impact of the COVID-19 lockdown on smoking (waterpipe and cigarette) behavior and its associations with sociodemographic characteristics and body mass index. METHODS The data were derived from a large-scale retrospective cross-sectional study using a validated online international survey from 38 countries (n=37207) conducted between 17 April and 25 June 2020. The Eastern Mediterranean Region (WHO-EMR countries) data related to 10 Arabic countries that participated in this survey have been selected for analysis in this study. A total of 12433 participants were included in the analysis of this study, reporting their smoking behavior and their BMI before and during the COVID-19 lockdown. Descriptive and regression analyses were conducted to examine the association between smoking practices and the participant's country of origin, sociodemographic characteristics, and BMI (kg/m 2 ). RESULTS Overall, the prevalence rate of smoking decreased significantly during the lockdown from 29.8% to 23.5% (p<0.05). The percentage of females who smoke was higher than males among the studied population. The highest smoking prevalence was found in Lebanon (33.2%), and the lowest was in Oman (7.9%). In Egypt, Kuwait, Lebanon, and Saudi Arabia, the data showed a significant difference in the education level of smokers before and during the lockdown (p<0.05). Smokers in Lebanon had lower education levels than those in other countries, where the majority of smokers had a Bachelor's degree. The findings show that the BMI rates in Jordan, Lebanon, Oman, and Saudi Arabia significantly increased during the lockdown (p<0.05). The highest percentages of obesity among smokers before the lockdown were in Oman (33.3%), followed by Bahrain (28.4%) and Qatar (26.4%), whereas, during the lockdown, the percentage of obese smokers was highest in Bahrain (32.1%) followed by Qatar (31.3%) and Oman (25%). According to the logistic regression model, the odds ratio of smoking increased during the pandemic, whereas the odds ratio of TV watching decreased. This finding was statistically significant by age, gender, education level, country of residence, and work status. CONCLUSIONS Although the overall rates of smoking among the studied countries decreased during the lockdown period, we cannot attribute this change in smoking

Analysis of the nutritional status in the Palestinian territory: a review study

“…Overall, 16 studies were found to be related to obesity among adults within the studied time frame (8 studies in the West Bank, two studies in the Gaza Strip, and five national studies) ( 89 – 104 ). Abdeen and his colleagues found that the prevalence of overweight in the West Bank was 35.5% among women and 40.3% among men, while obesity was 31.5% in women and 17.5% in men ( 89 ).…”

Impact of COVID-19 restrictions on health and well-being in the United Arab Emirates

“…In fact, most of the participants surveyed were particularly sedentary, spending long periods sitting or watching TV. Similarly, a survey conducted among 10 Arab countries (Bahrain, Egypt, Jordan, Kuwait, Lebanon, Oman, Palestine, Qatar, Saudi Arabia, and the United Arab Emirates), stated that within the UAE moderate activity levels decreased from 37.9% pre-lockdown to 34.3% during lockdown and high activity levels decreased from 15.8% pre-lockdown to 9.9% during lockdown (Al Sabbah et al, 2022).…”

“…Similarly, a survey in the US reported that among cigarette smokers, 33% stated an increase in their habits due to increased stress caused by the pandemic, with 23% reporting an increase in e-cigarette use (Kalkhoran et al, 2022). On the contrary, in 10 Arab countries in the Middle East, the average smoking rate decreased by 24% during lockdown (Al Sabbah et al, 2022).…”

“…Consequently, these overweight/obese patients had a 58% higher risk of developing severe COVID-19 symptoms compared to normal-weight patients (Al Bastaki et al, 2022). Hence, although lockdown protocols aimed to safeguard populations from COVID-19 risk, the low levels of physical activity and social isolation also worsened respiratory and cardiovascular health risk factors; as well as psychological stress, anxiety, and depression (Abouzid et al, 2021;López-Bueno et al, 2021;Stockwell et al, 2021;Al Sabbah et al, 2022). These changes resulted in a rise in smoking rates as a coping mechanism among users and non-users, although smokers had a higher chance of developing COVID symptoms due to constant lung infections and lower immunity (Al Hazzaa, 2004;Al Sabbah et al, 2022).…”

“…Hence, although lockdown protocols aimed to safeguard populations from COVID-19 risk, the low levels of physical activity and social isolation also worsened respiratory and cardiovascular health risk factors; as well as psychological stress, anxiety, and depression (Abouzid et al, 2021;López-Bueno et al, 2021;Stockwell et al, 2021;Al Sabbah et al, 2022). These changes resulted in a rise in smoking rates as a coping mechanism among users and non-users, although smokers had a higher chance of developing COVID symptoms due to constant lung infections and lower immunity (Al Hazzaa, 2004;Al Sabbah et al, 2022). Generally, lifestyle changes like dietary habits, smoking habits, and reduced levels of physical activity can also affect the immune system and increase the risks of obesity and coronary heart disease (Damiot et al, 2020;Okati-Aliabad et al, 2022;Schäfer et al, 2022).…”