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      Accomplishments and challenges in tobacco control endeavors – Report from the Gulf Cooperation Council countries

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          Abstract

          Objectives

          To review the tobacco governance and national responsibility for control, and existing countering measures to reduce the tobacco use among the Gulf Cooperation Council (GCC) member states.

          Methods

          We reviewed the data in regards to tobacco control efforts and difficulties encountered during implementation of the policies for all the GCC member states from the respective country profile in the WHO report on the global tobacco epidemic. Also, we utilized the measures outlined in the FCTC’s MPOWER package to not only assess the degree of national commitment, but also compare it against the level of significance that the legislatures give to this matter.

          Results

          We observed that there have been genuine advancements towards tobacco control in the GCC member states over the past few years. All the countries except Bahrain have national offices committed to tobacco control and 5 nations (excluding Oman) have dedicated support services for smoking cessation accessible to the general public. Similarly, majority of the member states have implemented a national-level ban on tobacco advertisement through national media cells as well as free dissemination of marketing material.

          Conclusion

          Application and implementation of measures outline in the MPOWER package, formulation and enforcement of sturdy laws on tobacco control, and development of infrastructure and trained workforce are fundamental to manage and reinforce tobacco control measures in the GCC region.

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          Mechanisms of action of environmental factors--tobacco smoking.

          Syed Hasan, Marcus Palmer, F. Wilson … (2004)
          To review the potential biological mechanisms underlying the effects of tobacco smoking on periodontitis. Smoking has major effects on the host response, but there are also a number of studies that show some microbiological differences between smokers and non-smokers. Smoking has a long-term chronic effect on many important aspects of the inflammatory and immune responses. Histological studies have shown alterations in the vasculature of the periodontal tissues in smokers. Smoking induces a significant systemic neutrophilia, but neutrophil transmigration across the periodontal microvasculature is impeded. The suppression of neutrophil cell spreading, chemokinesis, chemotaxis and phagocytosis have been described. Protease release from neutrophils may be an important mechanism in tissue destruction. Tobacco smoke has been found to affect both cell-mediated immunity and humoral immunity. Research on gingival crevicular fluid has demonstrated that there are lower levels of cytokines, enzymes and possibly polymorphonuclear cells in smokers. In vitro studies have shown detrimental effects of nicotine and some other tobacco compounds on fibroblast function, including fibroblast proliferation, adhesion to root surfaces and cytotoxicity. Tobacco smoking has widespread systemic effects, many of which may provide mechanisms for the increased susceptibility to periodontitis and the poorer response to treatment.
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            Polycyclic aromatic hydrocarbons, carbon monoxide, "tar", and nicotine in the mainstream smoke aerosol of the narghile water pipe.

            Wasan R. Saleh, Alan Shihadeh (2005)
            A smoking machine protocol and yields for "tar", nicotine, PAH, and CO are presented for the standard 171-puff steady periodic smoking regimen proposed by Shihadeh et al. [Shihadeh, A., Azar, S., Antonios, C., Haddad, A., 2004b. Towards a topographical model of narghile water-pipe cafe smoking: A pilot study in a high socioeconomic status neighborhood of Beirut, Lebanon. Pharmacology Biochemistry and Behavior 79(1), 75]. Results show that smokers are likely exposed to more "tar" and nicotine than previously thought, and that pyronsynthesized PAH are present in the "tar" despite the low temperatures characteristic of the tobacco in narghile smoking. With a smoking regimen consisting of 171 puffs each of 0.53l volume and 2.6s duration with a 17 s interpuff interval, the following results were obtained for a single smoking session of 10 g of mo'assel tobacco paste with 1.5 quick-lighting charcoal disks applied to the narghile head: 2.94 mg nicotine, 802 mg "tar", 145 mg CO, and relative to the smoke of a single cigarette, greater quantities of chrysene, phenanthrene, and fluoranthene. Anthracene and pyrene were also identified but not quantified. The results indicate that narghile smoke likely contains an abundance of several of the chemicals thought to be causal factors in the elevated incidence of cancer, cardiovascular disease and addiction in cigarette smokers.
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              Comparison of carcinogen, carbon monoxide, and ultrafine particle emissions from narghile waterpipe and cigarette smoking: Sidestream smoke measurements and assessment of second-hand smoke emission factors.

              Nancy Daher, Rawad Saleh, Ezzat Jaroudi … (2010)
              The lack of scientific evidence on the constituents, properties, and health effects of second-hand waterpipe smoke has fueled controversy over whether public smoking bans should include the waterpipe. The purpose of this study was to investigate and compare emissions of ultrafine particles (UFP, <100 nm), carcinogenic polyaromatic hydrocarbons (PAH), volatile aldehydes, and carbon monoxide (CO) for cigarettes and narghile (shisha, hookah) waterpipes. These smoke constituents are associated with a variety of cancers, and heart and pulmonary diseases, and span the volatility range found in tobacco smoke.Sidestream cigarette and waterpipe smoke was captured and aged in a 1 m(3) Teflon-coated chamber operating at 1.5 air changes per hour (ACH). The chamber was characterized for particle mass and number surface deposition rates. UFP and CO concentrations were measured online using a fast particle spectrometer (TSI 3090 Engine Exhaust Particle Sizer), and an indoor air quality monitor. Particulate PAH and gaseous volatile aldehydes were captured on glass fiber filters and DNPH-coated SPE cartridges, respectively, and analyzed off-line using GC-MS and HPLC-MS. PAH compounds quantified were the 5- and 6-ring compounds of the EPA priority list. Measured aldehydes consisted of formaldehyde, acetaldehyde, acrolein, methacrolein, and propionaldehyde.We found that a single waterpipe use session emits in the sidestream smoke approximately four times the carcinogenic PAH, four times the volatile aldehydes, and 30 times the CO of a single cigarette. Accounting for exhaled mainstream smoke, and given a habitual smoker smoking rate of 2 cigarettes per hour, during a typical one-hour waterpipe use session a waterpipe smoker likely generates ambient carcinogens and toxicants equivalent to 2-10 cigarette smokers, depending on the compound in question. There is therefore good reason to include waterpipe tobacco smoking in public smoking bans.
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                Author and article information

                Contributors
                Kamran Habib Awan
                Journal
                Journal ID (nlm-ta): Saudi Dent J
                Journal ID (iso-abbrev): Saudi Dent J
                Title: The Saudi Dental Journal
                Publisher: Elsevier
                ISSN (Print): 1013-9052
                ISSN (Electronic): 1658-3558
                Publication date PMC-release: 23 September 2017
                Publication date (Print): January 2018
                Publication date (Electronic): 23 September 2017
                Volume: 30
                Issue: 1
                Pages: 13-18
                Affiliations
                [a ]Department of Oral Medicine & Diagnostic Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
                [b ]College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT, United States
                [c ]Centre of Rural Health, Faculty of Health, University of Tasmania, Hobart, Tasmania, Australia
                [d ]Department of Periodontics, Faculty of Dentistry, Sebha University, Sebha, Libya
                Author notes
                [* ]Corresponding author at: College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT 84095, United States. kamranhabibawan@ 123456gmail.com
                Article
                Publisher ID: S1013-9052(17)30061-5
                DOI: 10.1016/j.sdentj.2017.08.003
                PMC ID: 6112370
                PubMed ID: 30166866
                SO-VID: 2840e2f0-0d53-409a-b376-7568e288ed63
                Copyright © © 2017 The Authors
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 25 May 2017
                Date revision received : 2 August 2017
                Date accepted : 3 August 2017
                Categories
                Subject: Review Article

                Keywords: tobacco control,public policy,gcc,cessation,surveillance and monitoring
                Data availability:
                Keywords: tobacco control, public policy, gcc, cessation, surveillance and monitoring

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