RESEARCH PAPER
Effect of tobacco control policies on intention to quit smoking cigarettes: A study from Beirut, Lebanon
Monique Chaaya 1  
,  
Rima Nakkash 2
,  
Dahlia Saab 1
,  
Lina Kadi 1
,  
 
 
More details
Hide details
1
Department of Epidemiology and Population Health, American University of Beirut, Beirut, Lebanon
2
Department of Health Promotion and Community Health, American University of Beirut, Beirut, Lebanon
3
Department of Community and Behavioral Health, The University of Iowa, Iowa City, United States
CORRESPONDING AUTHOR
Monique Chaaya   

Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
Publish date: 2019-09-02
 
Tob. Induc. Dis. 2019;17(September):63
KEYWORDS
TOPICS
ABSTRACT
Introduction:
In 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).

Methods:
This is a secondary data analysis of 154 cigarette smokers from a crosssectional 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.

Results:
Intention 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.

Conclusions:
This 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.

CONFLICTS OF INTEREST
The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none was reported.
FUNDING
This work was supported by the University Research Board (URB) of the American University of Beirut and Issam Fares Institute for Public Policy and International Affairs.
PROVENANCE AND PEER REVIEW
Not commissioned; externally peer reviewed.
 
REFERENCES (28)
1.
WHO Framework Convention on Tobacco Control, WHO Regional Office for Africa. The WHO Framework Convention on Tobacco Control: 10 years of implementation in the African Region. WHO Regional Office for Africa; 2015. https://www.afro.who.int/sites.... Accessed April 11, 2019.
 
2.
Eriksen M, Mackay J, Schluger N, Islami F, Drope J. The Tobacco Atlas. Atlanta: The American Cancer Society; 2015.
 
3.
World Health Organization. Fact sheet about health benefits of smoking cessation. http://www.who.int/tobacco/qui.... Accessed April 11, 2019.
 
4.
Hughes JR, Keely J, Naud S. Shape of the relapse curve and long‐term abstinence among untreated smokers. Addiction. 2004;99(1):29-38. doi:10.1111/j.1360-0443.2004.00540.x.
 
5.
Borland R, Yong HH, Wilson N, et al. How reactions to cigarette packet health warnings influence quitting: Findings from the ITC Four‐Country survey. Addiction. 2009;104(4):669-675. doi:10.1111/j.1360-0443.2009.02508.x.
 
6.
Fong GT, Hyland A, Borland R, et al. Reductions in tobacco smoke pollution and increases in support for smoke-free public places following the implementation of comprehensive smoke-free workplace legislation in the Republic of Ireland: findings from the ITC Ireland/UK Survey. Tob Control. 2006;15:iii51-iii58. doi:10.1136/tc.2005.013649.
 
7.
Zablocki RW, Edland SD, Myers MG, Strong DR, Hofstetter CR, Al-Delaimy WK. Smoking ban policies and their influence on smoking behaviors among current California smokers: a population-based study. Prev Med. 2014;59:73-78. doi:10.1016/j.ypmed.2013.11.018.
 
8.
Centers for Disease Control and Prevention. Antismoking messages and intention to quit-17 countries, 2008-2011. MMWR Morb Mortal Wkly Rep. 2013;62(21):417.
 
9.
Surani N, Gupta P, Fong T, Pednekar M, Quah A, Bansal-Travers M. Intention to quit among Indian tobacco users: Findings from International Tobacco Control Policy evaluation India pilot survey. Indian J Cancer. 2012;49(4):431. doi:10.4103/0019-509x.107752.
 
10.
Fong GT, Cummings KM, Borland R, et al. The conceptual framework of the International Tobacco Control (ITC) policy evaluation project. Tob Control. 2006;15(suppl 3):iii3-iii11. doi:10.1136/tc.2005.015438.
 
11.
Sibai A, Tohme RA, Mahfoud Z, Chaaya M, Hwalla N. Non-communicable Diseases and Behavioral Risk Factor Survey: Comparison of estimates based on cell phone interviews with face to face interviews. https://www.moph.gov.lb/Dynami.... Accessed April 11, 2019.
 
12.
Salti N, Chaaban J, Naamani N. The economics of tobacco in Lebanon: an estimation of the social costs of tobacco consumption. Subst Use Misuse. 2014;49(6):735-742. doi:10.3109/10826084.2013.863937.
 
13.
Nakkash RT, Torossian L, El Hajj T, Khalil J, Afifi RA. The passage of tobacco control law 174 in Lebanon: reflections on the problem, policies and politics. Health Policy Plan. 2018;33(5):633-644. doi:10.1093/heapol/czy023.
 
14.
Chaaya M, Nakkash R, Afifi R, et al. Implementation of an indoor smoking ban and an advertising/ sponsorship ban in Lebanon: a baseline cross-sectional study. Tob Prev Cessation. 2016;2(May). doi:10.18332/tpc/63118.
 
15.
Brennan E, Durkin S, Coomber K, Zacher M, Scollo M, Wakefield M. Are quitting-related cognitions and behaviours predicted by proximal responses to plain packaging with larger health warnings? Findings from a national cohort study with Australian adult smokers. Tob Control. 2015;24(Suppl 2):ii33-ii41. doi:10.1136/tobaccocontrol-2014-052057.
 
16.
Dunlop SM, Dobbins T, Young JM, Perez D, Currow DC. Impact of Australia's introduction of tobacco plain packs on adult smokers’ pack-related perceptions and responses: results from a continuous tracking survey. BMJ Open. 2014;4(12):e005836. doi:10.1136/bmjopen-2014-005836.
 
17.
Durkin S, Brennan E, Coomber K, Zacher M, Scollo M, Wakefield M. Short-term changes in quitting-related cognitions and behaviours after the implementation of plain packaging with larger health warnings: findings from a national cohort study with Australian adult smokers. Tob Control. 2015;24(Suppl 2):ii26-ii32. doi:10.1136/tobaccocontrol-2014-052058.
 
18.
Partos TR, Borland R, Thrasher JF, et al. The predictive utility of micro indicators of concern about smoking: findings from the International Tobacco Control Four Country study. Addict Behav. 2014;39(8):1235-1242. doi:10.1016/j.addbeh.2014.04.001.
 
19.
Myung SK, Seo HG, Cheong YS, Park S, Lee WB, Fong GT. Association of sociodemographic factors, smoking-related beliefs, and smoking restrictions with intention to quit smoking in Korean adults: Findings from the ITC Korea Survey. J Epidemiol. 2012;22(1):21-27. doi:10.2188/jea.je20110026.
 
20.
Berg CJ, Ling PM, Hayes RB, et al. Smoking frequency among current college student smokers: distinguishing characteristics and factors related to readiness to quit smoking. Health Educ Res. 2011;27(1):141-150. doi:10.1093/her/cyr106.
 
21.
Messer K, Trinidad DR, Al-Delaimy WK, Pierce JP. Smoking cessation rates in the United States: a comparison of young adult and older smokers. Am J Public Health. 2008;98(2):317-322. doi:10.2105/ajph.2007.112060.
 
22.
Hyland A, Borland R, Li Q, et al. Individual-level predictors of cessation behaviours among participants in the International Tobacco Control (ITC) Four Country Survey. Tob Control. 2006;15(suppl 3):iii83-iii94. doi:10.1136/tc.2005.013516.
 
23.
Hyland A, Li Q, Bauer JE, Giovino GA, Steger C, Cummings KM. Predictors of cessation in a cohort of current and former smokers followed over 13 years. Nicotine Tob Res. 2004;6(Suppl_3):S363-S369. doi:10.1080/14622200412331320761.
 
24.
Lee CW, Kahende J. Factors associated with successful smoking cessation in the United States, 2000. Am J Public Health. 2007;97(8):1503-1509. doi:10.2105/ajph.2005.083527.
 
25.
Vangeli E, Stapleton J, Smit ES, Borland R, West R. Predictors of attempts to stop smoking and their success in adult general population samples: a systematic review. Addiction. 2011;106(12):2110-2121. doi:10.1111/j.1360-0443.2011.03565.x.
 
26.
Abdullah AS, Driezen P, Quah AC, Nargis N, Fong GT. Predictors of smoking cessation behavior among Bangladeshi adults: findings from ITC Bangladesh survey. Tob Induc Dis. 2015;13(August). doi:10.1186/s12971-015-0050-y.
 
27.
Panda R, Venkatesan S, Persai D, Trivedi M, Mathur MR. Factors determining intention to quit tobacco: exploring patient responses visiting public health facilities in India. Tob Induc Dis. 2014;12(January). doi:10.1186/1617-9625-12-1.
 
28.
Høie M, Moan IS, Rise J. An extended version of the theory of planned behavour: Prediction of intentions to quit smoking using past behaviour as moderator. Addict Res Theory. 2010;18(5):572-585. doi:10.3109/16066350903474386.
 
eISSN:1617-9625