The Institute for Global Health and Development
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Item Factors associated with waterpipe tobacco smoking among Lebanese women(Taylor and Francis Group, 2018-01-19) Daou, Karim N.; Bou-Orm, Ibrahim; Adib, Salim M.Waterpipe tobacco smoking (WTS) has become a serious public health threat in the Middle East and beyond. To estimate the prevalence rates of cigarette and WTS among Lebanese women and describe characteristics associated with each behavior. Secondary analysis of women’s health data obtained in a national survey in 2010. Of 2,255 selected women, 78 percent reported no or past long-term WTS. Among the 12 percent of regular waterpipe smokers, 40 percent were light users (mean three waterpipe heads weekly), while 60 percent were heavy users (mean of 11 heads per week). About 70 percent were never or past long-term cigarette smokers. Younger age, location within Greater Beirut (GB) and having professional employment were significantly associated with use of WTS. Older age, GB location, lower education, and ever-married were significantly associated with cigarette smoking. WTS is becoming a socially normative behavior among empowered professional women, who can spare the time and expense to engage in this behavior in easily accessible cafés, which prohibit cigarette smoking. Government, media, and NGO campaigns against smoking should target waterpipe use, not only in Lebanon but also across the Arab world and among Arab communities in the Diaspora with messages different from anti-cigarette campaigns.Item Secular trends of hip fractures in Lebanon 2006-2017: Implications for clinical practice and public health policy in the Middle East region(ASBMR, 2019-09-10) Saad, Randa K.; Harb, Hilda; Bou-Orm, Ibrahim; Ammar, Walid; El-Hajj Fuleihan, GhadaCountry-specific hip fracture incidence rates (IRs) and longevity allow FRAX to be adapted to individual countries. Secular trends can affect tool calibration. Data on hip fracture IRs in the Middle East is scarce, and long-term secular trend studies are non-existent. Using the Ministry of Public Health hip fracture registry, we calculated age and sex-specific hip fracture IRs in Lebanon, from 2006-2017, among individuals aged ≥50 years. We used Kendall's tau-b (τb) test to determine the correlation between time and hip fracture IRs, and calculated both the annual % change in IRs and the % change in IR compared to the baseline period (2006-2008). The registry recorded 6,985 hip fractures, 74% at the femoral neck, 23% inter-trochanteric, and 3% sub-trochanteric. Men constituted 32% of the population, and were significantly younger than women (76.5 ± 11.0 years vs. 77.7 ± 10.3 years; p < 0.001). Annual overall IRs, per 100,000, ranged from 126.6 in 2014 to 213.2 in 2017 in women, and 61.4 in 2015 to 111.7 in 2017 in men. The average women to men IR ratio was 1.8 (range 1.5-2.1). IRs steadily increased with age, and IR ratios increased in parallel in both sexes, with a steeper and earlier rise (by 5 years) in women. Data showed a consistent decline in hip fracture IRs starting in 2006 in women, and in 2009 in men. There was a significant negative correlation between time (2006-2014) and hip fracture IRs in women (τb = -0.611, p = 0.022) but not in men (τb = -0.444, p = 0.095). The steady decrease in IRs reversed after 2015 in both sexes. This long-term data on secular trends in the Middle East is novel and consistent with worldwide changes in hip fracture rates. The impact of such changes on national FRAX-derived estimates is unclear, should be assessed, and may necessitate an update in the FRAX Lebanon calculator.