Approaches to Tobacco Dependence Treatment for women in East Mediterranean Region

Although the gap between the rates of tobacco use in males and females (30% and 4% respectively) is still larger than in the western world[1], the prevalence of tobacco use among women in the East Mediterranean Region (EMR) is on the rise.

The Global Youth Tobacco Survey showed that tobacco use is also increasing among girls (cigarettes 2%, other tobacco products 9%)[2]. One main reason behind it is that girls and women initiate and continue to smoke in order to control their body weight[3]. Furthermore, there is a shift in tobacco use from cigarettes to other tobacco products, basically waterpipe (Sheisha). Waterpipe smoking is now perceived to be less addictive and less harmful than cigarette smoking[4], more socially acceptable, and more of a modern social image[5].

Being the mother, the teacher, and the housewife creates a larger need for girls and women to be treated for their tobacco use. But the Tobacco Dependence Treatment (TDT) programs available in the area, on the other hand, are still not well structured nor widely spread in a majority of EMR countries, and the cessation medications are not continuously on hand.

In addition, the cost of treatment is high, and the health care systems do not appreciate the benefit of investing in the service. The programs available are being offered similarly to all sectors of the community; there are no dedicated centers or clinics to provide a unique service to this vulnerable group of smokers. Consequently, TDT program delivery and effectiveness have not been studied in depth among females.

The main approaches or key points that encourage girls and women to quit are those with social and cultural value, such as; fertility, delivery of a healthy baby, as well as beauty and appearance. Whereas prevention of osteoporosis, heart disease, and breast cancer rate a lower level of importance to those smokers. Another crucial point that should always be considered is the stigma; females are embarrassed to unveil their tobacco use, ultimately, their need for treatment.

There is a need to develop culturally sensitive and gender-specific programs to prevent initiation and maintenance of tobacco use among females, and utilize proficiently the available treatment programs for those who continue to smoke. Moreover, there is a need to adopt TDT guidelines specific for females, and to establish services in health care centers (e.g. Mother and Child Health care centers) where women feel more comfortable discussing their health needs and issues.

About the Author: A physician by training, Hiba Ayub, MBBS, is head of the Tobacco Control Unit in the Cancer Control Office at King Hussein Cancer Center (KHCC) in Jordan. KHCC is Global Bridges’ partner organization in the Eastern Mediterranean Region. In addition to being involved in tobacco cessation and public awareness activities, Dr. Ayub also conducts research, with a particular interest in cessation, waterpipe and epidemiology.

In 2010, she received the World No Tobacco Day award from the World Health Organization, which is given to those who’ve made “invaluable contributions to tobacco control.


  1. World Health Organization, (2010), “Gender, Women, and the Tobacco Epidemic: 3. Prevalence of Tobacco Use and Factors Influencing Initiation and Maintenance Among Women”
  2. Centers for Disease Control and Prevention, Global Youth Tobacco Survey, Global Tobacco Use Among Girls: www.cdc.gov/features/dstobacco_use_girls/
  3. World Health Organization,“Gender and Tobacco in the East Mediterranean Region”, Women in Health and Development, Regional Office for the Eastern Mediterranean.
  4. Amin TT, et al.(2010) Harm perception, attitudes and predictors of waterpipe (shisha) smoking among secondary school adolescents in Al-Hassa, Saudi Arabia. Asian Pac J Cancer Prev.;11(2):293-301.
  5. Khalil J. et al, (2013), Women and waterpipe tobacco smoking in the eastern mediterranean region: allure or offensiveness. Women Health, Jan;53(1):100-16. doi:10.1080/03630242.2012.753978.