Rima Nakkash

Rima Nakkash
American University of Beirut | AUB · Department of Health Promotion and Community Health

About

144
Publications
19,981
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2,253
Citations
Citations since 2017
75 Research Items
1589 Citations
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2017201820192020202120222023050100150200250300
2017201820192020202120222023050100150200250300

Publications

Publications (144)
Article
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Unlabelled: As the demand for dissemination and implementation (D&I) research grows globally, there is a need for D&I capacity building in regions where D&I science is underrepresented. The Workshop on Dissemination and Implementation Research in Health (WONDIRH) was aimed for participants in the Eastern Mediterranean region to (1) appreciate the...
Article
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Background Waterpipe smoking rates in Lebanon are among the highest in the in the world. Research has documented the effectiveness of introducing pictorial health warning labels (PHWLs) in curbing waterpipe smoking. Seventeen years after ratification of the WHO Framework Convention on Tobacco Control and twelve years post adoption of a tobacco cont...
Article
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Background Involving citizens in health policymaking leads to the development of policies that are tailored to their needs and enables them to exercise their right as citizens. Citizen engagement in health policymaking in low and middle-income countries (LMICs) is rarely practiced and so understanding barriers and facilitators to engagement and the...
Article
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Background Corporate funding has been described to be beneficial for humanitarian assistance in times of shrinking financial resources globally. Despite the growing global research on commercial determinants and their impact on population health, evaluations of corporate partnerships with humanitarian organizations and victims of multiple crises ar...
Article
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Objectives This study assessed the extent to which the elasticity of cigarette and waterpipe tobacco products differs between men and women. We also explored the levels of substitution and complementarity in tobacco products among men and women. Setting The study examines tobacco elasticities in three Arab countries: Lebanon, Jordan and the West B...
Preprint
UNSTRUCTURED Waterpipe tobacco smoking (WTS) is a traditional tobacco use method that originated in the Eastern Mediterranean Region (EMR) and has resurged in recent decades. WTS rates in the EMR are the highest worldwide, especially among youth, exceeding cigarette smoking rates in select jurisdictions. Despite its documented harm, the growing pre...
Article
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The recent concerns raised about commercial determinants of health are not new. Numerous organizations around the world are working on these issues. These groups have emerged in response to specific issues and contexts and bring with them a diversity of interests, worldviews and strategies for change. In creating the ‘Governance, Ethics and Conflic...
Article
Purpose: Waterpipe tobacco smoking (WTS) has substantially increased among young people in Lebanon, who perceive WTS as safer than cigarettes. Health warning labels (HWLs) can inform the adverse effects associated with smoking. Thus, their application to waterpipe offers a favourable policy to limit WTS epidemic. This study assessed the effectiven...
Article
Introduction The Framework Convention on Tobacco Control (FCTC) offers guidance on evidence-based policies to reduce tobacco consumption and its burden of disease. Recently, it has provided guidance for alternative tobacco products, such as the waterpipe. Waterpipe tobacco smoking (WTS) is prevalent worldwide and policies to address it need to take...
Article
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Objectives Tobacco smoking is on the rise in the Eastern Mediterranean region. In light of limited surveillance of smoking in the region, this study sought to understand the prevalence of cigarette and waterpipe smoking among adults and the factors associated with smoking in Lebanon, Jordan and Palestine (West Bank only). Design, setting and parti...
Article
Introduction: Waterpipe (WP) smoking is the leading tobacco use method among young adults in Lebanon. WP use is harmful, yet misperceptions about its safety exist. Implementing pictorial health warnings labels (HWLs) on WP products is a promising strategy to correct this misperception. This study aimed to culturally adapt a set of 12 pictorial HWL...
Article
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Efforts to adopt public health policies that would limit the consumption of unhealthy commodities, such as tobacco, alcohol and ultra-processed food products, are often undermined by private sector actors whose profits depend on the sales of such products. There is ample evidence showing that these corporations not only try to influence public heal...
Article
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This study aims to explore the perceived effectiveness of waterpipe (WP) tobacco specific health warning labels (HWLs) among young adult WP smokers and nonsmokers in Lebanon. Before participating in focus group discussions, participants (n = 66; WP smokers n = 30; nonsmokers n = 36; age 18–33) completed a brief survey to rate the effectiveness of 1...
Article
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Background Waterpipe tobacco smoking rates in the Eastern Mediterranean region are among the highest worldwide, yet little evidence exists on its economics. Estimates of demand elasticities for tobacco products are largely limited to cigarettes. This study aimed to estimate own-price and cross-price elasticities of demand for cigarettes and waterpi...
Article
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Introduction This study aimed to determine associations between health warning label content and motivation to quit waterpipe smoking by gender and smoking location. Methods Convenience samples of university students in three Eastern Mediterranean countries – Egypt (n=442), Jordan (n=535) and Palestine (n=487) – completed an online survey assessin...
Article
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Background Waterpipe tobacco smoking (WTS) has increased substantially in the Eastern Mediterranean Region (EMR), affecting young adults who perceive waterpipe as safer than cigarette smoking. Applying pictorial health warning labels (HWL) on tobacco products has been effective in communicating health risks associated with tobacco smoking. However,...
Article
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Introduction: A growing body of research has evaluated the effect of university tobacco-free policies on faculty and staff, however, none of these studies has been carried out in the Eastern Mediterranean Region. This study evaluates changes in faculty and staff attitudes, perceptions and smoking behavior, at 1 year post adoption of a tobacco-free...
Article
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Objective: To evaluate the effectiveness of a university tobacco-free policy by examining differences in students’ attitudes, perceptions of compliance and policy benefits, after one year of the policy’s implementation. Methods: Cross-sectional studies were undertaken to collect data pre- and 1 year post-policy implementation. The two samples were...
Article
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Objectives: Most non-communicable diseases are preventable and largely driven by the consumption of harmful products, such as tobacco, alcohol, gambling and ultra-processed food and drink products, collectively termed unhealthy commodities. This paper explores the links between unhealthy commodity industries (UCIs), analyses the extent of alignmen...
Article
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Introduction: Males have a higher prevalence of waterpipe tobacco smoking (WTS) than females in most Eastern Mediterranean Region (EMR) countries, with a smaller gender gap than that of cigarette smoking. The objective of this study was to determine gender differences among university students with respect to WTS initiation, smoking behavior, toba...
Article
Objective: Identifying the factors associated with nicotine dependence (ND) is essential to prevent initiation and continued use, and to promote cessation among youth. This study aims to document the predictors of the appearance of initial ND symptoms and full ND syndrome among adolescent waterpipe (WP) and cigarette smokers. Methods: A 6-year long...
Article
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Introduction: Despite the exceptionally high prevalence of tobacco use in Lebanon, few cessation programs exist. The American University of Beirut (AUB) developed one of the first smoking-cessation programs in the country in 2015, and the program became free-of-charge to patients in 2018. The program offers initial visit(s) with a primary care prov...
Article
Introduction E-cigarette use is becoming popular among youth worldwide and represents an emerging threat to public health. No previous study has looked into the prevalence of e-cigarettes use in the Eastern Mediterranean region. We report here on the prevalence of e-cigarette use in a cohort of 496 school and university students from Lebanon (62% m...
Article
Background Dwindling governmental funding for widespread natural disasters and armed conflicts have attracted corporate funding for humanitarian assistance. Although such funding has allowed expansion of humanitarian programs and capacity building, evaluations of such partnerships are rare and focus only on management aspects, without attention to...
Article
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Objectives The growing trend of for-profit organization (FPO)-funded university research is concerning because resultant potential conflicts of interest might lead to biases in methods, results, and interpretation. For public health academic programmes, receiving funds from FPOs whose products have negative health implications may be particularly p...
Article
We conducted a systematic scoping review to map the available evidence on smoke-free or tobacco-free (SF/TF) university policies globally. We specifically looked at (i) how policies were developed and communicated and (ii) what indicators were used to evaluate their impact. We searched for peer-reviewed literature, published up to January 2020, acr...
Article
Worldwide, over 70.8 million people are forcibly displaced from their homes as a result of persecution, conflict, violence, or human rights violation. In humanitarian crises, protection and the provision of basic needs are often prioritized. Research may be seen as opportunistic. However, without documenting and researching humanitarian responses,...
Article
Introduction There is a tendency of waterpipe smokers to advance their practice toward concurrent use (poly-tobacco use) of other tobacco products and nicotine delivery systems. This study investigated poly-tobacco use among waterpipe smokers, and its effect on their quit intention. Methods Descriptive cross-sectional design was utilized to recrui...
Article
Purpose Waterpipe (WP) smoking patterns and setting can result in a unique trajectory of nicotine dependence (ND) compared with cigarette smoking. This longitudinal study compared the development of ND symptoms among adolescent WP and cigarette smokers. Methods A cohort of 647 eighth and ninth graders in Lebanon were followed over 5 years. This st...
Technical Report
Full-text available
Amid COVID-19 pandemic and the growing evidence on tobacco link with increased severity of infections, this rapid response provides contextualized immediate actions for the Lebanese government and a long term action plan for effective tobacco control during COVID-19 and beyond.
Article
In Lebanon, approximately one in four adolescents suffers from a psychiatric disorder. Alarmingly, 94% of adolescents with a mental disorder have not sought any treatment. This study assessed the effectiveness of an evidence-based school-based universal mental health intervention (the FRIENDS program) in reducing depression and anxiety symptoms in...
Article
This study aims to model youth's off-premise alcohol demand and forecasts ethanol intake responsiveness to alcohol taxes. Using stated preference alcohol purchase data from a survey of 1024 university students in Lebanon, we derive price elasticities that we use to forecast the effects of two excise tax scenarios on overall ethanol intake. The firs...
Preprint
Full-text available
Background A growing body of research have evaluated the effect of university tobacco-free policies on faculty and staff, however, none of these studies has been carried out in the Eastern Mediterranean region. This study evaluates changes in faculty and staff attitudes, perceptions and smoking behavior, one year post-adoption of a tobacco-free pol...
Article
Background: Cigarette smoking is the most common form of tobacco consumption but other methods have grown in popularity. In the United Arab Emirates and other Gulf countries, smoking dokha, a form of tobacco mixed with herbs and spices in a midwakh pipe, is common. Aims: The aim of this study was to determine the prevalence of midwakh use in sch...
Article
Background: Research linking awareness of health effects of alcohol and harmful alcohol drinking status is limited. Aims: To investigate the association between awareness of long-term alcohol effects and alcohol use disorders. Methods: University students aged 18-25 years (n = 1155) completed a self-filled survey. Participants were asked if th...
Article
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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 t...
Article
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Background: The objective of this study was to examine waterpipe tobacco smoking patterns, places of smoking, and prices paid among university students in the Eastern Mediterranean Region. Methods: A cross-sectional online survey was administered to a convenience sample of university students in three countries. Participants were young adults (18–2...
Article
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Tobacco and waterpipe use among university students, Saudi Arabia: impact of tobacco sales ban Background: Waterpipe smoking is a method of tobacco consumption that continues to spread globally. In 2002, a ban of tobacco sales was adopted in the Saudi Arabian cites of Mecca and Medina. Aims: This study aimed to examine prevalence of waterpipe and...
Article
Background Waterpipe (WP) smoking is increasing globally. The rise of WP has been fuelled by widespread misperception of reduced-harm compared to cigarettes. Health warning labels (HWLs) are one strategy to communicate smoking-related risks and address reduced-harm misperceptions. Therefore, the development of WP-specific HWLs represents a priority...
Article
While technical and economic feasibility of water reuse projects is requisite for implementation, issues in relation to cultural values, public acceptability and perceptions shouldn't be marginalized. This research focuses on examining the Lebanese stakeholders' knowledge, perception, and attitude towards the reuse of treated wastewater and explore...
Article
The prevalence of waterpipe tobacco smoking in the Eastern Mediterranean Region is at alarmingly high levels, especially among young people. The objective of this research was to evaluate the preferences of young adult waterpipe smokers with respect to potential individual-level determinants of waterpipe smoking using discrete choice experiment met...
Article
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Background: Little research has been done to uncover the features of the waterpipe tobacco industry, which makes designing effective interventions and policies to counter this growing trend challenging. The objective of this study is to describe the features of the waterpipe industry. Methods: In 2015, we randomly sampled and conducted semi-structu...
Article
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Underage drinking among youth in Lebanon is increasing. Regulating availability is one of the best buy policies recommended by the World Health Organization. To quantitatively document the current status of alcohol availability to youth in Lebanon, we used GPS technology to survey alcohol outlet density in four highly populated neighborhoods in Bei...
Article
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The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) provides life-saving humanitarian aid for 5·4 million Palestine refugees now entering their eighth decade of statelessness and conflict. About a third of Palestine refugees still live in 58 recognised camps. UNRWA operates 702 schools and 144 health centres,...
Article
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Waterpipe tobacco smoking (WTS) is spreading worldwide. Research has indicated health consequences of WTS similar to cigarettes. Prevalence of WTS is high among young people. In Lebanon, current use rates of 35% have been documented among 13–15 year olds. We evaluated a school-based intervention. Method: We conducted a randomized-controlled-trial o...
Article
International and cross-cultural research is critical for understanding multilevel influences on health, health behaviors, and disease. A particularly relevant area of need for such research is tobacco control. The tobacco epidemic is one of the biggest public health threats globally, killing over 7 million people a year. Research critical to addre...
Article
Full-text available
Introduction Waterpipe tobacco smoking (WTS) continues to be very common in the Eastern Mediterranean Region (EMR), partially because of cultural acceptance but also because of misconceptions of its harm. This paper aimed to describe the beliefs towards waterpipe harm of university students who smoked waterpipe in five EMR countries. Methods This...
Article
Progress in tobacco control policy making has occurred worldwide through advocacy campaigns involving multiple players- civil society groups, activists, academics, media and policymakers. The Framework Convention on Tobacco Control (FCTC)-the first ever global health treaty-outlines evidence-based tobacco control policies. Lebanon ratified the FCTC...
Article
Background Policy discussions are often articulated through the news media. The aim of this study is to understand how waterpipe tobacco policy is narrated and developed over time in online news media. Methods We conducted a cross-sectional analysis of online news articles published in the year 2015. We used the online news content retriever servi...
Conference Paper
Background Waterpipe smoking originated in the Eastern Mediterranean region. It is highly prevalent among university students, and has been increasing in popularity despite mounting evidence showing it is harmful to health. The aim of this study was to measure preferences for waterpipe smoking and determine which product characteristics are most im...
Article
Background and challenges to implementation Although Lebanon ratified WHO's Framework Convention on Tobacco Control in 2005, smoking is rampant in the country. With high smoking rates among adults and youth, it is estimated that about 4,010 people die annually from tobacco caused diseases. Laws stipulating smoking bans in public places, including e...
Conference Paper
Background: Waterpipe tobacco smoking (WTS) prevalence in the Eastern Mediterranean Region (EMR) is among the highest in the world and it is increasing with time. This paper aims to investigate waterpipe harm believes among university students who smoke waterpipe in five EMR countries. Methods: This study was conducted in 2016 across five EMR coun...
Conference Paper
Background: Waterpipe tobacco smoking is a global public health problem that originated in the Eastern Mediterranean region (EMR). It is highly prevalent among university students, and has been increasing in popularity despite mounting evidence showing it is harmful to health. The aim of this study was to evaluate responses to various health warnin...
Article
Background Alternative tobacco product (ATP) use is increasing in Lebanon. Dokha (or 'diziness') is an ATP smoked in a pipe called a midwakh. Research evidence suggests high nicotine content, with resultant physiologic effects. The objective of this study was to assess prevalence and correlates of midwakh tobacco use among 7 th -12 th grade student...
Article
Background Understanding the internal structures of the tobacco industry is vital in the development of effective tobacco policy. Currently, little is known about the waterpipe tobacco industry. We aimed to understand more about product development, marketing methods, compliance with legislation and features of the waterpipe tobacco industry. Meth...
Article
Full-text available
Background: Little research has been done to uncover the features of the waterpipe tobacco industry, which makes designing effective interventions and policies to counter this growing trend challenging. The objective of this study is to describe the features of the waterpipe industry. Methods: In 2015, we randomly sampled and conducted semi-structu...
Article
Globalization and a glowing awareness of environmental issues are compelling firms to adhere to international environmental standards. Lebanese manufacturing industries are increasingly pressured to integrate environmental standards, mainly the ISO 14001 certification, in order to access - enter and compete - international markets. Although the ISO...
Article
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Background Waterpipe tobacco smoking rates in the Eastern Mediterranean region are some of the highest worldwide, especially among young people. This study aimed to improve our knowledge of the policy-relevant context of waterpipe smoking among six countries in the Eastern Mediterranean region. Methods In-depth interviews were conducted in Bahrain...
Article
Informed consent requirements for conducting research with human participants are set by institutional review boards (IRBs) following established guidelines. Despite this, researchers continue to face challenges in seeking and obtaining informed consent. This study discusses researchers’ views of such problems in Lebanon and Qatar, which vary in re...
Article
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We assessed compliance of waterpipe product packaging and labelling with the Framework Convention on Tobacco Control's Article 11. We evaluated samples collected at a trade fair against ten domains: health warning location, size, use of pictorials, use of colour, and packaging information on constituents and emissions. We also evaluated waterpipe a...
Article
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Introduction Waterpipe tobacco smoking is increasing globally particularly among youth. In Lebanon,the high prevalence of waterpipe tobacco smoking among younger age groups calls for immediate intervention particularly given its negative health effects. To date, such interventions have rarely been implemented or evaluated. Methods This manuscript...
Chapter
The Arab region has recently witnessed widespread financial support for collaborative research involving human subjects. This increase has not been coupled with a rise in the number of research ethics committees and many of those that are in place lack sufficient functionality. Investigating academic researchers’ views regarding conducting research...
Article
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Introduction Available in hundreds of device designs and thousands of flavors, electronic cigarette (ECIG) may have differing toxicant emission characteristics. This study assesses nicotine and carbonyl yields in the most popular brands in the US market. These products included disposable, pre-filled cartridge and tank-based ECIGs. Methods Twenty-...
Article
With dwindling support from governments toward universities, university–industry partnerships have increased. Ethical concerns over such partnerships have been documented, are particularly relevant when an institution receives money from a corporation whose products do harm and are intensified for academic public health institutions whose missions...
Article
Numerous epidemiological accounts suggest that waterpipe smoking (aka hookah, shisha, narghile) has become a global phenomenon, especially among youth. The alarming spread of waterpipe and accumulating evidence of its addictive and harmful effects represent a new threat in the global fight to limit tobacco-related morbidity and mortality. In respon...
Article
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Introduction Although the majority of countries ratified the World Health Organization Framework Convention on Tobacco Control, few have comprehensive smoke-free laws and compliance is not always satisfactory. In 2011, Lebanon, having among the highest smoking rates in the Eastern Mediterranean Region, passed a comprehensive tobacco control law (La...
Article
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Objectives Little is known about the distribution of cigarette smoking by place and persons at the national level or its burden on healthcare expenditure in countries of the Middle East. We examine in this study the pattern of cigarette smoking by age, gender and geography and assess its association with hospitalisation use in Lebanon, a small midd...
Article
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Objectives Youth have the misperception that waterpipe smoking is less harmful than cigarettes despite the evidence that it is associated with nicotine dependence and many of the diseases caused by cigarettes. There is a pressing need to identify effective health warnings that increase awareness about the harmful effects of waterpipe smoking. Our o...
Article
Originally an alternative tobacco product confined mostly to the Arab world,1 waterpipe (also called shisha, hookah, argileh, narghile) tobacco smoking (WTS) is increasing globally, and is mainly a youth phenomenon. Youth ever and current smoking rates outpace those of adults in almost every country.2 ,3 Evidence suggests that WTS is associated wit...
Article
Full-text available
Objectives Waterpipe smoking is highly prevalent among university students, and has been increasing in popularity despite mounting evidence showing it is harmful to health. The aim of this study was to measure preferences for waterpipe smoking and determine which product characteristics are most important to smokers. Setting A large university in t...