Addiction & Health

Addiction & Health

Fighting the Smoking Epidemic in Syria: First Online Course to Equip Health Professionals with Smoking Cessation Competencies

Document Type : Short Communication(s)

Authors
1 Faculty of Dentistry, Tishreen University, Latakia, Syria
2 Medical Education Master Program, Syrian Virtual University, Damascus, Syria
3 Health For All Research Group, Tishreen University, Latakia, Syria
4 Faculty of Medicine, Al Andalus University, Tartus, Syria
5 Faculty of Medicine, Tishreen University, Latakia, Syria
6 Department of Pediatric Dentistry, Faculty of Dentistry, Al-Rasheed Private University, Damascus, Syria
7 College of Population Health, The University of New Mexico, Albuquerque, NM, USA
8 Department of Clinical Pharmacy, Damascus Hospital, Damascus, Syria
9 Department of Pediatric Dentistry, Faculty of Dentistry, Damascus University, Damascus, Syria
10.34172/ahj.1666
Abstract
Background: The prolonged conflict in Syria has increased psychosocial stress and contributed to high smoking rates. Despite healthcare providers’ critical role in smoking cessation, medical curricula lack adequate coverage of related competencies, and high physician smoking rates remain major barriers. This study evaluated the effectiveness and feasibility of the Smoking Cessation Strategy Course (SCSC), an online course aimed at enhancing Syrian healthcare professionals’ knowledge, perceived skills, and attitudes toward smoking cessation.
Methods: This single-arm intervention involved a peer-led, asynchronous online course comprising 10 brief lessons (each 10 minutes long) and facilitated WhatsApp discussions. Participants (n = 120) included medical, dental, and pharmacy students and graduates. Pre- and post-intervention questionnaires assessed smoking cessation knowledge, perceived skills, and attitudes. Paired t-tests evaluated changes (P < 0.05).
Finding: Ninety-four participants completed the post-test (78.3% retention). Knowledge improved significantly (pre-test 11.5 ± 1.5 vs. post-test 17.4 ± 1.55; P < 0.001, d = 0.86) and perceived skills (pre-test 3.53 ± 0.60 vs. post-test 4.14 ± 0.66; P < 0.001, d = 0.82). Attitudes showed slight, non-significant (pre-test 3.00 ± 0.37 vs. post-test 3.24 ± 0.40; P = 0.19). Dropout analysis indicated no demographic differences, though non-completers held more negative baseline attitudes.
Conclusion: The SCSC significantly improved knowledge and perceived confidence in delivering smoking cessation interventions, demonstrating feasibility in a low-resource, conflict-affected context. While attitude changes were limited, this online model offers a scalable, low-cost approach to strengthening tobacco treatment capacity in Syria and similar LMIC settings.

Highlights

Yazan Kenjrawi(GoogleScholar)(Pubmed)

Keywords

1.       Institute for Health Metrics and Evaluation (IHME). Global Burden of Disease Study 2019 (GBD 2019) Data Resources. Washington, DC: IHME; 2019. Available from: https://ghdx. healthdata.org/gbd-2019
2.       Kassel JD, Stroud LR, Paronis CA. Smoking, stress, and negative affect: correlation, causation, and context across stages of smoking. Psychol Bull. 2003;129(2):270-304. doi: 10.1037/0033-2909.129.2.270
3.       Alexander AC, Ward KD, Forde DR, Stockton M. Are posttraumatic stress and depressive symptoms pathways to smoking relapse after a natural disaster? Drug Alcohol Depend. 2019;195:178-85. doi: 10.1016/j.drugalcdep.2018.09.025
4.       Kheirallah KA, Cobb CO, Alsulaiman JW, Alzoubi A, Hoetger C, Kliewer W, et al. Trauma exposure, mental health and tobacco use among vulnerable Syrian refugee youth in Jordan. J Public Health (Oxf). 2020;42(3):e343-51. doi: 10.1093/ pubmed/fdz128
5.       Kakaje A, Alhalabi MM, Alyousbashi A, Ghareeb A, Hamid L, Al-Tammemi AB. Smoking habits and the influence of war on cigarette and shisha smoking in Syria. PLoS One. 2021;16(9):e0256829. doi: 10.1371/journal.pone.0256829
6.       Devonish J, Debnam C, Furgurson E, Sawa H, Dahlquist C, Arendt M. The role of all healthcare professionals in cessation. Tob Induc Dis. 2022;20:01. doi: 10.18332/tid/144766
7.       Fiore MC, Goplerud E, Schroeder SA. The Joint Commission’s new tobacco-cessation measures--will hospitals do the right thing? N Engl J Med. 2012;366(13):1172-4. doi: 10.1056/ NEJMp1115176
8.       Vijayaraghavan M, Yuan P, Gregorich S, Lum P, Appelle N, Napoles AM, et al. Disparities in receipt of 5As for smoking cessation in diverse primary care and HIV clinics. Prev Med Rep. 2017;6:80-7. doi: 10.1016/j.pmedr.2017.02.012
9.       World Health Organization (WHO). Toolkit for Delivering the 5A’s and 5R’s Brief Tobacco Interventions in Primary Care. Geneva: WHO; 2014. Available from: https://www.who.int/ publications/i/item/toolkit-for-delivering-5as-and-5rs-brief-tobacco-interventions-in-primary-care.
10.   Maziak W, Mzayek F, Asfar T, Hassig SE. Smoking among physicians in Syria: do as I say, not as I do! Ann Saudi Med. 1999;19(3):253-6. doi: 10.5144/0256-4947.1999.253
11.   Asfar T, Al-Ali R, Ward KD, Vander Weg MW, Maziak W. Are primary health care providers prepared to implement an anti-smoking program in Syria? Patient Educ Couns. 2011;85(2):201-5. doi: 10.1016/j.pec.2010.11.011
12.   Almerie MQ, Matar HE, Salam M, Morad A, Abdulaal M, Koudsi A, et al. Cigarettes and waterpipe smoking among medical students in Syria: a cross-sectional study. Int J Tuberc Lung Dis. 2008;12(9):1085-91.
13.   Kumar A, Ward KD, Mellon L, Gunning M, Stynes S, Hickey A, et al. Medical student INtervention to promote effective nicotine dependence and tobacco HEalthcare (MIND-THE-GAP): single-centre feasibility randomised trial results. BMC Med Educ. 2017;17(1):249. doi: 10.1186/s12909-017-1069-y
14.   Abdullah AS, Husten CG. Promotion of smoking cessation in developing countries: a framework for urgent public health interventions. Thorax. 2004;59(7):623-30. doi: 10.1136/ thx.2003.018820
15.   2008 PHS Guideline Update Panel, Liaisons, and Staff. Treating tobacco use and dependence: 2008 update US Public Health Service Clinical Practice Guideline executive summary. Respir Care. 2008;53(9):1217-22.
16.   Maziak W, Jawad M, Jawad S, Ward KD, Eissenberg T, Asfar T. Interventions for waterpipe smoking cessation. Cochrane Database Syst Rev. 2015;2015(7):CD005549. doi: 10.1002/14651858.CD005549.pub3
17.   Ward KD, Asfar T, Al Ali R, Rastam S, Weg MW, Eissenberg T, et al. Randomized trial of the effectiveness of combined behavioral/pharmacological smoking cessation treatment in Syrian primary care clinics. Addiction. 2013;108(2):394-403. doi: 10.1111/j.1360-0443.2012.04048.x
18.   Abdelazim SA, Nour-Eldein H, Ismail MA, Al Sayed Fiala L, Abdulmajeed AA. Effect of training program regarding smoking cessation counseling for primary health care physicians in Port Said city, Egypt. Z Gesundh Wiss. 2018;26(5):569-75. doi: 10.1007/s10389-017-0890-4
19.   Waheedi M, Al-Tmimy AM, Enlund H. Preparedness for the smoking cessation role among health sciences students in Kuwait. Med Princ Pract. 2011;20(3):237-43. doi: 10.1159/000321273
20.   Kenjrawi Y, Dashash M. The first asynchronous online evidence-based medicine course for Syrian health workforce: effectiveness and feasibility pilot study. JMIR Form Res. 2022;6(10):e36782. doi: 10.2196/36782
21.   Hanafi I, Kheder K, Sabouni R, Gorra Al Nafouri M, Hanafi B, Alsalkini M, et al. Improving academic writing in a low-resource country: a systematic examination of online peer-run training. Teach Learn Med. 2025;37(3):388-402. doi: 10.1080/10401334.2024.2332890
22.   Schmelz AN, Nixon B, McDaniel A, Hudmon KS, Zillich AJ. Evaluation of an online tobacco cessation course for health professions students. Am J Pharm Educ. 2010;74(2):36. doi: 10.5688/aj740236
23.   Asfar T, Ward KD, Al-Ali R, Maziak W. Building evidence-based tobacco treatment in the Eastern Mediterranean region: lessons learned by the Syrian Center for Tobacco Studies. J Smok Cessat. 2016;11(2):116-23. doi: 10.1017/jsc.2016.5