Socioeconomic differences in smoking in Jordan, Lebanon, Syria, and Palestine: A cross-sectional analysis of national surveys

INTRODUCTION: The association between education and wealth, as fundamental determinants of health, and smoking is well-established. Yet, social inequalities have received little attention in the expanding field of tobacco research in the Arab region. In this study, we examine inequalities in cigarette smoking by education and wealth in four Arab countries. METHODS: Utilizing the most recently available population-level data sets (Syria 2009 PAPFAM, Jordan 2012 DHS, Palestine 2010 Family Health Survey, and Lebanon 2004 PAPFAM), we tested the association between cigarette smoking and education and wealth–controlling for age, marital status, and region of residence–for each country, and among men and women depending on data availability. RESULTS: Cigarette smoking prevalence among Arab men is high– 51.3% in Syria, 39.7% in Palestine, and 42.1% in Lebanon; among women, prevalence is 8.4% in Syria, 10.9% in Jordan, and 24.3% Lebanon. Cigarette smoking shows the expected patterns inequalities by education among men in Syria, Palestine, and Lebanon, and among women in Jordan and Lebanon. On the other hand, wealth does not show a clear pattern in its association with cigarette smoking and, in some cases (men in Palestine and women in Syria) the behavioral risk is higher among the wealthiest. CONCLUSIONS: Available data from 2004–2012 show that cigarette smoking among men and women in the four Arab countries is predominant among those with limited access to education as a fundamental cause. The weak or absent negative association between wealth and cigarette smoking suggests that access to material resources does not precipitate a reduction in the consumption of tobacco.