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 12 HWLs’ and rank them according to four risk themes (WP health effects, WP harm to others, WP-specific harm, and WP harm compared to cigarettes). Differences in HWLs ratings by WP smoking status were examined and the top-ranked HWL in each theme were identified. HWLs depicting mouth cancer and harm to babies were rated as the most effective by both WP smokers and non-smokers. WP smokers rated HWLs which depicted harm to children and infants as more effective than non-smokers. The top-ranked HWLs for perceived overall effectiveness were those depicting “oral cancer”, “harm to babies”, “orally transmitted diseases” and “mouth cancer”. HWLs depicting oral lesions and harm to babies were rated as most effective, while HWLs showing the harmful effects of WP secondhand smoke on infants and children were rated as less effective by nonsmokers compared to smokers. Our study provides evidence on the potential effectiveness of HWLs for further evaluation in Lebanon and the Eastern Mediterranean region. The results will inform and guide the development and implementation of tobacco control policy.

In line with the global trends, electronic cigarettes (e-cigarettes) and heated tobacco products (HTPs) have found their way to the Lebanese market. The present study aims to explore the determinants of e-cigarette and HTP use among young adults in Lebanon. Convenience and snowball sampling were used to recruit participants aged 18–30 residing in Lebanon, who were familiar with e-cigarettes products. Twenty-one consenting participants were interviewed via Zoom and the verbatim transcriptions were analyzed thematically. The outcome expectancy theory was used to categorize the results into determinants and deterrents of use. HTPs were viewed by participants as another mode of smoking. The results showed that most participants perceived e-cigarettes and HTPs to be healthier alternatives to cigarettes/waterpipes and to be used as smoking cessation tools. Both e-cigarettes and HTPs were found to be easily accessible in Lebanon; although, in the recent economic crisis, e-cigarettes have become unaffordable. More research is needed to investigate the motivations and behaviors of e-cigarette and HTP users if effective policies and regulations are to be developed and enforced. Furthermore, greater public health efforts need to be made to increase awareness of the harmful impacts of e-cigarettes and HTPs and to implement evidence-based cessation programs tailored to those modes of smoking.

This pilot randomized controlled trial protocol aims to (1) assess the impact on the wellbeing of Syrian refugee young adults (18–24 years) of being a community mental health worker (CMHW) implementing WHO's evidence-based psychosocial intervention - Problem Management Plus (PM+) - with adults in their community, and (2) identify the mechanisms associated with the outcomes of enhanced wellbeing and coping, and reduced stress among these CMHWs. Over 108 million people have been forcibly displaced as of the end of 2022. Mental health consequences of these displacements are significant, yet human resources for health are not sufficient to meet the needs. A large proportion of refugee populations are youth and young adults (YA). Evidence indicates their engagement in supporting their communities leads to their own enhanced wellbeing and that of their community. This trial trains Syrian refugees to serve their communities as CMHW (n=19) or tutors (n=19) and compare wellbeing, stress and coping outcomes between these two groups and a control group (n = 40). We will also assess 7 mechanisms as potential pathways for the interventions to influence outcomes. Surveys will assess outcomes and mechanisms, hair samples will measure stress cortisol. The primary analysis will use a Bayesian Hierarchical Model approach to model the trajectories of the mechanisms and primary study endpoints over time for individuals in each of the arms. Our results will elucidate critical mechanisms in which engagement of young adults to support their community enhances their own wellbeing. National Institutes of Mental Health, NCT05265611, Registered prospectively in 2021. LBCTR2023015206, Registered in 2023.

Objectives In this work, which forms part of a larger study of a longitudinal intervention focused on empowering Community Mental Health Workers in a humanitarian context, we examine changes in and correlates of well-being of refugees as a result of discriminatory practices by the State, with comparisons motivated by a mechanistic model of well-being. Design This cohort study examines well-being at a single follow-up time as predicted by baseline characteristics in response to a changing social conditions including security raids on our participants; the parent interventional randomised trial focuses on a population of youth in a refugee context, but the present work precedes the main intervention period. Setting Refugee populations are among the most vulnerable globally, and the total refugee population is growing dramatically. As of 2022, more than 12 million Syrians have been forcibly displaced with 6.5 million of them classified as refugees. In Lebanon specifically, tension between refugees and the host government has recently risen most evident through security raids, threatening the well-being of already displaced persons. Participants The study recruited Syrian refugee young adults (18–24 years) who have completed at least high school; additional inclusion criteria included: living in the catchment areas within the Bekaa at the time of screening, having been involved in non-governmental organisations (NGOs) or service to their community and having expressed motivation to serve their community. Applicants who fit the inclusion criteria were further screened by a psychiatrist to ensure that they were not experiencing acute distress at the time of recruitment (February 2023–March 2023). Recruitment occurred through posters on social media platforms of Multi-Aid Programmes. Ninety-two young adults were randomly assigned to one of the three randomised controlled trial arms. Interventions None at the time of the study. Primary and secondary outcome measures Primary outcomes were measures of well-being at baseline and follow-up. Results We find that the ability of NGOs to work with refugee populations may be threatened in important ways by government security raids, with possibly the most vulnerable subjects participating at baseline being less likely to respond during the raids. Moreover, we discuss the paradoxical short-term effects of the isolation induced by the raids, where daily experience of stigmatising events actually decreased during this period. Conclusions These results highlight the challenging environment in which refugees in Lebanon live in, and raise important questions about long-term solutions to the crisis. Trial registration number NCT05265611; LBCTR2023015206.