In an article for The Guardian published earlier this year, Yousef Shawarbeh, the mayor of Amman, wrote that Jordan has a “culture of tobacco use that has been resistant to change”. He has a point. 

An astonishing 70% of Jordanian men are thought to be smokers. Laws prohibiting smoking in public places are widely disregarded. “Even the legislators push back on implementation”, noted Shawarbeh. “They are often seen smoking in parliament, as are cabinet ministers at their workplaces—all in defiance of the law”. Parliamentary votes on tobacco control have even been conducted underneath a pall of cigarette smoke.

“If you look around at the men in Jordan, you can barely identify a few who do not smoke”, adds Rasha Bader (King Hussein Cancer Centre, Amman, Jordan). Tobacco smoking is so firmly entrenched in the national culture that people think twice before asking a smoker to put out their cigarette in a public space. “You feel like you are asking something that is not part of the norm”, explains Bader. 

The prevalence of smoking is also increasing, particularly among women and young people.

The growing popularity of waterpipes, known locally as shisha or argile, among women and teenagers has led to a huge expansion in the number of waterpipe cafes. “They are spreading everywhere; 

it is invasive”, said Abeer Mowaswas, director of awareness and communication at the Ministry of Health. The 10% of Jordanian women who report that they smoke cigarettes or shisha does not reflect the true prevalence. Women who consume cigarettes in Jordan have historically been stigmatised, but waterpipes have become more and more socially acceptable. “Women can use waterpipes openly; the cafes have become an important way for Jordanians to socialise especially with the lack of clubs, community centres, and sport centres in this country”, Bader told The Lancet Respiratory Medicine.

68% of adults in Jordan and 62% of young people are regularly exposed to second-hand smoke. “These numbers are alarming, going against people's right to breathe and putting the majority of the population's heath at risk”, commented Maria Cristina Profili (WHO, Amman, Jordan). Young people are especially keen on waterpipes. A survey of roughly 1000 students from middle schools and high schools in Jordan's Zarqa governorate found that almost a third reported smoking waterpipes during the previous week. Youth smoking is a substantial problem in Jordan. A prospective cohort study of 1781 schoolchildren in the country found that 327 (19%) were already smoking by the seventh grade (mean age 12·7 years). When schools finish for the day, students can be seen queuing up to buy single cigarettes from convenience stores. The sale of single cigarettes is prohibited, but similar to most of Jordan's tobacco legislation, the rule is rarely enforced.

“Teenagers do not see any problem with smoking”, said Bader. “Everyone around them smokes—their teachers, their older siblings, their parents. There are barely any role models who do not smoke.” The easy affordability of tobacco products compounds the problem. A packet of cigarettes can be acquired for less than 1 Jordanian dinar, the equivalent of little more than £1. Predictably, the incidence of asthma and other respiratory diseases is increasing in Jordan.
“Jordan's Ministry of Health is strongly committed to tackling the tobacco epidemic”, said Mowaswas. “But lots of measures depend on other ministries, such as trade, justice, or finance, and so we need to advocate for tobacco control from an economic perspective as well”. The immediate priority is to implement the legislation that prohibits smoking in public places, which can also be deployed against waterpipe cafes.

“After 8 years of declaring hotels, malls, restaurants, and cafes as public places, the vast majority still allow smoking indoors, claiming that serving shisha is their core business”, explains Mowaswas. 

But taking action against these establishments is challenging. It requires the consent of a multi-member committee that includes, among others, the Ministry of Tourism, the Ministry of Health, the Jordan Restaurant Association, and the Jordan Hotel Association.

People living in Jordan are often unaware that smoking in public places is not permitted. Approximately 700 government employees are responsible for enforcing the smoking ban across the entire nation of 10 million people. Moreover, inspections are only done after a complaint. As yet, there is no standardised protocol for issuing warnings and fines, or for monitoring establishments and closing down repeat offenders. “Our number one priority is to enhance the smoke-free public places law enforcement”, said Mowaswas.

Shifting entrenched attitudes about smoking will take time. Persuading legislators to take tobacco control seriously would be a good start. “The government should live up to its responsibility and lead by example”, wrote Shawarbeh in his article in The Guardian. “It is our duty to exert a more determined effort…to make sure that regulations are strictly applied and enforced—and not to violate the laws we seek to uphold”.  

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