Background. This dissertation focuses on two major epidemics, Waterpipe (WP) and Cigarette tobacco smoking, as two considerable global public health issues. It consists of three papers that were published in international peer review journals. We aimed at evaluating the acute and chronic effects of WP and cigarette smoking on the cardiovascular and respiratory systems, as well as evaluating the patient's acceptability of shocking pictorial versus actual textual warnings on tobacco packages as an effective control intervention towards smoking cessation".Methods. In the first part of the study, patients were recruited from restaurants in Beirut and Mount Lebanon in order to evaluate the acute (after 45 minutes of waterpipe smoking or immediately following one cigarette smoking) and chronic (before the smoking session) effects on the Forced Expiratory Volume at 1 second (FEV1), Forced Expiratory Volume at 6 seconds (FEV6), FEV1/FEV6, Diastolic Blood Pressure (DBP), Systolic Blood Pressure (SBP) and heart rate (HR). The second part of the study recruited patients from 5 outpatient clinics located in 5 hospitals in Lebanon. The purpose was to evaluate the acceptability of shocking pictorial health warnings versus the actual textual warnings on packages as an effective tobacco control intervention by evaluating their impact on smoking behaviors and motivation.Results. Mean values of FEV1, FEV6, FEV1/FEV6, DBP, SBP in the acute effect of smoking WP and cigarette smokers were very close. There was a trend to significant acute variation between the three groups for DBP (p=0.05) and a significant variation for HR (p˂0.001): DBP increased in WP smokers while it decreased in cigarette smokers. However, the HR increased in both WP and cigarette smokers after the smoking session, but much more with WP. The pulmonary functions (FEV1, FEV6 and FEV1/FEV6) and the cardiovascular values (DBP, SBP and HR) were significantly associated with the following factors: duration of smoking, age at first WP and quantity of smoking. Among the 127 WP smokers, a higher effect of the shocking pictorial warnings was observed in the highly motivated group versus the lower motivated group (OR=4.47, p=0.001); indeed, a higher switching in their favorite tobacco brand was observed in the highly motivated group versus the lower group (OR=2.76, p=0.008). In addition, smokers who had chronic cough were highly motivated to quit waterpipe smoking compared to smokers without chronic cough (OR=7.24, p=0.03).Higher motivation to quit cigarette smoking was seen among male smokers versus females (OR=1.8, p=0.02), among smokers who had stopped smoking for at least 1 month during the last year due the textual warning (OR=2.79, P˂0.001), among smokers who considered very important to report health warning on cigarette packs (OR=1.92, p=0.01), among smokers who had chronic expectorations (OR=1.81, P=0.06) and among smokers who would change their favorite cigarette pack if they put shocking images on the pack (OR=1.95, p=0.004).Conclusions. WP smokers seem as affected as cigarette smokers for the pulmonary values and that acute effect of WP immediately measured after the smoking session increases DBP and SBP; however, acute effect of cigarette decreases DBP and SBP, while both cigarette and WP smoking increase HR. The reduction of most Pulmonary Function Test (PFT) values could be due to the long duration of smoking, younger age of smoking the first WP and quantity of smoking. It differs between cigarette and WP, and between chronic and acute effect of smoking. Moreover, pictorial graphic warnings are more influencing on the behavior of waterpipe smokers than textual warning. On the other hand, low dependent and highly motivated to quit cigarette smokers appeared to be more hypothetically susceptible to shocking pictorial warnings. Motivation to quit cigarette smoking was affected by sensitivity to warnings, but not to the presence of all chronic respiratory symptoms. Thus, our study provides further reasons to the policymakers in Lebanon to incorporate more tobacco labeling policies in order to help in reducing the widespread of waterpipe and cigarette tobacco smoking and in increasing the awareness concerning the health symptoms effect of smoking. / Doctorat en Sciences de la santé Publique / info:eu-repo/semantics/nonPublished

La consommation de la cigarette constitue de nos jours un problème de santé publique. L’OMS a mis plusieurs outils à la disposition des Etats, dont les avertissements sanitaires pour lutter contre le tabagisme. Au Burkina Faso, l’avertissement sanitaire actuel en vigueur est sous forme textuelle de petite taille. La littérature en marketing social s’est intéressée à l’impact des avertissements sanitaires textuels et visuels sur les réactions affectives, cognitives et conatives des fumeurs et des non-fumeurs. Des divergences existent toujours sur l’efficacité des avertissements sanitaires de façon générale et de façon particulière, ceux qui suscitent des émotions négatives. Aussi très peu de recherches ont été réalisées sur des individus non-lettrés. Partant de ces constats, la présente thèse s’est fixée pour objectif de tester l’impact sur les fumeurs et les non-fumeurs, de l’avertissement sanitaire textuel actuel en vigueur au Burkina Faso et des 72 nouveaux avertissements sanitaires visuels proposés par l’OMS pour les pays africains. Nous avons mené une étude qualitative à travers des entretiens individuels. Les résultats indiquent que l’avertissement sanitaire textuel actuel a peu d’impact sur les réactions affectives, cognitives et les intentions comportementales des fumeurs et des non-fumeurs. En revanche, les avertissements sanitaires visuels ont plus d’impact sur les fumeurs et les non-fumeurs comparativement à l’avertissement sanitaire textuel. Les avertissements sanitaires qui suscitent plus d’émotions négatives (peur) ont plus d’impact sur l’intention comportementale des fumeurs et des non-fumeurs. Une étude quantitative a ensuite été réalisée pour comparer l’avertissement sanitaire textuel actuel en vigueur au Burkina Faso à 4 nouveaux avertissements sanitaires visuels choisis parmi les 72, à l’issue de l’étude qualitative. Les résultats de l’étude quantitative vont dans le sens de ceux de l’étude qualitative. A l’exception de la variable « lecture », le niveau d’instruction des fumeurs (lettré ou non-lettré) n’exerce pas une influence sur l’impact des avertissements sanitaires. Le sexe et la tranche d’âge des individus n’ont pas aussi d’effet significatif sur l’impact des avertissements sanitaires. La présente thèse contribue à enrichir la littérature sur les avertissements sanitaires dans les pays en développement et sur des cibles non-lettrées. Sur le plan de la santé publique, nos résultats suggèrent l’apposition des avertissements sanitaires visuels sur les paquets de cigarettes au Burkina Faso pour la lutte contre le tabagisme. / Smoking cigarettes is nowadays a public health issue. The World Health Organization has made several tools available to the States, including health warnings for nicotinism. In Burkina Faso, the current health warning in force is in small size textual form. Social marketing literature has focused on the impact of textual and visual health warnings on the affective, cognitive and conative responses of smokers and non-smokers. Divergences still exist on the effectiveness of health warnings in a general way and particularly, those which arouse negative emotions. Thus, very little research has been carried out on illiterate individuals. Based on these observations, the present thesis aims to test the impact on smokers and non-smokers, of the current textual health warning in force in Burkina Faso and the 72 new visual health warnings proposed by the WHO for African countries. We conducted a qualitative study through individual interviews. The results show that the current textual health warning has little impact on the emotional, cognitive and behavioral intents of smokers and non-smokers. But, visual health warnings have a greater impact on smokers and non-smokers compared to the textual health warning. Health warnings that cause more negative emotions (fear) have more impact on the behavioral intent of smokers and non-smokers. A quantitative study has then been carried out to compare the current textual health warning in force in Burkina Faso with 4 new visual health warnings selected from the 72, following the qualitative study. The quantitative study’s results are in line with those of the qualitative study. With the exception of the « reading » variable, smokers’ level of education (literate or non-literate) does not influence the impact of health warnings. Gender and age range of individuals do not also have a significant effect on the impact of health warnings. This thesis helps to enrich the literature on health warnings in developing countries and on non-literate people. In terms of public health, our results suggest the addition of visual health warnings on cigarette packets in Burkina Faso to fight against smoking.