The tobacco smoke had a sweet apple scent as Dr. Wasim Maziak exhaled. Then he inhaled again, and the water inside the pipe bubbled and danced.

Standing in a half-circle around him were a half-dozen Memphis researchers and staff who spend most days helping folks avoid tobacco. Their usual targets are cigarettes, snuff and chewing tobacco. But thanks to a $1.7 million, five-year international grant, this week they took a crash course on tobacco use in Syria. It didn't include the Marlboro Man. The money is earmarked to launch the Syrian Center for Tobacco Studies, an effort that will include crafting smoking cessation programs for the Middle Eastern nation and training Syrian researchers. Dr. Kenneth Ward of the University of Memphis Center for Community Health is the study's principal investigator. Other researchers include Maziak, a Syrian physician and epidemiologist, and Dr. Tom Eissenburg of Virginia Commonwealth University. Battling tobacco in Syria means helping Syrians kick cigarettes as well as the smoking done in cafes, homes and restaurants using a form of tobacco known as narghile and the water pipe or hookah Americans might recognize from Lewis Carroll's Alice in Wonderland. "This is a more social type of smoking," said Maziak, after he completed the water pipe demonstration. Maziak, a nonsmoker, said it left him dizzy and with a carbon monoxide level that rivaled a cigarette smoker's. Maziak and two Syrian colleagues were in Memphis for training last week. "In the last five years it has become trendy among young men and women," he explained. Ward said it is also starting to catch on in the United States. Although there is apparently just one such Mid-South cafe, he said they are cropping up in cities along the West Coast. Many narghile smokers incorrectly believe it is safer than cigarettes, explained Maziak, who is also a research fellow at Germany's University of Munster. While cigarettes and water pipes deliver comparable doses of nicotine, tobacco's addictive agent, early research indicates water pipe smokers are inhaling more carbon monoxide and about 20 times more tar, which is packed with cancer-causing agents. One of the project's research goals is to better understand the risks. The grant is administered by the National Institutes of Health's Fogerty International Center. The funds come from NIH and other federal health agencies as well as the Canadian government and World Health Organization. It was one of 14 recent NIH grants that focus on tobacco use in the developing world. In a statement, Health and Human Services Secretary Tommy Thompson called smoking one of greatest challenges facing global health. If current smoking patterns persist, deaths due to tobacco use are expected to hit 10 million by 2025. That is more than the combined deaths due to AIDS, tuberculosis, automobile accidents, homicides, suicides and childbirth. Seventy percent of those deaths will occur in developing countries. In Syria, smoking started gaining in popularity about 20 years ago and today about half of Syrian men smoke, a pattern repeated in neighboring countries like Jordan and Lebanon. The health consequences, including more death and disability, will likely be felt in the next decade, Maziak said. In comparison, about 25 percent of U.S. men smoke. As death and disability from smoking climb, Maziak said, it becomes a barrier to national development. "Tobacco control efforts in Syria are still in an embryonic stage," he said. While tobacco advertising and smoking are banned in government buildings and hospitals, the smoking ban isn't widely enforced; and although 60 percent of Syrian male smokers surveyed said they wanted to quit there are few resources to help them. Researchers hope the Syrian center will help fill the void and serve as a model for similar efforts in neighboring countries. The center, located in Aleppo, Syria, will involve representatives of the Syrian Society Against Cancer, the Aleppo School of Medicine and the Aleppo Department of Health. Syria's neighbors include Iraq, a nation at the center of an international disarmament effort and the likely target of military action by the administration of President Bush. Ward is to visit Syria for several weeks this summer and hopes international tension won't disrupt research. Project participants have already had a sample of the stress. Ward and Maziak said they were writing the grant proposal when the 2001 terrorist attacks occurred. They almost abandoned the project assuming it wouldn't be funded. But federal health officials encouraged them to complete their submission.

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