Smoking knowledge, attitude and behavior of child labor who live in Tehran during 2013-2014

Children and adolescent smoking is one of the most important health problems in the world. There is a major concern that child labor may generate a pseudo maturity syndrome, including smoking. The current survey focus on smoking behavior, knowledge and attitude of child labor are working in Tehran. The study adopted a cross-sectional design, based on a primary pilot descriptive cross sectional study, using GYTS self-administered questionnaire. 816 child labor, which were student of work labor schools or worked as child labor on Tehran parks and crossing roads, were randomly selected using multi stage cluster sampling. DATA analyzed using SPSS v.22 [IBM statistic] software and chi square test to compare the frequency of variables in different groups. 50.6% of our participants were boy and child laboring age varied from 11 to 17 years old. 18.6% of child labor had smoking experience [Confident Interval 95%=17.3-20.1]. 9.8% of them were current smoker [CI 95%=8.6-10.9] and 1.2% were current regular smoker [CI 95%=0.9-2.1]. Child labor smoking hazard knowledge was evaluated by considering the minimum and maximum score of 10 to 30. Results demonstrated that the mean score of knowledge, attitude and behavior were 17.1 +/- 6.2, 36.5 +/- 16.1 [range 15-45] and 46.1 +/- 3.0 [range 25-75], respectively. Considering to our findings, planning tobacco control program for these specific groups is required, aiming at preventing cigarette smoking by increasing the knowledge and correcting their attitude

impacts of cigarette packaging pictorial warning labels on smokers in the City of Tehran

Cigarette smoking is considered the first preventable cause of death in the world. Social, familial, and personal factors play an important role in prevention or cessation of smoking. Educating the public in order to enhance their knowledge, change their attitude and improve their habits is also effective in this respect. In 2007, the executive protocol of the Comprehensive Law on Smoking Control was compiled in the Ministry of Health and according to the Article 5 of this law pictorial health warning labels had to be applied on cigarette packaging. This study was designed and conducted in 2 phases of before and 9 months after the implementation of this law and evaluated the effect of it on smokers' knowledge, attitude and pattern of smoking. This was a cross-sectional descriptive study conducted to evaluate the effect of cigarette packs' pictorial health warning labels on the knowledge, attitude and smoking pattern of smokers residing in Tehran. After calculating the size of understudy population and estimation of the exclusions, 1731 subjects were randomly selected using the multiphase cluster method from the 22 districts of Tehran. Data were collected using a questionnaire designed according to the standard questionnaire of the World Health Organization [WHO] and International Union Against Tuberculosis and Lung Disease [IUATLD]. Qualitative and quantitative value and reliability of the variables including cigarette consumption, knowledge about the law, and pattern of smoking were evaluated in 2 phases and the quality of pictures and their effects on the mentioned variables were assessed in the 2nd phase. Before adopting the pictorial warning labels in the first phase of the study, 1731 respondents were evaluated out of which 71.8% were males and 28.2% were females. These cases had an average of 17.6 +/- 12.3 years history of smoking. A total of 38% [675 subjects] used Iranian cigarette brands and 39.5% were aware of the implementation of pictorial health warning labels on cigarette packs. In terms of smokers' attitude towards the implementation of this law, they mostly had no opinion about it. A total of 33.3% stated that they may cut down on smoking as the result of this law. Men had a higher percentage of smoking a cigarette first thing in the morning before breakfast and women had a higher rate of consuming foreign cigarette brands [P<0.001]. In the second phase of the study, 1590 cases of the phase 1 subjects participated. Subjects had a significantly higher knowledge about the implementation of pictorial health warning labels on cigarette packs [P<0.001]. Attitude towards this law did not change significantly compared to the first phase although the mean score improved by 0.07%. Enforcement of this law resulted in decreased consumption in 7.6% of the participants. However, the Wilcoxon test did not show any significant difference. In terms of the quality of pictures, 61.6% had no opinion, and 28.7% expressed that the pictures had poor quality. No significant difference was observed between the Iranian or foreign brands in terms of smoking rate after applying the pictorial warning labels. We believed that the smoking rate would decrease after applying the pictorial health warning labels on cigarette packs. However, it did not happen. Also, adopting these labels did not have a significant effect on smokers changing their favorite brand from Iranian to foreign brands or vice versa. Type and quality of pictures require major revision and corrections

[Smoking cessation success rate and its relation to severity of nicotine withdrawal syndrome]

Smoking cessation at any age is the most effective way to reduce disease progression especially in pulmonary disorders such as chronic obstructive pulmonary disease. Understanding the barriers against successful quit can increase the efficacy of smoking cessation programs. In this study we have evaluated the relation between successful cessation and intensity of nicotine withdrawal syndrome. It was a cross sectional study. During a one year course the volunteers stopped their smoking by nicotine gum under the supervision of the physician. At the end of the course the intensity of nicotine withdrawal syndrome was evaluated. Then the relation between smoking cessation rate and the intensity of nicotine withdrawal syndrome was evaluated. 298 participants were studied. 67.8% were male and 74.2% were married. The mean age of participants was 38.5 +/- 11 years. At the end of the course 45% were successful in smoking cessation. The mean score of craving in successful and unsuccessful participants was 4.6 +/- 3.7 and 8 +/- 3, respectively [p<0.001]. The mean score of restlessness in successful and unsuccessful participants was 3.8_3.2 and 6.2 +/- 3.9, respectively [p=0.003]. The mean score of anxiety among successful and unsuccessful participants was 3.4 +/- 3.2 and 5.4 +/- 3.6, respectively [p=0.01]. There was statistical relation between intensity of some of nicotine withdrawal symptoms [anxiety, restlessness, and craving] with successful cessation. So implementation of special treatment for these signs and symptoms is valuable in smoking cessation program

Severity of nicotine withdrawal symptoms after smoking cessation

Smoking is among the most common preventable causes of early death in the world. Implementation of smoking cessation programs is among the effective strategies of tobacco control. More than half the smokers experience nicotine withdrawal syndrome after quitting and this could be one of the main reasons of unsuccessful smoking cessation. This study evaluated the severity of nicotine withdrawal symptoms 14 days after quitting [the last visit of smokers to the smoking cessation clinic]. This was a cross sectional study conducted on volunteers for smoking cessation from Nov. 2006 to Nov. 2007. During a one month course, volunteers attended 4 sessions of treatment and training [1 session per week]. Since the 2[nd] session, they stopped smoking with the aid of nicotine gum and behavioral therapy under the supervision of a physician. Fourteen days after quitting [4[th] session], the severity of nicotine withdrawal symptoms was evaluated using the Minnesota test and was compared between males and females using the Chi square test. A total of 197 participants were studied, 65% of which were males, 76.6% were married, 49.2% successfully quit smoking during the study period, 12.2% cut down smoking, and 38.6% did not finish the course. The mean score for increase in appetite, irritability and depression was 4.6 +/- 3.4, 4.3 +/- 3.4 and 3.6 +/- 3.3, respectively. The mean score for severity of depression was 4.5 +/- 3.4 in women and 3.19 +/- 3.2 in men [p=0.03]. The mean score for severity of anxiety was 4.6 +/- 3.6 in women and 2.6 +/- 2.9 in men [p=0.004]. Also, the mean score for severity of irritability was 5.7 +/- 3.3 and 3.6 +/- 3.3 in women and men, respectively [p=0.002]. The severity of symptoms related to nicotine withdrawal syndrome was considerably low 14 days following abstinence. However, the severity of nicotine craving was significantly higher compared to other symptoms. Severity of more than half the symptoms was significantly higher in women but further investigations are required in this regard

Smoking habits of adolescent students in Tehran

Cigarette smoking is among the main preventable causes of untimely death, morbidity and mortality in the world. Various reasons have been suggested for cigarette smoking among students which are mostly related to the culture and customs of a country. This study aimed to evaluate the factors associated with cigarette smoking among students. This cross-sectional analytical study was conducted in Tehran in 2008 and used "Global Youth Tobacco Survey" [GYTS] self-administered questionnaire for data collection. A total of 4, 523 students [2, 251 girls and 2, 272 boys] were selected by using randomized multi-stage cluster sampling. SPSS version 16 software, chi-square test and logistic regression test were used for data analysis. A total of 4, 523 students [50.2% boys and 49.8% girls] with a mean age of 14.69 +/- 2.09 yrs were evaluated. The prevalence of smoking experience, current smoking, and current regular smoking among students was 25.5%, 7.4%, and 1.9%, respectively. The score of knowledge was 5.29 +/- 1.29 for all students, 5.34 +/- 1.23 for nonsmoker students, and 4.57 +/- 1.74 for current smokers [P<0.01]. The mean score of attitude towards smoking was 27.29 +/- 7.41 for all students, 27.56 +/- 7.20 for non smokers and 21.10 +/- 7.69 for current smokers. The difference between the scores of current smokers and nonsmokers was statistically significant [P<0.01]. In evaluation of the correlation between cigarette smoking and different variables, several factors were found to increase the likelihood of smoking among students including the male gender, older age, low grades, having smoker friends, pocket money more than 300, 000 Rials [$30.00] per month, exposure to family members' smoking, lack of parental advice, low scores for knowledge, low scores for attitude, passive smoking[exposure to secondhand smoke at home or outside], poor perception of anti-smoking messages broadcasting by the media, watching actors smoking [cigarette or hookah] in movies, and last but not least viewing smoking advertisements and cigarette commercials [OR=1.464-57.707]. Considering our study findings, planning and implementation of educational tobacco control programs are required at schools aiming at preventing cigarette smoking by increasing the knowledge and correcting the attitude of students

Public awareness about framework convention on tobacco control [FCTC] in Tehran

The global tobacco epidemic is currently responsible for 5.2 million morbidity and mortality per year seventy percent of which occur in developing countries. Framework Convention on Tobacco Control [FCTC] is the first international public health treaty ratified by all countries in order to encounter the ever-growing tobacco epidemic. This study was designed to evaluate the public awareness of Tehran residents about FCTC. This was a cross-sectional study and sampling was performed in main city centers during the years 2007-2008 by using non-probability sampling method. The questionnaires were designed according to the World Health Organization [WHO] and IUATLD standard questionnaires and a total of 2053 individuals were questioned. Of the participants, 47.2% had experienced smoking [55.5% of men and 28.8% of women]. The frequency of daily cigarette consumption was 22/7% [29/7% of men and 7% of women] [P<0.001]. Forty-six percent of the participants had experienced hookah [50% of men and 36/8% of women] [P=0.0000]. A total of 184 individuals [9%] were aware of FCTC among which, 35 individuals [19%] who comprised 1/7% of the total understudy population claimed to have a complete knowledge regarding some details. Awareness about FCTC was 5.1% among those with an educational level equal or below high school diploma. This rate was 14.9% in those with a bachelor's degree and 33.3% [more than twice the rate] in those with higher educational levels [P<0.001]. Prevalence of smoking was found to be higher in our study compared to similar studies. Higher level of education was significantly associated with greater awareness regarding FCTC. The overall public awareness was low and implementation of public awareness programs regarding FCTC is necessary

Tobacco smoking pattern: cigarette vs. hookah

Smoking causes 5.2 million deaths annually in the world of which 70% occur in developing countries. Hookah smoking is increasing around the world especially in the Eastern Mediterranean Region including Iran. This study was carried out to evaluate the pattern of tobacco smoking in both forms of cigarette and hookah smoking. A cross- sectional study was conducted among a random population in the main squares of Tehran in 2006. The sample size consisted of 2053 people in the age range of 10 to 80 years. Non-Probability Sampling method was used. Questionnaires designed and adapted according to WHO and IUATLD questionnaires given to these people. Forty-six percent of the sample had experienced hookah smoking. The prevalence of occasional hookah smoking in the previous year was 45%, while 10% of the participants used hookah at least once a week, 17.9% at least once a month and 17.1% at least once a year;47.2% of participants had experienced cigarette smoking. Prevalence of daily cigarette smoking was 22.7%; 22.7% of current smokers and 25.01% of non-smokers consumed hookah at least once a week. Prevalence of hookah smoking is very similar among cigarette smokers and non-smokers. In this study the prevalence of cigarette smokers was more than national data and the rate of cigarette and hookah smoking among women was higher than that of other studies in this realm. These issues need to be further investigated and more serious studies are required in this regard

relation between exhaled carbon monoxide level and smoking cessation outcome

Smoking is the first preventable cause of mortality in the world. Smoking cessation is affected by various factors like nicotine dependence rate, individual issues and social factors. Measuring the level of exhaled carbon monoxide is a simple noninvasive diagnostic method for determination of smoking status and nicotine dependence; and this study evaluated its correlation with the outcome of smoking cessation. In this cross-sectional study, all individuals who had attended the smoking cessation programs in Tehran smoking cessation clinic for 6-sessions during a one- year period were questioned using a questionnaire designed according to the WHO and NRITLD questionnaires. At first, level of exhaled carbon monoxide was measured in all cases and those who quit smoking [no smoking even one puff] after the third treatment session were followed by phone in 1, 3, 6, 12 and 24 month intervals respectively. Three hundred forty- seven cases were questioned in this study out of which, 292 [84.1%] cases were males. At the end of the treatment course, 237 cases [68.3%] successfully quit smoking, 27 cases [7.8%] cut down smoking and 83 cases [23.9%] were excluded from the study due to the exceeded absence from the course. After disregarding the excluded group, the success rate of smoking cessation was calculated to be 89.8%. Measurement of the level of expired carbon monoxide [CO] showed that the exhaled CO level was < 10 parts per million [ppm] in 98 cases [28.2%], between11-20 ppm in 149 cases [42.9%] and > 20 ppm in 100 [28.8%] cases. The highest rate of success in quitting smoking was observed among those with expired CO level < 11-20 ppm and cigarette consumption less than 30 cigarettes per day [p=0.00]. Since cases with high concentration of exhaled carbon monoxide showed lower success rates in quitting smoking, more specific treatment courses along with more precise consultation and follow up are recommended for such cases

Tobacco dependency evaluation with fagerstrom test among the entrants of smoking cessation clinic

Smoking is considered the first preventable cause of mortality worldwide. There are many predictive factors on smoking cessation including social, family and individual issues. High nicotine dependency is one of the factors that make the cessation harder for the smoker. There are several methods for estimating the nicotine dependency rate in practice among which Fagerstrom test is one of the most suitable and non-invasive ones. This was a cross-sectional study. Data were collected from all smokers who had participated in the group therapy smoking cessation courses in Tehran smoking cessation clinic. The questionnaires were designed based on these data and nicotine dependency rate was evaluated via Fagerstrom test [FT]. The smokers declared that they had quit smoking since the third session of the cessation course; this claim was confirmed by testing the expiratory carbon-monoxide rate. Finally, data were analyzed by using t-test and Chi-square test via SPSS software version 12. There were 986 cases in this study including 786 [79.7%] males. Evaluation of the nicotine dependency rate showed that more than half of the smokers [n= 544, 55.2%] had high dependency, 330 [33.5%] had moderate dependency and 112 [11.3%] had low dependency. At the end of the course, 642 subjects quit smoking successfully. The maximum rate of success in cessation was among the smokers with low nicotine dependency [79 cases, 70.5%] and the minimum rate of success was among the smokers with high nicotine dependency [323 cases, 59.4%] [P=0.00]. According to the results of this study smokers with high nicotine dependency had a low chance to quit successfully. Therefore, it is recommended to follow them up for a longer period of time and use combination therapy for them

Comparison of clinic visits among children of smoking and non-smoking families

Complications of cigarette smoking are of the major obstacles of a society. Both active and passive smoking cause various forms of diseases in men, women and children. Since almost one third of the world's population are children under 14 years of age, preventing the unwanted health consequences of involuntary smoking can help in improvement of health as well as the health level of the society. In cooperation with the "Iran Statistics Center" and by using PPS method a number of families required for the study were selected among 22 districts of Tehran. After obtaining a consent, a questionnaire was filled out by a physician through interviewing the families randomly. In this study, 214 families were questioned out of which 129 had at least one smoker member in their family [60.2%]. A total number of 825 individuals were studied [including 270 men, 281 women and 274 children under the age of 14], out of which 87 men [32.2%], 42 women [14.9%] and overall 129 subjects [23.4% of the population over the age of 14 and 15.6% of the general population] were smokers. The mean number of visits to the physician by the children of all families was 3.7 +/- 1.8 per year. This number was 2 +/- 0.9 and 4.7 +/- 1.56 in the non-smoking and smoking families respectively [p=0.000]. Mean exhaled CO level of a non-smoker or passive smoker of a smoking family was 20.2 +/- 5.8; whereas this rate was 6.6 +/- 3.5 in a non-smoker member of a non- smoking family [p=0.000]. Comparison of the number of visits does not significantly indicate the disease-inducing role of passive smoking but only that these visits are more in families that smoke

Daily expenditure on cigarette smoking in Tehran

Smoking is the leading cause of preventable deaths worldwide. Since the price and expense of tobacco products are important factors relating to smoking and tobacco control, it is necessary to calculate the expense of daily smoking in order to enforce tobacco control programs. This study was done to assess the expense of daily smoking among smokers in Tehran. A cross-sectional study was done among a random population sample of 3026 smokers in different areas of Tehran. Data collection was done via WHO and IUATLD [International Union Against Tuberculosis and Lung Disease] questionnaires by questioning health-care workers. Finally data were analyzed by Chi-Square, Fischer's exact and logistic regression tests. Among 3026 participants, 2413 [80.9%] persons were male. The mean age of the population was 40 +/- 12.7 years. 49.2% of the population [1439 persons] had below diploma degrees and the maximum frequency distribution of occupation belonged to employees [36.7%]. The mean age of initiation of smoking was 21 +/- 8.19 yrs. and the mean number of cigarettes smoked daily was 16.81 +/- 10.61 cigarettes. 41.8% of population [1192 persons] had daily smoking expense of 2,510 to 4,500 Rials[*]. The mean was 4,680 +/- 388.78 Rials. In evaluation of daily smoking expense according to gender, over 6,500 Rials daily expenditure was more frequent among men [20.1%] in comparison with women [13.5%] [P=0.000]. Persons with daily income of less than 50,000 Rials, spent 9.3% of it for smoking. Because of the low price of cigarette in Iran, there is huge expenditure on smoking. Therefore, it is recommended to pay special attention to economical strategies in tobacco control programs and to coordinate with WHO Framework Convention on Tobacco Control [FCTC]

Smoking in Iranian physicians: preliminary report

The medical community has a special role both in preventing and controlling smoking. According to research studies conducted in many countries, many medical staff members are smoker themselves and there is a significant correlation between the rate of smoking in physicians and smoking in the society. Considering the fact that we did not have such information in regard in our society, this study was conducted nationwide to evaluate smoking and its related diseases among members of the Iranian Medical Council. A cross sectional, descriptive study was done by sending questionnaires in accordance with standard criteria from World Health Organization [WHO] and International Union Against Tuberculosis and Lung Disease [IUATLD]. The population under study were all Medical Council members, 80000 people in number. This study was conducted in 2003 by sending the questionnaires via the Journal of the Iranian Medical Council to all members. The answers were sent back by prepaid envelopes via express mail. Data obtained from 3270 returned questionnaires indicated that 13.1% of the population under study were smokers. This number did not show any significant difference compared to the rate of smoking in the society [12.5% in the year 2000]. However, smoking in 19.6% of the male physicians and 5.5% of female physicians showed a significant difference as compared with the rate of smoking in males and females in the society [25.2% in males and 2.5% in females in the year 2000]. Also, 16.6% of general physicians, 12.5% of pharmacists, 12.5% of dentists, 10.6% of specialists, 18.2% of nurses, 1.4% of midwives, and 4.7% of other medical personnel were smokers. The most common age at which smoking was started was 18 yrs in 31%. It must be mentioned that 10.5%of people had started smoking before the age of 15. In 39.6%, they were suffering from various related diseases. This rate was 37.2%, 46.4% and 45% in non-smokers, exsmokers and smokers respectively [p=0.00]. In smokers, the rate of smoking-related diseases increases with an increase in the number of cigarettes smoked daily; as 28.2% of the people who smoke less than 10 cigarettes per day are sick. This rate is 44.6% in persons who smoke more than 20 cigarettes a day [p=0.00]. The obtained results are useful in smoking control training programs for the medical community and health priorities nationwide

effect of training and behavioral therapy recommendations on smoking cessation [a report of the first "Smoking Cessation Clinic" in Iran]

Cigarette smoking is considered as the commonest preventable cause of morbidity and mortality. The present study shows that over a 2- year period, a total of 743smokers have been registered in monthly therapeutic and training courses of Smoking Cessation Clinic. They have received audio-visual training and behavioral therapy. For Nicotine Replacement Therapy [NRT], nicotine dependence of the patients was assessed by Fagrostrom Tolerance Test in the beginning of each course. The test scores of 170 people [31.2%] were less than 7 [low nicotine dependence], and 376 individuals [68.8%] had scores of 7 or more [high nicotine dependence]. At the end of the course, 90% from the first group and 87.5% from the second group had successfully quitted smoking. In the above-mentioned groups, 23.5% from the first group and 48.9% from the second one received not only behavioral therapy but also NRT. However, it is noteworthy that all the smokers with respect to the training provided during the course were prescribed NRT while its usage was up to the patient. This means that half of the second group [51.1%] had succeeded to quit smoking only by means of education and behavioral therapy without any NRT. The role of this kind of training in implementing smoking cessation program is essential