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

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

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

Evaluation of age and smoking habit by verbal autopsy

Cigarette smoking is the first preventable cause of morbidity and mortality in the world and can result in various diseases, disability and death. International studies have reported that about half of the smoking-related deaths occur in the middle ages. We decided to assess the age of death among smokers and non-smokers in this study. This descriptive cross-sectional study was conducted at Tehran Behesht-e-Zahra Cemetery between September 2005 and March 2006. To estimate the sample size, a pilot study was performed on 112 deaths in March 2005 and based on the results; the sample size was estimated to be 2500. Five days of each month were selected randomly. On these days a physician [co-author] visited the Cemetery office and collected the data with the help of office operator. Information was obtained from first-degree relatives of the deceased after obtaining consent. The under-study variables were age at the time of death and cigarette use. Data were analyzed by SPSS software version 11 and using ANOVA test. A total of 7858 cases were studied out of which 57.3% were males. There were 63.1% [4960] non-smokers, 25.1% [1971] smokers and 11.8% [927] ex-smokers. The mean age of death among total under-study population was 56.8 yrs [55.1 yrs in males and 57.6 yrs in females]. The mean age of death was 57.9 yrs among non-smokers, 50.1 yrs among smokers and 56.8 yrs among ex-smokers [p=0.00]. Results showed that age of death was lower among smokers but we could not determine a direct correlation between cigarette smoking and death in these patients

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

Esophagogastroduodenoscopy and O2 saturation in COPD patients

Diagnostic upper gastrointestinal [GI] endoscopy without sedation in selected patients has become more common over the past few years, none-the-less sedatives are avoided in the elderly. We studied the effect of rapid esophagogastroduodenoscopy [EGD] without sedation on patients with COPD to determine the critical hypoxemia during endoscopy. In a prospective study, easy EGD was performed electively in 74 patients with COPD [FEV1, FVC, and FEV1.FVC < 60%] during 25 months in Masih Daneshvari Hospital. All patients had continuous monitoring and recording of arterial oxygen saturation with pulse oximeter. Patients had similar characteristics concerning age, gender, cardiopulmonary function and other interventional factors. Hypoxemia during the procedure was also registered. It is noticeable that easy endoscopy refers to performing EGD in less than 10 minutes without sedation. This study showed that during non-sedated EGD, SaO2 dropped to less than 90% in 23% [16 cases] of patients with COPD. None-the-less following administration of oxygen during the procedure, PaO2 tended to normal values and therefore the procedure was continued without interruption in all cases. This study showed that easy endoscopy in COPD patients with normal cardiac function may be considered as a safe procedure with no complication

Helicobacter pylori seroprevalence in patients with bronchiectasis

This study assessed Helicobacter pylori [HP] seroprevalence in bronchiectatic patients and determined whether there is a potential association between bronchiectasis and H.pylori infection or not. This study was conducted on forty consecutive patients [26 men, 14 women; mean age 48.90 +/- 16.67 years, range 21-86 years] with bronchiectasis diagnosed by clinical symptoms and high resolution CT-scan. Helicobacter pylori IgG serum levels were measured in serum by enzyme-linked immunosorbent assay. Forty healthy subjects [25 men, 15 women; mean age 55.50 +/- 11.91 years, range 16-77 years] were selected as controls with no history of cerebrovascular, ischemic heart or respiratory diseases. Control subjects were matched for age, gender and socioeconomic status. Significant differences were observed in the seroprevalence of H.pylori between the two groups, who had similar age, gender distribution and socioeconomic status [76.0% vs. 54.4%, p=0.001]. Similarly, H.pylori IgG levels were significantly higher in bronchiectatic patients than in control subjects attended the hospital with non-respiratory conditions [1.43 +/- 0.55 and 1.07 +/- 0.44 U/ml, respectively; p < 0.05]. The association between Hp infection and bronchiectasis was confirmed in this study. Additional studies with larger numbers of patients and randomized control studies should be undertaken to assess the relationship and impact of the H.pylori eradication on bronchiectasis

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]