Pattern of smoking and nicotine dependence in patients with psychiatric disorders

Smoking prevalence is high among psychiatric patients. This study aimed to evaluate the prevalence of smoking, related factors and nicotine dependence in patients suffering from psychiatric disorders. This analytical descriptive study was performed on patients who had been hospitalized for at least 2 days in Razi Hospital during 2010. Data were collected via an interview and the obtained information was recorded in a questionnaire. Fagerstrom test was also used. After determining the prevalence of smoking in these patients, the related factors and nicotine dependence were also evaluated using multiple logistic regression test and SPSS software. A total of 78.4% of men and 36.2% of women in this study were smokers and 64.4% had high nicotine dependence. Final logistic regression models showed that smoking was related with advanced age, male sexuality, hookah consumption, and depression. High nicotine dependence was correlated with hookah consumption and history of suicide attempt. Prevalence of smoking is higher among psychiatric patients compared to the public. Adequate intervention and strategies are necessary in these patients to promote smoking cessation

Efficacy of telephone quit-line for smokers in Iran: 12 months follow up results

Smoking cessation is an effective intervention for cancer prevention. For some reasons many smokers cannot attend quit programs and they prefer to have a consultation over the phone. In this study we share our experience regarding setting up a quit-line for smoking cessation for the first time in Iran. Two general practitioners were trained to give consultation over the phone via quit line in Tehran. The quit program consisted of 4 sessions with 1 week interval. Our telephone counseling was both reactive and proactive from 8 AM till 5 PM during the years 2005 - 2008. In reactive counseling, the smoker initiates the call and speaks with a counselor about his/her current concerns. In proactive counseling, the counselor calls the smoker and provides counseling in a systematic manner. Smoking status was determined based on smokers' self-report and regular follow-ups were conducted after quitting. Some cases were randomly selected for CO respiratory test in order to confirm their abstinence. A total of 480 cases entered the cessation program out of which, 80% were males. The mean age was 38.5 +/- 7.9 years, 72.7% of participants were married, 75.2% of subjects were educated and 51.3% of cases had high nicotine dependence. A total of 332 cases received a brief advice on quitting, 148 people continued their active participation to complete the course and 122 cases [82.4%] quitted smoking. The sustained abstinence rate after 1, 3, 6 and 12 months was 59%, 41%, 31% and 18%; respectively. This method is an appropriate and accessible method which can be suggested to smokers during smoking cessation counseling

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

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

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