Burden of obstructive lung disease study in Tehran: research design and lung spirometry protocol

Chronic obstructive pulmonary diseases [COPD] are planned to rank fifth in burden of disease and third with respect to mortality by 2020. Carrying out research regarding different aspects of COPD is mentioned as important health priorities by academic institutions and governments. The burden of lung disease [BOLD] Initiative was designed a decade ago to develop robust models that can be used to estimate the prevalence and current and future economic burden of COPD. The goal of the present project is to describe the prevalence and determining the causes and risk factors of COPD in the population of Tehran city. This cross sectional study follows a stratified cluster sampling strategy with proportional allocation within strata. The target population is all noninstitutionalized inhabitants, aged 18-40 in one group and over 40 in another, who inhabit in Tehran city. The stratification of the sample according to the 22 municipal districts of Tehran is incorporated in the sampling process. Proportional to the number of households in the 22 districts, the appropriate number of clusters is weighted according to each district. For each cluster, a team of three members approaches the index household, which is specified through the aforementioned random selection of clusters, and continues the enumeration in 10 neighbor households in a systematic manner. As a study protocol, there are no specific results to present; our purpose is to share our design with the scientific body. We expect that findings from the BOLD study in Tehran will show the status of COPD and its causes in the community

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

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 harm reduction programs among patients of a smoking cessation clinic in Tehran, Iran

Background: Recently, harm reduction programs have been used to reduce mortality and morbidity among smokers. The main objective of this study was to evaluate the effect of harm reduction programs on the smoking patterns of subjects who presented to a smoking cessa-tion clinic in Tehran, Iran

Methods: This observational study was conducted between September 2008-September 2009 on 132 patients who were unable to quit smoking. Patients were enrolled by the first come first service method. During the study period, subjects were assigned to either group or individual visits every 15 days in conjunction with the use of nicotine gum. The main objective of this study was to evaluate at the third and sixth months of follow-up: the number of smoked cigarettes, level of expired carbon monoxide [CO], and numbers of nicotine gum used. Data were analyzed by the Wilcoxon rank, Fisher's exact, and Pearson's chi-square tests and SPSS version 17 software

Results: A total of 87.1% of the subjects were males. We noted decreases in the number of cigarettes smoked daily and the level of expired CO, whereas the amount of nicotine gum used significantly increased during the time interval between the first session and the third and sixth month follow-up visits [p<0.001 for all variables]. During the follow up sessions, 64.4% of subjects reduced the number of cigarettes they smoked daily by at least 50% and 12.9% of subjects quit smoking

Conclusion: Behavioral and pharmacological therapy in harm reduction programs result in a decrease in the number of cigarettes smoked daily and a reduction in the amount of expired CO. Therefore, these methods can be beneficial in achieving complete smoking cessation

Pattern of tobacco consumption among TB patients in a tuberculosis referral center

Tuberculosis [TB] is among the major causes of illness and death worldwide, especially in Asia and Africa. On the other hand, tobacco use is the most important preventable and the second biggest cause of death throughout the world. Smoking is associated with recurrent tuberculosis and its related mortality. Also, it could affect clinical manifestations, bacteriological conversion and outcome of treatment. This study aimed to evaluate the pattern of tobacco smoking, history of previous quit attempts, and attitude towards quitting in tuberculosis patients. It was a cross-sectional study done amongst pulmonary TB patients presented to Masih Daneshvari Hospital. Two hundred patients entered the study as [First Come First Serve]. Self-reported questionnaires were designed according to the standard questionnaires of smoking pattern. A total of 93.5% were males. The mean age was 39.8 +/- 1.73 yrs. Thirty-four percent of them were current smokers at the time of interview, 7.5% were occasional smokers and 28% of smoker patients had a history of at least one quit attempt. Considering the prevalence of smoking in TB patients, evaluation of tobacco smoking status in such patients and motivating them to quit smoking could be considered as important steps in their treatment process

Comparison of spermatozoa quality in male smokers and nonsmokers of Iranian infertile couples

Smoking has a negative effect on fertility and sperm quality. This study was designed to evaluate the effects of smoking on sperm quality and the related parameters such as sperm concentration, morphology and motility. This cross-sectional study was conducted on 180 infertile men with at least one year history of idiopathic infertility, who admitted to the Avicenna Infertility Center, Tehran, Iran. A complete history including smoking habits and other diseases was obtained and semen analysis was performed for all participants. Statistical analysis was performed using SPSS software version 16 and t test and Mann-whitney tests with a significance level of alpha = 0.05. Comparison of sperm parameters in the two groups of smoker and nonsmoker subjects showed that active smoking [p=0.04] and cigarette consumption even in small amounts [p=0.03] decreased sperm concentration, However, no significant correlation was detected between smoking status and morphology or motility of sperms. This study failed to find a significant correlation between sperm analysis and smoking status except for sperm concentration, which was significantly decreased in the active smokers ,even in those consuming small amounts of tobacco. This finding propounds that tobacco consumption may negatively affect fertility

effects of demographic factors and cigarette smoking status on drug treatment success rate in outpatient treatment and rehabilitation centers

This was an analytical historical cohort study based on an existing data base study conducted in different areas of Tehran. The present study determined the effect of demographic factors and cigarette smoking status on success rate of addiction treatment in outpatient treatment and rehabilitation clinics for substance abusers. We accomplished our study in outpatient clinics authorized by the "welfare organization," which included three governmental treatment centers and private centers among those located in 22 regions of Tehran. Data were collected using a checklist, which contained demographic characteristics, personal information and information about prevention, treatment and follow-up records of 1372 patients. Factors associated with addiction treatment success rate were reviewed using multiple logistic regression tests. Our study showed that addiction treatment was successful in only 258 cases [18.8%]. The final multiple regression model showed that single and married patients were 2.18 times [P=0.033] and 2.70 times more successful in quitting than divorced, or separated cases [P=0.005]. In addition, patients who lived in rental or mortgaged houses were 1.43 times more successful than homeowners [P=0.036]. More than 90% of participants in this study were daily smokers at the time of the study. Patients who did not have a history of smoking were 1.69 times more successful than ex-smokers [P=0.007]. Based on our study results only a few people were successful in addiction treatment; marital status, type of housing, residential status and smoking status were the most important factors associated with the outcome of addiction treatment

Factors associated with secondhand smoke exposure in infants

Determining the factors associated with secondhand smoke [SHS] exposure in children provides valuable information for smoking control strategies. This study aimed to assess factors related to SHS exposure in infants based on urinary cotinine measures. A cross-sectional analysis of the data that were collected as part of the randomized controlled trial was conducted. Participants were 130 smoking households with children under the age of 1 year attending a health care center in southern Tehran. Eligible parents consented to participate in this study and completed a questionnaire including demographic data, questions regarding smoking at home, smoking status and Fagerstrom test through face-to-face interview. The Infants' urinary cotinine level was measured using gas chromatography, adjusted with urinary creatinine level and reported as cotinine [ng]/ creatinine [mg]. Factors related to infants' SHS exposure were assessed using the multivariate logistic regression model based on standard cut-point [30 ng of urinary cotinine/mg creatinine]. The final multivariate logistic regression model showed that social status [p=0.002], home smoking restriction [p=0.05] and the infant's age [p=0.01] were associated with the infants' SHS exposure determined based on urinary cotinine levels. These results support the influence of social status, home smoking restriction and infant's age on the exposure of infants to SHS

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

What kind of cigarettes do smokers use in Tehran?

Smoking is the first preventable cause of death in the world. Regulating the production, import, distribution and sell of cigarettes is the most prominent action for implementation of tobacco control programs. In this regard, it is necessary to know the smoker's choice in terms of different cigarette brands. This study has been designed before the implementation of Framework Convention of Tobacco Control [FCTC] and Iranian Comprehensive Tobacco Control Law. This cross-sectional study was conducted through questioning during the year 2006. Health-care personnel were chosen for conduction of this project and participated in training courses conducted with the cooperation of Health Departments of 3 major universities in Tehran. The Questionnaires were designed according to WHO and IUATLD questionnaires. Health-care workers distributed the questionnaires among smokers in specific areas. A total of 3026 people participated in this study among which 2413 [79.7%] were men. Consumption of foreign-made cigarettes was 65.5% whereas consumption of locally-made cigarettes was 34.5%. Also, the use of legally-imported cigarettes was 55.9% compared to the use of illegally-imported cigarettes which was 44.1%. Consumption of foreign-made and illegally-imported cigarettes was higher among women [78.4% and 72.5%, respectively]. Also, consumption of foreign-made cigarettes among the age group of under 25 years old was less than any other age group [52%]. Consumption of foreign-made and illegally-imported cigarettes was considerably high in our population and even higher among women. Therefore, it is recommended that the authorities make it hard for the people to access illegally-imported and smuggled cigarettes by complete implementation of tobacco control programs and by adopting effective anti-smuggling measures

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

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]

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