Factors associated with smoking contemplation and maintenance among Iranian adolescents

Background: Evidence is scarce on which factors contribute to cigarette and waterpipe contemplation and no previous study has examined the factors associated with waterpipe maintenance.

Aims: This study aimed to determine the factors associated with cigarette and waterpipe smoking contemplation and maintenance among Iranian adolescents.

Methods: Factors including depression, risky behaviour, family conflict, attitude to smoking acceptability and self-efficacy were examined using a questionnaire for 5500 adolescents at the smoking contemplation or maintenance stage.

Results: Students with depression had nearly double the chance [95% confidence interval [CI]: 1.41–2.72] of cigarette smoking contemplation. Risk takers had odds of 2.13 [95% CI: 1.51–2.94] and 1.49 [1.22–1.85] of cigarette and waterpipe [hookah] smoking contemplation, respectively. Those facing family conflict had odds of 1.87 [95% CI: 1.38–2.53] and 1.53 for cigarette and waterpipe smoking contemplation, respectively. The contemplation odds for students with more positive attitude to smoking acceptability were 2.12 [95% CI: 1.51–2.97] and 1.72 for cigarette and waterpipe smoking, respectively. Higher self-efficacy was associated with lower cigarette and waterpipe smoking contemplation. Risky behaviour was related to smoking maintenance. A more positive attitude to smoking acceptability was related to higher waterpipe maintenance [odds ratio = 1.57 95% CI: 1.03–2.40].

Conclusions: Depression, attitude to smoking acceptability and risky behaviour are factors associated with smoking contemplation and maintenance.

Smoking motivators are different among cigarette and waterpipe smokers: the results of ITUPP

The present study explores different drivers of cigarette and water pipe smoking among middle and high school students in Isfahan province. A questionnaire-based cross-sectional study was conducted. Trained staff collected questionnaires and saliva samples for response accuracy evaluation. Prevalence by demographic, parental and educational factors was calculated. Logistic regression was applied to compare behavior drivers of those who purely smoked cigarettes or a waterpipe. Waterpipe smokers were considered as the reference category. This study reported ORs along 95% confidence intervals; 5408 questionnaires were returned. The sample age was 15.37 +/- 01.70 on average. The self-reported prevalence of cigarette and waterpipe experimentation was 11.60% [n = 624] and 20.70% [n = 1,109], respectively; and 5.08% [n = 311], 11.06% [n = 619] for smokers, and 13.30% [n = 711] for the whole sample. Psychological factors were the most important driver for cigarette smoking; bad event happening with odds of 2.38 [95% CI: 1.29-4.39]; angriness 2.58 times [95% CI: 1.51-4.43]; and distress by 2.49 times [95% CI: 1.42-4.40]. Habitual situations were strong predictors of cigarette smoking, but not a predictor of waterpipe smoking, such as smoking after a meal [OR = 3.11, 95% CI: 1.67-5.77]; and smoking after waking up [OR = 2.56, 95% CI: 1.42-4.40]. Comprehensive and multifaceted preventive programs must tailor identified factors and increase family's awareness

Outcomes of a comprehensive healthy lifestyle program on cardiometabolic risk factors in a developing country: the Isfahan healthy heart program

This study evaluated the outcome of a comprehensive, community-based healthy lifestyle program on cardiometabolic risk factors. The Isfahan Healthy Heart Program [IHHP] was a comprehensive action-oriented, multi-component intervention with a quasi-experimental design and reference area. IHHP targeted the population-at-large [n = 2,180,000] in three districts in central Iran. Data from independent sample surveys before [2000 - 2001] and after [2007] this program were used to compare differences in the intervention area and reference area over time after controlling for age, education level and income. The samples in 2000 - 2001 and 2007 included 6175 and 4719 participants in intervention area, and 6339 and 4853 in reference area, respectively. Multiple interventional activities were performed based on the four main strategies of healthy nutrition, increased physical activity, tobacco control and coping with stress. The prevalence of abdominal obesity, hypertension, hypercholesterolemia, hypertriglyceridemia and high LDL-C decreased significantly in the intervention area versus the reference area in both sexes. However the reduction in overweight and obesity was significant only in females [P < 0.05 for all]. There were no significant changes in the prevalence of diabetes mellitus. In the intervention area, the prevalence of hypercholesterolemia decreased from 23.5% to 12.5% among females without any changes in females in the reference area [p < 0.0001]. In males, hypercholesterolemia decreased significantly in both intervention area [18.5% to 9.6%] and reference area [14.4% to 9.8%; p = 0.005]. Mean triglyceride levels had a significant decrease in the intervention area and a non-significant decrease in the reference area [p < 0.0001]. A comprehensive healthy lifestyle program comprising preventive and promotional activities that considers both population and high risk approaches can be effective in controlling cardiometabolic risk factors in a middle-income country

Establishment of health clinics as mass screening and referral systems for chronic non-communicable diseases in primary health care

This study aimed to establish a comprehensive screening and referral system for chronic non-communicable diseases [CNCD] in the routine primary health care, and to determine the prevalence of diabetes, pre-diabetes, metabolic syndrome, and dyslipidemia in adult population invited by public announcement to the Health clinics in Isfahan, Iran. This survey was conducted from March 2010, and the current paper presents data obtained until November 2011. To provide health services for prevention and control of CNCDs, with priority of type2 diabetes mellitus, Health clinics were established in different parts of Isfahan city with a population of approximately 2,100,000 in Iran. The general populations aged 30 years and above were invited to the Health clinics by public announcement. A total of 198972 participants were screened. The mean age of participants was 47.8 years [48.5 men, 47.3 women], with a range of 1 to 95 years old and standard deviation of 12.3 years [12.7 men, 12.1 women]. Overall, 22% of participants had impaired fasting glucose, 25% had hypercholesterolemia, 31% had hypertriglyceridemia, and 20% had metabolic syndrome. The high prevalence of dysglycemia and diabetes in our survey may serve as confirmatory evidence about the importance of mass screening and early diagnosis of CNCDs' risk factors. Our model of establishing Health clinics, as a comprehensive referral system in the routine primary health care can be adopted by Middle Eastern countries, where CNCDs notably diabetes are an emerging health problem