Evaluating Possible Mechanisms Linking Obesity to COVID-19: a Narrative Review.

Currently, pneumonia caused by the coronavirus disease 2019 (COVID-19) is a pandemic. To date, there is no specific antiviral treatment for the disease, and universal access to the vaccine is a serious challenge. Some observational studies have shown that COVID-19 is more common in countries with a high prevalence of obesity and that people with COVID-19 have a higher body mass index. In these studies, obesity increased the risk of disease, as well as its severity and mortality. This study aimed to review the mechanisms that link obesity to COVID-19.

Water-pipe Smoking Addiction in Iran; Evaluation of Reliability and Validity of Lebanon Water-pipe Dependence Scale Among Iranian Water-pipe Tobacco Smokers.

BACKGROUND: Water-pipe smoking is increasing around the world. However, there is no comprehensive information on nicotine addiction in water-pipe smokers. This study was carried out to translate and validate the Lebanon Water-pipe Dependence Scale- into Persian language; besides, tobacco dependence was evaluated in Iranian water-pipe smokers. METHODS: A forward-backward translation procedure was done to provide the Iranian version of the questionnaire. Our subjects were current water-pipe smokers who were known in prevalence study that conducted in Tehran. Psychometric properties of the instrument including validity (content, face and construct validity) and reliability (internal consistency and test-retest analysis), were evaluated. RESULTS: A total of 465 participants took part in this study, of whom 298 (64%) were male. The mean age was 30 (standard deviation 10.2). Fifty three percent of subjects got score more than 10 on LWDS questionnaire that indicating dependence. The internal consistency of the LWDS (Persian Version) was 0.85. The physiologic dependence, psychological craving, and negative reinforcement domains had acceptable reliability (Cronbach's alpha was 0.94, 0.81, 0.77 respectively), but reliability was low (alpha = 0.45) in the positive reinforcement domain. External consistency of the LWDS was assessed by test retest. Intra class correlation (ICC) was calculated for all items (n = 20) and ICC for all of them was >0.7 and the mean ICC was 0.9. Content validity was acceptable; all of obtained content validity indexes (CVIs) were above 80%. The result of goodness of fit shows an adequate model (Comparative Fit Index (CFI = 0.94), Root Mean Square Error of approximation (RMSE) = 0.08). CONCLUSIONS: The study revealed strong documents for the reliability and validity of the LWDS for use in Iran. However, further study may be required to improve the reliability results in the positive reinforcement domain.

Estimating of Net Transition Probabilities in Triple Stages of Cigarette Consumption in Iranian Men.

BACKGROUND: The present study was designed to estimate the net transition probabilities in triple stages of cigarette consumption in Iranian men over 15 years old. MATERIALS AND METHODS: Data from the national surveillance of risk factors of non-communicable diseases in 2011 were entered in the present study. Data of 3130 Iranian men between the ages of 15 and 69 years old were included. Individuals were divided to three groups of current smoker, past smoker and nonsmoker based on cigarette consumption. Afterwards, net transition probability of different stages of cigarette consumption over a year was assessed. RESULTS: Net transition probability from nonsmoker to smoker was at its highest level until 30 years of age at 19.1 per 1000 men and then net transition reduces to reach zero per 1000 men at the age of 45 years old. However, net transition probability from smoker to nonsmoker was at a very low level until 45 years of age but, it increases afterwards to reach a plateau at the age of 64 years old. Net transition probability from smoker to nonsmoker is estimated to be 23.1 per 1000 men at the age of 69 years old. CONCLUSION: For the first time, the present study has estimated the transition probabilities in different stages of cigarette consumption in Iranian adults. Findings showed that risk of becoming a smoker in younger individuals is much higher than the risk in middle-aged and old population. However, tendency to quit smoking is increased after the age of 45 years old. Therefore, health policy makers should concentrate on younger age groups in their preventive strategies regarding control of tobacco consumption.

Evaluation of the prevalence of waterpipe tobacco smoking and its related factors in Tehran, Islamic Republic of Iran.

This study is designed to evaluate the prevalence of waterpipe tobacco smoking and its related factors among Iranian adults. This is a cross-sectional study carried out during 2013/14 in Tehran, Islamic Republic of Iran, among 1830 citizens aged over 15 years. Sampling was through Stratified multistage cluster sampling with proportional allocation within strata. Global Adult Tobacco Survey (GATS) questionnaire for waterpipe consumption was used for data gathering. Data were statistically analyzed by SPSS software. The prevalence of current waterpipe tobacco smoking was 17.6% .Waterpipe use prevalence in men was significantly more than women (24.2% vs. 11.3%). Multivariate analysis showed that age, sex, cigarette consumption, waterpipe consumption at home and ignorance of safety issues significantly influenced current waterpipe smoking (P = 0.001). Thus, prevalence of waterpipe smoking in Iranian adults is high and significant. Tackling waterpipe smoking should be considered in tobacco control programmes. However, further studies in this field are needed.

Evaluation of the prevalence of waterpipe tobacco smoking and its related factors in Tehran, Islamic Republic of Iran

This study is designed to evaluate the prevalence of waterpipe tobacco smoking and its related factors among Iranian adults. This is a cross-sectional study carried out during 2013/14 in Tehran, Islamic Republic of Iran, among 1830 citizens aged over 15 years. Sampling was through Stratified multistage cluster sampling with proportional allocation within strata. Global Adult Tobacco Survey [GATS] questionnaire for waterpipe consumption was used for data gathering. Data were statistically analyzed by SPSS software. The prevalence of current waterpipe tobacco smoking was 17.6% .Waterpipe use prevalence in men was significantly more than women [24.2% vs. 11.3%]. Multivariate analysis showed that age, sex, cigarette consumption, waterpipe consumption at home and ignorance of safety issues significantly influenced current waterpipe smoking [P = 0.001]. Thus, prevalence of waterpipe smoking in Iranian adults is high and significant. Tackling waterpipe smoking should be considered in tobacco control programmes. However, further studies in this field are needed

La présente étude est conçue pour estimer la prévalence de la consommation de tabac par pipe à eau et de ses facteurs associés dans la population adulte iranienne. Il s'agit d'une étude transversale, conduite entre 2013 et 2014 à Téhéran, en République islamique d'Iran, parmi 1830 citoyens âgés de plus de 15 ans. La technique utilisée était celle de l'échantillonnage en grappe stratifié à plusieurs niveaux avec allocation proportionnelle dans les strates. Le questionnaire de l'enquête mondiale sur le tabagisme chez les adultes pour la consommation de tabac par pipe à eau a été utilisé afin de collecter les données. Celles-ci ont été analysées sur le plan statistique à l'aide du logiciel SPSS. La prévalence de la consommation de tabac par pipe à eau au moment de l'étude était de 17,6%, et était plus importante chez les hommes que chez les femmes [24,2% contre 11,3%]. L'analyse multivariée a montré que l'âge, le sexe, la consommation de cigarettes, la consommation de pipe à eau à la maison et l'ignorance des questions de sécurité influençaient de façon significative la consommation de tabac par pipe à eau [p = 0,001]. Par conséquent, la prévalence de la consommation de tabac par pipe à eau est élevée et significative parmi les adultes iraniens. La question de la consommation de tabac par pipe à eau devrait être traitée dans le cadre des programmes de lutte antitabac. Néanmoins, d'autres études dans ce domaine sont requises

Prevalence and Geographic Distribution Pattern of Asthma in Tehran by ECRHS.

BACKGROUND: Asthma, involving 5-10% of global population, has a heterogeneous distribution in the community regardless of age and its prevalence and incidence tend to grow worldwide as reported by many recent epidemiologic surveys. MATERIALS AND METHODS: The present study aimed to survey the prevalence of asthma symptoms in Tehran as the first attempt in terms of situation analysis of the disease in the Iranian society by using relevant parts of the European Community Respiratory Health Survey (ECRHS) questionnaire. RESULTS: Wheezing was reported in 48% of males and 34% of females in the age range of 20-44 years, around 50% of which was associated with breathlessness or cold., the people who answered "yes" to the questions 1 (wheezing), 4 (coughing), 5 (asthma history) or 7 (nasal allergy) were totally 211 among whom 124 (58.8%) were males and the rest (41.2%) were females. CONCLUSION: Asthma symptoms decrease the quality of life and impose high costs on the healthcare system in many countries. A low rate of participants had been informed about their asthma by physicians and not all of them were taking medications. Risk factor analysis and control is strongly advised in order to lessen the prevalence of the disease and symptoms. Air pollution, smoking, unhealthy life style and many personal and social factors need to be assessed and eliminated. It seems that a- second phase- ECRH survey should be conducted to assess the situation of asthma through population of Tehran.

Evaluation of Dual Tobacco Smoking (Water Pipe and Cigarettes) and Associated Factors in Adults in Tehran.

BACKGROUND: Concurrent use of tobacco products such as cigarettes and water pipes may be associated with increased risk of nicotine dependence and smoking-related complications. Accurate statistics are not available regarding the prevalence of water pipe use or concurrent use of cigarettes and water pipe in the Iranian population. Thus, this study sought to assess the prevalence of concurrent use of cigarettes and water pipes and their related factors in Iran. MATERIALS AND METHODS: This cross-sectional study was conducted on Tehran residents over 15 years of age, who were selected via cluster, multi-stage randomized sampling, from different geographical districts of Tehran between November and December 2014. The data were collected using the water pipe section of the Global Adult Tobacco Survey (GATS) questionnaire. RESULTS: A total of 1,830 individuals participated in this study, 243 (13.3%) of which exclusively used water pipes, 76 (4.2%) used both cigarettes and water pipes, and 120 (6.6%) exclusive smoked cigarettes. Of those who used both cigarettes and water pipes, 86.8% were men and 13.2% were women (P < 0.001). The mean age of those who only used water pipes was 28.01 ± 8.7 years while the mean age of those who used both water pipes and cigarettes was 33.1 ± 1.1 (P < 0.001). Male sex (adj. OR: 3.8) and older age (adj. OR: 1.06) increased the odds of using both tobacco products. CONCLUSION: The prevalence of concurrent use of cigarettes and water pipes and that of exclusive water pipe use were 4.2% and 13.3%, respectively. The prevalence of exclusive cigarette smoking was 6.1%. Those who smoked both cigarettes and water pipes had a higher mean age than those who exclusively used water pipes and they were mostly men. Among those who used cigarettes and water pipes, the mean age at which they began using water pipes was lower than the mean age at which they began smoking cigarettes. In other words, dual smokers started water pipe smoking sooner than cigarette smoking. Future studies with different methodologies are required to further scrutinize the relationship between water pipe and cigarette smoking. Smoking cessation programs must specifically target dual smokers.

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 cessation 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.

Correlation between the age of smoking initiation and maintaining continuous abstinence for 5 years after quitting.

Many factors affect tobacco quit rate. In this study we investigated the abstinence rate after 5 years based on the age of smoking initiation. This pre-post field trial study was conducted on 398 smokers who participated voluntarily in a smoking cessation clinic in 2005. They were followed for 5 years and their success or failure in continuous abstinence was evaluated and recorded in 2010. Three hundred and five participants (76.6%) succeeded at the end of the course. Follow up at the end of 2010 revealed that 111 (27.8%) cases were still maintaining their continuous abstinence after 5 years including 64 men and 47 women. The mean age of smoking initiation in successful and failed subjects was 21.9 and 20.7 years respectively. The age of smoking initiation could be a predictor of maintaining abstinence in the future. Starting smoking at an earlier age could have a negative effect on long-term abstinence.

Behavior and Knowledge of Iranian Professional Athletes towards Smoking.

PURPOSE: This study aimed to assess the rate of tobacco consumption among professional athletes in Iran and assessing their knowledge and attitude in this regard. METHODS: A total of 738 athletes from 10 different types of sports were evaluated. Athletes were all members of the priority leagues. After obtaining consent from the Physical Education Organization and coordination with the related federations, athletes were asked to fill out the standard questionnaire. RESULTS: All understudy subjects were males. The mean age was 28.4±2.7 yrs. The mean age of initiation of sport in these subjects was reported to be 12.3±4.01 yrs. A total of 178 (24.6%) subjects had experienced cigarette smoking and 308 (42.3%) had experienced hookah smoking. Sixty four subjects (9%) were current smokers. The mean score of knowledge about hazards of smoking was 5.6±0.9 among those who had experienced smoking. This score was 7.9±0.5 among those with no smoking experience (P=0.04). CONCLUSIONS: Rate of smoking among professional athletes is lower than general population average. So participation in organized sports may be a protective factor against tobacco use in people.

Health Experts' Opinions about Tobacco Control Activities in Iran: Results from a Delphi Panel of National Experts.

BACKGROUND: Iran signed the Framework Convention on Tobacco Control on June 16, 2003 and it was ratified by the parliament and the House of Representatives on November 6, 2005. Finally, it came into force on February 4, 2006. In this study, we aimed to evaluate health experts' opinion about tobacco control activities in Iran. MATERIALS AND METHODS: This was a qualitative case study. We used a series of open-ended questionnaires to assess important information regarding Iranian National Tobacco Control law and FCTC implementation. The study population comprised of health experts. Use of this method ensured the validity of questionnaires' contents. The first round of the questionnaire had been pre-tested in a pilot study. The final structure and lay out of questionnaires consisted of three main parts. The first part was designed with 7 multiple choice questions. Participants were able to rank answers from five (the most important) to one (the least important). The second part comprised four questions mainly on National Tobacco Control Program (NTCP) and the final part was about FCTC. Data collection was carried out between May 2010 and May 2011. In the analysis process each interview was considered as a separate case and then compared to other cases to ascertain variations in answers. RESULTS: All 40 members (100%) of the panel completed the entire process. All the participants had a consensus on tobacco control program in Iran. They believed the prevention programs to be important priorities in this regard. Tobacco Company as a governmental organization is believed to be the main barrier against tobacco control activities in Iran, and banning sales of tobacco to minors and controlling its smuggling are important factors for decreasing the supply of tobacco products. It is essential to implement comprehensive tobacco control law in Iran. CONCLUSION: It is essential to implement comprehensive tobacco control law in Iran that covers all the priorities mentioned above. Considering the chronological aspect of law implementation, priority should be given to the more important parts of the law.

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

BACKGROUND: 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. MATERIALS AND METHODS: 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 α= 0.05. RESULTS: 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. CONCLUSION: 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.