Intention to Quit Smoking and Associated Factors in Smokers Newly Diagnosed with Pulmonary Tuberculosis.

BACKGROUND: Several studies have shown that smoking, as a modifiable risk factor, can affect tuberculosis (TB) in different aspects such as enhancing development of TB infection, activation of latent TB and its related mortality. Since willingness to quit smoking is a critical stage, which may lead to quit attempts, being aware of smokers' intention to quit and the related predictors can provide considerable advantages. MATERIALS AND METHODS: In this cross-sectional study, subjects were recruited via a multi-stage cluster sampling method. Sampling was performed during 2012-2014 among pulmonary TB (PTB) patients referred to health centers in Tehran implementing the directly observed treatment short course (DOTS) strategy and a TB referral center. Data analysis was conducted using SPSS version 22 and the factors influencing quit intention were assessed using bivariate regression and multiple logistic regression models. RESULTS: In this study 1,127 newly diagnosed PTB patients were studied; from which 284 patients (22%) were current smokers. When diagnosed with TB, 59 (23.8%) smokers quit smoking. Among the remaining 189 (76.2%) patients who continued smoking, 52.4% had intention to quit. In the final multiple logistic regression model, living in urban areas (OR=8.81, P=0.003), having an office job (OR= 7.34, P=0.001), being single (OR=4.89, P=0.016) and a one unit increase in the motivation degree (OR=2.60, P<0.001) were found to increase the intention to quit smoking. CONCLUSION: The study found that PTB patients who continued smoking had remarkable intention to quit. Thus, it is recommended that smoking cessation interventions should be started at the time of TB diagnosis. Understanding the associated factors can guide the consultants to predict patients' intention to quit and select the most proper management to facilitate smoking cessation for each patient.

Prevalence of water pipe smoking in the city of Mashhad (North East of Iran) and its effect on respiratory symptoms and pulmonary function tests.

BACKGROUND: The prevalence of water pipe (WP) smoking was studied using a standard questionnaire. Pulmonary function tests were also compared between WP smokers and non-smokers. MATERIALS AND METHODS: The prevalence of WP smoking was studied using a standard questionnaire. Pulmonary function tests including forced vital capacity (FVC), forced expiratory volume in one second (FEV1), maximal mid-expiratory flow (MMEF), peak expiratory flow (PEF), maximal expiratory flow at 75%, 50%, and 25% of the FVC (MEF75,50,25) were compared between WP smokers and non-smokers. RESULTS: A total of 673 individuals including 372 males and 301 females were interviewed. The number of WP smokers was 58 (8.6%) including 24 males (6.5%) and 34 females (11.3%). All pulmonary functional test (PFT) values in WP smokers were lower as compared to the non-smokers (P < 0.05 to P < 0.001). The prevalence and severity of respiratory symptoms (RS) in WP smokers were higher than non-smokers (P < 0.05 to P < 0.001). There were negative correlations between PFT values and positive correlation between RS and duration, rate, as well as total smoking (duration X rate) (P < 0.05 to P < 0.001). CONCLUSION: In this study the prevalence of WP smoking in Mashhad city was evaluated for the first time. The results also showed a significant effect of WP smoking on PFT values and respiratory symptoms.

Comparison of pulmonary function and respiratory symptoms in water pipe and cigarette smokers.

BACKGROUND AND OBJECTIVE: A major type of smoking in Middle Eastern countries is water pipe (WP) smoking. In the present study, pulmonary function tests (PFT) and respiratory symptoms (RS) were compared in WP smokers and deep inspiration (S-DI) or normal inspiration (S-NI) cigarette smokers. METHODS: Pulmonary function and RS were compared among WP smokers, deep or normal inspiration cigarette smokers, and non-smokers. RESULTS: All PFT values in WP smokers and S-DI, but only some values in S-NI, were lower than those of non-smokers (P < 0.05 to P < 0.001). In addition, all PFT values in WP smokers and S-DI were lower than the corresponding values in S-NI, except for forced expiratory volume in 1 s and maximal expiratory flow at 25% of forced vital capacity (P < 0.05 to P < 0.001). The prevalence of RS, except for sputum production, was greater in all three groups of smokers than in non-smokers (P < 0.05 to P < 0.001). However, the severity of most RS in WP smokers and S-DI, but only the severity of wheezing in S-NI, was greater than that in non-smokers (P < 0.05 to P < 0.01). There were inverse correlations for PFT values and positive correlations for RS, with duration and total amount of smoking (P < 0.05 to P < 0.001). CONCLUSIONS: The results from this study showed that there was a profound effect of WP smoking on PFT values and RS, which were similar to the effects of deep inspiration cigarette smoking.

The impacts of cigarette packaging pictorial warning labels on smokers in the city of tehran.

BACKGROUND: Cigarette smoking is considered the first preventable cause of death in the world. Social, familial, and personal factors play an important role in prevention or cessation of smoking. Educating the public in order to enhance their knowledge, change their attitude and improve their habits is also effective in this respect. In 2007, the executive protocol of the Comprehensive Law on Smoking Control was compiled in the Ministry of Health and according to the Article 5 of this law pictorial health warning labels had to be applied on cigarette packaging. This study was designed and conducted in 2 phases of before and 9 months after the implementation of this law and evaluated the effect of it on smokers' knowledge, attitude and pattern of smoking. MATERIALS AND METHODS: This was a cross-sectional descriptive study conducted to evaluate the effect of cigarette packs' pictorial health warning labels on the knowledge, attitude and smoking pattern of smokers residing in Tehran. After calculating the size of understudy population and estimation of the exclusions, 1731 subjects were randomly selected using the multiphase cluster method from the 22 districts of Tehran. Data were collected using a questionnaire designed according to the standard questionnaire of the World Health Organization (WHO) and International Union Against Tuberculosis and Lung Disease (IUATLD). Qualitative and quantitative value and reliability of the variables including cigarette consumption, knowledge about the law, and pattern of smoking were evaluated in 2 phases and the quality of pictures and their effects on the mentioned variables were assessed in the 2(nd) phase. RESULTS: Before adopting the pictorial warning labels in the first phase of the study, 1731 respondents were evaluated out of which 71.8% were males and 28.2% were females. These cases had an average of 17.6±12.3 years history of smoking. A total of 38% (675 subjects) used Iranian cigarette brands and 39.5% were aware of the implementation of pictorial health warning labels on cigarette packs. In terms of smokers' attitude towards the implementation of this law, they mostly had no opinion about it. A total of 33.3% stated that they may cut down on smoking as the result of this law. Men had a higher percentage of smoking a cigarette first thing in the morning before breakfast and women had a higher rate of consuming foreign cigarette brands (P < 0.001). In the second phase of the study, 1590 cases of the phase 1 subjects participated. Subjects had a significantly higher knowledge about the implementation of pictorial health warning labels on cigarette packs (P < 0.001). Attitude towards this law did not change significantly compared to the first phase although the mean score improved by 0.07%. Enforcement of this law resulted in decreased consumption in 7.6% of the participants. However, the Wilcoxon test did not show any significant difference. In terms of the quality of pictures, 61.6% had no opinion, and 28.7% expressed that the pictures had poor quality. No significant difference was observed between the Iranian or foreign brands in terms of smoking rate after applying the pictorial warning labels. CONCLUSION: We believed that the smoking rate would decrease after applying the pictorial health warning labels on cigarette packs. However, it did not happen. Also, adopting these labels did not have a significant effect on smokers changing their favorite brand from Iranian to foreign brands or vice versa. Type and quality of pictures require major revision and corrections.

The prevalence of smoking among the population in the city of Mashhad (north east of Iran) and pulmonary function tests among smokers.

INTRODUCTION: Smoking is known as a major cause of chronic obstructive pulmonary disease (COPD). In this study the prevalence of smoking in the population of Mashhad city was evaluated as well as pulmonary function tests (PFTs) of smokers. MATERIAL AND METHODS: The prevalence of smoking was studied using a standard questionnaire. Pulmonary function tests, including forced vital capacity (FVC), forced expiratory volume in one second (FEV1), maximal mid-expiratory flow (MMEF), peak expiratory flow (PEF), and maximal expiratory flow at 75%, 50%, and 25% of the FVC (MEF75,50,25), were measured in all smokers. RESULTS: In total, 1435 individuals were interviewed including 999 males and 436 females. The number of smokers among the interviewed individuals was 183 (12.7%) including 172 male (17.2%) and 11 female (2.5%). The results showed that all values of PFTs in smokers were reduced. There were significant negative correlations between smoking duration and rate as pack/year and values of PFT (p<0.05). CONCLUSIONS: In this study the prevalence of smoking in the population of Mashhad city was shown for the first time. The effect of smoking on PFTs showed that smoking leads to constriction of large and medium airways, which is due to duration and rate of smoking.