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.

Effect of passive exposure to cigarette smoke on blood pressure in children and adolescents: a meta-analysis of epidemiologic studies.

BACKGROUND: Hypertension is an emerging disease in children and adolescents resulting in future morbidities. Cigarette smoking is one of the most studied contributing factors in this regard; however, there are contradictory results among different studies. Therefore, the present meta-analysis tends to assess the relationship between passive exposure to cigarette smoke and blood pressure in children and adolescents. METHOD: Medline, Embase, Scopus, EBSCO, and Web of Sciences were systematically reviewed for observational studies up to May, 2017, in which the relationship between cigarette smoking and hypertension were assessed in children and adolescents. The meta-analysis was performed with a fixed effect or random effects model according to the heterogeneity. RESULTS: Twenty-nine studies were included in present meta-analysis incorporating 192,067 children and adolescents. Active smoking (pooled OR = 0.92; 95% CI: 0.79 to 1.05) or passive exposure to cigarette smoke (pooled OR = 1.01; 95% CI: 0.93 to 1.10) were not associated with developing hypertension in the study population. Despite the fact that active cigarette smoking did not significantly affect absolute level of systolic and diastolic blood pressure, it was shown that passive exposure to cigarette smoke leads to a significant increase in absolute level of systolic blood pressure (pooled coefficient = 0.26; 95% CI: 0.12 to 0.39). CONCLUSION: Both active and passive cigarette smoking were not associated with developing hypertension in children and adolescents. However, passive cigarette smoke was associated with higher level of systolic blood pressure in children and adolescents.

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.

A randomized controlled trial of smoking cessation methods in patients newly-diagnosed with pulmonary tuberculosis.

BACKGROUND: Tuberculosis (TB) and tobacco use are two major alarming global health issues that tend to be co-prevalent in many developing countries and various surveys have provided evidence on their entangled associations. Accordingly, it is strongly suggested that smoking cessation be incorporated in TB control programs. Therefore, we aimed to evaluate the effectiveness of two smoking cessation methods among newly-diagnosed pulmonary TB patients. METHODS: A total of 210 newly-diagnosed pulmonary TB patients from Tehran, Iran with smoking habits were included in this randomized clinical trial during 2012-2013. Patients were assigned to three groups of control (just TB medical treatment), brief advice (TB medical treatment plus individualized counseling sessions of quitting behavioral therapy) and combined intervention (TB medical treatment plus individualized counseling sessions of quitting behavioral therapy plus medical treatment with slow release bupropion). Patients' abstinence was followed at six time point during six months. Data were analyzed by SPSS v.22 using Generalized Estimating Equations (GEE) model. RESULTS: Abstinance rate at the end of six months were 71.7 % for combined intervention group, 33.9 % for brief advice group and 9.8 % for the control group (p < 0.001). Combined intervention group and brief advice group respectively had 35 times (p < 0.001, OR = 35.26, 95 % CI = 13.77-90.32) and 7 times (p < 0.001, OR = 7.14, 95 % CI = 2.72-18.72) more odds of not being an active smoker at each time point, compared to the control group. CONCLUSION: Considering the prevalence and importance of TB and the substantial influence of these preventive measures on controlling tobacco use, application of such programs is recommended. TRIAL REGISTRATION: The survey was registered in the Iranian registry of clinical trials website (irct.ir) in August 31, 2013 with IRCT ID: IRCT2013062613783N1 .

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.

Reduced Phagocytic Capacity of Blood Monocyte/Macrophages in Tuberculosis Patients Is Further Reduced by Smoking.

Tuberculosis (TB) and tobacco use are two major alarming global health issues posing immense threats to human populations. Mycobacterium tuberculosis (MTB) by activation of macrophages could induce the sequences of cells activation and releases of inflammatory cytokines such as CXCL-8, Il-12 and TNF-α which in turn induces the immune system network. However no information is available on other activity of cells by MTB and smoking. In the current study we aimed to investigate the serum levels TNF-a, CXCL-8 and phagocytosis capacity in tuberculosis patients with and without smoking. 103 subjects entered the study including 61 new diagnosed pulmonary TB patients (23 smokers and 38 nonsmokers) and 42 control healthy subjects. The phagocytosis of fluorescein isothiocyanate dextran (FITC-dextran) in blood monocytes/macrophages through flowcytometry was assessed. Serum levels of TNF-a and CXCL-8 were analyzed by ELISA methods. A lower percentage of cells from TB patients who smoked [50.29% (43.4-57.2), p<0.01] took up FITC-dextran after 2h compared to non-smoking TB subjects [71.62% (69.2-74.1)] and healthy cases [97.45% (95.9-99.1). Phagocytic capacity was inversely correlated with cigarette smoking as measured by pack years (r=-0.73, p<0.001). The serum levels of TNF-a and CXCL-8 were significantly higher in the TB patients who smoked compared to the TB non-smoker group (p<0.001, p<0.01 respectively). Blood monocytes/macrophages from TB patients have reduced phagocytic capacity which is further reduced in TB patients who smoke. Smoking enhanced serum levels of TNF-a and CXCL-8 suggesting a greater imbalance between the proinflammatory and anti-inflammatory factors in these patients.

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.

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.

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

BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.  

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.