Cigarette smoking in patients newly diagnosed with pulmonary tuberculosis in Iran

BACKGROUND

The association between pulmonary tuberculosis (PTB) and tobacco smoke has been verified by most studies on the subject; figures from different countries for the prevalence of smoking among PTB patients vary.

OBJECTIVE

To assess the prevalence of and factors associated with smoking among TB patients in Iran.

DESIGN

In this cross-sectional study, subjects were included on a first-come, first-served basis from among newly diagnosed PTB patients using a multistage cluster sampling method during 2012-2014. Data were collected during face-to-face interviews and a questionnaire was used to gather information on smoking habits.

RESULTS

Of 1127 newly diagnosed PTB patients included in the study (mean age 50.0 ± 19.8 years), 228 (20.2%) were daily smokers, 20 (1.8%) were occasional smokers and 93 (8.9%) had quit before diagnosis. Simultaneous drug use (P < 0.001, OR 75.21), increasing age (P = 0.001), being single (P < 0.001, OR 16.95), being an Iranian national (P < 0.001, OR 6.26) and living in a rural area (P < 0.001, OR 5.85) were found to be independent risk factors for smoking in study patients.

CONCLUSION

The prevalence of smoking among PTB patients in Iran is relatively high. It is therefore necessary to include smoking cessation interventions in the National TB Programme.

Utilization of a telephone interactive voice-response tobacco cessation support service in the Islamic Republic of Iran

Telephone smoking cessation counselling is a very cost-effective means of reaching dependent smokers in a population. We investigated the frequency of contacts and the types of topics that people accessed after a national telephone helpline was set up in the Islamic Republic of Iran at the beginning of 2011. From a total of 23 979 calls received over a 24-month period, 26.5% of callers hung up without selecting any menus. The most frequently accessed menu was addresses of smoking cessation support services (23.9%), followed by methods of smoking cessation (14.0%), self-help materials for quitting smoking (11.8%) and nicotine dependence assessment (10.4%). The average number of contacts decreased dramatically after the first month of the service but there was a significant increase in the 2 months preceding the feast of Ramadan. Religious messages provide a good opportunity to engage individuals in smoking cessation and may be useful in the planning of media campaigns.

Dual addictions, parallel treatments: nicotine replacement therapy for patients receiving methadone treatment in the Islamic Republic of Iran

This parallel, randomized, open-ended clinical trial tested the impact of nicotine replacement pharmacotherapy during the course of methadone treatment among opiate abusers. A total of 424 men entered the study at 4 drug treatment centres in Tehran, Islamic Republic of Iran. The intervention group received a 6-week regimen of nicotine replacement pharmacotherapy at no charge. After 6 months, 211 persons (99.5%) in the control group continued to smoke and 1 person (0.5%) had quit. In the intervention group, 117 (55.1%) persons smoked, 15 (7.1%) persons had quit and 80 (37.7%) had reduced by more than 50% the number of cigarettes they smoked at the start of the study (P < 0.0001). The findings suggest that the use of nicotine replacement pharmacology in tandem with methadone maintenance treatment can lead to dramatically improved efficacy for treatment of dual addictions.

Which form of nicotine replacement therapy is more effective for quitting smoking? A study in Tehran, Islamic Republic of Iran

Nicotine replacement therapy can double the chance of success for smokers attempting to quit. This observational study aimed to compare quit rates of different formulations of nicotine replacement among clients referred to a smoking cessation clinic in Tehran, Islamic Republic of Iran. Clients entering the study (n = 308) participated in 4 sessions of behavioural therapy, chose a type of nicotine replacement to use (patches, chewing gum, tablets or both patches and gum) and were followed up for 12 months. After 4 weeks of quitting, 88.2% (246/279) reported abstaining from smoking. Self-reported maintenance rates for quitting were 54.9% after 6 months and 36.2% after 12 months follow-up. A significant correlation was found between type of nicotine replacement and quit rate. Use of nicotine patches and chewing gum together had the highest quit rate (95.2%) after 4 weeks and at 12 months follow-up (62.5%). Consuming 2 forms of nicotine replacement in therapy could result in enhanced rates of long-term quitting.

Status and costs of smoking cessation in countries of the Eastern Mediterranean Region

The aim of this cross-sectional observational study was to address the health care situation in regard to smoking cessation efforts and expenditure, and to provide a basis for future studies and for implementing tobacco control programmes throughout the Eastern Mediterranean Region of the World Health Organization. Information collected included methods and cost of services for tobacco cessation from all 16 participating countries. In 10 countries, cessation programmes were directed by primary physicians. In 13 countries, nicotine gum and in 14 countries nicotine patches were accessible in pharmacies. Bupropion was available at pharmacies (with a written prescription) in 6 countries and varenicline in 7 countries. However, the mean cost of each service was significantly higher than the price of a pack of cigarettes. In countries with support services for tobacco cessation, directors need to provide care at the society level that is considerably less costly and widely accessible.

Comparison of tobacco control policies in the Eastern Mediterranean countries based on Tobacco Control Scale scores

This cross-sectional survey aimed to provide an overview of tobacco control strategies in the countries of the Eastern Mediterranean Region (EMR). A questionnaire to collate data on implementation of 6 major policies was developed based on the previously published Tobacco Control Scale and using MPOWER measures of the WHO Tobacco Free Initiative and the Tobacco Atlas. Only 3 of the 21 countries scored higher than 50 out of 100: Islamic Republic of Iran (61), Jordan (55) and Egypt (51) More than half of countries scored less than 26. Highest scores were achieved by Afghanistan in cigarette pricing, Oman in smoking bans in public places, Islamic Republic of Iran in budgeting, prohibition of advertisements and health warnings against smoking and Syrian Arab Republic, Tunisia and Kuwait in tobacco cessation programmes. The low mean total score in EMR countries (29.7) compared with European countries (47.2) highlights the need for better future planning and policy-making for tobacco control in the Region.

Quitting smoking with varenicline: parallel, randomised efficacy trial in Iran

BACKGROUND

Smoking cessation programmes were first introduced in Iran in 1997. To date a number of types of nicotine replacement therapy have been prescribed.

OBJECTIVE

To evaluate the effectiveness of varenicline for tobacco cessation.

METHODS

This was a randomised parallel clinical study conducted in 2010. Participants were smokers willing to quit who were visiting a smoking cessation clinic for the first time and were randomly divided into three groups: all three groups received brief counselling on cessation, Group 2 received nicotine patches and Group 3 was prescribed varenicline for 8 weeks.

RESULTS

There were 272 participants in the study: 91 in Group 1, 92 in Group 2 and 89 in Group 3. At the end of the first month, 128 of the 272 subjects (47.1%) succeeded in quitting: 17 (18.7%) in Group 1, 60 (65.2%) in Group 2 and 51 (57.3%) in Group 3 (P = 0.000). At follow-up after 12 months, 58 subjects (21.3%) remained smoke-free, of whom 6 (6.6%) were in Group 1, 23 (25%) in Group 2 and 29 (32.6%) in Group 3 (P = 0.000).

CONCLUSION

In the study, varenicline treatment was slightly more effective than but not significantly different from nicotine replacement therapy.

Adverse reactions of prophylactic intravenous immunoglobulin; a 13-year experience with 3004 infusions in Iranian patients with primary immunodeficiency diseases

Intravenous immunoglobulin (IVIG) replacement therapy improves health-related quality of life in patients with a primary immunodeficiency disease, although there have been reports of adverse reactions associated with its regular administration. The study population was composed of 99 patients with primary antibody deficiencies. All the patients were diagnosed with a primary immunodeficiency disease and received at least 4 infusions of IVIG at the Children's Medical Center Hospital, Tehran, Iran over a 13-year period (1995-2007). A total of 3004 infusions were recorded, and 216 (7.2%) of these were associated with adverse reactions in 66 patients. Adverse reactions were classified as mild (172 reactions), moderate (41 reactions), and severe (3 reactions). The rate of adverse reaction varied by diagnosis from 3.35% in patients with X-linked agammaglobulinemia to 17.4% in IgG subclass deficiency. There were no age-related differences in the rates of adverse reactions. Adverse reactions to IVIG infusions are occasionally encountered; therefore, physicians and nurses should be aware of these reactions in order to manage and prevent them.

Prevalence of smoking among high-school students of Tehran in 2003

This study in 2003 determined the prevalence of smoking and its associated factors among high-school students in Tehran, Islamic Republic of Iran. Out of 1095 students aged 14-18 years, 29% (31% boys, 26% girls) were occasional and 5% (6% boys and 2% girls) daily smokers. Among occasional smokers, 21% had family members who also smoked, whereas for students who had never tried smoking, no family members smoked. Of 316 occasional smokers, 12% lived with a single parent compared with only 5% of never smokers. Regression analysis showed that significant risk factors for daily smoking were: having a brother or sister who smokes (OR = 8.58) and having more than 1 family member who smokes (OR = 6.33).