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Cigarette Smoking in Iran and Other Asian Countries: Results of Isfahan Cohort Study (Ics)

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Cigarette Smoking in Iran and Other Asian Countries: Results of Isfahan Cohort Study (Ics) WCRJ 2018; 5 (4): e1168 A COMPARATIVE STUDY ON THE PREVALENCE AND RELATED FACTORS OF CIGARETTE SMOKING IN IRAN AND OTHER ASIAN COUNTRIES: RESULTS OF ISFAHAN COHORT STUDY (ICS) M. MOHAMMADIAN1, N. SARRAFZADEGAN2, H. REZA ROOHAFZA3, M. SADEGHI4, A. HASANZADEH5, M. REJALI6 1MSC in Epidemiology, Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran 2Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran 3Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran 4Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran 5Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran 6Epidemiologists, Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran Abstract – Introduction: Cigarette smoking is one of the most well-known risk factors for cardiovascular diseases, cancers and pulmonary diseases. The present study aimed to investigate the prevalence of cigarette smoking and its related factors in central parts of Iran and compare the results with other Asian countries. Materials and Methods: The prevalence and related factors of cigarette smoking in central parts of Iran were determined using a population-based cohort study in Iran. Also, the prevalence of cigarette smoking was extracted for all Asian countries and compared with the prevalence of smoking in Iran. Results: The overall prevalence of cigarette smoking in central parts of Iran was equal to 20.75% (38.4% in men and 3.1% in women). The odds ratio of cigarette smoking was 19.59 (95% Confidence interval (CI) = 12.97-30.60) in men compared to women, 2.07 (95% CI = 1.26-3.49) in the 45-54 age group, 1.79 (95% CI =1.09- 3.03) in the 55-64 age group, and 1.61 (95% CI= 0.93-2.84) in the 65-74 age group compared to the 75-years-and-older age group. In 2012, in Asian coun- tries, the highest prevalence of cigarette smoking was observed in Russia (32.7%), but the lowest prevalence was in Oman (8.5%). It seems that the prevalence of cigarette smoking was medium in Iranian population. Conclusions: The higher prevalence of cigarette smoking was observed in people in the 45-54 age group, people with a good economic status, married people, unemployed people, those with low BMI, people who are very dissatisfied with their health status, those with secondary school ed- ucation levels, and people who had the higher consumption of tea and coffee. Compared to other Asian countries, the prevalence of cigarette smoking was medium in Iran. KEYWORDS: Prevalence, Related factors, Cigarette smoking, Asian countries. LIST OF ABBREVIATIONS: BMI: Body Mass Index, OR: Odds Ratio, CI: Confidence interval. Corresponding Author: Mehri Rejali, MD; e-mail: [email protected] 1 CIGARETTE SMOKING IN IRAN AND OTHER ASIAN COUNTRIES INTRODUCTION cigarette smoking may be less than actual in wom- en of this region 36. Therefore, it is very important to The health has a vast meaning and its definition is conduct appropriate studies at the individual level to affected by different factors1-5. Several studies6,7 have determine the prevalence of cigarette smoking among found that unhealthy lifestyles, cigarette smoking, Asian men and women, because the epidemiological poor nutrition and inactivity are the most important appearance and factors related to this behavior should risk factors threatening public health. Controlling be properly investigated in order to carry out any pro- these risk factors reduces a half of early mortalities gram for the prevention and control of high-risk be- in human societies8-11. In today’s societies, cigarette havior in human societies. The present study aimed smoking is one of the most well-known risk factors to investigate the prevalence of cigarette smoking and for cardiovascular diseases, cancers and pulmonary its related factors in central parts of Iran and compare diseases9,12-15. Nicotine is an addictive substance in the results with other Asian countries. cigarettes leading to the addiction to cigarettes in smokers. The addiction to this substance makes it dif- ficult for smokers to quit smoking16. Cigarette smok- MATERIALS AND METHODS ing is considered to be the most common psychiatric disorder due to the high prevalence of nicotine addic- The present study was conducted using data from a tion in smokers17. Unfortunately, cigarette smoking population-based cohort study in three counties (Is- is a common phenomenon with high prevalence in fahan, Arak, and Najafabad) in central parts of Iran. many societies despite the fact that risks of cigarette Details of research method, including the sample size, smoking have been well proved18-20. Some socioeco- procedure, patients’ inclusion and exclusion criteria, nomic factors related to the cigarette smoking are as and their follow-up in the Isfahan Cohort Study (ICS) follows: the level of education, type of occupation, were fully described in a paper by Sarrafzadegan et al and monthly earnings21-23. Based on results of vari- 37. The present study was conducted on 1726 people ous studies, the prevalence of cigarette smoking in over 35 years of age living in urban and rural areas in people with lower education is higher than those with three central counties of Iran as participants in ICS. Af- higher education levels24,25. The prevalence of ciga- ter obtaining informed consent from subjects, a struc- rette smoking in people with more stressful jobs is tured interview was conducted by trained interviewers higher than other people26,27. Some lifestyle factors with associate degrees in the health for at least half- such as the mobility, type of nutrition, and body mass hour using a questionnaire, including the demographic index (BMI) are also related to the state of cigarette information, socioeconomic status, knowledge level, smoking28,29. Cigarette smoking is a major public attitude and performance regarding non-communi- health problem and one of the most important causes cable and chronic diseases, lifestyle-related behav- of preventable mortality worldwide30,31. Based on the ior (including cigarette smoking, physical activity current model of smoking in the world, about 10% and dietary habits). The status of cigarette smoking of women and 50% of young men smoke cigarettes. was a studied index in the present study. Therefore, More than five million deaths attributable to cigarette individuals were put in two groups of smokers or smoking were diagnosed and recorded in 2010; how- non-smokers. A person with a current consumption ever, predictions indicate that the number of deaths or history of smoking a cigarette per day was put in attributable to smoking will increase to 10 million the smokers group, and a person who had no history cases per year due to the increase in the mean age of smoking was put in the non-smokers group 38. The of societies in the next few decades32-34. During the present study examined the prevalence of cigarette twentieth century, around one hundred million mor- smoking and its relation with gender, age, educa- talities from cigarette smoking occurred globally, tion level, economic status, marital status, physical especially in developing countries34,35. If the current activity, occupation, BMI, health status and tea and smoking model continues, it is expected that the cig- coffee consumption. Qualitative variables were stud- arette smoking will cause deaths for one billion peo- ied as the frequency and its percentages. The logistic ple during this century, and most of them will occur regression was applied to investigate and determine in low and middle-income countries36,37. Cigarette smoking-related factors. To calculate odds ratios of smoking habit is different in Asian countries than smoking, a group with the lowest prevalence of ciga- the rest of world, for instance, the cigarette smok- rette smoking was considered as the reference group; ing is not an acceptable behavior in the Asian wom- and odds ratios for other components of that variable en, and thus, the prevalence of cigarette smoking is were calculated based on the reference group and re- much lower in Asian women than men; nevertheless, ported with a 95% confidence interval (CI). The sig- it should be noted that Asian women’s self-report of nificance level was considered to be 0.05 in all analy- cigarette smoking may be unreliable due to the social ses. SPSS18 (SPSS Inc., Chicago, IL, USA) software prohibition, and in fact, the estimated prevalence of was used to analyze data. 2 CIGARETTE SMOKING IN IRAN AND OTHER ASIAN COUNTRIES RESULTS smoking was 19.59 (95% confidence interval (CI)= 12.97-30.60) in men compared to women. Com- A total of 1726 people were included in the study, pared to the 75-years-and-older age group, odds of which 851 (49.30%) were male and 875 (50.70%) ratio of cigarette smoking was equal to 2.07 (95% were female. The overall prevalence of cigarette CI = 1.26-3.49) in the 45-54 age group, and 1.79 (CI smoking was equal to 20.75% in all subjects and =1.09- 3.03) in the 55-64 age group, and 1.61 (95% it was equal to 38.4% in men and 3.1% in women. CI = 0.93-2.84) in the 65-74 age group. The odds The prevalence of cigarette smoking was 22.3% in ratio of cigarette smoking in married people was married people, 7.16% in single people, 23.3% in equal to 3.71 (95% CI = 2.15-6.86) compared to the 45-54 age group, 20.8% in the 55-64 age group, single ones. Compared with obese people, odds ra- 19.2% in the 65-74 age group, 12.8% in people in tio of cigarette smoking was equal to 1.77 (95% CI the 75-years-and-older age group, 18.8% in people = 1.27-2.47) in overweight people, and 2.85 (CI= with a low economic status, 22.5% in people with a 2.01- 4.05) in people with normal body mass in- medium economic status, and 26.8% in people with dex, and 8.2 (95% CI = 3.33- 20.23) in people with a good economic status.
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