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Pattern of Cigarette Smoking Hamzeh et al. Substance Abuse Treatment, Prevention, and Policy (2020) 15:83 https://doi.org/10.1186/s13011-020-00324-z RESEARCH Open Access Pattern of cigarette smoking: intensity, cessation, and age of beginning: evidence from a cohort study in West of Iran Behrooz Hamzeh1, Vahid Farnia2, Mehdi Moradinazar3, Yahya Pasdar4, Ebrahim Shakiba5, Farid Najafi6 and Mostafa Alikhani2* Abstract Background: Smoking is a social epidemic and one of the main risk factors for premature deaths and disabilities worldwide. In the present study, we investigated the Pattern of Cigarette Smoking: intensity, cessation, and age of the beginning. Methods: Data collected from the recruitment phase of Ravansar (a Kurd region in western Iran) Non- Communicable Disease (RaNCD) cohort study was analyzed by using Chi-square test, univariate and multivariate logistic regressions, Poisson regression, and linear regression. Results: Totally 10,035 individuals (47.42% males) participated in the study. Mean age was lower for males (47.45 yr) than for females (48.36 yr). Prevalence of smoking was 20% (36.4% of males and 5.23% of females). Compared to female participants, males showed a 7-fold higher prevalence of smoking and started smoking about 4 years earlier. Being married, having a lower BMI, living in rural areas, and being exposed to secondhand smoke (SHS) were predictors of higher smoking prevalence rates. Furthermore, current exposure to SHS, higher smoking intensity, later smoking initiation, male gender, younger age, lower education, and lower BMI were related to lower likelihood of stopping smoking. Heavy smokers began to smoke about 4 years earlier than casual smokers did. Finally, being divorced/ widow/ widower/ single and childhood exposure to SHS were found to increase the likelihood of becoming a smoker. Conclusions: Based on present research results, health programs specific to smoking cessation should take socio- demographic factors, smoking history, and current smoking behavior into account. Keywords: Cigarette smoking, Prevalence, Smoking cessation Background causes of preventable diseases and deaths, being respon- Cigarette is a rubbish substance readily available to the sible for approximately 6 million deaths per year world- general public and smoking is highly indecent socially. wide [2]. Smoking creates higher mortality rates in the Young people and teenagers turn easily to smoking and population consisting of men and women starting to become addicted to cigarettes because they are inexpen- smoke between adolescence and middle age in addition sive and abundant [1]. Smoking is one of the leading to imposing heavy financial costs. Since the 1960s, regu- lar male/ female smokers have shown the age-adjusted relative risks of twice/ trice higher than those shown by * Correspondence: [email protected] non-smokers. Smoking shortens life expectancy by 10 2Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran years on average because tobacco use puts people at Full list of author information is available at the end of the article high risk of developing related diseases, with people © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Hamzeh et al. Substance Abuse Treatment, Prevention, and Policy (2020) 15:83 Page 2 of 9 sometimes dying from common health problems such as Methods pneumonia and/or from surgical operations involved [3]. Design and sample Smoking is associated with increased medical costs, re- Ravansar Non-Communicable Disease (RaNCD) cohort duced life expectancy, aggression, crime and theft. Obvi- study is a part of PERSIAN (Prospective Epidemiological ously, proven relationships exist between smoking and Research Studies in Iran) Cohort, focusing on Ravansar respiratory, cardiovascular and cancer diseases [4, 5]. permanent residents in the 35–65-year-of-old age group. Although many adverse health effects of tobacco occur All 19 cohort sites (Covering Iranian people from differ- later in life, smoking can be associated with educational ent ethnicities) of PERSIAN used the same questionnaire problems [6, 7], consuming other kinds of substances containing different parts. Details of the study design [8], delinquency [9], damaged psycho-social functions and rationale for conducting PERSIAN cohort were dis- [9], depression and anxiety [10], and high-risk sexual be- cussed elsewhere [20]. haviors [9]. Although prevalence rates of smoking began Geographically located in west of Iran, Ravansar is a to decline in most countries during recent decades, it is town in Kermanshah province close to Iraqi borders. still high in many parts of the globe. Most residents belong to Kurdish ethnicity. Recruitment Iranian tobacco controlling policies have not been im- phase of the study started in November 2014 and ended plemented effectively [11]. According to data available in February 2017, during which more than 10,000 people on the 18–65-year-of-old age group, prevalence of signed the letter of informed consent to participate in cigarette smoking was 25.4% in Iran in 2011 [12]. the study [20]. Average estimates from the National Bureau of Statistics To collect information, participants were invited to the indicate an annual consumption of 55 billion cigarettes in study site. After the enrolment of participants, bioelec- Iran. Based on international sources, 2–3 times higher tric impedance was assessed by anthropometric mea- than the money paid for purchasing cigarette is spent on sures. Body mass index (BMI) was calculated as body medical and health expenditures in our country. As indi- weight (kg) divided by height (m2). Subjects with 25.0 ≤ cated by reports from World Health Organization BMI ≤ 29.9 kg/m2 and with BMI ≥ 30 kg/m2 were classi- (WHO), if status quo of tobacco use remains unchanged, fied in overweight and obese groups, respectively [21]. Iran will be among regional countries with the highest in- Term illiterate was defined as having little or no educa- crease in tobacco consumption by the next 40 years [11]. tional literacy. Low – educated subjects were considered As smoking accounts for 50% of premature deaths, as those completing< 5 years and/or 6–9 years of educa- healthcare system gives the priority to smoking cessation tion. Also, subjects with 10–12 years and ≥ 13 years of [13]. It is difficult to stop smoking successfully, with its education were classified in middle-educated and high- relapse being very common [14]. Many smokers make educated groups, respectively. We used wealth index as several attempts to quit cigarettes, but they usually fail a proxy for economic status. Wealth index (WI) was to keep abstinence [15]. In 2018, 55.1% (21.5 million) of generated by performing principal component analysis adult smokers self-reported that they had made an at- (PCA) on data related to durable goods, housing, and tempt to quit smoking in the past year, only 7.5% (2.09 other amenities [22]. Information available on infrastruc- million) of whom stopped smoking successfully [16]. A ture (drinking water supply, sanitary facilities), housing study conducted in Iran indicated that only 2.7% of conditions (e.g. the number of rooms, type of homeow- smokers were able to quit cigarettes [17]. Smoking ces- nership), possession of a variety of durable appliances sation depends on many factors capable of increasing (e.g. dishwasher, car, TV), and education levels in the likelihood of success in quitting cigarettes. Recogniz- dataset was used to generate socio-economic status ing and focusing on these key factors will help to avoid (SES) index for each participant. Study participants costs of treatment imposed by smokers on national were divided into 5 SES groups from the lowest (1st) healthcare system in the future, rising the levels of pub- to the highest (5th) quintiles. lic health [18]. Therefore, it is very important to find fac- A national health interview Survey (NHIS) was used to tors related to the success of the smoking cessation [19]. evaluate smoking status. Those respondents who For this reason, it is important to have knowledge of smoked ≥ 100 cigarettes in their lifetime were defined as socio-demographic differences, type of smoking habits, smokers. Term “ex-smoker” referred to individuals who age of smoking initiation, smoking intensity, and ability stopped smoking cigarettes and/or tobacco. to quit cigarettes in any population. Term “former smoker” was intended to define those Given the relatively high prevalence of smoking in Iran
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