Publications by authors named "Hooman Sharifi"

22 Publications

  • Page 1 of 1

Water-pipe Smoking Addiction in Iran; Evaluation of Reliability and Validity of Lebanon Water-pipe Dependence Scale Among Iranian Water-pipe Tobacco Smokers.

Int J Prev Med 2020 11;11:196. Epub 2020 Dec 11.

Tobacco Prevention and Control Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.

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 ( = 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.
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http://dx.doi.org/10.4103/ijpvm.IJPVM_555_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8000159PMC
December 2020

Burden of Obstructive Lung Disease in Iran: Prevalence and Risk Factors for COPD in North of Iran.

Int J Prev Med 2020 3;11:78. Epub 2020 Jul 3.

Division of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, Oregon.

Background: Globally chronic obstructive pulmonary disease (COPD) was reported as the fourth leading cause of death (5.1%) in 2004 and is projected to occupy the third position (8.6%) in 2030. The goal of the present project is to describe the prevalence and risk factors of COPD in a province in the north of Iran.

Methods: This study followed a stratified cluster sampling strategy with proportional allocation within strata. The stratification of the sample according to the 31 provinces of Iran is incorporated in the sampling process. The single most important outcome measure obtained as part of this protocol was spirometry before and after the administration of 200 mg (2 puffs) of salbutamol. The descriptive statistics for categorical variables included the number and percent and for continues variables included the mean ± SD.

Results: A total of 1007 subjects were included in the study. Among all participants, 46 (5%) subjects had COPD on the basis of symptoms and 43 (8.3%) subjects had COPD on the basis of spirometry criteria. In univariate analysis, urban inhabitants in comparison with rural inhabitants had lower COPD risk (OR: 0.48; 95% CI: 0.24-0.95), smoker had higher risk compared with nonsmokers (OR: 1.97; 95% CI: 1.01-3.82), and subjects with exposure to dust (OR: 2.07; 95% CI: 1.09-3.94) had higher risk compared with contrary status.

Conclusions: This study showed that occupational and environmental smoke exposure was associated with COPD. A new design of preventive measures must be taken to control cooking energy and cooking stoves, particularly in rural areas.
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http://dx.doi.org/10.4103/ijpvm.IJPVM_478_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7513778PMC
July 2020

Estimating of Net Transition Probabilities in Triple Stages of Cigarette Consumption in Iranian Men.

Tanaffos 2018 Oct;17(4):233-240

Tobacco Prevention and Control Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.

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.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6534800PMC
October 2018

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

BMC Pediatr 2019 05 21;19(1):161. Epub 2019 May 21.

Tobacco Prevention and Control Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.

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.
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http://dx.doi.org/10.1186/s12887-019-1506-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6528314PMC
May 2019

Prevalence of Asthma and Asthma-like Symptoms: a Study in Five Provinces of Iran.

Tanaffos 2019 Apr;18(4):321-328

Chronic Respiratory Diseases Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Asthma is a complex chronic inflammatory airway disease affecting millions of people worldwide. The prevalence of asthma attacks in most regions of the world, including the developing countries, increases due to urbanization, industrialization, and lifestyle.

Materials And Methods: The present study aimed at investigating the prevalence of asthma and asthma symptoms in five provinces of Iran using the stratified cluster sampling method and the European Community Respiratory Health Survey (ECRHS) questionnaire.

Results: A total of 4918 subjects were enrolled in the study. The prevalence of nocturnal cough was 27.4% (95% confidence interval (CI): 26%-28%); it was the most common asthma symptom followed by nocturnal shortness of breath (19.6%; 95%CI: 18-21%). For participants aged 20-44 years, the most prevalent symptoms were coughing attacks (37.7%), shortness of breath (26.5%), and nasal allergies (22.7%), respectively.

Conclusion: There was a significant association among gender, age, and nasal allergy. Relevant studies should be conducted to figure out the countrywide distribution and the real burden of the disease.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7309887PMC
April 2019

Burden of obstructive lung disease study in Iran: First report of the prevalence and risk factors of copd in five provinces.

Lung India 2019 Jan-Feb;36(1):14-19

Division of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, Oregon, USA.

Background: Chronic obstructive pulmonary disease (COPD) is a global health burden that affects 300 million people worldwide. Globally, COPD was reported as the fourth leading cause of death in 2004 and is projected to occupy the third position in 2030. The goal of the present project is to describe the prevalence and determine the causes and risk factors of COPD in five provinces of Iran.

Methods: This study followed a stratified cluster sampling strategy with proportional allocation within strata. The target population is all noninstitutionalized inhabitants, aged 18 and over, who inhabit in different provinces in Iran in the year 2017. The stratification of the sample according to the 31 provinces of Iran is incorporated in the sampling process. The core questionnaire was developed from preexisting validated questionnaires. The single most important outcome measure obtained as part of this protocol was spirometry before and after the administration of 200 mg (two puffs) of salbutamol.

Results: The most commonly reported respiratory symptoms were as follows: wheezing (N=217, 20.4%, 95% confidence interval [CI]: 18%-22.8%), sputum production (N=173, 16.5%, 95% CI: 14.3%-18.8%), and dyspnea (N=131, 12.3%, 95% CI: 10.3%-14.3%). The overall COPD prevalence defined by the postbronchodilator spirometric Global Initiative for Chronic Obstructive Lung Disease criteria was 4.9%, higher in men (6.4%) than in women (3.9%). The prevalence of COPD was strongly dependent on smoking status, age, and sex.

Conclusion: COPD is considered a preventable disease, and avoidance of exposure to major risk factors can prevent the vast majority of cases. The present study findings add to the literature on the prevalence of COPD in Iran and will help policy-makers, specialists, and all stakeholders to strategize and evaluate medical services required for reducing the prevalence of respiratory diseases. The data from our present study will serve as baseline information for future national and regional studies of COPD.
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http://dx.doi.org/10.4103/lungindia.lungindia_129_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6330801PMC
January 2019

Prevalence of tobacco use and associated factors in Tehran: Burden of Obstructive Lung Disease study.

Lung India 2017 May-Jun;34(3):225-231

Division of Pulmonary and Critical Care Medicine, Oregon Health and Sciences University, Portland, Oregon, USA.

Background: Tobacco use is one of the leading causes of preventable deaths in the world. The aim of this study was to determine the prevalence of all common types of tobacco use and identify factors associated with tobacco use among adults in Tehran based on information from the population-based Burden of Obstructive Lung Disease study in Tehran.

Materials And Methods: This study had a stratified cluster sampling strategy with proportional allocation within strata. The target population was all noninstitutionalized residents of Tehran over 18 years of age in 2013. A total of 1798 individuals were visited in 22 districts of Tehran; 811 (45.1%) men and 987 (54.9%) women participated in structured interviews.

Results: The estimated prevalence of current cigarette smoking was 10.6% overall, 20.9% in men and 2.2% in women. The prevalence of smoking was the highest among respondents between 45 and 54 years in both males and females. The mean age of initiation of tobacco smoking was 21.04 ± 6.42 years. The mean Fagerström test score was 2.87 ± 2.36 among current smokers. The mean number f cigarettes smoked daily by the participants was 11.39 ± 10.92 cigarettes/day (95% confidence interval = 12.58-10.21) (range 1-60 cigarettes).

Conclusions: The 10.6% prevalence of cigarette smoking is alarming in Tehran. We found that male gender, hookah smoking experience, and poor health status were major risk factors in our study population. Hookah smoking can be considered as a reflection of tobacco smoking in the society.
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http://dx.doi.org/10.4103/0970-2113.205323DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5427748PMC
May 2017

Evaluation of Dual Tobacco Smoking (Water Pipe and Cigarettes) and Associated Factors in Adults in Tehran.

Tanaffos 2016 ;15(3):180-186

Tobacco Prevention and Control Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Concurrent use of tobacco products such as cigarettes and water pipes may be associated with increased risk of nicotine dependence and smoking-related complications. Accurate statistics are not available regarding the prevalence of water pipe use or concurrent use of cigarettes and water pipe in the Iranian population. Thus, this study sought to assess the prevalence of concurrent use of cigarettes and water pipes and their related factors in Iran.

Materials And Methods: This cross-sectional study was conducted on Tehran residents over 15 years of age, who were selected via cluster, multi-stage randomized sampling, from different geographical districts of Tehran between November and December 2014. The data were collected using the water pipe section of the Global Adult Tobacco Survey (GATS) questionnaire.

Results: A total of 1,830 individuals participated in this study, 243 (13.3%) of which exclusively used water pipes, 76 (4.2%) used both cigarettes and water pipes, and 120 (6.6%) exclusive smoked cigarettes. Of those who used both cigarettes and water pipes, 86.8% were men and 13.2% were women (P < 0.001). The mean age of those who only used water pipes was 28.01 ± 8.7 years while the mean age of those who used both water pipes and cigarettes was 33.1 ± 1.1 (P < 0.001). Male sex (adj. OR: 3.8) and older age (adj. OR: 1.06) increased the odds of using both tobacco products.

Conclusion: The prevalence of concurrent use of cigarettes and water pipes and that of exclusive water pipe use were 4.2% and 13.3%, respectively. The prevalence of exclusive cigarette smoking was 6.1%. Those who smoked both cigarettes and water pipes had a higher mean age than those who exclusively used water pipes and they were mostly men. Among those who used cigarettes and water pipes, the mean age at which they began using water pipes was lower than the mean age at which they began smoking cigarettes. In other words, dual smokers started water pipe smoking sooner than cigarette smoking. Future studies with different methodologies are required to further scrutinize the relationship between water pipe and cigarette smoking. Smoking cessation programs must specifically target dual smokers.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5304963PMC
January 2016

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

Iran J Allergy Asthma Immunol 2016 Jun;15(3):174-82

Tobacco Prevention and Control Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.

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.
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June 2016

Prevalence and Geographic Distribution Pattern of Asthma in Tehran by ECRHS.

Tanaffos 2016 ;15(4):236-242

Tobacco Control Research Center, Iranian Anti Tobacco Association, Tehran, Iran.

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.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5410120PMC
January 2016

Burden of obstructive lung disease study in Tehran: Prevalence and risk factors of chronic obstructive pulmonary disease.

Lung India 2015 Nov-Dec;32(6):572-7

Oregon Health and Science University, Portland, Oregon, USA.

Background: Chronic obstructive pulmonary disease (COPD) was ranked the sixth-most common cause of death worldwide in 1990, but now it is the third-most common cause. The goal of the present study was to assess the prevalence and determine the causes and risk factors of COPD in Tehran.

Materials And Methods: This study followed a stratified cluster sampling strategy with proportional allocation within strata. The target population was all non-institutionalized inhabitants, aged 18 to 40 in one group and over 40 in another who resided in Tehran in 2013. The core questionnaire was developed from pre-existing validated questionnaires that had already been used in multi-national studies. The single most important outcome measure obtained as part of this protocol was spirometry before and after the administration of 200 mg (two puffs) of salbutamol.

Results: The most commonly reported respiratory symptoms were: sputum production in 291 patients (16.2%) [95% confidence interval (CI): 14.5-17.9%], chronic cough in 171 (9.5%) (95% CI: 8.2-10.9%), wheezing in 377 (21.0%) (95%CI: 19.1-22.9%) and dyspnea in 388 patients (21.6%) (95% CI: 19.7-23.5%). The overall COPD prevalence defined by the post-bronchodilator spirometric functional criteria was 9.2%. This value in men (10.1%) was higher than in women (8.5%); the prevalence was significantly higher in subjects aged over 55 years (P ≤ 0.002). The prevalence of COPD was strongly dependent on smoking status, especially in ex-smokers, and increased considerably with age. 69% of patients with COPD were non-smoker.

Conclusion: The high prevalence of verified COPD, a great deal of which was undiagnosed before by a physician, highlights the necessity of raising awareness of this disease among health professionals, and use of spirometry in the primary care setting. A future cross-sectional and prospective cohort study should be performed to explore all risk factors and their impact on decline in lung function and worsening of respiratory symptoms especially in non-smokers.
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http://dx.doi.org/10.4103/0970-2113.168129DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4663859PMC
December 2015

Smoking and wound complications after coronary artery bypass grafting.

J Surg Res 2016 Feb 21;200(2):743-8. Epub 2015 Sep 21.

Department of Cardiovascular Diseases, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: The harmful effects of smoking on the postsurgical wound healing disturbances have been widely investigated across various surgical procedures. These effects after coronary artery bypass graft (CABG) surgery have been less explored. We aimed to investigate the association of smoking and the wound healing problems in post-CABG patients.

Materials And Methods: We compared the incidence of wound complications in 405 smokers and 405 nonsmokers who underwent an elective CABG surgery. The incidence of leg and sternal wound complications was evaluated during the first 7 d as well as at a 6-wk postoperative visit.

Results: One hundred fifty-six leg wound complications were noted in 132 patients (16.3%). The overall rate of leg wound healing disturbances was significantly higher in smokers than those in nonsmokers (odds ratio, 1.47; 95% confidence interval, 1.109-4.019; P = 0.010). The incidence rates of leg wound edge necrosis and dehiscence were significantly higher in smokers compared with those in nonsmokers (3.7% versus 0.7%, P = 0.004 and 6.6% versus 0.7%, P < 0.0001, respectively). We found no significant differences between the incidence of postoperative leg wound infection, hematoma, wound edema, and seroma in active smokers and those who never smoked. Thirty-seven postsurgical sternal wound complications (4.6%) were developed in 33 patients (4.1%). The overall rate of sternal wound healing disturbances was similar between smokers and nonsmokers. There was a trend between the sternal wound dehiscence and smoking (P = 0.03); however, the other sternal wound complications were not associated with smoking.

Conclusions: Smoking may contribute to the disturbances of wound healing, especially wound dehiscence, in post-CABG patients.
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http://dx.doi.org/10.1016/j.jss.2015.09.017DOI Listing
February 2016

Interim Report from Burden of Obstructive Lung Disease (BOLD Study) in Tehran: Prevalence and Risk Factors of Chronic Obstructive Pulmonary Disease.

Tanaffos 2014 ;13(3):6-13

Oregon Health and Science University, Portland, Oregon, USA.

Background: Chronic Obstructive Pulmonary Diseases (COPD) is estimated to rank fifth in burden of disease and third in terms of mortality by 2020 worldwide. It is characterized by chronic inflammation and non-fully reversible airflow obstruction, causing structural changes in the lungs that can be demonstrated by a post bronchodilator FEV1/FVC ratio <70%.

Materials And Methods: The sampling frame of the current study was the population of Tehran, the capital of Iran with the current population of nearly 8.1 million. A stratified cluster sampling strategy with proportional allocation within strata was used in this study. The target population was all Tehran residents, aged 18 to 40 in one group and over 40 in another, in the year 2013. The stratification process of the sample according to the 22 municipal districts of Tehran city has been incorporated in the sampling process. Proportional to the number of households in the 22 districts, the appropriate number of clusters is weighted according to each district. The decision about the number of clusters is based on total sample size; mean household members; and logistical facilities for subject enumeration, transport, and examination.

Results: The overall COPD prevalence defined by the spirometric functional criteria was 10%, higher in men 12 (11.9%) than in women 15 (8.8%); the prevalence was significantly higher in subjects aged over 55 years (P =0.001). Only 10(3.7%) of these COPD patients had already been diagnosed by a physician. Of all subjects fulfilling the criteria for COPD according to the Burden of Obstructive Lung Disease (BOLD) guidelines (post bronchodilator FEV1/FVC<70%), 90(33.3%) had chronic productive cough, and 262(96.7%) had either long-standing cough, sputum production, recurrent wheeze, dyspnea, or attacks of shortness of breath.

Conclusion: Due to the small sample size at this stage of project, conclusions should be drawn with caution. In this first epidemiological report in Tehran about COPD, a moderate prevalence of the disease was determined, and a high percentage of this figure had not been diagnosed before by a physician.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4338047PMC
February 2015

Burden of obstructive lung disease study in tehran: research design and lung spirometry protocol.

Int J Prev Med 2014 Nov;5(11):1439-45

Oregon Health and Science University, Portland, Oregon, USA.

Background: Chronic obstructive pulmonary diseases (COPD) are planned to rank fifth in burden of disease and third with respect to mortality by 2020. Carrying out research regarding different aspects of COPD is mentioned as important health priorities by academic institutions and governments. The burden of lung disease (BOLD) Initiative was designed a decade ago to develop robust models that can be used to estimate the prevalence and current and future economic burden of COPD. The goal of the present project is to describe the prevalence and determining the causes and risk factors of COPD in the population of Tehran city.

Methods: This cross-sectional study follows a stratified cluster sampling strategy with proportional allocation within strata. The target population is all noninstitutionalized inhabitants, aged 18-40 in one group and over 40 in another, who inhabit in Tehran city. The stratification of the sample according to the 22 municipal districts of Tehran is incorporated in the sampling process. Proportional to the number of households in the 22 districts, the appropriate number of clusters is weighted according to each district. For each cluster, a team of three members approaches the index household, which is specified through the aforementioned random selection of clusters, and continues the enumeration in 10 neighbor households in a systematic manner.

Results: As a study protocol, there are no specific results to present; our purpose is to share our design with the scientific body.

Conclusions: We expect that findings from the BOLD study in Tehran will show the status of COPD and its causes in the community.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4274551PMC
November 2014

Cotinine level is associated with asthma severity in passive smoker children.

Iran J Allergy Asthma Immunol 2015 Feb;14(1):67-73

Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Disease, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Asthma environmental triggers play important roles in severity of disease. Passive smoking could exacerbate asthma symptoms and enhance the decrease in lung function. Cotinine levels could be a reflection of passive exposure to the cigarette both in adults and pediatrics. The aim of this study was to determine degree of association of asthma severity and cotinine level as a marker of passive smoking. In a cross-sectional study, 100 pediatric patients (under 10 years old) with asthma were enrolled, 50 of whom, had been exposed to passive smoking and 50 others included as controls. A complete clinical history, lab exam, and spirometry were performed. A sample of urine, serum and saliva was collected from all attendant patients and controls in the study after confirmation of diagnosis and determination of severity of asthma. The results revealed that age, sex, age of onset of asthma, family history and allergic history were not significantly different between two groups of patients. According to GINA classification, percentage of patients with severe asthma was significantly higher in passive smoker group (p=0.001). Cotinine was significantly higher in passive smoker group compared to control group in serum (p=001), saliva (p=0.001), and urine (p=0.0014). In passive smoker group, cotinine levels were significantly higher in serum (p=0.001), urine (p=0.007), and saliva (p=0.01) of patients with severe asthma than moderate and mild asthma. Serum cotinine (OR: 1.81, 95% CI: 1.35-2.32, p=0.024), urine cotinine (OR: 3.56,95% CI = 1.29-5.53, p=0.01) and saliva cotinine (OR: 1.66, 95% CI: 1.23-1.98, p=0.031) were also significantly associated with higher risk of severe asthma. Cotinine levels were higher in passive smokers compared to non-passive smokers. Besides, cotinine was a predictive risk factor for severe asthma.
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February 2015

Cotinine level is associated with asthma severity in passive smoker children.

Iran J Allergy Asthma Immunol 2015 Feb;14(1):67-73

Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Disease, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Asthma environmental triggers play important roles in severity of disease. Passive smoking could exacerbate asthma symptoms and enhance the decrease in lung function. Cotinine levels could be a reflection of passive exposure to the cigarette both in adults and pediatrics. The aim of this study was to determine degree of association of asthma severity and cotinine level as a marker of passive smoking. In a cross-sectional study, 100 pediatric patients (under 10 years old) with asthma were enrolled, 50 of whom, had been exposed to passive smoking and 50 others included as controls. A complete clinical history, lab exam, and spirometry were performed. A sample of urine, serum and saliva was collected from all attendant patients and controls in the study after confirmation of diagnosis and determination of severity of asthma. The results revealed that age, sex, age of onset of asthma, family history and allergic history were not significantly different between two groups of patients. According to GINA classification, percentage of patients with severe asthma was significantly higher in passive smoker group (p=0.001). Cotinine was significantly higher in passive smoker group compared to control group in serum (p=001), saliva (p=0.001), and urine (p=0.0014). In passive smoker group, cotinine levels were significantly higher in serum (p=0.001), urine (p=0.007), and saliva (p=0.01) of patients with severe asthma than moderate and mild asthma. Serum cotinine (OR: 1.81, 95% CI: 1.35-2.32, p=0.024), urine cotinine (OR: 3.56,95% CI = 1.29-5.53, p=0.01) and saliva cotinine (OR: 1.66, 95% CI: 1.23-1.98, p=0.031) were also significantly associated with higher risk of severe asthma. Cotinine levels were higher in passive smokers compared to non-passive smokers. Besides, cotinine was a predictive risk factor for severe asthma.
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February 2015

The determinants of high school students smoking habits with special focus on teachers smoking in Iran: a population based study.

Pneumologia 2012 Jan-Mar;61(1):28-33

Tobacco Prevention and Control Research Center (TPCRC), Masih Daneshvari Hospital, Shaheed Beheshti Medical Science University, Tehran, Iran.

Introduction: Approval of smoking by friends and teachers is likely to increase the probability of smoking by the students. This study aims to determine whether adolescent smoking is associated with teachers or other students smoking, after controlling for confounders.

Materials & Methods: In a cross sectional study, a representative sample of 4599 students in the third grade were selected from high schools in Tehran. A 21 item questionnaire was administered consisting of demographic and tobacco smoking habit questions. Pattern of adolescent tobacco smoking was compared between two sexes. Association between smoking behavior and perceived exposure to teachers smoking were assessed using bivariate and multivariate analyses, adjusting for parental, best friends and sibling smoking and sex. A multivariate logistic regression model was constructed and adjusted Odds Ratios were estimated.

Results: In total, 4591 students, aged 17 to 19 years, consisting of 2092 (45.6%) boys and 2499 (54.4%) girls, with the overall mean age of 17.53 +/- 0.59 years, were recruited. Of the students studied, 250 (12.1%) of boys and 131 (5.3%) of girls reported being current smokers (p = 0.001). The proportion of smoker and non-smoker students reporting to have been exposed to teachers smoking inside the school building was 209 (55.7%) and 1191 (29.3%), respectively (p = 0.001). Of those reporting being exposed to teachers smoking outdoors on school premises, 220 (58.7%) were smokers and 1205 (29.2%) were non-smokers (p = 0.001). After adjusting for sex, smoking habit of father, mother, brothers, sisters and best friends, adolescent perceived exposure to teachers smoking on school premises, but not inside school, was significantly associated with current smoking (OR = 2.1, 95 % CI:1. 7-2. 7). Adolescent exposure to best friend smoking was strongly associated with current smoking after adjusting for above variables (OR=6. 7, 95 % CI:5-9).

Conclusion: Teachers smoking during school hours and best friend smoking are the two important determinants to be considered in any project aiming to establish tobacco-free schools.
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May 2012

Efficacy of harm reduction programs among patients of a smoking cessation clinic in Tehran, Iran.

Arch Iran Med 2012 May;15(5):283-9

Tobacco Prevention and Control Research Center (TPCRC), Masih Daneshvari Hospital, Shaheed Beheshti Medical Science University, Tehran, Iran.

Background: Recently, harm reduction programs have been used to reduce mortality and morbidity among smokers. The main objective of this study was to evaluate the effect of harm reduction programs on the smoking patterns of subjects who presented to a smoking cessation clinic in Tehran, Iran.

Methods: This observational study was conducted between September 2008-September 2009 on 132 patients who were unable to quit smoking. Patients were enrolled by the first come first service method. During the study period, subjects were assigned to either group or individual visits every 15 days in conjunction with the use of nicotine gum. The main objective of this study was to evaluate at the third and sixth months of follow-up: the number of smoked cigarettes, level of expired carbon monoxide (CO), and numbers of nicotine gum used. Data were analyzed by the Wilcoxon rank, Fisher's exact, and Pearson's chi-square tests and SPSS version 17 software.

Results: A total of 87.1% of the subjects were males. We noted decreases in the number of cigarettes smoked daily and the level of expired CO, whereas the amount of nicotine gum used significantly increased during the time interval between the first session and the third and sixth month follow-up visits (p < 0.001 for all variables). During the follow up sessions, 64.4% of subjects reduced the number of cigarettes they smoked daily by at least 50% and 12.9% of subjects quit smoking.

Conclusion: Behavioral and pharmacological therapy in harm reduction programs result in a decrease in the number of cigarettes smoked daily and a reduction in the amount of expired CO. Therefore, these methods can be beneficial in achieving complete smoking cessation.
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http://dx.doi.org/012155/AIM.008DOI Listing
May 2012

Health Experts' Opinions about Tobacco Control Activities in Iran: Results from a Delphi Panel of National Experts.

Tanaffos 2012 ;11(4):50-5

Chronic Respiratory Diseases Research Center, NRITLD, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Iran signed the Framework Convention on Tobacco Control on June 16, 2003 and it was ratified by the parliament and the House of Representatives on November 6, 2005. Finally, it came into force on February 4, 2006. In this study, we aimed to evaluate health experts' opinion about tobacco control activities in Iran.

Materials And Methods: This was a qualitative case study. We used a series of open-ended questionnaires to assess important information regarding Iranian National Tobacco Control law and FCTC implementation. The study population comprised of health experts. Use of this method ensured the validity of questionnaires' contents. The first round of the questionnaire had been pre-tested in a pilot study. The final structure and lay out of questionnaires consisted of three main parts. The first part was designed with 7 multiple choice questions. Participants were able to rank answers from five (the most important) to one (the least important). The second part comprised four questions mainly on National Tobacco Control Program (NTCP) and the final part was about FCTC. Data collection was carried out between May 2010 and May 2011. In the analysis process each interview was considered as a separate case and then compared to other cases to ascertain variations in answers.

Results: All 40 members (100%) of the panel completed the entire process. All the participants had a consensus on tobacco control program in Iran. They believed the prevention programs to be important priorities in this regard. Tobacco Company as a governmental organization is believed to be the main barrier against tobacco control activities in Iran, and banning sales of tobacco to minors and controlling its smuggling are important factors for decreasing the supply of tobacco products. It is essential to implement comprehensive tobacco control law in Iran.

Conclusion: It is essential to implement comprehensive tobacco control law in Iran that covers all the priorities mentioned above. Considering the chronological aspect of law implementation, priority should be given to the more important parts of the law.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4153223PMC
September 2014

Comparison of spermatozoa quality in male smokers and nonsmokers of Iranian infertile couples.

Int J Fertil Steril 2011 Oct 22;5(3):152-7. Epub 2011 Dec 22.

National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

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.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4122830PMC
October 2011

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

Arch Iran Med 2011 May;14(3):183-7

Tobacco Prevention and Control Research Center, Masih Daneshvari Hospital, Shaheed Beheshti Medical Science University, Tehran, Iran.

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.  
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http://dx.doi.org/011143/AIM.008DOI Listing
May 2011

Pattern of Tobacco Consumption among TB Patients in a Tuberculosis Referral Center.

Tanaffos 2011 ;10(2):50-5

Tobacco Prevention and Control Research Center, NRITLD,Shahid Beheshti University of Medical Sciecnes, Tehran-Iran.

Background: Tuberculosis (TB) is among the major causes of illness and death worldwide, especially in Asia and Africa. On the other hand, tobacco use is the most important preventable and the second biggest cause of death throughout the world. Smoking is associated with recurrent tuberculosis and its related mortality. Also, it could affect clinical manifestations, bacteriological conversion and outcome of treatment. This study aimed to evaluate the pattern of tobacco smoking, history of previous quit attempts, and attitude towards quitting in tuberculosis patients.

Materials And Methods: It was a cross-sectional study done amongst pulmonary TB patients presented to Masih Daneshvari Hospital. Two hundred patients entered the study as "First Come First Serve". Self-reported questionnaires were designed according to the standard questionnaires of smoking pattern.

Results: A total of 93.5% were males. The mean age was 39.8±1.73 yrs. Thirty-four percent of them were current smokers at the time of interview, 7.5% were occasional smokers and 28% of smoker patients had a history of at least one quit attempt.

Conclusion: Considering the prevalence of smoking in TB patients, evaluation of tobacco smoking status in such patients and motivating them to quit smoking could be considered as important steps in their treatment process.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4153150PMC
September 2014