Persistent use of hookah smoking among Iranian women: A qualitative study.

INTRODUCTION: Hookah smoking is the most common method of tobacco smoking among Iranian women and its rate has significantly increased over the past few decades. This study aimed to explore reasons behind persistent use of hookah smoking among Iranian women. METHODS: This qualitative study was conducted from December 2014 to March 2016. Participants were 38 Iranian women living in Tehran, the capital of Iran. They were hookah smokers at the time of this study or at least had a history of its use. Data were collected using semi-structured face-to-face interviews and were analyzed using the qualitative content analysis method. RESULTS: The main factors for persistent use of hookah smoking from the perspective of women were entertainment, a pretext to gather with old friends and family members, and a method for the creation of social networks. Hookah smoking has been described as entertainment and fun. CONCLUSIONS: Strategies aimed to curb the social issue of hookah smoking by women need to focus on the provision of appropriate entertainment methods with the consideration of advantages, such as gathering with friends and family members and consolidating relationships.

Experiences of Cigarette Smoking among Iranian Educated Women: A Qualitative Study.

BACKGROUND: Smoking is a well-known public health problem in women as well as men. In many countries including Iran, there is an increase in tobacco use among women. Exploring the experience of smoking by educated women in order to develop effective tobacco prevention programs in these women is necessary. This study aimed to explore the experiences of smoking among Iranian educated women. METHODS: This study used a method of qualitative content analysis with the deep individual, semi-structured interviews on a sample of 14 educated female smokers, selected purposefully. Data were analyzed using qualitative content analysis with conventional approach while being collected. RESULTS: The data analysis led to 16 subcategories which were divided into four main categories: (1) Personal factors including subcategories of imitation, show-off and independence, inexperience and curiosity, personal interest and desire, improved mood, and social defiance; (2) family factors including smokers in the family, intrafamily conflicts, and family strictures and limitations; (3) social factors including subcategories of effects of work and school environment, gender equality symbols, peer pressure, and acceptance among friends; and (4) negative consequences of smoking including subcategories of a sense of being physically hurt, psychological and emotional stress, and being looked upon in a negative and judgmental manner. CONCLUSIONS: The findings of this study showed that smoking among Iranian educated women is a multifactorial problem. Thus, it is necessary to address smoking among educated women in a holistic approach that focuses on different determinants including personal, family, and social factors particularly the gender roles and stereotypes.

Risk and protective profile of tobacco and alcohol use among Iranian adolescents: a population- based study.

BACKGROUND: Identification of risk and protective factors is of great importance in designing preventive and interventional programs. The aim of the present study has been to investigate peer/individual, family, school, and community risk and protective factors as predictors of tobacco and alcohol use among Iranian adolescents. METHODS: In a cross-sectional population-based study, 870 Iranian adolescents aged 15-18 years old, filled out the adopted form of "Communities That Care Youth Survey". Thirty-two risk and protective factors were entered in adjusted logistic regression analyses to predict the lifetime cigarette and alcohol use. RESULTS: Sixteen risk and seven protective factors predicted both lifetime cigarette and alcohol use in the bivariate logistic regression analysis. In the multivariate logistic regression analysis 12 risk factors including friends' use of drugs, interaction with antisocial peers, sensation seeking, intention to use, perceived risks of drug use, family history of drug use, poor family management, parental attitudes favorable toward drug use, family conflict, academic failure, school low commitment, perceived availability of drugs predicted both lifetime cigarette and alcohol use as well as four protective factors including religiosity, self-esteem, family rewards for prosocial involvement, and school rewards for prosocial involvement. The highest OR were related to the risk factor of "Rewards for antisocial involvement" [3.9(1.5-10)], and protective factor of "Religiosity" [0.1(0.1-0.3)]. CONCLUSION: The present study has produced evidences about risk and protective factors related to adolescents substance use and can help designing and implementing of preventive interventions for maintaining and promoting adolescents health.

Psycho-social Needs Impact on Hookah Smoking Initiation among Women: A Qualitative Study from Iran.

BACKGROUND: In Iranian women, the use of hookah is the most common method of tobacco smoking. This study aimed to find the role of psycho-social needs and gaps as a possible risk factor for hookah smoking initiation in women. METHODS: This qualitative study was conducted during 2012-2013 in Tehran, Iran. Thirty-six women participated in the study. They were current or former users of hookah. Data were collected through in-depth individual interviews and was analyzed through content analysis. RESULTS: Four main categories were identified from the data. This study focused on the category: Psycho-social needs and gaps. This category has five sub-categories which explain why women begin to smoke hookah including curiosity; desire for non-feminine, forbidden, and negative activities; need for amusement and recreation; for others: To show off; attract attention; satisfy and join others and protection. CONCLUSIONS: From this study, a variety of factors which contribute to the initiation of hookah smoking among women have been identified. Keeping young girls and women away from seemingly happy gatherings of hookah smokers; Providing appropriate recreational facilities for young women and training families on how to help their children in the event of a crisis-like intention to take up smoking behavior, can be some effective ways for reducing hookah smoking initiation among women.

The Role of Family on Hookah Smoking Initiation in Women: A Qualitative Study.

Hookah smoking has recently emerged as a popular alternative to cigarette smoking particularly among young adults and women. This study focused on the role of family members' smoking behaviours as a possible risk factor for initiation of hookah smoking in women. 36 in-depth interviews were conducted with Iranian women of diverse ages for understanding the factors contributing to the initiation of hookah smoking. Four main themes were identified from the data. This study focused on the role of family as a facilitator for hookah smoking initiation. The results of this study indicate that the entry of hookah into homes can be effective in the spread of hookah smoking among adult and young women, in three ways: Girls' participation in the preparation of hookah and the frequent observation of people who smoke hookah at home can be effective in hookah smoking initiation among young girls; the husband of a young woman has an important role in the initiation of smoking hookah; when parents invite children to smoke hookah at home, in order to protect them against public censure, the mother (a middle aged woman) may intend to start smoking hookah. Therefore, tobacco use prevention interventions should be focused on targeting the family as well.

Factors that Contribute in the First Hookah Smoking Trial by Women: A Qualitative Study from Iran.

BACKGROUND: Hookah smoking is growing in popularity especially among women but little is known about the determinants influencing on hookah smoking initiation. In order to address this emerging health risk, a qualitative study was conducted to explore the factors that contribute in the first hookah smoking trial by women. METHODS: This qualitative study was conducted during 2012 to 2013 in Tehran, Iran. Participants were recruited to represent diversity in smoking status, ethnicity, age groups and residence. Data was collected through in-depth individual interviews and was analyzed through content analysis. RESULTS: Four main themes were identified from the qualitative data including: Positive attitude toward hookah smoking; Social and family facilitators; Psychosocial needs and gaps and Sensory characteristic of hookah. CONCLUSION: From this study, a variety of factors which contribute to the initiation of hookah smoking among women have been identified. Since one of the major causes of increased hookah smoking may be its ordinary use, all factors causing the ordinary use should be eliminated, and efforts should be made in opposition to hookah smoking promotions.

The effects of secondhand smoke exposure on infant growth: a prospective cohort study.

Mother's and infant exposure to cigarette smoke is one of the most important public health problems. There is no study in Iran evaluating the impact of cigarette smoke on infant growth and development. The purpose of this study was to determine the effects of cigarette. This prospective cohort study was conducted on 51 cigarette smoke-exposed infants (exposed group) and 51 non-exposed infants (non-exposed group). They were evaluated for weight, height and head circumference three times; five to seven days, two months and four months after birth. Urine samples were also collected in each turn. Exposure to secondhand smoke was assessed through questionnaires and urinary cotinine levels. The analysis was performed using an independent t-test, Mann-Whitney U test, chi-square and Fisher's exact and Kappa tests. Mean urinary cotinine level in the exposed group was 38.57±2.85 ng/mg creatinine at baseline, 86.95±1.16 at two months and 63.32±2.08 at four months of age. These indicated a gradual reduction of exposure from two to four months. The weight and height of the exposed group were significantly lower than the non-exposed group (P< 0.001) at two and four months after birth. The results of the present study showed that the exposure to secondhand smoke during infancy may lead to weight and height growth reduction in the first four months of life.

A population-based study of health-promoting behaviors and their predictors in Iranian women of reproductive age.

Health-promoting behaviors have been recognized as major factors for maintenance and improvement of health. The objective of this study was to determine the status of health-promoting behaviors and their predicting factors in Iranian women of reproductive age. This was a population-based cross-sectional study in which 1359 Iranian women of reproductive age were selected by proportional random multistage cluster sampling in Tehran. Questionnaires including sociodemographic characteristics, Health-Promoting Lifestyle Profile-II (HPLP-II) and Personal Resource Questionnaire 85-Part 2 (PRQ85-Part 2) were completed by interview. The association between the dependent variables (HPLP-II and subscales) and the independent variables (social support and sociodemographic characteristics) was analyzed using the multivariable linear regression model. Among the six dimensions of health-promoting behaviors, women scored highest in interpersonal relations (3.08 ± 0.51) and lowest in physical activity (2.04 ± 0.64). The Pearson test indicated perceived social support to be significantly correlated with HPLP-II (r = 0.53; p < 0.001) and all its subscales (r = 0.12-0.60; p < 0.001). Multivariable regression analysis indicated social support to be a predictor of HPLP-II and all its subscales, except for physical activity. Social support and sociodemographic characteristics accounted for 29.8% of the variance in the HPLP-II score and 6.9-39.3 in the six subscales. The findings of the present study confirm the importance of social support and modifiable variables (sociodemographic) in the occurrence of health-promoting behaviors in women and accredit the theoretical relationships among the concepts of the health-promotion model.

Family and peer risk factors as predictors of lifetime tobacco use among Iranian adolescents: gender similarities and differences.

INTRODUCTION: Family and peer risk factors are considered as important predictors of tobacco use in adolescents. Furthermore, information regarding gender differences in lifetime tobacco use of adolescents is essential for designing gender-specific tobacco prevention policies. METHODS: In a cross-sectional population-based study, 870 Iranian adolescents (430 boys and 436 girls) aged 15-18 years old, filled out the adopted form of "Communities That Care Youth Survey". Four family and two peer risk factors were entered in adjusted logistic regression analyses to predict the lifetime tobacco use (cigarette and smokeless tobacco) in boys and girls, separately. RESULTS: Boys reported higher prevalence of lifetime cigarettes use compared to girls (22.8% vs. 17.8%, p = 0.04). However, the prevalence of lifetime smokeless tobacco use in girls was the same as boys, even slightly higher (7.9% vs. 7.1%, P=0.5). "Family history of drug use" and "Friends use of drugs" were common risk factors predicting cigarettes and smokeless tobacco use between both genders. On the other hand, other family risk factors included "Poor family management", "Parental attitude favorable toward drug use" and "Family conflict" were the predictors of lifetime tobacco use only in girls, but not in boys. CONCLUSION: Design and implementation of preventative programs for adolescents tobacco use should be conducted with emphasis on the role of smoker parents at home, and friendship with substance user peers with antisocial behaviors. It seems that family risk factors may have more value in prevention of tobacco use in female adolescents.

The effects of maternal passive smoking on maternal milk lipid.

Passive smoking was long overlooked by those in the medical and legal professions as being harmful to one's health, but in recent years the negative effect of passive smoking has come to the fore in the media and laws have been changed so that less people are obliged to unwillingly suffer from passive smoking, particularly in the workplace and in indoor settings. To study the effects of environmental tobacco smoking exposure during the breast-feeding period on maternal milk lipids. This cohort study was conducted on 45 mothers environmental tobacco smoking exposure and 40 non-exposed post-partum mothers referred to the Shahid Ayat health center, Tehran, Iran. Socioeconomic conditions and the demographic characteristics of exposed and non-exposed groups were recorded. Milk samples were collected twice--at baseline (5-7 days after delivery) and four months after delivery. The samples were reserved at -20°C until assay. Milk lipids including cholesterol, triglyceride (TG), high density lipoprotein (HDL) and low density lipoprotein (LDL) were evaluated. Dietary intake assessment was performed by means of the 24-hour dietary recall questionnaire both times. Maternal occupation status and education levels were significantly different between the two groups. Lipids profiles of milk were significantly higher 5-7 days after delivery in the non-exposed group and four months after delivery. Dietary intake was not significantly different between the two groups. Maternal environmental tobacco smoking exposure affects milk lipids which are essential for infant growth.

Alcohol and drug use prevalence and factors associated with the experience of alcohol use in Iranian adolescents.

BACKGROUND: Alcohol and other drugs use is a problem among adolescents leading to numerous physical, social, and educational damages. OBJECTIVE: For determining the prevalence of alcohol and other substance use as well as the factors associated with the experience of alcohol use in adolescents. PATIENTS AND METHODS: This is a population-based and cross-sectional study, which was conducted in August 2010 on adolescents aged 15-18 years in Tehran. Data were collected by a Youth Risk Behavior Surveillance System (YRBSS) in 1,201 adolescents. The multistage cluster sampling method was used. Questions belonging to the domain of alcohol and other substance use were analyzed. RESULTS: In general, 15.1% of adolescents had experienced alcohol, which is significantly higher in boys (21.9%) compared to girls (8.4%) (P = 0.000). 3.1% of adolescents had experience using opium and marijuana. 5.6% had used ecstasy. The results of multivariate logistic regression indicated that low parental control rather than medium control [AOR: 0.09], lifetime cigarette use [AOR: 10.41], having a tobacco user friend [AOR: 4.36], and having an alcohol user friend [AOR: 5.84] are factors that are significantly related to the experience of alcohol use in female adolescents. In addition, studying in private schools rather than public schools [AOR: 3.46], lifetime cigarette use [AOR: 3.41], lifetime water pipe use [AOR: 4.43], experience of sexual activity [AOR: 8.52], having an alcohol user friend [AOR: 12.60], and having a water pipe user in family [AOR: 2.98] are factors that are significantly related to the experience of alcohol use in male adolescents. CONCLUSIONS: We recommend interventional plans based gender aimed at improving adolescent health with regard substance abuse.

Personal and Family Factors Affecting Life time Cigarette Smoking Among Adolescents in Tehran (Iran): A Community Based Study.

OBJECTIVES: The prevalence of smoking among adolescents varies in different parts of the world. The current study aims to survey the socio-demographic and family characteristics related to adolescent lifetime cigarette smoking among 1201 Iranian adolescents aged 15-18 years old. METHODS: This study is a population-based cross-sectional survey conducted using the multistage random cluster sampling method in Tehran, Iran in the summer of 2010. RESULTS: The prevalence of lifetime cigarette use amongst boys (30.2%) was about 1.5 times that of girls (22.2%), (p=0.002). Older age, low parental control, very little parental supervision in the adolescent's selection of friends, and having a friend or family member who smokes were associated with lifetime cigarette use among male adolescents. Moreover, the use of verbal punishment by the parents was a protective factor for female lifetime cigarette use. Smoking has become one of the great health threats among Iranian adolescents. CONCLUSIONS: As a result, health promotion programs should be gender based whilst educational and interventional programs for preventing tobacco use should begin before adolescence.

The effect of cigarette smoke exposure on vitamin D level and biochemical parameters of mothers and neonates.

BACKGROUND: Exposure to cigarette smoke during pregnancy leads to several adverse effects on mother and child. The purpose of this study was to evaluate the effect of being a passive smoker during pregnancy on vitamin D level and related biochemical indices including parathyroid hormone, calcium, phosphorus and alkaline phosphatase in mothers and newborns. METHODS: One hundred eight pregnant women and their newborns participated in a historical cohort study in two equal groups (n = 54) with and without cigarette smoke exposure. Maternal blood and urine samples and blood samples of umbilical cord were obtained in the delivery room. Concentration of 25-hydroxy vitamin D and related biochemical indices in samples of maternal and cord blood were investigated. Exposure to cigarette smoke was evaluated through questionnaire and maternal urine and umbilical cord serum cotinine levels. RESULTS: The mean level of 25-hydroxyvitamin D in maternal serum was 9.28 ± 5.19 ng/mlin exposed and 10.75 ± 5.26 ng/ml in non-exposed group(p > 0.05). The mean concentration of 25-hydroxy vitamin D in cord serum was 10.83 ± 6.68 ng/ml in the exposed and 11.05 ± 4.99 ng/ml in the non-exposed group(p > 0.05). The exposed mothers had significantly higher parathyroid hormone level (p = 0.013), lower serum calcium (p = 0.024) and higher serum alkaline phosphatase (p = 0.024). There was a significant correlation between maternal and umbilical cord serum 25-hydroxyvitamin D within both exposed and non-exposed groups (p < 0.001). CONCLUSION: Maternal exposure to cigarette smoking during pregnancy negatively influences serum calcium level and increase parathyroid hormone and alkaline phosphatase in mothers.

Sociodemographic Characteristics and Secondhand Smoke Exposure among Women.

BACKGROUND: Exposure to secondhand cigarette smoke is an important health hazard. This study was designed to assess the sociodemographic risk factors related to women's exposure to secondhand smoke. MATERIALS AND METHODS: A case-control analysis of data collected as part of a prospective cohort study was conducted. Participants were 340 female Tehran residents exposed to cigarette smoke. Women consented to participate in this study and completed a questionnaire containing socio-demographic characteristics, household characteristics and smoking status at home through a face-to-face interview. Factors related to women's exposure to secondhand smoke were assessed using the multivariate logistic regression model. RESULTS: The final multivariate logistic regression model showed that lower levels of education (p = 0.002) and social class (p = 0.03) increase the risk of exposure to secondhand smoke in women. CONCLUSION: These results support the effect of women's educational level and social class on their exposure to secondhand smoke.

The experiences of women of reproductive age regarding health-promoting behaviours: a qualitative study.

BACKGROUND: Health promotion is critical for community and family health. Health-promoting behaviours provide solutions for maintaining and promoting health. Although several studies have addressed the frequency and different types of health-promoting behaviours in women, little information is available about their experiences. This study aimed to explore the experiences of women of reproductive age regarding health-promoting behaviours. METHODS: In the present study, which was conducted in Tehran, Iran, 15 females, who were selected purposefully, participated in individual in-depth, semi-structured interviews. The interviews were recorded, transcribed verbatim, and analysed using conventional content analysis. RESULTS: Nine main categories were derived from the analysis, including establishing an appropriate eating pattern, establishing a balanced rest/activity pattern, spirituality, stress management, personal sensitivity and responsibility, establishing an appropriate pattern of social interactions, practicing safe and healthy recreations, feeling improvement in physical-functional health, and feeling improvement in emotional and psychological health. The first 7 categories represent the nature and types of real health-promoting behaviours in women of reproductive age, whereas the last 2 constitute feeling and understanding of the implementation of these behaviours. CONCLUSION: The study findings show that the women experience improvement in physical-functional, emotional, and psychological health by implementing health-promoting behaviours. It is therefore necessary to introduce strategies in the context of the community culture for improving different aspects of health-promoting behaviours in women of reproductive age to maintain and improve their overall health.

Prevalence of water pipe use and its correlates in Iranian women of reproductive age in Tehran: a population-based study.

OBJECTIVE: The objective of this study was to determine the prevalence of water pipe smoking and its associated sociodemographic factors among Iranian women of reproductive age in Tehran. SUBJECTS AND METHODS: This was a population-based cross-sectional study of 1,359 Iranian women aged 15-49 years. The multistage random cluster technique was used to obtain the sample. Questionnaire-based interviews with questions relating to water pipe smoking and sociodemographic variables were used to collect the data. The multivariate logistic regression model was used to analyse the relationships between the dependent variable (water pipe smoking) and the independent variables (sociodemographic characteristics). RESULTS: The prevalence of water pipe smoking was 6.3% among Iranian women. Water pipe smoking was more likely in the age range of 15-24 years [odds ratio (OR) = 4.8, 95% confidence interval (95% CI) = 2.7-8.6] compared to the age range of 35 years or older, in women with a university education (OR = 1.9, 95% CI = 1.3-3.0) compared to women with a high-school diploma or lower, and in women with an average crowding index score (OR = 4.7, 95% CI = 2.1-10.6) compared to women living in small families. CONCLUSION: The findings of this study show that Iranian women with a university education and the younger age group (15-24 years) were at most risk of water pipe smoking. The findings of this study about associated factors may contribute to the development of efficient health promotion programmes for the prevention and cessation of water pipe smoking.

Association of self-reported passive smoking in pregnant women with cotinine level of maternal urine and umbilical cord blood at delivery.

Passive smoking during pregnancy leads to adverse effects on mother and infant. The present investigation was designed to evaluate the association between maternal reported passive smoking with the cotinine concentration of maternal urine and umbilical cord blood at delivery and to determine the accuracy of maternal reporting of exposure to cigarette smoke during pregnancy. This was a cross-sectional study. From the 108 non-smoker pregnant women who were referred for delivery, 54 were passive smokers. Urine samples were collected from the mothers in the delivery room and blood samples after birth were taken from the umbilical cord. Passive smoking was evaluated through questionnaire and cotinine level of urine and umbilical cord blood. The geometric mean cotinine concentration of the maternal urine and the umbilical cord serum were, respectively, 27.4 ± 29.96 ng/mL and 3.71 ± 1.22 ng/mL in the exposed group (P < 0.001) and 0.75 ± 2.29 and 0.40 ± 0.63 in the non-exposed group (P < 0.001). There was a statistically significant correlation between maternal urinary and umbilical cord serum level of cotinine (P < 0.001, r = 0.58). Significant associations were shown between maternal reports of exposure to cigarette smoking with cotinine level of urine (kappa = 96%) and umbilical cord (kappa = 98%) (P < 0.001). This study shows that the pregnant woman's report of passive smoking during pregnancy in Iran is accurate. The questionnaire is an appropriate method to evaluate smoke exposure and could replace cotinine measurement.

Reduction of secondhand smoke exposure among healthy infants in Iran: randomized controlled trial.

INTRODUCTION: The objective of this study was to assess whether counseling both mothers and fathers reduces their infants' exposure to secondhand smoke (SHS). METHODS: Participants were 130 nonsmoking children aged less than 1 year, exposed to their fathers' or mothers' smoking, and recruited from a health center in southern Tehran. Eligible families were randomly assigned to intervention or control group. Infant urine samples were collected, and parents were interviewed at baseline and at a 3-month follow-up in each of the 2 groups. Mothers of the intervention group were provided 3 counseling sessions, one of which was face to face and 2 of which were by telephone. Fathers were provided 3 counseling sessions by telephone. Parents were also given an educational pamphlet and a sticker depicting a smoke-free home. The control group received usual care. Changes in infant urinary cotinine levels, parental cigarette consumption in the presence of the child, and home- and car-smoking bans were assessed. RESULTS: The intervention was effective in reducing infant urinary cotinine levels (1-tailed p = .029). There was a greater decrease in the total daily cigarette consumption in the presence of the child in the intervention group compared with the control group, and the differences between the 2 groups were statistically significant (1-tailed p = .03). While the differences between home-smoking bans in the 2 groups were statistically significant (1-tailed p = .049), the differences between car-smoking bans did not reach significance. CONCLUSION: Counseling similar to that employed in other countries can reduce infant exposure to SHS, suggesting generalizability.

Violence-related behaviors and self-inflicted injuries among 15-18 year old Iranian adolescents.

In this population-based cross-sectional study, we determined the prevalence of intentional injuries and associated factors among 1201 adolescents in Tehran, Iran. Overall, 63.9% of adolescents had at least one intentional injury behavior which was significantly higher in males. Gender preference for males by parents, very high or very low supervision, waterpipe smoking, and alcohol consumption were significantly associated with injuries in females. In addition, poor wealth index, parental punishment and smoking were incriminating factors in males.

Bone mineral density, body mass index and cigarette smoking among Iranian women: implications for prevention.

BACKGROUND: While risk factors of osteoporosis in Western populations have been extensively documented, such a profile has not been well studied in Caucasians of non-European origin. This study was designed to estimate the modifiable distribution and determinants of bone mineral density (BMD) among Iranian women in Australia. METHODS: Ninety women aged 35 years and older completed a questionnaire on socio-demographic and lifestyle factors. BMD was measured at the lumbar spine (LS) and femoral neck (FN) using DXA (GE Lunar, WI, USA), and was expressed in g/cm2 as well as T-score. RESULTS: In multiple regression analysis, advancing age, lower body mass index (BMI), and smoking were independently associated with LS and FN BMD, with the 3 factors collectively accounting for 30% and 38% variance of LS and FN BMD, respectively. LS and FN BMD in smokers was 8% lower than that in non-smokers. Further analysis of interaction between BMI and smoking revealed that the effect of smoking was only observed in the obese group (p = 0.029 for LSBMD and p = 0.007 for FNBMD), but not in the overweight and normal groups. Using T-scores from two bone sites the prevalence of osteoporosis (T-scores