ARTICLE INFO

Article Type

Descriptive & Survey Study

Authors

Chenary   R. (*1)
Saeedfiroozabadi   M. (2)
Shirmohammadi-Khorram   N. (3)






(*1) Department of Health Education, Faculty of Health, Hamadan University of Medical Sciences, Hamadan, Iran
(2) The Persian Gulf Biomedical Sciences Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran
(3) Biostatistics Department, School of Health, Hamadan University of Medical Sciences, Hamadan, Iran

Correspondence

Article History

Received:  February  29, 2020
Accepted:  April 21, 2020
ePublished:  September 20, 2020

BRIEF TEXT


According to various studies, many factors increase smoking, and understanding the patterns of increase in these behaviors is important for designing prevention policies and programs.

… [1-14]. According to various studies, many factors increase drug use, including poor economic conditions, low levels of education, availability of drugs, etc. It is important to understand the patterns of increasing these behaviors to determine more effective prevention policies and plans. Therefore, in epidemiological studies, before designing interventions, factors affecting high-risk behaviors (such as smoking cigarette and water pipe) are identified [15].

The aim of the present study was to investigate the nicotine dependence status and related demographic patterns in cigarette and water pipe consumers in Bushehr city.

This research was a cross-sectional descriptive-analytic study.

In this study, 366 people smoking cigarette and water pipe in Bushehr city in 2017 were selected by convenience sampling method.

The minimum sample size was 300 people using the available sampling method, which increased to 366 people considering possible attrition of 20%.

Data collection tools included the Nicotine Dependence Syndrome Scale (NDSS) and the demographic information questionnaire (age, sex, marital status, level of education, type of use, duration of use, frequency of use, and intention to quit) which was completed by a self-report method. Using multivariate logistic regression models, the relationship between demographic characteristics and nicotine dependence was investigated. SPSS 23 software was used for data analysis.

Out of 366 people who used water pipe and cigarettes, 259 were men and 107 were women. The mean age of cases was 37.33 ±14.11 years and their mean duration of use was 15.53 ± 13.15 years. Also, the average number of cigarettes smoked per day was 6.72 ± 9.06 and the number of water pipes used was 1.61 ±1.85 (Table 1).The mean total score of nicotine dependence was 46.81 ±11.18. Also, the mean score of subscales of nicotine dependence was as follows: motivation: 10.70 ± 4.26, priority: 5.7 ±2.80, tolerance: 6.87 ± 2.51, continuity: 7.80 ± 2.67, and stereotypic behaviors: 16.35 ± 4.45. In terms of the severity of nicotine dependence, 1.4% had very low dependence, 21.7% had mild dependence, 61.8% had moderate dependence, 14.5% had high dependence and 0.6% had very high dependence. In order to validate the results, due to the small number of people in some nicotine addiction severity categories, the frequency of people in very low dependency classes was combined with mild dependence as well as high dependence and very high dependence. Also, the severity of nicotine dependence was examined at three levels: mild, moderate, and severe. Accordingly, 23.0% of people had mild dependence, 61.7% had moderate dependence, and 15.3% had severe dependence. The variables of age, level of education, and duration of use were significant predictors of nicotine dependence. The regression coefficients of the model for the age of onset of use (p <0.001) indicated that those who started water pipe use at a young age had more dependence. Thus, with increasing the age of the participants, the chance of severity of their nicotine dependence decreases by 94% (odds ratio = 0.943). The severity of nicotine dependence was related to the level of education of the participants, so that the severity of dependence was higher in individuals with below diploma (p <0.001) and diploma (p = 0.022) education and by an increase in the level of education, the severity of nicotine dependence decreased; that is, the chance of people with below diploma education regarding the severity of dependence was 3.49 times higher than those with above diploma education, and the chance of people with diploma education regarding the severity of dependence was 2.37 times higher than those with above diploma education. The regression coefficients of the model for the duration of nicotine use (p <0.001) indicated that with an increase of one year in the participants' duration of use, the chances of their severity of dependence increased by 8%. There was no significant relationship between participants' gender, marital status, type of use, number of daily use, and intention to quit with the severity of nicotine dependence (p> 0.05; Table 2).To determine the demographic predictors of nicotine dependence subscales, the motivation dimension was correlated with participants' education levels; so that the intensity of motivation was higher in people with below diploma and diploma education and with increasing education level, the intensity of motivation decreased by 12% (β = 0.128) and 17% (β = 0.172), respectively. The regression coefficients of the model for the age of onset indicated that people who started water pipe at a young age had a stronger motivation level so that by one year increase in the age of participants, their motivation intensity decreased by 44% (β = -0.447). Also, by one year increase in use, the intensity of motivation increased by 63% (β = 0.635). The priority dimension was correlated with the level of education of the participants so that with increasing the level of education, the priority of consumption increased by 18% (β = 0.181). Also, by one year increase in age, the priority of choosing a place to smoke and water pipe increased by 26% (β = 0.265); that is, people with higher education and older age preferred places, where they could easily smoke cigarette or water pipe. The regression coefficients of the tolerance model for the age of onset indicated that people who started water pipe at a young age had a stronger tolerance level. By one year increase in the age, their tolerance intensity decreased by 35% (β = -0.353). Also, by a year increase in use, the tolerance increased by 24%, i.e. with increasing the duration of consumption, the consumption increased by 24% (β = 0.247). The model regression coefficients regarding the continuity dimension in terms of the age of onset of use indicated that people who started water pipe use at a young age had a stronger level of continuity. Thus, by one year increase in the age, the intensity of continuity decreased by 23% (β = -0.231). Also, by a year increase in use, the continuity increased by 34%, i.e. with increasing the duration of consumption, the regular consumption of cigarettes and water pipe increased by 34% (β = 0.343). The stereotyped behavior was correlated with the participants' duration of consumption so that by one year increase in use, stereotyped behavior increased by 32% (β = 0.325), and in all conditions, they smoked cigarettes and water pipe (Table 3).

… [16-26]. In the study by Pedro et al. [27], smoking was more common among people with lower levels of education. The study by Firoozabadi et al. [28] also confirmed this. The results of a study by King et al. [29] also confirmed that smoking was lower in people with higher education. However, in the study by Gurong et al. [30], literate people smoked more. These discrepancies indicate that the patterns of smoking in different countries and different populations are different, which confirms the need to design strategies to reduce smoking based on demographic and local characteristics. … [31, 32].

It is suggested that purposeful interventions be implemented in educational institutions (especially in secondary schools and high schools).

Another limitation was the lack of cooperation of sample people with the researcher.

Nicotine dependence is moderate among cigarette and water pipe consumers in Bushehr city and people with a lower level of education, a longer duration of use, and the onset of use at a younger age are more strongly dependent on nicotine.

We would like to thank the Vice-Chancellor for Research and Technology of Bushehr University of Medical Sciences and all the people who cooperated with us in conducting this study.

None to declare.

This study was the result of research approved by the Persian Gulf Tropical Medicine Research Center of Bushehr University of Medical Sciences (IR.BPUMS.REC.1396.128).

This study was funded by the Bushehr University of Medical Sciences.

TABLES and CHARTS

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