Geographical Patterns And Time Trends In Prevalence Of Cigarette Smoking And Water-Pipe Use In Iran: Analysis Of Pooled Data Of Six Consecutive Rounds Of National Survey, 2004-2011

Ali RAFEI, Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Iran

1 Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
2 Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran

PURPOSE: To estimate the prevalence of daily use of tobacco products including cigarette and water-pipe in Iran, and to investigate the geographical patterns and time trends of tobacco use in Iran.
METHODS: We pooled the data of six consecutive rounds of STEPS survey in Iran from 2004 to 2011, to obtain a representative sample of about 4,000 Iranian adults aged 15-64 years for each province (30 provinces). Complex sample survey analysis was utilized to estimate percentages with daily cigarette smoking, daily use of water-pipe, and dual use of the products over the years of study at both national and province levels by gender, residential area, and age-groups. We also employed a multiple logistic regression model to estimate Odds Ratio (OR) and 95%CIs to evaluate the trends over time.
RESULTS: The total prevalence of cigarette-only smokers, water-pipe-only users, and dual smokers were estimated 10.7%, 2.2%, and 0.4% in Iran, respectively. The prevalence of the daily use of water-pipe significantly decreased from 2004 to 2011 (OR=0.9; P<0.0001). For cigarette smoking, no significant trend was observed over the years of study (OR=1.0; P=0.898). The prevalence of daily cigarette smoking ranged from 6.3% in Bushehr province in the southern Iran to 14.6% in West Azerbaijan province in the northwestern part of the country. In addition, the percentage with daily use of water-pipe ranged from 0.6% in Ilam province in the western part of Iran to 12.4% in Bushehr in the southern Iran.
CONCLUSION: We used national data and conducted a large study and reported pattern of tobacco consumption in overall and by type of tobacco use in Iran. Geographical pattern of smoking was opposite to the pattern of water-pipe consumption. Research is needed to evaluate health impact of waterpipe use in Iran, in particular, in the high prevalence provinces.