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Background: In 2008, the World Health Organization (WHO) introduced a package of measures including 6 main policies (MPOWER) to control tobacco use. Aims: This study aimed to perform a quantitative analysis of MPOWER in the WHO regions. Methods: This cross-sectional study collected information in summer 2018 using pages 136-149 of the 2017 MPOWER report and a validated check list with 10 criteria, with a possible maximum score of 37. The scores were summed and presented in descending order for the 6 WHO regions. Results: The highest mean score was recorded by the European Region (26.41), followed by: South-East Asia Region (25), Western Pacific Region (24.88), Region of the Americas (22.05), Eastern Mediterranean Region (21.40) and African Region (17.40). There were significant differences (P < 0.05) in the means. Conclusions: Although many efforts have been made in the Eastern Mediterranean Region, many challenges to policy implementation and enforcement remain compared with other regions, and require urgent action by governments in the Region. Keywords: Eastern Mediterranean Region, MPOWER, policies, tobacco control, tobacco use

Background: Perfect implementation of the six priority policies advocated by the MPOWER package is the most important challenge for member states (MS) to reach tobacco control goals. Methods: A validated checklist set according to the WHO Report on the Global Tobacco Epidemic was filled out five times based on biannual reports from 2011 to 2019 for 22 MS in the Eastern Mediterranean Region. It contained ten topics including smoking prevalence and seven elements of six MPOWER policies and compliances resulting with possible maximum score of 37. High score indicates better implementation. Results: The total score for the region increased from 416 in 2011 to 509 in 2019. Six countries (27% of the region) had more than 75% of total score, whereas 11 countries were between 50% and 75% and five countries had <50% of total score in 2019. In all five reports, Iran was ranked first in the region even in 2019, when it witnessed a 2 point decrease. Iran held the first place alongside with Pakistan and Saudi Arabia with 32 points. The highest score in the indicators was related to the monitoring, reaching from 35 in 2011 to 59 in 2019. The lowest score increase in the indicators was related to the Smoke-free Policy compliance and the prevalence of consumption, reaching from 18 to 20 and 44-48, respectively, between 2011 and 2019. Conclusions: Although several remarkable achievements have been made regarding tobacco control goals, many policy implementation challenges remain and require urgent action by member states in the Eastern Mediterranean region.

Background: Iran and Iraq are the two main target markets for tobacco smuggling in the Eastern Mediterranean Region. Tow cigarette pack survey in Tehran, were done in 2009 and 2015 which were showed that illicit cigarettes used rate were 20.9% and 15.4% respectively. We designed this study to update trends in the illicit cigarette trade in Tehran. Methods: A cross-sectional study of 2331 smokers aged 15 years and over was conducted in Tehran in January 2018. The sampling method was the same as previous studies. Smokers were asked to show the interviewers their current pack of cigarettes, which was categorised as either: (1) legal cigarettes: displaying governmental pictorial warning and hologram or (2) illegal cigarettes: with no governmental labeling. The packs were also categorised as either domestic (a Persian brand name) or foreign (a foreign brand name). Results: The sample included 1827 males (78.3%) and had a mean age of 40.3±12.1 years. In total, 1427 smokers (61.2%) had foreign and 904 (38.8%) had domestic cigarettes; 2072 (88.9%) had legal cigarettes and 259 (11.1%) had smuggled cigarettes. There was a statistically significant difference in the use of smuggled cigarettes and foreign cigarette by younger smokers (36.8±3.1vs 42.9±5.3 years) (p< 0.001). Marlboro was the only smuggled cigarette brand (259 packs; 100%). Discussion: The lower prevalence of illicit cigarettes in Tehran in 2018 compared to previous studies may be due to the control and monitoring on legal cigarettes distribution. All other foreign cigarette brands except Marlboro were imported legally or had legal joint production.

Background: Providing smoking cessation services are special importance to tobacco control programs. To date, Champix is a new expensive medication for smoking cessation available nationally. Champix has both agonist and antagonist activities and can reduce nicotine dependence and withdrawal symptoms. The purpose of this study was to evaluate the duration of using Champix based on its cost. Methods: This quasi-experimental study was conducted with smokers presenting to the Tanaffos Smoking Cessation Clinic in Tehran, Iran 2016. Smokers were visited by a physician 3 times at 1-week intervals for counseling. Smokers started to use Champix and stopped smoking in the 2nd week of counseling and were followed up by phone and through regular visits to the clinic at 1, 3, and 6 months postintervention. Some of them did not continue medication for 12 weeks because of its cost. Results: A total of 227 smokers including 133 males (58%) with a mean age of 43 years were enrolled of whom 116 (51.1%), 89 (43.6%), and 34 (20.6%) had quit smoking after 1, 3, and 6 months, respectively. Quit rates were significantly higher among those who used Champix for more than 6 weeks, and this rate was not correlated with age, sex, educational level, or nicotine dependence. Conclusions: Use of Champix for more than 6 weeks increases the quitting success rate compared with using for a shorter time. The cost of Champix was important for smokers and adding Champix to the list of insurance medication or getting it free of charge is needed.

Background: A report of the MPOWER activities of countries worldwide is published once every two years by the WHO. Our objective was to perform a quantitative analysis of WHO report on tobacco control program in countries and regions to make a simple view of global tobacco control programs and to find best parties on it. Methods: This was a cross-sectional study by filling out a validated check list from the 2015 WHO report (MPOWER). All 10 measures were changed to indicators and getting scores. The scores were entered independently by two individuals and a third party compared the values and confirmed their accuracy. The scores were summed and presented in a descending order. Results: Fifteen countries, which acquired the highest scores (85% of total 37) included Panama and Turkey with 35, Brazil and Uruguay with 34, Ireland, United Kingdom, Iran, Brunei, Argentina and Costa Rica with 33 and Australia, Nepal, Thailand, Canada and Mauritius with 32 points. Conclusions: These 15 countries may indicate as a best model for other parties in implementation and enforcement of tobacco control program. Comparison of scores of different countries in this respect can be beneficial since it creates a challenge for the health policy makers to find weakness of the tobacco control programs to work on it.

To determine the concentration of particulate matters (PM 2.5 and PM 10 ), 36 samples were collected from indoor/outdoor air of hookah cafés (HS), cigarette cafés (CS), both hookah and cigarette (HCS), and no-smoking building (NS) in Tehran City from December 2017 to March 2018. The mean ± SD of PM 10 concentration in the indoor air of the cafés in terms of HS, CS, HCS, and NS sites has been 702.35, 220.20, 1156.60, and 60.12 μg/m 3 , while for PM 2.5 , the values have been 271.92, 111.80, 619.10, and 22.25 μg/m 3 , respectively. It was also found that the PM concentration inside the cafés was higher during weekend session (with a higher number of active smokers), than during the weekday sessions. Moreover, the PM levels in the indoor air of the cafés were considerably higher than those of the outdoors ( p  < 0.05). Based on path analysis, the number of “active smokers” had the highest influence on production of PM inside the cafés, followed by the tobacco type. Finally, the mean excess lifetime cancer risk (ELCR) for PM 2.5 in the indoor air of cafés was observed in the range of 0.64 × 10 −5 –14.98 × 10 −5 . Also, the mean of hazard quotient (HQ) for PM2.5 and PM 10 was calculated in range of 0.82–18.4 and 0.16–3.28, respectively, which corresponds to an unacceptably high risk for human health. The PM levels in the indoor air of smoking cafés in Tehran are significantly high, such that it can cause serious risks for the health of both the customers and personnel. Thus, it is necessary that suitable controlling strategies be adopted for this public health threat.

Background: Few studies have shown that smokers are more likely than nonsmokers to contract COVID-19, while others report that smokers are underrepresented among those requiring hospital treatment for this illness. This study was designed and implemented for investigating the severity and outcome of COVID-19 based on underlying smoking status. Materials and Methods: This was a case-control study that was implemented in Tehran and Ahvaz with all COVID-19 patients from February to July 2020. Patients were divided into two groups of COVID-19 positive (1044 cases) and negative (1231 controls) randomly based on entrance number. Results: The frequency of smokers in the case group is significantly lower than the control group (15.4% vs. 28%). However, the number of days of hospitalization and the use of more than 3 medications in the group of smokers were significantly higher. A comparison between groups of case and control based on smoking indicates that the death rate was significantly higher in smokers with COVID-19. Conclusions: The results of this study showed that although the number of smokers in COVID-19 patients is significantly lower, smokers run an aggresive curse and have higher mortality.

Background Today, waterpipe (WT) smoking is a rising issue worldwide, and has taken a significant and growing share of tobacco consumption in the world. Present study aimed to explore the predictors of WT cessation in the light of the theory of planned behavior (TPB). Methods This cross-sectional analytical study was conducted in 2021–2022 using a multi-stratified cluster sampling on 1,764 women in Bandar Abbas, southern Iran. Data were collected through a reliable and valid questionnaire. The three-part questionnaire includes demographic information, behavioral information of WT smoking, and the constructs of the TPB along with an additional habit construct. Multivariate logistic regression analysis was run to model the predictor constructs of WT smoking. The data were analyzed statistically in STATA14.2. Results With an increase in one attitude score, the odds of cessation increased by 31% ( p  < 0.001). Also, with an increase of one score in knowledge, the odds of cessation are increased by 0.05% (0.008). With an increase of one score for intention, the odds of cessation are 26% (0.000). in social norms, the odds of cessation are 0.02% (0.001). With an increase of one score in perceived control, the odds of cessation increased by 16% (0.000) and inhabit score, the odds of cessation decrease by 37% (0.000). In the model where the habit construct was present, the accuracy, sensitivity, and pseudo R2 indices were 95.69%, 77.31%, and 65%, respectively and after removing the habit construct, the so-called indices changed to 90.7%, 50.38% and 0.44%, respectively. Conclusions The present research confirmed the effectiveness of the TPB model in predicting waterpipe cessation behavior. The knowledge obtained from this research can help develop a systematic and effective intervention to facilitate waterpipe cessation. Focusing on the habit variable can play a critical role in waterpipe cessation in women.

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.

Scenes depicting smoking are among the causes of smoking initiation in youth. The present study was the first in Iran to collect some primary information regarding the presence of smoking scenes in movies and propagation of tobacco use. This cross-sectional study was conducted by polling audience about smoking scenes in Persian movies on theaters in 2011. Data were collected using a questionnaire. A total of 2000 subjects were selected for questioning. The questioning for all movies was carried out 2 weeks after the movie premiered at 4 different times including twice during the week and twice at weekends. A total of 39 movies were selected for further assessment. In general, 2,129 viewers participated in the study. General opinion of 676 subjects (31.8%) was that these movies can lead to initiation or continuation of smoking in viewers. Women significantly thought that these movies can lead to initiation of smoking (37.4% vs. 29%). This belief was stronger among non-smokers as well (33.7% vs. 26%). Despite the prohibition of cigarette advertisements in the mass media and movies, we still witness scenes depicting smoking by the good or bad characters of the movies so more observation in this field is needed.