Hazards of cigarettes, smokeless tobacco and waterpipe in a Middle Eastern Population: a Cohort Study of 50 000 individuals from Iran

Abstract

Background There is limited information about the hazards of cigarettes, smokeless tobacco, and waterpipe in the Middle East. The aim of this study was to determine the association between different types of tobacco use and earlier death in the Golestan Cohort Study. Methods The Study includes 50,045 adults (aged 40–75) from northeastern Iran. The baseline questionnaire (2004–2008) assessed information about use of cigarettes, chewing tobacco (nass), and waterpipe. To assess the use of each type of tobacco compared with never tobacco users, we used Cox regression models adjusted for age, socioeconomic status, area of residence, education, and other tobacco used, and stratified by sex, ethnicity, and opium use. Results 17% of participants reported a history of cigarette smoking, 7.5% chewing tobacco (nass), and 1.1% smoking waterpipe, and these figures declined in the later birth cohorts. During a median follow-up of 8 years, 4,524 deaths occurred (mean age 64.8±9.9 years). Current (HR=1.44; 95%CI: 1.28–1.61) and former (HR=1.35; 95%CI: 1.16–1.56) cigarette smokers had higher overall mortality relative to never tobacco users. The highest cigarette-associated risk was for cancer death among current heavy smokers (HR=2.32; 95%CI: 1.66–3.24). Current nass chewing was associated with overall mortality (HR=1.16; 95%CI: 1.01–1.34), and there was a 61% higher risk of cancer death in people chewing nass more than 5 times a day. We observed an association between the cumulative lifetime waterpipe use (waterpipe-years>=28) and both overall (HR=1.66; 95%CI: 1.11–2.47), and cancer mortality (HR=2.82; 95%CI: 1.30–6.11). Conclusions Regular use of cigarettes, smokeless tobacco and waterpipe were associated with the risk of earlier death (particularly from cancer) in our cohort.

A prospective study of tea drinking temperature and risk of esophageal squamous cell carcinoma

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“…In analysis of the combined effects of measured temperature and amount, drinking 700 mL/day tea or more at ≥60°C was associated with about 90% higher risk of ESCC. Since in this study cigarette smoking prevalence was relatively low (particularly in women) and alcohol consumption was negligible, there would be minimal residual confounding from smoking and alcohol, which could be a problem in other studies.…”

The incidence and mortality of cancer in Eastern Mediterranean Regional Office (EMRO) and its relationship with Human Development Index (HDI): An Ecological Study

“…Studies reported the tobacco, inappropriate nutritional regimen, Body Mass Index, occupational dangers, and weather contamination as the cancer determinants in East-Mediterranean region [26][27]. The lung cancer was reported as the third cause of mortality in East-Mediterranean region in which tobacco usage was indicated as the main risk factor of it [28][29]. Inappropriate life style and physical inactivity were reported as the main causes of colorectal cancer [30].…”

Molecular and health effects in the upper respiratory tract associated with tobacco smoking other than cigarettes

“…A similar study in Middle Eastern Populations including 50,000 cohort members provided information on the association of cancer mortality with cumulative lifetime water‐pipe use. Water‐pipes were associated with the risk of earlier death . The study on esophageal squamous cell carcinoma (702 cases) in Kashmir, India established an association with water‐pipe smoking .…”