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Several epidemiological studies have reported that passive smoking (PS) is a public health hazard and perhaps increases the risk of heart disease. This study evaluated the relationship between female coronary heart disease and PS among married women who described themselves as non-smokers in an area of south-east Iran. Using household exposure to tobacco smoke as an estimate of PS, a hospitalbased case-control study of CHD was conducted in Kerman, Iran. We interviewed 200 married female CHD cases, aged 42-84 years (mean [standard error, SE] 60.0 [0.5]) and 400 hospital-based controls aged 42-85 (mean [SE] 60.3 [0.4]). The controls were non-CHD patients, selected from the same hospital as the cases, and matched for marital status and age (±5 years). All of the cases and controls had never smoked. Information on PS was collected for each person. The prevalence of PS at home was 39% for cases and 32.3% for controls. The corresponding prevalence rates for PS at work were 1.5% and 0.8%. Household PS increases the risk of female CHD, but this increase was not statistic all y significant. Compared to non-smokers, exposure to husband's smoking increases the risk by about 40% (odds ratio (OR) 1.40, 95% confidence interval (CI): 0.96-2.05), although no trends were observed with the number of years of exposure. The OR increases with an increase in PS (p<0.05). The odds ratio for PS at work did not suggest an increased risk. The results suggest that passive exposure to cigarette smoke may have a deleterious effect on the health of non-smokers and that married non-smoking women may be at an increased risk of developing CHD through passive exposure to their husband's cigarette smoke.

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Passive smoking (PS), a well-known health risk, is the major source of indoor pollution. There is some inconsistent evidence that PS during pregnancy may increase the risk of low birth weight. The aim of the present study was to determine the effects of PS exposure during pregnancy on weight, length and cranial circumference at birth of babies born to women who have described themselves as nonsmokers, in Kerman, Iran. A random sample of 702 admitted women aged 11 to 50 years [mean (standard deviation) 26.5 (6.1)] who delivered a live full-term singleton baby without apparent malformation during the six consecutive months from June to December 1994 were interviewed on the second day post-partum and asked about smoking in all household members. They comprised about 36.4% of total deliveries in Bahonar Kerman Medical School Hospital during this period. All women were nonsmokers, 278 (39.6%) were passive smokers while 424 (60.4%) were not exposed to tobacco smoke. Potential confounders, including fetal gender, maternal age, parity, weight gain, complications during pregnancy, maternal education, birth interval and gestation were adjusted for by multiple linear regression analysis. Infants born to passive smokers were on the average 22 gr. lighter than those born to nonsmokers, albeit this difference was not statistically significant (p = 0.56) [95% confidence interval (CI): -51, 95.7]. A mean reduction of 0.04 cm [95% CI: -0.19,0.27] in birth length and 0.05 cm [95%CI: -0.12, 0.22) in cranial circumference was found. In multiple linear regression model, exposure to PS during pregnancy did not show any effect on weight, length and cranial circumference at birth after adjusting for confounding variables.

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Early wound excision and grafting of burn wounds is regarded not only as the method of choice in speeding up the healing process in deep burns, but also limits contracture and infection, On the other hand, smoking has generally been implicated in the delay of the healing process in a variety of surgical procedures, In this study we report the outcome of a cross-sectional study of all the 395 medical records of adult patients who underwent split-thickness auto grafting during a six month period (Sep, 1999 to March 2000) in Taleghani Burn Center, Ahwaz. The subjects, both male and female, who underwent auto grafting for deep burns, were allocated into smoker and nonsmoker groups, The results showed that rejection of the auto grafts was significantly more widespread and more common among cigarette smokers. The extent of rejection was 6.7±0.5% of the graft area as compared to 2,9+0,3% in the control group (p<0,01), The incidence of rejection and successful take was 66.6 and 28.7% respectively among the cigarette smoking group (O.R. 4.95). The reason for the increase in rejection may be due to the toxic constituents in cigarette smoke. We recommend that smokers be encouraged to abstain from smoking prior to and post-burn grafting surgical procedures, which may be a useful preventive measure, Further research in this field is undergoing in order to assess the effectiveness of this recommendation in reducing the incidence of graft rejection.

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Smoking has been shown to be a complicating factor in normal wound healing. Both nicotine and carbon monoxide adversely affect multiple stages of the healing process. From 1991 to 1999,407 muscle flap procedures were performed on 374 patients in a single surgical unit. A retrospective review of 261 patients was completed. Patients were divided into three groups: Group A, no smoking history group B, smokers for at least one year, and group C, active smokers up to the time of surgery. Patients were excluded who had diabetes, had a recurrent malignancy, or used steroids. A total of 261 patients were included in the study. The age, sex, number of patients and primary operative indications were matched in the 3 groups. Active smokers were shown to have a complication rate significantly higher in the immediate post-operative period compared with non-smokers and smokers who had quit. The most common complications were partial muscle necrosis and partial skin graft loss. This series suggests that active smoking at the time of muscle transposition significantly increases the rate of postoperative complications.

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  Abstract

  Background : Noise is the most common hazard in the workplace and noise induced

  hearing loss considered to be the most common occupational disease as well.

  Cigarette smoking, in some studies, has been known to induce hearing loss. The purpose

  of this study was to evaluate the effect of contemporary exposure to occupational

  noise and cigarette smoking on hearing.

  Methods : 478 assembly workers of an automobile plant which were exposed to

  the noise more than TLV (threshold limit value) level included in this study. After

  considering the exclusion criteria, all participants according to the smoking status

  were divided in smoker and nonsmoker groups and compared for hearing impairment.

  Hearing impairment in this study was assessed with the offered method of

  American Academy of Otolaryngology (AAO).

  Results : Of 478 assembly workers, 225 persons were smokers and others non

  smokers. Prevalence of hearing impairment in smokers was significantly higher

  (p<0.001). Hearing impairment had a significant relation with smoking status even

  after adjusting for cofounders like age and duration of work (OR=8.23, 95%

  CI=3.63-18.66).

  Conclusion : The results of this study suggested that cigarette smokers had more

  hearing impairment than non smokers. According to these results we concluded that

  in working environments, especially in noisy ones, workers must be encouraged to

  quit smoking and regular audiometric tests, especially for smokers, must be applied.

  We must consider not only the noise, but indeed all effective elements of hearing impairment

  in working environment that could compromise the hearing.

 

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 Abstract

 Background: Research suggests that factors in the environment are major determinants of health behavior for populations. This cross-sectional study used a combination of quantitative and qualitative data collection methods to determine the prevalence of smoking and identify the possible associations between smoking and environmental variables among school pupils in Iran.

 Methods: A self-reported questionnaire was administrated and collected data from 2200, students15-18 from 100 high schools who agreed to take part in the research. The sample was selected from the Iranian Education System Database using a two-stage cluster sample based on a random sample of schools and pupils as a representative sample of this population. Almost 90% of respondents had completed the questionnaires. Examination of the test-retest answers over all questions among 70 students in two weeks interval revealed reliability coefficient ranges 0.72 to 0.98. The Adjusted Enter Logistic Regression Models were applied to significant variables identified through Chi square tests. In addition, 40 of the sample took part in focus groups exploring the facilitators and barriers to smoking behavior. Content analysis was also used to extract themes from the focus group discussions.

 Results: The effects of social environment variables including peers', mothers', and sisters' smoking on cigarette consumption among young people were explored in this study. Levels of cigarette availability and exposure, effects of parents' attitudes and supervision, legislation on tobacco control, expanding life opportunities and more options for leisure activities perceived as influencing factors on adolescent smoking were all highlighted in the focus group discussions.

 Conclusion: The qualitative and quantitative findings revealed the impact of social environment on smoking behavior among young people. This study provides strong evidence to support environmentally oriented smoking prevention programs targeting young people.

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  Background: Smoking has physical, psychological, and social impacts on women’s health and subsequently the community’s health. Therefore, it is important to have an estimation of smoking among Iranian women.

  Since comprehensive data are not available in this respect, the authors performed a systematic review and metaanalyzed all high-quality studies in this field.

  Methods: All available electronic papers were searched by certain keywords and were included in this study according to the inclusion criteria regardless of the publication year. Furthermore, non-electronic resources including the final report of research projects, dissertations, unpublished papers (grey literature) and books published by the Iranian ministry of health were also evaluated in the study. The materials were assessed for their quality and meeting the inclusion and exclusion criteria. Considering the high degree of variability in many selected

  studies, we used random effect method for meta-analysis.

  Results: The highest and lowest rates of cigarette smoking among women were 10.5% and 0.04%, respectively. The prevalence rates of smoking were different in various subgroups ranging from 0 to 0.4% in students, 1.1 to 3.1% in adults, and 1.4 to 8.7% in all subgroups. According to the meta-analyses performed for the subgroups, the mean age of participants, performing the study in urban or rural areas, and the year of paper publication were major sources of heterogeneity.

  Conclusion: The studies were highly different with regard to their findings, and it seems that there is an age and time trend for the findings. Furthermore, the prevalence of smoking was different in various regions of the country.

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  Background: Smoking imposes considerably high economic costs both on the healthcare system as well as on a country as a whole. This study was aimed at systematically reviewing the currently published literature on the direct and indirect costs associated with smoking globally. 

  Methods: A systematic review was performed on systematically searched articles from PubMed and Scopus databases published during the period 1990 to 2014. A combination of key terms such as “economic burden”, “direct cost”, “indirect cost”, and smoking, tobacco or cigarette” and “productivity lost was used for the search. Original research article published in English with the age of study population greater than 35 years, at least three smoking-related diseases and reported direct or indirect cost of smoking were the inclusion criteria.   

  Results: Fourteen original articles were included in the review. The cost of outpatient care and premature deaths were found to be the most important cost driver of direct and indirect costs respectively. The study showed that smoking-related diseases were responsible for 1.5 – 6.8 % of the national health system expenditures and 0.22-0.88% of GDP of a country.        

  Conclusion:  Our review indicated that the costs of smoking are substantial, and smoking have a significant impact on the economy of a country. Policies such as increasing the taxation on a cigarette are required and should be implemented to reduce the economic burden of smoking.     

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    Background: Smoking is recognized as one of the main public health problems worldwide and is accounted for a high financial burden to healthcare systems and the society as a whole. This study was aimed at examining the effect of smoking status on cost of hospitalization among patients with lung cancer (LC), chronic obstructive pulmonary disease (COPD) and ischemic heart diseases (IHD) in Iran in 2014.
   Methods: A total of 1,271 patients (consisting of 415 LC, 427 COPD and 429 IHD patients) were included in the study. Data on age, sex, and insurance status, length of hospital stay and cost of hospitalization were extracted from the medical records of the patients. The smoking status of the patients was obtained through a telephone survey. A generalized linear model (GLM) was used to compare the costs of hospitalization of current, former and never smokers. The analysis was done using Stata v.12.
   Results: The mean±SD cost of hospitalization per patient was 45.6 ± 41.8 million IR for current smokers, 34.8±23 million IR for former smokers and 27.6±24.6 million IR for never smokers, respectively. The findings indicated that the cost of hospitalization for current and former smokers was 65% and 26% in the unadjusted model and 35% and 24% in the adjusted model higher than for never smokers.
   Conclusion: The findings revealed that smoking drains a large hospital resource and imposes a high financial burden on the health system and the society. Therefore, efforts should focus on reducing the prevalence of smoking and the negative economic consequences of smoking.  
 

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    Background: Hypertension was considered as a disease of the elderly but due to unhealthy dietary and lifestyle changes its incidence has increased in younger population. Smoking and obesity are emerging concerns the world is facing globally in younger age groups. This study is therefore aimed to identify these cardiovascular risk factors among Pathan and Persian young adults.
   Methods: It was a cross-sectional study carried out at multiple undergraduate, postgraduate educational institutes and hospitals using non-probability convenient sampling among young adults aged between 15 to 40 years for a period of six months from Apr 1st, 2017 to Sep 30th, 2017. Mean±SD was calculated for continuous variables and categorical variables were expressed as frequencies. Chi-square test and Fisher exact test were used for statistical analysis.
   Results: A total of 708 subjects were included. Mean±SD age was 26.12±3.7 years. Out of 708, 300(42.37%) were smokers with 209 (29.52%) active and 91 (12.85%) passive smokers. Among smokers, 216 (30.5%) were males while 84 (11.87%) were females. A total of 432 (61.02%) subjects were not doing any exercise, and 636 (89.83%) were consuming junk food. A total of 165 (23.3%) subjects were overweight, and 15 (2.1%) were obese. Stage-1 hypertension was present in 72 (10.2%), while 16 (2.25%) subjects had stage-2 hypertension.
   Conclusion: There is an increased prevalence of cardiovascular risk factors which includes hypertension, smoking, and obesity among Pathan and Persian young adults.

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Background: Worldwide, 1-6 percent of infants have at least one congenital anomaly that can lead to long-term consequences. This may have significant impacts on individuals, families, health-care systems, and societies. The aim of this study was to estimate the Population Attributable Fraction (PAF) of some congenital anomalies by three selected risk factors (obesity, diabetes and smoking) in the northwest of Iran and to estimate the number of preventable defects at birth in the population if we could reduce 50 percent of the exposure rate to these three risk factors at population level.
   Methods: The regional data on smoking, obesity, and diabetes were entered in Population Estimate of Attributable Fraction of Congenital Conditions Everywhere (PEACE) software developed by International Clearinghouse for Birth Defects Surveillance and Research (ICBDSR). It calculates the PAF for congenital anomalies attributed to exposure to those three risk factors.
   Results: This study showed that main anomalies attributed to "obesity" include Spina Bifida 40.1% (95% CI: 31.7-47.7), Hydrocephaly 26.8 (95% CI: 9.3-42.3) and Anencephaly 17.4 (95% CI: 1.6-31.9). The highest attributable defect to "smoking" was Cleft lip w/out Palate 5.8% (95% CI: 4.3-7.4), whereas for "diabetes" it was Tetralogy of Fallot 33.3 (95% CI: 17.2-49.5). A similar pattern was found when assumed in the model, the impact of 50 percent reduction in the exposure to each of the risk factors on preventable cases of birth defects in the population.
  Conclusion: Obesity, diabetes, and smoking in women of childbearing age increased the risk of occurrence of congenital anomalies. However, obesity and diabetes had a remarkably greater impact compared to smoking. More studies are needed to investigate the role of passive smoking as a risk factor for the occurrence of birth defects.
 
 

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Background: Lung cancer (LC) is a global public health priority. In this study, the epidemiology and current trends of primary LCs were investigated in northeast of Iran.
   Methods: Demographic and pathologic records of primary LCs during 1985-2012 in Mashhad (capital of northeast of Iran) were reviewed. Data were obtained from archives of the largest referral oncologic hospital and the only private outpatient radiation-oncologic clinic in the region. To investigate trends, study duration was classified into 3 periods: 1985-1995, 1995-2005, and 2005-2012. Patients were placed in one of these 3 groups, based on the date of their pathologic diagnosis. Data were analyzed by SPSS 16 software. T test, chi-squared, and ANOVA tests were used for data analysis, and statistical significant level was set at < 0.05.
   Results: Among 939 cases with pathologic diagnosis of primary LC, male-to-female ratio was 2.36. Mean±SD age at diagnosis was 61.47±12.01 years in males and 58.45±12.75 in females (p=0.001). Squamous cell carcinoma (SCC) was the most frequent pathologic subtype. Mean age at diagnosis and rate of smokers were unchanged during the study (p= 0.978 and 0.153, respectively). Relative frequency of leading pathologic subtypes changed in 3 intervals (p<0.001): it was increasing in adenocarcinoma and large cell carcinoma and decreasing in SCC and small cell lung cancer (SCLC). There were statistically significant differences in the mean age at diagnosis (p<0.001), rate of smokers (p<0.001), and male-to-female ratio (p=0.011) between leading pathologic subtypes.
   Conclusion: Similar to universal picture, rate of adenocarcinoma in northeast of Iran was rising during recent decades, especially among younger patients, women, and nonsmokers. These trends are indicative of changes in exposures and smoking habits and reveal the need for regional studies in these contexts.
 

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Background: Irritable Bowel Syndrome (IBS) is one of the most commonly diagnosed gastrointestinal disorders, and its etiology is believed to be multifactorial. The role of smoking in the pathophysiology of IBS still remains inconclusive. Hence, we aim to investigate whether or not an association exists between smoking and IBS.
   Methods: A cross-sectional study was conducted in a tertiary care hospital of Karachi. A sample size of 200 smokers and 200 non-smokers was selected. A two-part self-reported questionnaire was administered to the participants and the diagnosis of IBS was based on the Rome III diagnostic criteria. All data were analyzed using the Statistical Package for the Social Sciences version 17. Statistical tests employed were Independent samples t-test, chi-square test, and binary logistic regression analysis to obtain Odds Ratio (OR) for various variables. A P-value <0.05 was considered statistically significant.
   Results: Overall prevalence of IBS based on Rome III criteria was 9.5% (95% CI 9.45-9.60). Smoking was significantly found to be associated with IBS (P=0.002). Binary logistic regression analysis indicated that non-smokers were more likely to have IBS (Crude OR: 3.00, 95% CI 1.23-7.30) than smokers, and females were more likely to have IBS (Crude OR: 3.73, 95% CI 1.56-7.69) than males. Age, BMI, and food groups were not found to be significantly associated with IBS.
   Conclusion: Our study concludes that IBS was more prevalent among non-smokers and amongst females. Further studies are required to firmly establish the role of smoking in IBS.
 

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Background: Smoking is considered as the second leading risk factor of early death and disability throughout the world.  Smoking is the second leading risk factor of early death and disability in the world. The workplace is an important setting for the implementation of cigarette smoking prevention and control interventions. This study aimed to determine the prevalence of cigarette smoking and related factors by focusing on ADHD and risk-taking behaviors among a sample of Iranian workers.
   Methods: This cross-sectional study was conducted on 2434 male workers of Kaveh Industrial City in Saveh. Random cluster sampling was used in the selection of workers.  All workers completed five sets of anonymous and validated questionnaires. ADHD was measured by Conner’s Adult ADHD Rating Scales. Data analysis was done using chi-square, independent t-test and logistic regression model in STATA 10. Also, P-value <0.05 was considered statistically significant.
   Results: The mean age of the workers was 32.80±7.05 years. The prevalence of cigarette smoking in the lifetime, last year, last month, and daily or almost daily  in the last month were 26.2%, 20.6% , 18.5%, and 13.1% respectively. After adjustment, age (OR=1.08), sensation seeking (OR=1.57), hookah smoking (OR=4.21), alcohol use (OR=2.51), sexual risk behaviors (OR=2.25), religiosity (OR=0.95) and self-esteem (OR=2.02) were associated with cigarette smoking.
   Conclusion: Our results showed that 13.1 % of workers were regular smokers (daily or almost daily). Specific programs in workplaces, including interventions to enhance self-steam and reduce anxiety, can be effective in lowering cigarette smoking prevalence. Also, comprehensive interventions to reduce or prevent different risk-taking behaviors can be considered as elements of preventive action plans.
 

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Background: Cigarette smoking is known as a gateway drug for illicit drug use in youth. The objective of this study is to assess the prevalence of cigarette smoking in the college students in Iran.  
   Methods: We searched electronic databases including Scopus, Medline/PubMed, Google Scholar and Web of Science, and national databases such as Magiran, Scientific Information Database, Iranmedex, Medlib, Irandoc, and IranPsych from 1946 to 21st July 2018 without any language restriction using a proper search strategy. We used a random effect model to calculate the pooled prevalence of cigarette smoking in college students in Iran. Chi-square test and I² index were used to evaluate the heterogeneity between the studies. We used the meta-regression and subgroup analysis to assess the potential source of heterogeneity. Stata software, version 11 (StataCorp, TX) was used for all statistical analysis.
    Results: We included 60 eligible articles in our study. The pooled prevalence of cigarette smoking at least once in the lifetime was 19% (95%CI: 17-22). The I² index indicated considerable between-study heterogeneity (I² =98%, p<0.001). The pooled prevalence of cigarette smoking at least once in the lifetime in males and females was 28% (95% CI: 23-34) and 9% (95% CI: 6-13), respectively. In multivariable meta-regression, a significant association was shown between the year of study (β=-13.1, p=0.011) and sampling method (β=-12.8 p=0.017) and daily use in the last month.
   Conclusions: Increasing prevalence of smoking among Iranian university students is an important health priority. Increasing preventive and health education programs are recommended.
 

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Background: There are relatively scant data to determine whether hospital visitors could serve as a proper source of controls in case-control studies of illicit drug use. The aim of this study was to evaluate using neighborhood versus hospital visitor controls in reporting opium use.
   Methods: We used data from 2 independent case-control studies of cancer in Iran. In the first study, controls were selected from neighborhoods of the patients. For the second one, controls were selected from among hospital visitors. In the latter study, hospital visitors were companions of the patients or others visiting the hospital for reasons other than disease treatment. We used stata (version 12; Stata Corp( for all analyses and with a significance level of 0.05.
   Results: Data from 616 of neighborhood controls and 414 of hospital visitor controls were analyzed. Opium point prevalence among men was significantly higher in hospital visitors than neighborhood controls (43.3% vs 32.2%; P = 0.047), while the prevalence of cigarette smoking was very similar in both control groups (46.3% vs 47.2%; P = .847). Using a logistic regression analysis, in an unadjusted analysis, neighborhood controls were less likely to report opium use in both genders, with (unadjusted OR = 0.77; 95% CI: 0.59,1). After adjusting for potential confounders, the differences of opium use between the 2 control groups became more pronounced (Adjusted OR = 0.26; 95% CI: 0.10, 0.69).
   Conclusion: Because of the similarity of reporting cigarette smoking among neighborhood controls but substantially lower reporting of opium use among them, we concluded that neighborhood controls underreport opium use—a sensitive question— and that using neighborhood control biases the findings in case-control studies. Hospital visitor controls may be more appropriate than neighborhood controls for case-control studies of illicit drugs.
 

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Background: Typically, blood pressure dips during sleep and increases during daytime. The blood pressure trend is affected by the autonomic nervous system. The activity of this system is observable in the low and high activity conditions. The aim of this study was to assess the effect of individual characteristics on systolic blood pressure (SBP) across day-night under low and high activity conditions.
   Methods: The samples were 34 outpatients who were candidates for evaluation of 24 hours of blood pressure with an ambulatory. They were admitted to the heart clinic of Farshchian hospital, located in Hamadan province in the west of Iran. The hourly SBP during 24 hours was considered as a response variable. To determine the factors effecting SBP in each condition, the hidden semi-Markov model (HSMM), with 2 hidden states of low and high activity, was fitted to the data.
   Results: Males had lower SBP than females in both states. The effect of age was positive in the low activity state (β=0.30; p<0.001) and negative in high activity state (β= -0.21; p=0.001). The positive effect of cigarette smoking on SBP was seen in low activity state (β=5.02; p=0.029). The overweight and obese patients had higher SBP compared to others in high activity state (β=11.60; p<0.001 and β=5.87; p=0.032, respectively).
   Conclusion: The SBP variability can be displayed by hidden states of low and high activity. Moreover, the effects of studied variables on SBP were different in low and high activity states.

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Background: Bibliometric analysis may indicate the most active specialist, authors, and journals in a given research field. To the authors' knowledge, there is no bibliometric analysis to provide a macroscopic overview in the field of secondhand smoke that harms non-smoker.
   Methods: Using the bibliometric method, 644 articles that were present in the Scopus database between 1973-2020 on the subject were considered. The data were analyzed by two visualization and science-mapping software called Bibliometrix and VoS Viewer. Also, reference publication year stereoscopy and Co-Citation historiography were used. In the qualitative analysis, 52 articles were selected that had the most citation and were analyzed.
   Results: In this paper, the findings show that the documents were published in 364 sources with an average citation per document of 25.14 and more than 3 authors or nearly 4 authors per document. The peak reference publication year stereoscopy happened in the year 199 with 974 references. The countries with the highest number of MCP were the USA, China, and Spain. The “International Journal of Environmental Research” and “Public Health”, has raised their publications in the field of secondhand smoke and pregnancy rapidly since 2003. Among the titles, "passive smoking" was the most used.
   Conclusion: The study highlights the importance of understanding the harmful effects of secondhand smoke on the developing fetus. The findings also shed light on key research trends, influential authors, and active research areas, which can guide future studies and support evidence-based decision-making in the field of maternal and child health.

 

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Background: People with waterpipe tobacco smoking (WTS) seem to be more at risk for the serious complications of coronavirus disease 2019 (COVID-19). This study aimed at assessing the behavioral intention (BI) of WTS by women in the COVID-19 pandemic and its contributing factors.
   Methods: This cross-sectional descriptive-correlational study was conducted in 2020 (ie, during the COVID-19 pandemic). Participants were 300 women randomly selected through multistage sampling from comprehensive healthcare centers in Khorramabad, Iran. Data collection instrument was a 42-item questionnaire with 4 main subscales, namely knowledge, attitude, differential association, and BI. Data were collected through both online and phone-based methods and were analyzed using non-parametirc path analysis.
   Results: The prevalence of WTS among women was 13% (95% CI, 11.06-14.94) and the mean scores of attitude, differential association, and behavioral intention among participants with WTS were significantly higher than participants without WTS (P < 0.001). Moreover, 46.12% (95% CI, 38.12-54.08) of participants with WTS reported intention to quit WTS due to the COVID-19 pandemic and 43.6% (95% CI, 35.66-51.54) of women with WTS and 16.5% (95% CI, 14.20-18.80) of women without WTS believed in the protective effects of WTS against COVID-19. The path analysis model showed that the BI of WTS had a significant inverse relationship with knowledge and a significant direct relationship with attitude and differential association.
   Conclusion: This study suggests the need for quality educational and counseling interventions for the general public to correct popular misconceptions about the protective effects of WTS against COVID-19.