Motivations towards Smoking Cessation, Reasons for Relapse, And Modes of Quitting

Motivations towards Smoking Cessation, Reasons for Relapse, And Modes of Quitting: A Comparative Study among Former and Current Smokers


BACKGROUND: Tobacco kills more than 7 million people each year. More than 6 million of those deaths are the result of direct tobacco use while around 890,000 are the result of non-smokers being exposed to second-hand smoke.According to National Health Services, Regulations and Coordination ministry; Pakistan was ranked 54th amongst 84 countries with high prevalence of tobacco smoking. Number of smokers reaches 25 million in Pakistan. According to WHO, tobacco killed over seven million people every year, out of which 108,000 people died in Pakistan.. This study is part of a larger research project that aims to investigate factors that influence outcomes of anti-smoking counseling in health care setting; including the role of doctor, the role of nurse and patient’s experience of smoking cessation. The Objective of the study was: To determine and compare among former and current smokers, the reasons why smokers initially started smoking , the motivations towards smoking cessation, reasons for relapse ,modes of quitting and other associated factors.

STUDY DESIGN: A comparative cross-sectional Study.

PLACE AND DURATION: Armed Forces Institute of Cardiology and National Institute of Heart Diseases, Rawalpindi from July 2017 till June 2018.

METHODOLOGY: Current Smokers were recruited in the study, who had been smoking cigarettes daily for ≥ one year and made an attempt to quit the smoking while former Smokers who had quit the cigarettes smoking for ≥ one year and never relapsed and previously had been daily smokers were recruited. Smokers who were using smokeless tobacco, who never quit smoking and who didn’t smoke daily were excluded from the study.

RESULTS: A Total of 1024 participants were recruited in the study. Out of which 512 were current smokers and 512 were former smokers. Mean age of the study participants was 45.3±5.8 years. The most common motivations for smoking cessation among former smokers were found to be; health concerns (Diagnosed with cardiovascular diseases) in 281(54.8%) study participants, followed by persistent cough, setting good example for children, religious inclination, smoking ban at work place and unpleasant smell to the people around while the most common reasons for relapse in current smokers were; company/friends in 290(56.6%) current smokers followed by stress in 94(18.3%) then personal tragedy, constipation/gas issue and pleasure obtained from smoking.

Our study results yielded that most of the people initiate smoking after getting influence from their company. The development of cardiovascular diseases remains the main source of motivation behind smoking cessation. Relapse causes also remain an important issue, in our study, these encompassed, most notably: company around, stress, lack of the pleasure previously obtained from smoking. It appears that it is essential to work out measures for relapse prevention to enhance the number of successful smoking cessation attempts.

KEYWORDS: Cardiovascular disease, Relapse, Smoking cessation, Stress.


  1. Danaei G, Vander Hoorn S, Lopez AD, Murray CJ, Ezzati M; Comparative Risk Assessment collaborating group (Cancers). Causes of cancer in the world: comparative risk assessment of nine behavioural and environmental risk factors. Lancet. 2005;366(9499):1784–1793.
  2. World Health Organization (WHO). WHO Report on the Global Tobacco Epidemic, 2011: Warning about the Dangers of Tobacco. Geneva: WHO; 2011. Available from: Accessed August 28, 2020.
  3. 2008 PHS Guideline Update Panel, Liaisons, and Staff. Treating tobacco use and dependence: 2008 update US Public Health Service Clinical Practice Guideline executive summary. Respir Care. 2008;53(9): 1217–1222.
  4. Neroth P. Stubbing out Communist habits. Lancet. 2005;366(9480): 109–110.
  5. Centers for Disease Control and Prevention (CDC). State-specific prevalence of cigarette smoking and smokeless tobacco use among adults – United States, 2009. MMWR Morb Mortal Wkly Rep. 2010; 59(43):1400–1406.
  6. CDC. Smoking-attributable mortality, years of potential life lost, and productivity losses – United States, 2000–2004. MMWR Morb Mortal Wkly Rep. 2008;57(45):1226–1228.
  7. Federico B, Costa G, Ricciardi W, Kunst AE. Educational inequalities in smoking cessation trends in Italy, 1982–2002. Tob Control. 2009;18(5): 393–398.

Corresponding Author: Dr. Rehana Khadim
Designation: Managing Editor
Department: Pakistan Armed Forces Medical Journal Office
Institution: Army Medical College, Rawalpindi
Email address:
Cell no. 03345538381
Co-Authors: Maj General Farhan Tuyyab, Dr Mubbra Nasir, Dr Urooj Alam, Dr Ruqqia Tahir Dr Shazia Fatima Malik

Sarcopenic Obesity; Risk Factors and Dietary Control

Sarcopenic Obesity; Risk Factors and Dietary Control


Background: The world population is rapidly growing and it is predicted that till 2050 about 22% population will be older than 60 years and almost 5% will be aged more than 80 years. In line with growing age incidence of health ailments is increasing results in increased risks of falls, disability, loss of independence and premature deaths. Additionally these conditions increase burden on our health care system and national economy. Physical impairments with growing age is highly multifactorial however with age, decrease in muscle mass and strength accompanied by reduced skeletal muscle functioning is a major contributor, termed as sarcopenia. The imbalance of energy intake and fat accumulation results in obesity.

Sarcopenic Obesity causes: Sarcopenic Obesity (SO) a major public health concern prevalent in older aged people causes obesity with sarcopenia or age related decline in muscle mass and strength. There is interplay between changing lifestyles, lack of physical activity, hypercaloric diet, hormonal imbalance, inflammation, oxidative stress, insulin resistance and aging resulting in increased fat accumulation and declined muscle mass. Globally sacrcopenic obesity is growing rapidly due to non specific symptoms, remains undiagnosed and unsuspected.

Risk Factors: Studies have shown that sacrcopenic obesity is synergistically associated with functional decline and increased incidence of non communicable diseases (NCDs) such as dislipidemia, hypertension, diabetes, cardiometabolic disorders and mortality.

Control and concluding remarks: The effective strategies to counteract sarcoplasmic obesity include hypocaloric diet with high protein intake, micronutrient supplements, bariatric surgery along exercise strategies. However further research is required to clearly understand optimal weight loss, intensity, frequency and type of exercise and combined effect of nutrition and exercise on physical functioning parameters and body composition in sarcopenic obese older adults.

Keywords: Sarcopenic obesity, aging, NCDs, nutrition and diet, Exercise and physical activity

Nimra Sameed, Dr. Samreen Ahsan, Dr. Muhammad Farhan Jahangir Chughtai
Department of Food Science and Technology
Khwaja Fareed UEIT, Rahim Yar Khan
Corresponding email:

Association between water intake and body measurements; A cross sectional study in the students of a Pakistani Dental College

Association between water intake and body measurements; A cross sectional study in the students of a Pakistani Dental College


INTRODUCTION: We are all aware of the role of water as an essential nutrient in human health. Life style Medicine researches have shown high prevalence of inadequate hydration habits globally. In this study, the relationship of water intake with anthropomorphic measurements in young adults of a particular geographical location was observed.

MATERIALS & METHODOLOGY: This cross sectional study was conducted on 250 undergraduate students of IIDC, RIU from Feb to May 2021. For the assessment of water intake an online questionnaire was filled whereas for the anthropomorphic measurements, Physiology & Biochemistry labs were utilized according to the recommendations of the International Standards for Anthropometric Assessment (ISAK). These included: BMI, WH ratio and Abdominal measurements taken from the level of belly button & 2 inches below and the difference measured . Differences in water consumption according to these 3 parameters were analyzed through one way ANOVA test and considered significant at p ≤ 0.05.

RESULTS: A total of 259 healthy volunteers with Mean±SD=19.587±1.2307 where 179 female(61.1%) & 80 males (27.3%) . Chi square correlation showed significant association of gender with all the variables (p<0.05). BMI for both genders fell into the normal range whereas WH ratio and abdominal measurement diff. was above the normal range in females pointing towards a central obesity tendency (android type). One way Anova for the comparison of various levels of water intake showed significant association with BMI only.

CONCLUSIONS: Significant association was found between water intake & BMI with large individuals requiring more water consumption as compared to individuals with smaller size. Therefore, a “tailored water prescription” that considers gender, age and BMI differences is required.

Reducing surgical site infections through quality improvement initiative

Reducing surgical site infections through quality improvement initiative: A tertiary cardiac care facility experience in a developing country


Introduction: Amongst healthcare associated infections (HAIs), surgical site infections (SSIs) are a preventable cause of increased morbidity and mortality and are associated with substantial financial costs. SSI rates are an indicator of the quality of surgical and postoperative care, which necessitates the need for robust surveillance systems for these healthcare associated infections. Patients undergoing coronary artery bypass grafting (CABG) are at a greater risk for infection due to their relatively older age and the presence of comorbid conditions like diabetes mellitus and obesity.

Objective: To establish the adult cardiothoracic surgical site infections registry to determine adult surgical site infection (SSI) rates and study impact of quality improvement initiatives on SSI rates.

Methods: The Adult Cardiothoracic SSI registry was developed at Armed Forces Institute of Cardiology and National Institute of Heart Disease, Rawalpindi, Pakistan. Monthly SSI rates were monitored for both CABG and Valvular heart surgeries inclusive of chest and leg SSIs instituted to control the increased SSI rate in October 2014 after a multidisciplinary approach.

Results: A total number of 2640 cardiac surgeries were carried out and the cumulative SSI rate was 2.0% (54) for a period of two year i.e. August 2014 to August 2016. The SSI rate for chest infections was 19.0% (10) and for leg wound (harvest site) infections was 81.0% (44). There was an increase in SSI rate 5% (04) during October 2014. After process improvements the rate declined to 1% in November 2014 and has remained less than or equal to 2% as of August 2016.

Conclusion: A high SSI rate was investigated and multi-modal process improvements and infection control measures were implemented, leading to a decrease in SSI rate from 4.0% to 2.0%.

Keywords: cardiothoracic surgery, registry, surgical site infection, quality improvement.

Comparison of survival times amongst patients undergoing primary percutaneous coronary intervention

Comparison of survival times amongst patients undergoing primary percutaneous coronary intervention, pharmaco-invasive and thrombolytic therapy for acute st elevation myocarial infarction in a tertiary care hospital: a survival analysis


Background: Acute myocardial infarction remains a time-sensitive medical emergency associated with significant morbidity and mortality. Research supports the superiority of PPCI over fibrinolytic therapy that can improve outcomes when delivered within a specified timeframe, however; effectiveness of treatment options in the terms of survival over the period of time has not been tested in our setup.

Objective: To compare the survival times in patients with acute myocardial infarction treated with PPCI,PI and streptokinase.

Material and Methods: A prospective study was conducted in Armed Forces Institute of Cardiology, Rawalpindi from Jan 2017 to July 2019 using consecutive sampling. Total 294 patients fulfilling the inclusion criteria were stratified into three groups i..e group I patients who underwent PPCI and group II who underwent parmaco-invasive therapy and group III who were administered streptokinase. All the groups were followed for 30 months. In this study the probability of the patients to survive after PPCI at the end of 6 months duration was found to be 96% for PPCI, 93% for PI and 75% for SK. Similarly, probability of the patients to survive at the end of 30 months in case of PPCI was 91%, 89% in case of PI and 64% for SK.

Conclusions: This study will help determine the benefits of PPCI over fibrinolysis in terms of survival and will play a pivotal role in policy decisions for sustainability of a 24/7 PPCI reperfusion strategy to decrease overall mortality related to acute myocardial infarction.

Dr Javeria Kamran

Polypharmacy and barriers to medication adherence among the elderly with chronic diseases attending a tertiary care hospital in Rawalpindi

Polypharmacy and barriers to medication adherence among the elderly with chronic diseases attending a tertiary care hospital in Rawalpindi


Taking a number of medicines, whether they are prescription drugs, OTC drugs, an herbal or dietary supplement is known as polypharmacy. The elderly are susceptible to multiple chronic conditions, and are at a greater risk to polypharmacy; hence they face a number of problems adhering to their treatment plan. The purpose of this study was to evaluate barriers to medication adherence faced by the elderly with chronic diseases and to find and its association with polypharmacy.

Materials and Methods:
The cross sectional study was done within six months in a tertiary care hospital of Rawalpindi, Pakistan. Descriptive analysis was done by calculating frequency and percentages; Chi-square test was applied in inferential analysis for the variables of interest to determine statistical association.

Data was collected from a total of 173 respondents. Mean age of the respondents who participated in the study was found to be 69.12±7.6, the average number of years from which they were suffering from the disease was 14.32±6.6. Out of 173 respondents, (84.4%) N=146 were males and 15.6% N=27 were females. Among the four barriers 121 (69.9%) respondents faced patient related factors,126(72.8%) faced healthcare system related factors,114(65.9%) faced socio-economic factors,82(47.4%) faced therapy related factors and 74(42.8%) faced condition related factors.

This study identified barriers to medication adherence faced by the elderly due to polypharmacy. A significant association was found between number of medicines taken by the elderly and the associated barriers. Polypharmacy causes difficulty adhering to treatment, as age increases so does the diseases especially in the elderly, which is the main cause of increasing number of medicines taken by the elderly and hence increased barriers to adherence. The use of multiple drugs may be appropriate for some individuals, but inappropriate for others. Strategies should be made by the public health professionals and should be implemented by the health care professionals while choosing therapies to assess the risk, benefit ratio of the treatment given especially in elderly with multi morbidities.

Dr. Aleena Khan
(Pharm-D, MS Public Health)
Research Officer
Research & Development Dept
Phone no: 03215636536
Category: Oral
Presentation/Poster Presentation