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Direct and Indirect Estimation of the Prevalence of Waterpipe and Cigarette Smoking Among Adults in Arak: An Approach Based on Network Scale-up Method
Maryam Zamanian, Rahmatollah Moradzadeh,
Volume 20, Issue 1 (6-2024)
Abstract
Background and Objectives: Indirect methods for estimating hidden populations are essential. The present study aimed to assess the prevalence of cigarette and waterpipe consumption in the Arak metropolis, Iran, directly and indirectly through network scale-up.
Methods: This cross-sectional study was conducted on 1,604 participants. Daily and weekly cigarette and waterpipe consumption data were collected to measure the prevalence directly. The indirect network scale-up method was used to estimate the size of cigarette and hookah smokers. A confidence interval of 95% was considered.
Results: About 49.9% of the participants were men. The average age of men was 39.8 and women 38.7 years. In the direct method, the prevalence of smoking at least one cigarette per day during the last year in women and men was 1.8% (1.0-3.0) and 38.3% (34.9-41.9), respectively. The prevalence of using waterpipe at least once a day during the last year was as much as 0.9% (0.03-1.8) and 4.1% (2.8-5.7) for women and men. In the indirect method of network scale-up during the last year, the prevalence of continuous smoking was 4.8% (4.3-5.0) in women and 19.7% (19.6-19.9) in men. The prevalence of waterpipe in women was calculated at 7.8% (7.8-8.0) and 9.8% (9.7-9.9) in men.
Conclusion: Based on the results, the prevalence of waterpipe and cigarette smoking was high in the Arak, especially among young people. It is suggested to the health system policymakers to pay attention to measures related to reducing the prevalence of these two risk factors, especially among young people, in their health plans.

Estimation of the Incidence of Abortion in Women of Reproductive Age 18-54 in Kerman City in 2022-2023
Shima Shadkam Farrokhi, Amir Hossein Nekouei, Saeedeh Haji Maghsoudi, Hamid Sharifi, Aliakbar Haghdoost,
Volume 21, Issue 2 (9-2025)
Abstract
Background and Objectives: Abortion is a significant health and social issue in Iran, which affects women's physical and mental health, as well as population growth rates. This study evaluated and compared direct and indirect estimates of abortion incidence and its associated factors among women of reproductive age in Kerman, Iran.
Methods: This cross-sectional study estimated the incidence of abortion using direct and indirect methods (Proxy network Scale-Up Method). In the direct method, 471 women aged 18-54 were interviewed about their personal experiences with abortion. In the indirect method, 450 women provided information about abortions within their close social networks. The number of abortions reported by each individual was divided by the corresponding person-time to estimate the incidence rate using the direct method. The number of abortions reported within the social network was divided by the size of each individual’s close network population for the indirect abortion incidence estimation.
Results: The annual abortion incidence is estimated indirectly at 62 per 1,000 women of reproductive age (95% CI = 52, 73), with 57% attributed to spontaneous abortion and 43% to induced abortion. Factors such as more children, higher socioeconomic status, and an educated spouse were associated with increased abortion rates.
Conclusion: The occurrence of abortion in Kerman, as in the rest of the country, was a serious health issue. The underlying and root causes should be addressed to manage it more effectively. And it should be noted, more than half of these abortions are spontaneous, meaning that there are inherent limitations in reducing the number of abortions even with optimal management.

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