Smoking Status and Determinants Among Iranian Adults With Diabetes: Findings From the National Steps 2021 Survey Publisher



Behgam N ; Salehi S ; Akbarpour S ; Tabatabaei Malazy O ; Mozafari S ; Asgari S ; Rezaei N
Source: Journal of Diabetes and Metabolic Disorders Published:2026

Abstract

Background: Understanding patterns of active and passive smoking among individuals with diabetes is essential for targeted prevention, improved glycemic control, and reduction of cardiometabolic complications. The Middle East and North Africa (MENA) region, which includes Iran, has the highest age-standardized diabetes prevalence worldwide, yet evidence on smoking patterns among Iranian adults with diabetes remains limited. Methods: We used data from the 2021 WHO STEPS survey, a nationally representative population-based study conducted across all 31 provinces of Iran. Adults aged ≥ 25 years were included. Diabetes was defined by self-reported physician diagnosis, glucose-lowering medication use, fasting plasma glucose (FPG) ≥ 126 mg/dL, or hemoglobin A1c (HbA1c) ≥ 6.5%. Among 18,119 eligible participants, 3,078 adults with complete data met diabetes criteria and were included in weighted analyses. We estimated the prevalence of current smoking and passive smoke exposure and compared cardiometabolic indicators across smoking categories. Survey-weighted logistic regression identified determinants of smoking behavior. Results: Among 3,078 adults with diabetes, mean age was 58.4 years (95% CI: 57.8, 59.0) and 53.1% (95% CI: 50.3, 55.9) were female. Overall, 12.2% (95% CI: 10.6, 14.0) were current smokers and 26.0% (95% CI: 23.8, 28.3) reported passive exposure. Smoking patterns varied substantially by sex, age, body mass index (BMI), residence, and employment status. Compared with never smokers, current smokers had lower high-density lipoprotein cholesterol (HDL-C), higher triglycerides, and lower systolic blood pressure (SBP). Male sex strongly predicted current smoking (aOR: 4.69, 95% CI: 3.65, 6.01), whereas age ≥ 60 years was associated with lower odds of both active smoking (aOR: 0.61, 95% CI: 0.48, 0.77) and passive exposure (aOR: 0.67, 95% CI: 0.53, 0.86). Conclusions: Active and passive smoking are common among Iranian adults with diabetes and show substantial gender differences. Their associations with unfavorable lipid profiles underscore the need for integrating gender-responsive tobacco control approaches into diabetes care and prevention programs. © The Author(s), under exclusive licence to Tehran University of Medical Sciences 2026.