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Background: A short, valid, and reliable instrument is required for the easy assessment of health literacy in online surveys. Objectives: In this study, we investigated the validity and reliability of the Persian version of the 8-item Health Literacy Questionnaire as a brief online survey tool in 18-65-year-old Iranians. Methods: This was a cross-sectional study undertaken in thirty-one provinces of Iran. A total of 2374 Iranian people with age 18 - 65 years participated in this study. To ensure the quality of English-to-Persian translation, the process of forward-backward translation was conducted. The scale’s factor structure was assessed using a series of exploratory factor analyses (EFA) and confirmatory factor analyses (CFA). In order to assess reliability, Cronbach’s alpha estimation, test-retest reliability, and Spearman correlation coefficients were applied. Results: Most of the participants were male (1610, 67.8%), married (1610, 67.8%), and 31 - 59 years old (1672, 70.4%). Cronbach’s alpha coefficients for the factors of finding & evaluating, understanding, decision making, interaction, and the questionnaire as a whole were 0.76, 0.46, 0.75, 0.82, and 0.59, respectively. Test-retest correlation coefficients for these factors and the questionnaire as a whole were 0.85, 0.94, 0.75, 0.82, and 0.86, respectively. Based on CFA, the four-factor structure of the 8-item health literacy (HL) fitted the data well. Conclusions: The validity and reliability of the online version of the Persian 8-item Health Literacy Questionnaire to measure the HL of the public were approved. This short online tool can be helpful for future online survey studies on the health literacy of Persian-language populations at a large scale.

Background: In this study, we aimed to assess the cognitive determinants of weight control behaviors by dietary patterns among postmenopausal women with osteoporosis. Methods: This cross-sectional study, based on the theory of planned behavior (TPB) was conducted from July to December 2017 among 240 postmenopausal women with osteoporosis in Tabriz, Iran. A validated and reliable TPB-based instrument, namely Weight-CuRB, and the food frequency questionnaire (FFQ) were used. Results: The results of exploratory factor analysis (EFA) indicated three dietary patterns (total variance explained=24.44%); healthy (n=71), mixed (n=78), and western (n=91). In addition, food items consumed by participants were classified into twenty-two food groups for dietary pattern analysis. In the healthy and western dietary patterns, attitude (β: 0.140, P

The Article Abstract is not available.

Our aim in the present study was to estimate the psychometric properties of the full-length Adelaide driving self-efficacy scale (ADSES) for use among community-based resident older adults in Tehran, Iran.We recruited older adults (60+ years) from various sampling units nested in the Tehran district's general urban population (20 subjects/questionnaire-item). The questionnaire was translated and back-translated by using recommended pathways. Multiple forms of validity and reliability, including Cronbach alpha, were estimated. Also, we measured intra-class correlation coefficient, and did confirmatory factor analysis (CFA).A total of 243 participants (mean age: 65.8, 95%CI 65.4-66.3) met our inclusion criteria. For ADSES, the alpha coefficient was 0.77, the intraclass correlation coefficient was 0.97 (95% CI: 0.95-0.98), and the average item-test correlation was 0.67. Upon CFA, we found a 0.95 comparative fit index, a coefficient of determination = 92.6%, and standardized size of the residual = 0.04.Our Persian language ADSES was found to have adequate validity and factor structure parameters for evaluating driving self-efficacy among community-based older adults in a non-western context. Our questionnaire is an essential first step toward evaluating driving self-efficacy among older adults, especially where no such tool is available, to help develop driving self-efficacy as a healthy aging measure.

This was a descriptive-analytical study carried out using a cross-sectional method to present a conceptual model of students’ health information-seeking behavior. The proposed model developed a bas...

Objective The objective of this study was to assess depressive symptoms among rural health workers (RHWs) through a multi-factorial socio-ecological framework (SEF) encompassing personal, interpersonal, organizational and community components. Patients and methods A random sample of 394 RHWs in all rural areas of East Azerbaijan and fulfilling our other inclusion criteria were recruited. The participants underwent the Short-Form Beck's Depression Inventory and a validated researcher-constructed SEF questionnaire, including subscales on personal, interpersonal, organizational and community factors associated with depressive symptoms. Internal consistency and factor structure parameters of the SEF were also calculated. Results A total of 394 RHWs were screened, of whom 170 (43.2%) had mild to major depressive symptoms. Only 6.8% were identified with major depressive symptoms. The SEF-based scale was found to have acceptable content validity (content validity index and ratio were 0.80 and 0.77, respectively) and reliability (Cronbach's alpha=0.7). In the structural equation modeling, the fit indices showed our model to fit the data well (χ 2=14.06, df=14, χ 2/df=1.00, CFI=0.967, RMSEA=0.032). The highest direct contribution to depressive symptoms was found from the personal factors component (β=-2.32). Also, "work load and roles interference" (from organizational level, β=-0.76) and "family/colleague support" (from community level, β=-1.28) made significant direct contributions towards depressive symptoms. Besides the SEF components, female gender (β=1.69), family history of mental illness (β=-1.48), having chronic illnesses (β=-1.64) and being religious (β=3.43) were the strongest direct contributors to depressive symptoms. Conclusion Depressive symptoms were common among RHWs, arising from all personal-, interpersonal-, organizational- and community-level factors. Our SEF had adequate internal consistency and factor structure parameters to be applied in the Middle East and North Africa (MENA) region countries, such as Iran, as a theoretical framework to plan for interventional efforts aiming at preventing depressive symptoms among RHWs. The burden of depressive symptoms should be reduced through multi-factorial interventions and rational perspectives.

Rural health workers play a detrimental role in implementing rural osteoporosis prevention programs. To successfully implement such programs, addressing their gender-based cognitive needs seems to ...

Haleh Heizomi,1 Zeynab Iraji,2 Rogayeh Vaezi,1 Devender Bhalla,3– 5 Donald E Morisky,6 Haidar Nadrian1,7 1Department of Health Education and Promotion, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran; 2Department of Statistics and Epidemiology, Tabriz University of Medical Sciences, Tabriz, Iran; 3Pôle Universitaire Euclide, Intergovernmental UN Treaty 49006/49007®, Bangui, Central African Republic; 4Iranian Epilepsy Association®, Tehran, Iran; 5Nepal Interest Group of Epilepsy and Neurology (NiGEN), Kathmandu, Nepal; 6Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA; 7Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, IranCorrespondence: Haidar NadrianDepartment of Health Education and Promotion, Faulty of Health,Tabriz University of Medical Sciences, Attar-e-Neyshabouri Street, Tabriz, IranTel +989181734596Email haidarnadrian@gmail.comObjective: We examined the gender-based associations of health literacy (HL) with self-reported medication adherence (MEDA) among patients with primary hypertension (pHTN).Patients and Methods: The subjects were recruited from the general population through all health centers of the Heris county, east Azarbaijan. They were to be adults (30+ years age), with pHTN of any stage, of any gender, and without comorbid illness. All underwent detailed face-to-face interview. We used valid questionnaires for HL and MEDA. Hierarchical regression was done to establish the association between MEDA, socio-demographic variables, and nine HL domains by gender. Other statistical procedures were also done.Results: A total of 300 (48.6% males, mean age: 56.7± 9.3) subjects participated; 43.0% were uneducated, 73.0% had moderate socioeconomic status, 68.0% had poor HL, and 7.0% maintained high adherence. Men were better in reading skills (p=0.002), and accessing (p=0.01) and using (p=0.02) health information, but women were better in health knowledge (p=0.004). The average regression estimate (±standard deviation) between HL and MEDA was 0.37± 0.09, lower among men (0.361± 0.11) than women (0.396± 0.08), p=0.003. Upon hierarchical regression, the association between HL and MEDA was significant for communication and decision-making skills alone among both men (34.5%) and women (40.6%), individually.Conclusion: HL had substantial association with MEDA among those with HTN, for both men and women, particularly the communication and decision-making. With considerations on gender differences, this association should be confirmed through interventional studies to help make HL a formal mitigating strategy for MEDA and other public health goals.Keywords: medication adherence, health literacy, hypertension, gender

Background: Considering the increasing prevalence rate of smoking among Iranian adolescents,and recent evidence on the relationship between obscenity of smoking and tendency of adolescents towards the behavior, there is a need for an appropriate measurement tool to measure the level of obscenity on cigarette smoking among adolescents. This study was conducted to develop a valid and reliable questionnaire for measuring the obscenity of cigarette smoking in adolescents. Methods: This study was conducted in Tabriz, Iran, using an exploratory sequential mixed methods design. To explain the concept of obscenity and develop the questionnaire’s items, 18 students attended semi-structured individual interviews and 13 others took part in focus group discussions (FGDs) in three groups of 4-5. Extracting and summarizing the codes derived from the interviews, an item pool was developed, from which the initial draft of the scale was provided.Next, the psychometric properties of the scale were assessed using face, content, construct, and predictive validity, as well as internal consistency, and reliability in a sample of 1013 high school students. Results: The 22-item Cigarette Smoking Obscenity Scale (CSOS) was developed based on thecodes derived from qualitative data. Explanatory factor analysis revealed five-factor structure(Negative Attitude; Negative Consequence; Negative Valuation; Inappropriate Relationship; Agateway to addiction). In confirmatory factor analysis, the χ2/df ratio was 3.911 for the CSOS five-factor structure. Suitable values were obtained for the goodness of fit indices (GFI = 0.88,AGFI = 0.85, NFI = 0.87, IFI = 0.90, CFI = 0.90, RFI = 0.85, and RMSEA = 0.072). The Cronbach’s alpha and intraclass correlation (ICC) coefficients for the constructs ranged between 0.77 to 0.90 and 0.80 to 0.91, respectively. Conclusion: The validity and reliability of the CSOS was appropriate; therefore, it can be used infuture studies as a suitable tool for measuring the obscenity of cigarette smoking in adolescents.

Background: Since physical inactivity is currently a global concern, encouraging individuals to physical activity (PA) is a priority in public health policies. This study was conducted to analyse the process of change in adopting policies aimed at promoting PA in policy agenda-setting.Methods: This qualitative study was conducted by using document review and semi-structured interviews with 23 key informants of different sections and levels of the policy-making process of the PA promotion programs in Iran. Purposive sampling with maximum variation was used to identify key informants. Analysis of documents and interviews was performed based on the Kingdon’s multiple streams Framework (MSF): problem, policy and political streams. MAXQDA-10 software was applied to manage data analysis process. Result: The problem stream was found to be the high prevalence of physical inactivity, perceived subjective barriers, and contextual factors for PA within the country. The policy stream focused on integrating PA services into primary health care, conducting national and global calendar campaigns and events, and existing legal structures to promote PA in the community. In the political stream, the support of national documents and various legislative and governing authorities, as well as international support, especially the World Health Organization’s 2018-2030 program, provided a favourable environment for this issue. Conclusion: Despite the opening of a policy window for policy-making to promote PA in Iran, several challenges were identified that hindered the policies; the championship and professional approach in the Ministry of Sports, lack of inter-sectoral cooperation, restrictions due to international sanctions and the Covid-19 pandemic, and managerial-structural problems. As the policy window is not used in an appropriate manner, the policymakers need to revisit the policies, with a particular attention to feasibility of the policies, the organizational culture of different Iranian ministries, and the mediating and advocating roles of the Ministry of health in operationalizing the policies.

Background Type 2 diabetes mellitus (T2DM) is one of the most important risk factors for cardiovascular diseases, with a high economic burden on health care systems. Since gender and residency can affect people’s lifestyle and health behaviors, this study was conducted to investigate the prevalence of T2DM and its determinants by gender and residency. Methods A secondary analysis study was conducted on the survey data of the IraPEN (Iran’s Package of Essential Non-Communicable Disease) pilot program conducted in 2017 in Naghadeh County, Iran. Data of 3,691 participants aged 30–70 years from rural and urban areas of the County were included into data analysis process. Sociodemographic factors, anthropometric measurements, and cardiovascular risk factors related to T2DM were assessed. Results The overall prevalence of T2DM within the population was 13.8%, which was significantly higher among women (15.5%) than men (11.8%), and non-significantly higher in urban (14.5%) areas than rural (12.3%) areas. In both genders, age (male: OR 1.01, 95% CI: 1.00–1.03; P = 0.012; female: OR 1.03, 95% CI: 1.02–1.04; P Conclusion Given the higher prevalence of T2DM among females, risk reduction strategies at the community level should be more targeted at women. The higher prevalence of T2DM risk factors among the urban population is a wake-up call for policymakers to pay more attention to the consequences of unhealthy and sedentary lifestyles within urban communities. Future actions should be focused on appropriate timely action plans for the prevention and control of T2DM from early years of life.

Background: Compared to non-smokers, non-daily smokers (NDS) experience a higher level of health risks associated to smoking. However, the most of them do not consider themselves as smokers. This study aims to investigate the prevalence of NDS and its predictors among students. Methods: This web-based study was conducted in Tabriz, Iran, from July to August, 2019. In total, 3666 students were randomly selected from all universities in Tabriz in proportion to the number of students in each university. Data were collected applying an online questionnaire. NDS predictors were assessed using logistic regression model. Results: A total of 15.7% and 7.8% of the students were daily and NDS, respectively. Compared to the non-smokers, the NDSs were more likely to present high-risk behaviors such as substance abuse (Odds Ratio (OR) = 2.96, Confidence Interval (CI) 95%: 2.12-4.13), alcohol consumption (OR = 2.54, CI 95%: 1.78-3.62), and experience of hookah smoking (OR = 9.30, CI 95%: 6.06-14.25) and its regular use (OR = 24.22, CI 95%: 14.86-39.46). The predictors of NDS were female gender (OR = 6.25, CI 95%: 4.57-10.14), denying of being a smoker (OR = 11.69, CI 95%: 6.86-19.91), not being addicted to nicotine (OR = 10.02, CI 95%: 4.21-23.85), and with no effort to quit smoking in the recent months (OR = 2.27, CI 95%: 1.28-4.04). Conclusion: NDSs, due to their characteristics such as not considering themselves as smokers, lack of intention to quit smoking, and showing high-risk behaviors, should be paid attention by health policy makers while planning smoking cessation programs.

Objective To determine 1) the indexes/indicators used for evaluating the “strengthening community actions” mechanism of the Ottawa Charter for Health Promotion and 2) to extract the characteristics and key components of the indexes/indicators using a scoping review. Data Source:In May 2020, the search was conducted across three databases: Medline (via PubMed), Embase, and Scopus. Inclusion and Exclusion Criteria: All primary studies relating to development, identification, and measurement of health promotion indices/indicators associated to the “strengthening community actions” were included. The review articles were excluded. Data Extraction The data were extracted to a data-charting form that was developed by the research team. Two authors reviewed the extracted data. Data Synthesis To summarize and report the data, a descriptive numerical analysis and a narrative descriptive synthesizing approach were used. Results In total, 93 study articles were included. A majority of studies (82%) were conducted in developed countries. Different types of recognized indices were categorized into seven groups: social cohesion (n = 3), community capacity (n = 1), community participation (n = 7), social capital (n = 6), social network (n = 3), social support (n = 1), and others (n = 5). Conclusions Having a collection of “strengthening community actions” indices/indicators in hand, health policymakers and health promotion specialists might be able to do their best in considering, selecting, and applying the most appropriate indices/indicators while evaluating community health promotion interventions in different settings.

Background: The level of physical activity (PA) among middle-aged Iranians is less than optimal. This study will be carried out to analyze and recommend policy options to promote PA among urban middle-aged adults in Tabriz, one of the metropolitan cities in Iran. Methods: This multi-method policy analysis study will include the following four phases: First, a qualitative content analysis to explore the reasons for lack of PA. Second, a comparative study of successful PA programs and policies in Iran and other similar developing countries. Third, a qualitative thematic analysis based on the policy triangle to analyses PA promotion policies using the key informants’ views. Fourth, analysis and prioritizing the policy options suggested by a panel of experts using the analytical hierarchy process (AHP) techniques. Conclusions: Prospective policy analysis promises the systematic process of selecting potentially effective policy options to promote PA in metropolitan settings of developing countries. The results of this study will provide a comprehensive vision of the most appropriate policy options based on the criteria of acceptability, effectiveness, and feasibility for addressing PA at the local and national levels. Considerations on the challenges of PA policymaking cycle and the barriers to the implementation of current policies in the Iranian context will also be identified.

Background Despite the improvement of living standards and public health as well as conducting the specific programs based on pediculosis control guidelines, Head Lice Infestation (HLI) is still a worldwide health concern. The purpose of this study was to investigate the cognitive factors associated to school-age children's HLI among mothers in an urban community. Subjects and Methods In this cross-sectional study, a multi-stage cluster random sample of 619 mothers of students in elementary schools of Chaldoran County, located in North-West of Iran, was recruited to participate in the study. Data were collected applying a set of questionnaires including socio-demographic and cognitive-behavioral factors, including Pediculosis Preventive Behaviors (PPBs), HLI knowledge, threat appraisal, as well as HLI prevention perceived self-efficacy, response efficacy, and perceived collective family efficacy. Results Statistically significant differences were found in the children's HLI by their mother's age and performance in PPBs (p-value=0.001). Hierarchical multiple linear regressions were performed with PPBs as outcome variable. According to their natures, the predictors for this outcome variable were classified in two different blocks. Demographic characteristics (p > 0.05), and cognitive constructs (p< 0.001) explained 9% and 21.1% of the observed variance in PPBs, respectively. Pediculosis was found as an epidemic among the students, particularly female students, of Chaldoran County, which call for action by health stakeholders and policymakers. Conclusion The healthcare providers are recommended to develop HLI prevention programs, within which the mothers and their school-age children as well as school mangers and public places' employers are considered as the core target groups for interventions. Besides PPBs, response efficacy and perceived collective family efficacy to perform the behaviors should be considered as the core categories while designing such prevention programs.

Background: Optimism is known to be associated with many health behaviors. However, the associations between optimism, tobacco smoking and substance abuse in adolescents are not well documented. This study aimed to address this research gap in a large school-based population. Methods: Participants (N = 1104) were selected based on multi-stage cluster sampling method. Cigarette and hookah smoking behaviors, illicit drug use, optimism, and relevant covariates were measured using a validated questionnaire. Data were analyzed using ordinal logistic regression. Results: After adjustment, higher optimism score was a protective factor against being situated in advanced stages of cigarette smoking (odds ratio [OR] = 0.88, 95% CI: 0.84-0.91), hookah smoking (OR = 0.91, 95% CI: 0.88-0.94), and illicit drugs usage (OR = 0.90, 95% CI: 0.85-0.95). Moreover, the results showed that negative-stability and negative-globality domains of optimism were significantly higher among advanced-stage smokers and illicit drug users. Conclusion: Optimism was found to be a protective factor against tobacco smoking and substance abuse; whereas pessimism (negative-stability and negative-globality) was found to be a determinant factor. Further research is needed to investigate the effects of optimism on the transition in cigarette and hookah smoking stages.

Purpose Applying cloud computing (CC) in education is a great opportunity to globalize knowledge with the minimum costs and maximum accessibility. This study aims to understand and predict teacher intention to use cloud commuting as infrastructure in Smart education. Design/methodology/approach This was a cross-sectional study in which faculty members’ perception concerning CC services adoption in education were assessed based on the extended model of theory of planned behavior, by researcher-developed questionnaire (a = 0.9). Collected data were analyzed by regression analysis and the final model was tested by structural equation modeling. Findings Attitude towards the behavior, perceived behavior control and privacy; had direct and significant associations with faculty members’ intention to use CC. However, subjective norms (p = 0.311) and security (p = 0.505 ) were not significant predictors of intention to use CC. Originality/value The results of this study elucidate the critical factors associated with teacher’s behavioral intentions toward CC services and also serve as a valuable reference for education sector to plan for the better use of these services. The presented model can be considered as best practice framework for adapting cloud commuting as infrastructure in education. Applying CC services in education is great opportunity and should be subsequently the major concern of educational organizations. This study clearly identified significant and non-significant factors that should be considered when successful implementation on could computing services is in progress.

Brucellosis is an endemic disease in many countries, especially in the Mediterranean region, as well as countries such as the Islamic Republic of Iran. Despite the preventive measures against brucellosis adopted in different countries throughout the world, the disease is still a public health concern.Our aim in the present study was to examine the cognitive factors associated with Brucellosis Preventive Behaviours (BPBs) among diagnosed patients utilizing Empowerment Model.In 2013, applying a cross-sectional study, all 238 patients with brucellosis in Chaldoran County, Islamic Republic of Iran, were recruited to answer a researcher-made EM-based questionnaire and BPBs Scale through interview.Hierarchical multiple linear regressions were performed with BPBs as the outcome variable. Predictors for this variable, according to their natures, were classified in two different blocks. In the first block, significant effect was found on BPBs by demographic variables (ΔR2 = 0.301). In the second block, the level of education, knowledge, and self-efficacy were significant predictors (P0.001) of BPBs (ΔR2 = 0.808).The Empowerment Model was found as a helpful framework in predicting the risk factors of BPBs. Health care providers in low- and middle-income countries should consider the patients' knowledge on the disease and their level of self-efficacy to perform BPBs as the core categories of empowerment while designing brucellosis prevention programmes.العوامل الإدراكية المرتبطة بالسلوكيات الوقائية من داء البروسيلات بين المرضى الذين تم تشخيصهم: تطبيق نموذج التمكين.توحيد بابا زادة، حيدر ندريان، سهيلا رنجبران، حامد رضاخاني مقدم، مهران أغه ميري.يعد داء البروسيلات مرضًا متوطنًا في العديد من البلدان، لا سيّما في إقليم شرق المتوسط، بما في ذلك جمهورية إيران الإسلامية. ورغم تبني التدابير الوقائية لمكافحة داء البروسيلات في مختلف بلدان العالم، لا يزال المرض يُمثِّل قلقًا بالنسبة للصحة العامة.تمثَّل هدفنا في هذه الدراسة في فحص العوامل الإدراكية المرتبطة بالسلوكيات الوقائية من داء البروسيلات بين المرضى الذين تم تشخيصهم بالمرض باستخدام نموذج التمكين.في عام 2013 ، تم تطبيق دراسة مقطعية، حيث تم اختيار 238 مريضًا مصابًا بداء البروسيلات في مقاطعة تشالدران، جمهورية إيران الإسلامية، للإجابة على استبيان قائم على نموذج تمكين وضعه باحثون ومقياس السلوكيات الوقائية من داء البروسيلات من خلال إجراء مقابلة معهم.أُجريت الارتدادات الخطية المتعددة الهرمية باستخدام السلوكيات الوقائية من داء البروسيلات بمثابة متغير المخرجات. وتم تصنيف المؤشرات لهذا المتغير، وفقًا لطبيعتها، في مجموعتين مختلفتين. في المجموعة الأولى، كان هناك أثر كبير على السلوكيات الوقائية من داء البروسيلات وفق المتغيرات السكانية (0.301 = 2RΔ). وفي المجموعة الثانية، كان المستوى التعليمي ومستوى المعرفة والكفاءة الذاتية مؤشرات مهمة (0.001P) للسلوكيات الوقائية من داء البروسيلات (0.808 = 2RΔ).وُجِدَ أن نموذج التمكين يعد إطارًا مفيدًا في التنبؤ بعوامل الخطر الخاصة بالسلوكيات الوقائية من داء البروسيلات. ويجب على مقدمي الرعاية الصحية في البلدان منخفضة ومتوسطة الدخل الأخذ في الاعتبار مدى معرفة المرضى بالمرض ومستوى كفاءتهم الذاتية في اتباع السلوكيات الوقائية من داء البروسيلات بمثابة الفئات الأساسية للتمكين، ووضع برامج للوقاية من داء البروسيلات في الوقت ذاته.Facteurs cognitifs associés aux comportements de prévention de la brucellose chez les patients diagnostiqués : application du modèle d’autonomisation.Dans de nombreux pays, la brucellose est une maladie endémique, en particulier dans la Région de la Méditerranée, ainsi que dans des pays tels que la République islamique d’Iran. En dépit des mesures de prévention de la brucellose adoptées dans différents pays à travers le monde, cette maladie reste un problème de santé publique.La présente étude avait pour objectif d’examiner les facteurs cognitifs associés aux comportements de prévention de la brucellose chez les patients diagnostiqués à partir du modèle d’autonomisation.Dans le cadre d’une étude transversale réalisée en 2013, l’ensemble des 238 patients atteints de brucellose dans la circonscription de Chaldoran, en République islamique d’Iran, ont été recrutés. Lors d’un entretien, il a été demandé aux patients de remplir un questionnaire basé sur le modèle d’autonomisation ainsi que sur une échelle des comportements de prévention de la brucellose élaborés par les chercheurs.Des régressions linéaires hiérarchiques multiples ont été réalisées, les comportements de prévention de la brucellose constituant la variable de jugement. En fonction de leur nature, les facteurs prédictifs de cette variable ont été classés en deux groupes distincts. Dans le premier groupe, on a constaté un effet significatif sur les comportements de prévention de la brucellose en fonction des variables démographiques (ΔR2 = 0,301). Dans le second groupe, les niveaux d’éducation, de connaissances et d’efficacité personnelle constituaient des facteurs prédictifs significatifs (p0,001) des comportements préventifs de la brucellose (ΔR2 = 0,808).Le modèle d’autonomisation a constitué un cadre utile pour prévoir les facteurs de risque associés aux comportements de prévention de la brucellose. Dans les pays à revenu faible et intermédiaire, il est recommandé aux prestataires de soins de santé de prendre en compte les connaissances des patients sur la maladie ainsi que leur niveau d’efficacité personnelle concernant les comportements de prévention de la brucellose comme catégories de base de l’autonomisation dans le processus d’élaboration de programmes de prévention de cette maladie.

Our aim was to develop a framework-based weight control behavior questionnaire (Weight-CuRB) and test its psychometric properties among a non-probability sample of 240 postmenopausal women with osteoporosis. Appropriate validity, simplicity, functionality and reliability were observed for the Weight-CuRB. The explanatory model fits the data well (χ2 [139] = 245.835

Background: Health-care systems play a key role in responding to the growing problems of patients with type 2 diabetes by supporting their autonomy in providing routine care. The Health Care Climate Questionnaire (HCCQ) was designed to assess patients' perceived degree of autonomy support within the care practice settings. The main purpose of this study was to translate and evaluate psychometric properties of the Persian version of the HCCQ (HCCQ-P) to be applied among Iranian and other Persian-speaking patients with type 2 diabetes. Method: Translation/back-translation procedures were carried out to prepare a preliminary draft of the HCCQ-P that was subsequently sent for face and content validity appraisal by a group of 15 health education/promotion and nursing specialists. Minor revisions were performed based on the feedback, and the content validity ratio (=0.91) and content validity index (=0.95) were within the acceptable range. The structural validity of the scale was assessed by exploratory and confirmatory factor analysis. Results: The exploratory and confirmatory factor analysis outputs (root mean square error of approximation=0.079, comparative fit index=0.976, Tucker Lewis index=0.967, standardized root mean square residual=0.022) demonstrated the proper performance and fitness statistics of the translated HCCQ in a one-dimensional model similar to the original scale. The internal consistency and reliability scores endorsed the validity of the translated measure (α=0.945, intraclass correlation coefficient=0.999, P=0.000). Conclusion: In this study, the translated HCCQ-P scale showed robust internal validity for its application in the assessment of health-care settings' supportiveness in care provision to Persian-speaking patients with type 2 diabetes. Future cross-cultural and multidisciplinary studies are recommended to investigate the applicability of the scale in different patients/cultural groups and health-care settings.

Background: Although the number of pedestrian traffic accidents is decreasing worldwide, more than one-third of traffic fatalities in Iran are related to pedestrians. High-risk behaviors of pedestrians increase their vulnerability to road traffic injuries. Objectives: This study aimed to investigate gender differences in adopting safe pedestrian behaviors in Tabriz, Iran. Methods: This cross-sectional study was carried out among pedestrians aged 18 years and over (n = 508) living in the second municipal district of Tabriz, Iran. The stratified random sampling method was used to recruit a representative sample of adults from 23 July to 21 November 2019. A standardized, structured questionnaire was used for evaluating traffic behaviors in five domains (i.e., adhering to traffic rules, pedestrians’ traffic violations, positive pedestrian behaviors, pedestrians’ distraction, and pedestrians’ aggressive behaviors). The data was analyzed by SPSS version 22 using independent t-test, regression, chi-square, and ANOVA tests. Results: Overall, 58.5% of the participants were female. Women had significantly higher scores in three domains of pedestrian traffic behaviors (i.e., no traffic violations, not being distracted, and not having aggressive behavior) than men (P < 0.001). Additionally, married women and women with higher education levels earned significantly higher scores than others in total pedestrian traffic behaviors. There were significant differences between men and women regarding the use of a personal car and walking daily more than an hour (P < 0.05). Conclusions: Our findings suggest gender differences in the five dimensions of pedestrian traffic behaviors in Iran. Gender-specific risk reduction strategies in the Iranian pedestrians’ safety intervention programs may promote safe traffic behaviors of pedestrians.

Background Health literacy is essential to self-care, which is an important precedence to improve the quality of healthcare services and a key factor in health. It also plays a pivotal role in decision-making in various health fields. Therefore, policymakers consider health literacy to be a primary tool to promote community health and enhance the proper use of healthcare services. The present study aimed to assess the health literacy status of the Kurdish population in Kurdistan province, Iran based on the nine constructs of the Iranian health literacy questionnaire (IHLQ) individually and collectively and determine the significant effects of demographic variables on health literacy. Methods This cross-sectional study was conducted on the Iranian adult Kurdish population living in the urban and rural areas of Kurdistan province, willing to participate during April 2017–September 2018. Data were collected using the IHLQ. The sample size was determined to be 980 people, with 490 in the rural areas and 490 in the urban areas. The researchers visited potential participants at their doorstep, asking them to complete the questionnaire. The willing participants were assisted in completing the IHLQ in case they were illiterate; the questions and answers were read by the researchers to the participants, and the responses were recorded. Results About 50.4% (n = 494) of the Kurdish population had poor health literacy, while 34.0% (n = 333) had average health literacy, and 15.6% (n = 153) had good health literacy. Meanwhile, 60.2% of the participants obtained poor scores in the construct of health information access, and 74.1% (n = 726) obtained poor scores in the individual empowerment construct. In addition, the analysis of the adjusted model indicated that education level (lowest β = 7.42; P = 0.001) and in male participants (β = − 1.10; P = 0.001) were significantly associated with higher health literacy. Conclusion According to the results, the investigated Kurdish population mostly had average or low health literacy. Therefore, proper strategies should be adopted to enhance the health literacy of this population and increase their access to health information. Furthermore, effective training should be provided to these individuals (especially vulnerable social groups) to improve their individual capabilities to compensate for poor health literacy.

BackgroundProviding lonely older adults with informal home care services is important to improving their health and quality of life. The study aims to evaluate the feasibility of design, implementation and evaluation of an informal home care support intervention program (HoSIP) for community-dwelling lonely older adults in Gorgan, Iran.Method/designThis feasibility study is a mixed-method with a concurrent nested design. Lonely older adults will be enrolled as the HoSIP intervention group and will receive 12-weeks of informal home care service by peer supporters. The purpose of this feasibility study is to determine the recruitment capability and resulting sample characteristics, data collection procedure and outcome measures, the acceptability and suitability of the intervention and study procedures, the resource and ability to manage the study and intervention, and preliminary evaluation of participant response to intervention. Primary outcomes including participant feelings of loneliness, quality of life, general health, social network, social support, and self-care ability, will be assessed at baseline and post-intervention for the intervention and control groups. Semi-structured interviews will be conducted immediately after the intervention using content qualitative approach to describe participants’ experiences with HoSIP.DiscussionThrough this study we will examine the feasibility of delivering informal home care services to community-dwelling lonely older adults in a developing country through employing a concurrent nested mixed-method design.Trial registrationIRCT20190503043455N

Background The present study aimed to investigate the effects of a multi-level intervention on hookah smoking frequency and duration among Iranian adolescents and adults. Methods In this study, two comparable cities in Iran were selected to participate in an intervention program based on a social-ecological model (SEM). In each city, 133 hookah smokers in coffee houses were selected. Environmental changes in coffee houses such as serving light foods and games were conducted. A virtual group named “no hookah” was established on the Telegram application to train participants in the intervention group. Messages, pictures, and short videos were sent to the participants through that virtual network. The frequency and duration of hookah consumption were assessed in both groups at baseline and after the intervention. Results The frequency of hookah consumption decreased in 72.6% of participants in the intervention group (vs. 6.3% in the control group), and the duration of hookah consumption per session decreased in 39.5% of participants in the intervention group (vs. 5.5% in the control group). Conclusions Using multi-level interventions through a social-ecological model can reduce hookah consumption in adults.

Background High-risk behaviors are among the most serious threats for the physical and mental health of adolescents and young adults. Our aims in this study were to investigate the subgroups of students based on risky behaviors and to identify the prevalence rate of these subgroups. Methods This cross-sectional web-based survey was conducted from July to August 2019 in Tabriz, Iran. We performed proportional sampling in all nine universities of the city, according to the number of students in each university. Applying an online survey questionnaire, the data were collected from 3649 students and analyzed using Latent Class Analysis. Results For total sample, standardized prevalence rates of cigarette smoking, hookah use, alcohol consumption, substance abuse and unsafe sex were 18.5 (Confidence Interval (CI) 95%: 17.3–19.8), 9.1 (CI 95%: 8.2–10.1), 9.2 (CI 95%: 8.3–10.2), 8.3 (CI 95%: 7.4–9.3) and 14.5 (CI 95%: 13.3–15.7), respectively. Three latent classes of risky behaviors were determined among students: a) low risk b) smoking and c) high risk. About 18% of boys and 1.5% of girls were in the high risk class. Cigarette smoking (18.5%, CI 95%: 17.3–19.8) and substance abuse (8.3%, CI 95%: 7.4–9.3) were the most and the least common risky behaviors among the students. Conclusion In this we-based survey, a considerable number of students, particularly boys (18%), was at high-risk class, stressing the need for preventive interventions for this group of youth. Our findings are beneficial for planning and development of risky-behavior preventive strategies to prevent high-risk behaviors among college students.

Background :High-risk behaviors is one of the most serious factors threatening the physical and mental health of adolescents and young adults. The aims of this study were to investigate thesubgroups of students based on risky behaviors and to identify the prevalence rate of these subgroups. Methods: This cross-sectional web-based survey was conducted from July to August 2019 in Tabriz, Iran. Sampling of all universities in the city was performed proportionally according to the number of students in each university. . Applying an online survey questionnaire, the data were collected from 3649 students and included into Latent Class Analysis. Results: For both genders, standardized prevalence rates of cigarrette smoking, hookah use, alcohol consumption, substance abuse and unsafe sex were 18.5 (CI 95%: 17.3-19.8), 9.1 (CI 95%: 8.2-10.1), 9.2 (CI 95%: 8.3-10.2), 8.3 (CI 95%: 7.4-9.3) and 14.5 (CI 95%: 13.3-15.7), respectively. Three latent classes of risky behaviors were determined among students: 1) low risk 2) smoking and 3) high risk. About 18% of boys and 1.5% of girls were in the high risk class. Cigarrette smoking (18.5%, CI 95%: 17.3-19.8) and substance abuse (8.3%, CI 95%: 7.4-9.3) were the most and the least common risky behaviors among the students. Conclusion: In this we-based survey, a considerable percentage of students, particularly boys, were at high-risk class, stressing the need for preventive interventions for this group of youth. Our findings are beneficial for planning and development of risky-behavior preventive measures to prevent high-risk behaviors among college students.

Background The aim of the present study was to investigate the effects of a multi-level intervention based on the social ecological model on the frequency and duration of hookah smoking among a sample of Iranian adults. Methods In this study, two comparable cities in Iran were selected to participate in an intervention program based on a social ecological model (SEM). In each city, 133 hookah smokers in coffee houses were selected. Environmental changes in coffee houses such as serving light foods and games were conducted. A virtual group named "no hookah" was established on the Telegram application to train participants in the intervention group. Messages, pictures and short videos were sent to the participants through that virtual network. The frequency and duration of hookah consumption were assessed in both groups at baseline and after the intervention. Results The frequency of hookah consumption decreased in 72.6% of participants in the intervention group (vs. 6.3% in the control group); and the duration of hookah consumption per session decreased in 39.5% of participants in the intervention group (vs. 5.5% in the control group). Conclusions Using multi-level interventions through a social ecological model can reduce hookah consumption in young people.

Background Health literacy, as a social determinant of health, has a decisive role in providing different populations with healthcare services in an equal manner. Our aim in this study was to investigate the contribution of socio-demographic factors to functional health literacy (FHL) in a population of Iranian adults and identify differences in the contribution of these factors across genders. Methods This community-based cross-sectional study was conducted in 2015 to 2016 in Sanandaj, Iran. Multistage cluster sampling was employed to recruit 1000 people older than 18 (response rate = 89.2%) from 35 urban and 10 rural health care centers. Test of functional health literacy in adults (TOFHLA) was used to assess FHL. In order to measure inequality in FHL, concentration index decomposition was used. Results In total, 869 respondents (response rate: 86.9%) with a mean age (standard deviation; SD) of 33.68 (13.0) completed TOFHLA questionnaire. More than half of participants were women (57.5%). Participants demonstrated an average TOFHLA score of 51.9. Women demonstrated slightly higher TOFHLA scores (52.2 [SD: 0.46]) compared to men (50.7 [SD: 0.4]). However, the concentration index for gender was 10.9% suggesting gender contributed only moderately to TOFHLA scores. Comparatively, 54.3% of TOFHLA differences were attributed to geographic location. Among women, place of residence, monthly income, age, education level and being head of household contributed to 43%, 32%, 13%, 11.5% and 11% of FHL inequality, respectively. Among men, however, place of residence (45.2%), size of household (15.1%) and monthly income (13.5%) contributed most to inequality in FHL. Conclusions Although gender was not the strongest contributing factor for FHL inequalities, poor FHL was mostly concentrated among men. Different factors were attributed to FHL inequality by gender, as discussed inside. Understanding these differences may assist in identifying and targeting interventions towards men and women with low levels of FHL. Our findings shed light the critical role of social determinants of health (SDH) in promoting the health literacy of populations, particularly in developing countries like Iran.

Background The worldwide trend of hookah use among adolescents is increasing, and literature shows a relationship between obscenity and adolescents’ tendency toward hookah smoking. As there is a lack of appropriate instruments to measure the obscenity of hookah smoking, in the present study, we aimed to develop an instrument to measure hookah smoking obscenity among adolescents. Methods In this methodological study, a sequential exploratory design was used to conduct the study from February 2017 to July 2018 on adolescents in Tabriz, Iran. In the qualitative phase, we conducted semi-structured individual interviews (with 18 students) and a focus group discussion (FGD) (with 13 students) to explain the concept of obscenity and develop the items of hookah smoking obscenity scale (HSOS). We then examined the psychometric properties of the HSOS based on face, content, construct and predictive validities as well as internal consistency and repeatability. Findings The HSOS was developed with 21 items based on the results of qualitative data analysis. Applying confirmatory factor analysis (CFA), the χ2/degree of freedom (df) ratio was found to be 3.792 for the four-factor structure of the questionnaire and the fit indices of this structural model were satisfactory. The values of Cronbach’s alpha and the intraclass correlation coefficient (ICC) for the constructs in the HSOS ranged 0.81-0.93 and 0.79-0.92, respectively. Conclusion We found the HSOS with a good level of fit indices, validity, and reliability. The HSOS may be applied by school healthcare providers and health practitioners to find valid and reliable data on the obscenity of hookah smoking when developing hookah smoking prevention/cessation interventions among adolescents.

Background : Health literacy, as a social determinant of health, has a decisive role in providing different populations with healthcare services in an equal manner. Our aim in this study was to investigate the contribution of socio-demographic factors to functional health literacy (FHL) in a population of Iranian adults and identify differences in the contribution of these factors across genders. Methods : This community-based cross-sectional study was conducted in 2015 to 2016 in Sanandaj, Iran. Multistage cluster sampling was employed to recruit 1000 people older than 18 (response rate = 89.2%) from 35 urban and 10 rural health care centers. Test of functional health literacy in adults (TOFHLA) was used to assess FHL. In order to measure inequality in FHL, concentration index decomposition was used. Results: In total, 869 respondents (response rate: 86.9%) with a mean age (standard deviation; SD) of 33.68 (13.0) completed TOFHLA questionnaire. More than half of participants were women (57.5%). Participants demonstrated an average TOFHLA score of 51.9. Women demonstrated slightly higher TOFHLA scores (52.2 [SD: 0.46]) compared to men (50.7 [SD: 0.4]). However, the concentration index for gender was 10.9% suggesting gender contributed only moderately to TOFHLA scores. Comparatively, 54.3% of TOFHLA differences were attributed to geographic location. Among women, place of residence, monthly income, age, education level and being head of household contributed to 43%, 32%, 13%, 11.5% and 11% of FHL inequality, respectively. Among men, however, place of residence (45.2%), size of household (15.1%) and monthly income (13.5%) contributed most to inequality in FHL. Conclusions: Although gender was not the strongest contributing factor for FHL inequalities, poor FHL was mostly concentrated among men. Different factors were attributed to FHL inequality by gender, as discussed inside. Understanding these differences may assist in identifying and targeting interventions towards men and women with low levels of FHL. Our findings shed light the critical role of social determinants of health (SDH) in promoting the health literacy of populations, particularly in developing countries like Iran.

With the lack of respite care, caregivers will often suffer from physical, mental, and financial hardships. In the Middle East and North African countries, religion and cultural considerations may pull in opposite directions as a vast majority of families in the region care for their loved ones at home. Moreover, the sense of responsibility and obligations toward caring for an older family member also influences caregivers’ decision-making, even though such considerations may deprive them of even a short vacation or break. It is important for policymakers and stakeholders, in close participation with families and older adults receiving care, to take into account how various factors related to social, cultural, and religious matters affect quality of care and the well-being of care recipients and caregivers. Official policies could have an essential role in opening new avenues for temporary respite care, but authorities should be aware of the importance of cultural and religious principles while setting up such policies. Therefore, policymakers should engage with the relevant organizations, such as municipalities, nongovernmental organizations, charities, and religious institutions, to help the health system in establishing respite care facilities. In this article, we discuss a number of key issues and provide suggestions as to how this goal might be achieved. The availability of respite services could have a positive influence on the physical and mental health of both older adults in need of care and informal caregivers. In conclusion, those receiving care, caregivers, and the public health-care system will gain from the development of a range of respite care services.

Background: In 2015, the Iranian Urban Family Physician Program (UFPP) was implemented in urban health centers. In the present study, we aimed to evaluate the trend of health indicators across a ten-year period in an Iranian population and to measure the possible effects of this intervention on health indicators.Methods: An interrupted time series analysis (ITSA) was performed on a ten-years (from 2009 to 2018) of annual data set covering all healthcare indicators associated to the UFPP in Bonab County, Iran. The time of intervention was at the 7th data point in 2015. Health indicators were divided into two groups including process indicators (Modern Contraceptives Use (MCU), Prenatal and Postpartum care visits, Clinical Breast Examinations (CBE), brucellosis and tuberculosis (TB) incidence), and outcome indicators (Total fertility rate (TFR), Maternal Mortality Rate (MMR), Stillbirth Rate (SBR), Infant mortality Rate (IMR), Neonatal Mortality Rate (NMR), 1-59 months old Mortality Rate, Low Birth Weight (LBW), crud birth rate (CBR) and the rates of Infants fed by Formula milk.Results: The ratio of some process indicators, including the MCU (b = -5.13. 95% Confidence Interval (CI): -8.01 to -2.26), incidence of tuberculosis (b = .016. 95% CI: -1.01 to 1.34) and brucellosis (b = 3.04. 95% CI: -3.4 to 9.50) had a decreasing trend from 2008 to 2018. However, the CBE (b = 0.60. 95% CI: -4.97 to 6.18), prenatal care visits, (b= -4.25. 95% CI: -10.4 to 1.5) postpartum care visits (b = -22.83. 95% CI: -31.44 to -14.21), and first time care visits during pregnancy (b = -5.59. 95% CI: -14.52 to 3.32) were found with increasing trends. In contrast, the rate of at least six-time care visits during pregnancy was found to be in a decreasing trend (b = -10.32. 95% CI: -16.82 to -3.82). A series of outcome indicators including MMR (b = 24.78. 95% CI: 2.88 to 46.61), TFR (b= 0.07. 95% CI: 0.01 to 0.13), 1-59 Month old Mortality Rate (b = -.16. 95% CI: -.45 to .12), LBW (b = .33. 95% CI: -.08 to .40), Formula-fed infant rate (b = .48. 95% CI: -.007 to .97), Delivery rate in high-risk groups (b = 1.85. 95% CI: 1.22 to 2.49) and CS (b = -3.43. 95% CI: -5.73 to -1.12) had increasing trends from 2008 to 2018. In contrast, SBR (b = -.04. 95% CI: -.21 to .12), NMR (b = -.77. 95% CI: -2.91 to 1.36), IMR (b = -1.05. 95% CI: -2.99 to .89) and CBR (b = -.97. 95% CI: -1.85 to -.09) were in decreasing trends. Conclusion: The UFPP was found with positive impacts on some process, proximal and distal outcome indicators, but its positive impacts on the trends of some critical indicators, including MMR, NMR and IMR remained questionable. Our findings may shed light on the role of some other factors like social determinants of health in the programs like the UFPP.

Background: Despite the speculations in literature regarding the importance of “social undesirability of hookah smoking”, to our knowledge, no study has yet clearly attempted to define this phenomenon and to make sense of it in terms of the meanings adolescents bring to the concept. The present study was aimed to explore the perceptions of high school students on Social Undesirability of Hookah Smoking (SUoHS).Method: In this qualitative study, 31 students (16 boys and 15 girls) at the range of 15 to 17 years of age in Tabriz, Iran, were invited to participate in semi-structured individual interviews (18 participants) and focus group discussions (FGDs) (13 participants). The data were managed applying MAXQDA-10, and analyzed using interpretative thematic analysis. Results: The SUoHS was viewed at the “highly negative attitude towards hookah smoking and hookah smokers”. The students also explained the SUoHS in “the disvaluing to hookah smoking and smokers in the society”, “the negative attitude towards hookah smokers and their families”, and “the consequences of hookah smoking”. Conclusion: The SUoHS originates from the social context of society, and is rooted from the social values and norms within communities. These social values may affect the attitude and subjective norms of adolescents toward the behavior. Adolescents’ conceptions on SUoHS should be considered while designing hookah smoking prevention/cessation programs with the hope to bridge the gap between their recognition of SUoHS and subsequent behavior change.

Background Pedestrians are among the most vulnerable groups in traffic accidents. Our aim in this study was to explore the challenges associated to pedestrian safety from the perspective of traffic and transport stakeholders. Methods In 2018, applying a qualitative approach, twenty-four traffic and transport stakeholders were invited to participate in semi-structured individual interviews in Tabriz, Iran. To analyze data, conventional content analysis approach was used. MAXQDA software version 11 was applied to manage data analysis process. Findings: Participants reported a wide range of challenges which were grouped into six categories: "Challenges related to pedestrians", "Challenges related to drivers", "Management system challenges", "Environmental infrastructure challenges", "Educational and media challenges", and "Challenges of legislation and enforcement". Conclusion We identified pedestrian safety as a challenging urban traffic and transport issue with specific complexities, particularly in the management system. With a holistic approach to the challenges, as discussed inside, all reported obstacles seem to be overshadowed by one core challenge, namely the lack of a traffic management system with health-oriented approach and enough authority. Using evidence while policy-making and intervention planning, as well as media support is recommended.

Background Explaining the risk and protective factors of substance use (SU) is the most important principle while designing preventive interventions. The aim of this study was to investigate the prevalence rate and determinants of SU in adolescents based on the social development model (SDM). Method In 2018, applying a cross-sectional design, cluster multistage random sampling was employed to recruit 600 adolescents in Bam County, Iran, to participate in the study. A valid and reliable SDM-based instrument was used to collect data.Results The prevalence rate of using at least one substance was 42% (in girls 33.6% and in boys 50.3%). Having close friends with SU was found as the riskiest factor. A score increase in involvement in prosocial activities and interactions, attachment and commitment to prosocial others (family and school), and skills for interaction/involvement among adolescents reduced the probability of ever use of SU by 53%, 37% and 49%, respectively. Also, one score increase in perceived rewards for antisocial interaction/involvement, belief in antisocial values and situational perception among the participants increased the probability of ever use SU by 2.22, 2.24 and 1.22 times. Conclusion The SDM was helpful in determining the predictors of SU among Iranian adolescents. In community-based interventions to prevent SU among adolescents, a great focus should be firstly on identifying the probability of SU in close friends. Moreover, the involvement of adolescents in prosocial activities and interactions, attachment and commitment to prosocial others (family and school), and skills for interaction/involvement should be core categories while designing community-based interventional studies.

The pedestrians are among the most vulnerable group. This study was conducted to explain the challenges associated with pedestrian safety by taking into account the perspectives of Iranian residents in Tabriz. In this qualitative study, applying purposeful sampling approach, we recruited 49 residents to participate in structured qualitative interviews. To collect data, 3 Focus Group Discussions (FGDs) with 28 participants, and 21 individual interviews were conducted. Data analysis was performed applying conventional content analysis. MAXQDA10 was applied for the purpose of data management. After data analysis, six themes emerged including: (a) Pedestrians' own obstacles and challenges, (b) Driver' related obstacles and challenges, (c) Penal system related obstacles and challenges, (d) Advocacy-related obstacles and challenges, (e) Infrastructural obstacles and challenges, and (f) Management obstacles and challenges. Pedestrian safety was identified as a major but extremely intricate urban traffic and transportation issue. To promote pedestrian safety, it is essential for the municipal agencies to focus on the public's convenience through providing need-based infrastructures especially suiting to the elderlies. The agencies, here, must also introduce pedestrian penal system, penalty for using phone while driving, or superior road crossing mechanisms such as those discussed inside. The agencies should also focus on gross political commitment, and a broad strategy involving education, engineering and enforcement, institutional co-ordination within and between different levels of government and with private actors.

Objective The objective of this study was to assess depressive symptoms among rural health workers (RHWs) through a multi-factorial socio-ecological framework (SEF) encompassing personal, interpersonal, organizational and community components. Patients and Methods A random sample of 394 RHWs in all rural areas of East Azerbaijan and fulfilling our other inclusion criteria were recruited. The participants underwent the Short-Form Beck’s Depression Inventory and a validated researcher-constructed SEF questionnaire, including subscales on personal, interpersonal, organizational and community factors associated with depressive symptoms. Internal consistency and factor structure parameters of the SEF were also calculated. Results A total of 394 RHWs were screened, of whom 170 (43.2%) had mild to major depressive symptoms. Only 6.8% were identified with major depressive symptoms. The SEF-based scale was found to have acceptable content validity (content validity index and ratio were 0.80 and 0.77, respectively) and reliability (Cronbach’s alpha=0.7). In the structural equation modeling, the fit indices showed our model to fit the data well (χ2=14.06, df=14, χ2/df=1.00, CFI=0.967, RMSEA=0.032). The highest direct contribution to depressive symptoms was found from the personal factors component (β=−2.32). Also, “work load and roles interference” (from organizational level, β=−0.76) and “family/colleague support” (from community level, β=−1.28) made significant direct contributions towards depressive symptoms. Besides the SEF components, female gender (β=1.69), family history of mental illness (β=−1.48), having chronic illnesses (β=−1.64) and being religious (β=3.43) were the strongest direct contributors to depressive symptoms. Conclusion Depressive symptoms were common among RHWs, arising from all personal-, interpersonal-, organizational- and community-level factors. Our SEF had adequate internal consistency and factor structure parameters to be applied in the Middle East and North Africa (MENA) region countries, such as Iran, as a theoretical framework to plan for interventional efforts aiming at preventing depressive symptoms among RHWs. The burden of depressive symptoms should be reduced through multi-factorial interventions and rational perspectives.

Purpose We sought to examine the association between childhood asthma and self-reported maternal smoking during pregnancy (MSDP) after adjusting for a range of exposure misclassification scenarios using a Bayesian approach that incorporated exposure misclassification probability estimates from the literature. Methods Self-reported MSDP and asthma data were extracted from National Health and Nutrition Examination Survey 2011–2012. The association between self-reported MSDP and asthma was adjusted for exposure misclassification using a Bayesian bias model approach. Results We included 3074 subjects who were 1–15 years of age, including 492 asthma cases. The mean (SD) of age of the participants was 8.5 (4.1) and 7.1 (4.2) years and the number (percentage) of female was 205 (42%) and 1314 (51%) among asthmatic and nonasthmatic groups, respectively. The odds ratio (OR) for the association between self-reported MSDP and asthma in logistic regression adjusted for confounders was 1.28 (95% confidence interval: 0.92, 1.77). In a Bayesian analysis that adjusted for exposure misclassification using external data, we found different ORs between MSDP and asthma by applying different priors (posterior ORs 0.90 [95% credible interval {CRI}: 0.47, 1.60] to 3.05 [95% CRI: 1.73, 5.53] in differential and 1.22 [CRI 95%: 0.62, 2.25] to 1.60 CRI: 1.18, 2.19) in nondifferential misclassification settings. Conclusions Given the assumptions and the accuracy of the bias model, the estimated effect of MSDP on asthma after adjusting for misclassification was strengthened in many scenarios.

Identifying the challenges in source separation of waste in different communities may lead to better understanding on the potential outcomes of recycling programs. Our goal in this study was to identify the challenges of conducting household solid waste separation plan (HSWSP) at source in Tabriz metropolitan city, Iran. In this qualitative study, fourteen key informants on HSWSP at source were interviewed. Content analysis with conventional approach was used to analyze the data. MAXQDA10 was applied to organize the data, to categorize the codes and to identify the relationships between the concepts. Six core categories were identified as the main challenges in the HSWSP at source: (a) low level of participation among citizens; (b) garbage robbery; (c) unbalanced resources; (d) weakness in policymaking; (e) poor performance of private sector; and (f) lack of integrated management. Considering the six challenges identified as hindrances to the successful implementation of HSWSP at source, policymaking was found to connect all the challenges; thus, this work recommends the key authorities and HSWSP at source policymakers to consider revision of the recycling programs plan with appropriate focus on policy development. The work also recommends an integrated approach that will be unified across the city as well as flexible to incorporate variations at various regions of the city.

Background and Objective: Traffic and transport, as a political and social phenomenon, play an important role in the quality and socioeconomic structure of a society. This phenomenon constitutes one of the foundations of modern urban life and social needs of populations. Regarding this, the present study was performed to investigate the impacts of urban traffic and transport on the social determinants of health (SDH) based on the viewpoints of urban residents and key informants in Sanandaj, Iran. Materials and Methods: This qualitative study was conducted on 22 urban residents and 8 key informants selected through purposive sampling technique. The data were analyzed through conventional content analysis approach. Data collection was conducted using four focus group discussions (FGDs) (including 22 residents) and eight in-depth interviews. MAXQDA10 was applied for the purpose of data management. Results: The SDHs that were negatively affected by Sanandaj urban traffic and transport included socio-cultural (e.g., recreation and free times, daily work trends, safety of within-city commuting, tobacco use, and education) and environmental factors (e.g., vegetation, antiquities, noise pollution, urban aesthetic status, and environment, and soil, food, and water status). Conclusion: Urban traffic/transport stakeholders, health policy makers, and health professionals in Iran should pay much more attention to the impacts of urban traffic/transport plans on health and its determinants. It seems necessary to comprehensively assess urban traffic/transport on health status and its determinants in Iran.

The aim of our study was to investigate the therapeutic efficacy of pharmacological and non-pharmacological interventions on low sexual interest/arousal of peri- and post-menopausal women. In this ...

Even though Kurdistan, the western province of Iran, has a cancer surveillance system, a detailed analysis of incidence rate has not been yet performed. We describe Age Standardized Incidence Rates (ASRs) for esophageal cancer (EC) in Kurdistan Province of Iran in 2001–2015. Incidence cases of EC were obtained from a population-based cancer registry. We obtained ASRs and 95% confidence intervals (CI) per 100,000 populations for each calendar year group. Between 2001 and 2015, 1362 incidence cases with EC were reported to the cancer registry. Annual ASRs in 2006–2010 were more than the other years in both men and women, respectively. Most ASRs were reported among women in Divandarreh (18.95, 95% CI 14.76, 23.92), Saqez (12.75, 95% CI 10.73, 15.01), Sanandaj (8.84, 95% CI 7.64, 10.17), and Qorveh (8.19, 95% CI 6.54, 10.12), and among men in Divandarreh (19.38, 95% CI 15.38, 24.06), Saqez (13.64, 95% CI 11.49, 16.05), Sanandaj (8.70, 95% CI 7.56, 9.96), and Marivan (7.93, 95% CI 6.26, 9.88). It was concluded that EC in Divandarreh, Saqez, and Sanandaj has the highest ASRs, and these areas are considered as high-risk areas for this disease in the Iranian province of Kurdistan. Therefore, to understand the reasons of these problems, a considerable work is needed.

Our aim in this cross-sectional study was to assess the cognitive determinants of Cervical Cancer Screening Behavior (CCSB) among housewife women in Islamabad County, Iran. Through multistage random sampling we recruited and interviewed 280 housewife women. The women who perceived more benefits of performing the Pap test (OR = 1.11), and perceived fewer barriers (OR = 0.915), and higher self-efficacy to perform the test (OR = 1.12) were more likely to have a CCSB in the previous three years. Our findings are informative for the development of targeted interventions to foster CCSB among housewife women.

Introduction Pedestrians are among the most vulnerable groups in traffic accidents. The purpose of this study was to explore the strategies associated with pedestrian safety from the perspective of traffic and transport stakeholders. Methods In 2018, this mixed-method study with an explanatory design was conducted in two phases: a quantitative cross-sectional study (the first phase) was conducted among 508 residents in Tabriz, Iran. The valid and reliable Pedestrian Safety Behaviors (PSB) scale was used to collect data through self-report. In the second phase, the quantitative results were presented to twenty-four urban traffic and transport stakeholders during individual interviews (as the qualitative phase) to explore the strategies to promote the safety behaviors of pedestrians. The qualitative data were analyzed applying the conventional content analysis approach. Findings In the quantitative phase, the residents acquired more than 62% of the maximum possible score in all constructs. Among all the domains, aggressive behaviors (85.6%), distractive behaviors (77.2%), violation (21.56%), and PSBs (70.5%) were found with the highest scores. Age, gender, and educational level were significant predictors of safety pedestrians' behaviors (p ≤ 0.001). In the qualitative phase, the strategies to promote pedestrian safety were explored and grouped into four main categories: building public education policies on traffic safety, developing traffic safety infrastructure, improving the traffic management system, and strengthening urban traffic safety legislation. Conclusion Our findings provided strategies to promote pedestrian safety for urban traffic and transport systems of developing countries with specific complexities, particularly in the management system. The mixed-method approach used in the present study was helpful in identifying the most relevant strategies for promoting safe behaviors of pedestrians in Iran, as a developing country. These strategies may be considered while traffic safety policy-making and/or designing pedestrian safety promotion programs within urban environments. The strategies reported here may pertain not only to the Iranian community but also to other potential sectors in developing countries that have the responsibility of providing pedestrians with a safe roadway environment.

Background: Mental health problems, as one of the most neglected issues among adolescents,are common during adolescence and emerging adulthood. The aim of present study was to investigate the determinants of psychological well being among female adolescents in Tabriz,Iran. Methods: In this cross-sectional study, multi-stage cluster sampling was employed to recruit 289 female high school students to participate in the study during 2013–2014. A 3-section questionnaire was applied to collect data. Hierarchical linear regression analysis was applied to illustrate the variations in psychological wellbeing score on the basis of socio-demographic and psychological variables. Results: Self-efficacy, hopefulness, happiness and life satisfaction were positively correlated (r> 0.400) and perceived stress was negatively associated with psychological well-being (r =-0.689). In the first model, satisfaction with family lifestyle (β = 0.168, P < 0.001) and perceived stress (β = -0.470, P < 0.001) were the most significant positive and negative predictors for psychological wellbeing, respectively (R2 = 0.595, P < 0.001). In the second model (step 6),physical activity (β = -0.109, P < 0.019), have/had boyfriend (β = 0.237, P < 0.001), hopefulness(β = -0.130, P < 0.05) and happiness (-β = 0.387, P < 0.001) were significant predictors for perceived stress (R2 = 0.453, P < 0.001). Conclusion: Considering the various behavioral, mental and social predictors of psychological wellbeing, it seems that perceived stress has overshadowed the influence of a majority of the other factors. Such influence may be due to the specific cultural and context-based rules enforced for female adolescents in the Iranian community.

OBJECTIVE Previous studies have shown a remarkable difference in functional health literacy among residents of urban and rural areas which may be attributed to socioeconomic inequalities between these areas. The aim of this study was to investigate the differences (if any) in the level of functional health literacy and its determinants between urban and rural areas in Sanandaj, Iran. DESIGN A descriptive analytical cross-sectional study. PARTICIPANTS A multistage clustered random sample of 1000 respondents older than 18 years. In total, 892 respondents (response rate = 89.2%) completed test of functional health literacy in adults questionnaire through personal home-based interviews. Applying SPSS v. 16, a series of anova, t-test and logistic regression tests were conducted. MAIN OUTCOME MEASURES Inadequate/marginal functional health literacy. RESULTS Respondents residing in rural areas having a diploma education and lower, with no history of hospitalisation, with monthly income