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Introduction: This cross-sectional study aimed to assess the association between cardiovascular disease (CVD) risk factors and dinner consumption in a nationally representative sample of Iranian adolescents. Methods: The present study was conducted on 5642 adolescents aged 10-18 years old in 27 provinces in Iran. The subjects were included applying by multistage random cluster sampling. Participants who ate ≥5 dinners during a week were considered as a dinner consumer. Results: Among 5642 subjects, 1412 (25%) did not consume dinner. Dinner consumers were less likely to be overweight or obese (P < 0.001) and abdominally obese (P < 0.001) as well as to have an abnormal level of HDL-C (P = 0.02). Dinner skipper youths had a higher risk for overweight or obesity (odds ratio [OR]: 1.62; 95% CI: 1.39-1.89) and abdominal obesity (OR: 1.59; 95% CI: 1.36-1.85) which remained significant after adjusting confounding factors (P

Objective: Childhood obesity has become a priority health concern worldwide. Socioeconomic status (SES) is one of its main determinants. This study aimed to assess the socioeconomic inequality of obesity in children and adolescents at national and provincial levels in Iran. Methods: This multicenter cross‐sectional study was conducted in 2011–2012, as part of a national school‐based surveillance program performed in 40,000 students, aged 6–18‐years, from urban and rural areas of 30 provinces of Iran. Using principle component analysis, the SES of participants was categorized to quintiles. SES inequality in excess weight was estimated by calculating the prevalence of excess weight (i.e., overweight, generalized obesity, and abdominal obesity) across the SES quintiles, the concentration index (CCI), and slope index of inequality (SII). The determinants of this inequality were determined by the Oaxaca Blinder decomposition. Results: Overall, 36,529 students completed the study (response rate: 91.32%); 50.79% of whom were boys and 74.23% were urban inhabitants. The mean (SD) age was 12.14 (3.36) years. The prevalence of overweight, generalized obesity, and abdominal obesity was 11.51%, 8.35%, and 17.87%, respectively. The SII for overweight, obesity and abdominal obesity was −0.1, −0.1 and −0.15, respectively. CI for overweight, generalized obesity, and abdominal obesity was positive, which indicate inequality in favor of low SES groups. Area of residence, family history of obesity, and age were the most contributing factors to the inequality of obesity prevalence observed between the highest and lowest SES groups. Conclusion: This study provides considerable information on the high prevalence of excess weight in families with higher SES at national and provincial levels. These findings can be used for international comparisons and for healthcare policies, improving their programming by considering differences at provincial levels.

Background: Undoubtedly, one of the vital needs of man is security. Determinants and related factors to sense of social security is one of the most important research priorities, especially in adolescents and young people. Objective: To identify the factors affecting the social security of the youth. Methods: In 2017, using conventional content analysis, and benefiting from semi-structured in-depth interviews, we conducted a qualitative study exploring the opinions of young people about their feelings regarding social security. First, a targeted sampling method was determined to collect the data. Participants were young volunteers aged 18 to 30 who were selected from Tehran, the capital of Iran. Inclusion criteria for participants were willingness to participate in the study and ability to express their experiences. Data was extracted from 21 participants. Results: The participants consisted of 21 young people who met the study inclusion criteria, of whom 12 participants were male. Their mean age was 24.4±0.41 years and their education varied from primary school to master’s degree. Under two main categories of the need for economic and financial security and the need for a safe society, we extracted 11 subcategories following 32 codes. According to the findings, most participants agreed on the important role that sense of social security has in their lives and their health. Conclusion: The important role of sense of social security in participant’s lives and health was the main important point of our findings, emphasized by most of participants. Based on the results; the assessment of the specific needs of different target groups, the design, development and implementation of health programs led to more effective interventions.

Introduction: The aim of the present study is to explore the prevalence and mean of cardio-metabolic risk factors and liver enzymes of Iranian adolescents living in regions with different socioeconomic status (SES). To the best of our knowledge this is the first study reporting these data at sub-national level in Iran. Methods: This multi-centric study was performed in 2009-2010 on a stratified multi-stage probability sample of 5940 students aged 10-18 years, living in urban and rural areas of 27 provinces of Iran. Trained healthcare professionals measured anthropometric indices, systolic and diastolic blood pressures (SBP, DBP) according to standard protocols. Fasting venous blood was examined for fasting blood sugar (FBS), lipid profile and liver enzymes including alanine aminotransferase (ALT) and aspartate aminotransferase (AST). We classified the country into four sub-national regions based on criteria of the combination of geography and SES. Mean and frequency of risk factors were compared across these regions. Results: The mean of body mass index had linear rise with increase in the regions’ SES (P for trend

Background: Today, one of the most serious causes of mortality and disability among youth is the traffic accidents. Regarding its importance, this paper aimed to investigate the community-based program to promote the safe traffic behaviors among youth. Methods: This was a quasi-experimental conducted on 5000 youth in five Iranian cities named Lanjan, Gomishan, Fasa, Tehran, and Zahedan in 2015–2016. The questionnaire was based on the constructs of the theory of planned behavior as well as a questionnaire of pedestrian behavior and driving behavior, which was completed before and after the intervention. The educational intervention was carried out based on the theory of planned behavior. Finally, the obtained data were analyzed using STATA software. Results: Six months after the intervention, the mean score of the theory of planned behavior and safe driving behavior in different cities was significantly increased. Here, regarding the safe crossing of the street, the most behavioral changes were observed in Gomishan (P = 0.000), Fasa (P = 0.001), and Tehran (P < 0.0001). The mean score of driving behaviors in Gomishan (P < 0.000), Fasa (P = 0.016), Lanjan (P = 0.047), and Tehran (P < 0.0001) scores was significantly higher. conclusions: In most of the studied cities, it can be concluded that education based on the theory of planned behavior can improve the safe driving behaviors among youth. Therefore, it is recommended to be implemented this program in other cities using the theory of planned behavior.

Introduction: Current evidence suggests that ghrelin could contribute to the development of metabolic syndrome (MetS) in adults, but limited experience exists in adolescents. This study aims to explore the association of ghrelin levels with the MetS components among Iranian adolescents. Methods: In this case-control study, 32 adolescents with MetS and 148 healthy controls were selected randomly from the childhood and Adolescence Surveillance and Prevention of Adult Non communicable disease (CASPIAN-III) study. MetS was defined according to the Adult Treatment Panel III (ATP III) criteria modified for children and adolescents. Anthropometric measures (including body mass index [BMI], waist circumference [WC] and waist to height ratio [WHtR]), blood pressure (BP) and biochemical data (including fasting blood sugar [FBS], triglyceride [TG], high-density lipoprotein cholesterol [HDL-C], low-density lipoprotein cholesterol [LDL-C], total cholesterol [TC] and gerlin) were measured. Results: Total ghrelin level was significantly higher in students without MetS compared to those with MetS (748.89 ± 85.04 vs. 728.72 ± 90.36 [pg/mL]; P

Objective: This study aims to investigate the role of metabolic syndrome (MetS) and the hypertriglyceridemic‐waist (HW) phenotype in determining cardiometabolic risk factors and elevated liver enzymes in a national sample of Iranian pediatric population. Method: This nationwide study was conducted in the framework of the third survey of a surveillance program. Students, aged 10‐18 years, were recruited from 27 provinces in Iran. The prevalence of cardiometabolic risk factors was compared in students with and without HW and MetS. The association of HW with different cardiometabolic risk factors was determined. Results: The mean age of studied population was 14.73 ± 2.41 years. Prevalence of HW and MetS was 3.3% and 4%, respectively. Sixty‐nine (71.1%) participants with HW had MetS. The prevalence of obesity, elevated systolic blood pressure, hypercholesterolemia, and elevated ALT was significantly higher in subjects with HW phenotype and MetS than in their peers (p

Abstract Objectives: This study was conducted to explore the association of eating frequency (EF) with anthropometric indices and blood pressure (BP) in children and adolescents. Methods: This nationwide cross-sectional study was performed on a multi-stage sample of 14,880 students, aged 6–18 years, living in 30 provinces in Iran. Parents were asked to report dietary intake of children as frequency of food groups and/or items. EF was defined as the sum of the daily consumption frequency of main meals and snacks. Association of EF with weight disorders, abdominal obesity, and elevated BP was assessed using different logistic regression models adjusted for potential confounding factors. Results: Eating more frequently (≥6 vs. ≤3) was found among students who were at younger age (11.91 vs. 13.29 years) (p < 0.001). Students who reported an EF of 4 (OR: 0.67, CI: 0.57–0.79), 5 (OR: 0.74, CI: 0.62–0.87), and 6 (OR: 0.54, CI: 0.44–0.65) had lower odds of being obese compared to those who had EF ≤ 3. Having EF of 4 (OR: 0.82, CI: 0.71–0.94), 5 (OR: 0.86, CI: 0.74–0.99), and ≥6 (OR: 0.73, CI: 0.63–0.85) was related to lower prevalence of abdominal adiposity. Conclusion: Higher EF was associated with lower mean values of anthropometric and BP measures, as well as with lower prevalence of generalized and abdominal obesity in children and adolescents. Longitudinal studies are needed to assess the long-term effects of EF on body composition in the pediatric age group.

Background: Mental health is considered as an integral and essential component of overall health. Its determinants and related factors are one of the most important research priorities, especially in adolescents and young people. Using a qualitative approach, the present study aimed to identify factors affecting the mental health of youth in Iran. Methods: In 2017, following content analysis principles, and using semi-structured in-depth interviews, we conducted a qualitative study exploring the opinions of young people about mental health. A targeted sampling method was used, and participants were young volunteers aged 18 to 30 who were selected from Tehran province, Iran. Inclusion criteria for participants was willingness to participate in the study, and ability to express their experiences. Data collection was done with individual in-depth interviews. According to the explanatory model, the interviews were directed toward the concept of mental health and path of causality and auxiliary behaviors. Results: 21 young adults participated, who met the study inclusion criteria, of whom 12 participants were male. Their mean age was 24.4 ± 0.41 years and their education varied from primary school to Master’s degree. Mental health was considered as mental well-being and a sense of satisfaction and efficacy, not only the presence of a disease or mental disorder. Based on the opinions of the interviewees, three factors of personal characteristics, family and society are involved in mental health. Individual factors were associated with behavioral and physical problems. One of the most important issues was revealed as tensions in societal and family conflicts. Economic problems and unemployment of young people were also extracted from the social factor. Conclusion: In Iran, social factors such as jobs for the unemployed and job security are considered as important determinants in the mental health of young people.

Noncommunicable diseases (NCDs) and their risk factors are major health threats especially for developing countries. The aim of this study was to assess the association between breast feeding (BF) and birth weight (BW) with anthropometric measures and blood pressure (BP) in a nationally–representative sample of Iranian children and adolescents. Methods: In this national survey, 14,880 children and adolescents, aged 6–18 years, were selected using a multistage, cluster sampling method from rural and urban areas of 30 provinces of Iran. BF duration and BW were assessed by validated questionnaires completed by parents. Results: The study participants were 13,486 students (participation rate of 90.6%). They consisted of 49.24% girls, 75.6% urban residents, with a mean age of 12.5 years (95% confidence interval: 12.3–12.6). The family history of obesity had a significant association with BW (p

This study aims to assess the prevalence of growth disorders among a nationally representative sample of Iranian adolescents according to the socioeconomic status (SES) of their living area. Methods: This nationwide cross-sectional survey was conducted among a representative sample of 5624 adolescents aged 10–18 years. They were selected by multistage cluster sampling from 27 provinces of Iran. Subnational classification of the country was based on geography and social class of each region. Analysis of variance and Chi-square tests were used to compare the prevalence of growth disorders according to sex and SES of the living regions. Results: The mean and standard deviation for body mass index was 19.42 (4.09) kg/m2, with a significant trend from the Southeast region with lowest SES to the Central part with highest SES (ptrend

OBJECTIVE: This study aimed to evaluate the association of junk food consumption with hypertension and obesity in a national sample of Iranian children and adolescents. METHODS: This nationwide study was conducted in 2011-2012 among 14,880 students, aged 6-18 years, selected by cluster sampling from 30 provinces. Weight, height, waist circumference (WC), hip circumference (HC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), as well as systolic and diastolic blood pressure (BP) were measured. Junk food was divided into four categories, including salty snacks, sweets, sweetened beverages, and fast food. Subjects reported how many times they had consumed each item (daily, weekly, and seldom). RESULTS: The intake of sweets was significantly associated with anthropometric indices and BP levels. Moreover, a significant association was found between fast food consumption, BP levels, and anthropometric indices (except for WHtR and WHR). Sweet beverages consumption was significantly associated with anthropometric indices; however, the consumption of salty snacks was only significantly associated with height, HC, and WHR. The risk of general obesity (OR: 0.75, 95% CI: 0.65-0.87) and abdominal obesity (OR: 0.81, 95% CI: 0.72-0.92) among participants who seldom consumed sweets was less than those who consumed daily. Also, the risk of general obesity (OR: 0.85, 95% CI: 0.74-0.97) among students that seldom consumed sweetened beverages was less than subjects who consumed them on a daily basis. CONCLUSION: It was found that junk food consumption increased the risk of both general and abdominal obesity; therefore, consumption of junk food should be reduced via restricting TV advertisements and increasing taxes on junk foods.

Background: Hypertension is a major leading factor for global burden of diseases. Blood pressure (BP) tracks from childhood to adulthood.So, it is important to investigate its aff ecting factors. In this study we aimed to compare the BP status in the Iranian pediatric population according to the socioeconomic status (SES) of their living area. Materials and Methods: In this nationwide study, a representative sample of 14,880 students, aged 6-18 years was chosen by multistage random cluster sampling from 30 provinces in Iran. Anthropometric indices and BP were measured. A validated questionnaire, including the questions of the World Health Organization Global School-based Student Health Survey was completed. Findings were compared across the four regions of the country, categorized based on their elevating SES: Southeast, north-northeast, west, and central. Results: Participants consisted of 13,486 children and adolescents, that is, a participation rate of 90.6%, composed of 49.2% girls and 75.6% urban residents. The mean (standard deviation) age of participants was 12.47 (3.36) years. The region with highest SES (central) had the lowest rate of high BP (HBP), that is, 3.0% (95% of confidence interval [CI]: 2.4-3.9), and the region with lowest SES (southeast) had the highest rate, that is, 7.4% (4.4-12.2). The mean (95% CI) values of systolic BP for the four regions from lowest to highest SES were 100.5 (99.6-101.3), 100.9 (100.3-101.4), 101.7 (101.3-102), and 101.7 (101.2-102.1) mmHg. The corresponding mean Diastolic BP values were as follows: 65.4 (64.6-66.1), 63.4 (62.9-63.8), 65.6 (65.3-65.8), and 64.4 (64.0-64.7) mmHg. Conclusion: We found significant differences in mean BP and the frequency of HBP according to the SES of the living area. Further studies are necessary to find the underlying factors resulting in such differences.

Background: This study aimed to determine the association of serum 25-hydroxy Vitamin D (25(OH)D) levels with measures of general and abdominal obesity in Iranian adolescents. Materials and Methods: This nationwide cross-sectional study was conducted among 1090 students, aged 10-18 years, living in 27 provinces in Iran. Serum concentration of 25(OH)D was analyzed quantitatively by direct competitive immunoassay chemiluminescence method. Body mass index (BMI) and waist-to-height ratio (WHtR) were considered as measures of generalized and abdominal obesity, respectively. Results: Study participants consisted of 1090 adolescents (51.9% boy and 67.1% urban residents) with mean age, BMI, and waist circumference of 14.7 (2.6) years, 19.3 (4.2) kg/m 2 , and 67.82 (12.23) cm, respectively. The median serum 25(OH)D was 13.0 ng/mL (interquartile range: 20.6). Overall, 40% of participants were Vitamin D deficient, and 39% were Vitamin D insufficient. Serum 25(OH)D level was not associated with BMI and WHtR. Conclusion: We did not document any significant association between serum 25(OH)D level and anthropometric measures in adolescents. This finding may be because of considerably high prevalence of hypovitaminosis D in the study population.

Background: Excess weight in children and adolescents is a multi-factorial phenomenon and associated with earlier risk of obesity-related diseases. This study aims to assess the prevalence of weight disorders and the mean values of anthropometric indices according to regional, socioeconomic, and urban-rural variations among Iranian children and adolescents. Materials and Methods: This nationwide study was performed in 2011-2012 among a representative multi-stage cluster sample of 14,880 Iranian students aged 6-8 years. The World Health Organization (WHO) reference curves were used to define weight disorders. Abdominal obesity was defined as the waist-to-height ratio (WHtR) of more than 0.5. Iran was classified into four regions according to the socioeconomic status (SES). Results: The mean (95% confidence interval) of body mass index (BMI), waist circumference (WC), and hip circumference (HC) was 18.8 (18.7, 18.9) kg/m 2 , 67.0 (66.7, 67.3) cm, and 80.8 (80.3, 81.2) cm, respectively. The prevalence of underweight was 12.2%. A total of 9.7%, 11.9%, and 19.1% of students overweight, obese, and abdominally obese, respectively. The highest mean of BMI, WC, wrist circumference, HC, and WHtR were related to the second high SES (North-northeast) area (19.2 [18.8, 19.5], 68.3 [67.3, 69.4], 14.8 [14.7, 15.0], 82.6 [81.1, 84.0], and 0.464 [0.460, 0.468]). In contrast, the lowest SES (Southeast) region had the lowest mean of these anthropometric indices (17.6 [17.1, 18.2], 63.2 [61.7, 64.8], 14.5 [14.2, 14.8], 76.9 [74.9, 79.0], and 0.439 [0.434, 0.444]). Conclusion: We found considerable differences in the prevalence of anthropometric measures throughout the country by SES of the region. Health policy making and implementing health strategies should consider SES of regions.

Introduction: Providing health services for adolescents requires exploration of hidden factors from the perspective of adolescents, providers, and key individuals. Understanding the process of providing health services from adolescents point of view will help receiving and continuation of services. Although many studies have been conducted in Iran on adolescents health needs, few studies have dealt with provision of these services to adolescents. Aim: The present study aimed to explain the adolescents and key informants’ perception of healthcare provision. Materials and Methods: The present qualitative study was conducted according to grounded theory. Data were collected using deep semi-structured individual interviews and group discussion. Participants were selected through purposive sampling followed by theoretical sampling. Participants in present study were 65 adolescents, nine youths (19-24-yearold), and 19 parents and key people involved in providing health services. Adolescents and their parents were selected from different parts of Tehran. Data collection continued until data saturation, and was analysed using Corbin-Strauss (2008) method. Results: Issues relating to adolescents perception of the process of providing services included health concerns, society’s inappropriate behaviours, and weakness of the health services system in responding to adolescents needs, which as underlying factors contributed to adolescents confusion in receiving services and their proper coping with puberty. Conclusion: Due to lack of education on how to manage puberty by parents, schools, society, and the health system, participating adolescents from Tehran were confused about receiving information and unable to manage puberty problems. Solving this problem requires continuity of services and interaction of family, school and community.

Background: Factors affecting social health, especially in young adults, are among the most important research priorities. Knowledge of social factors affecting young adults' health will lead to understand them in the social context. The present study is aimed to explain the perspective of young adults on social factors affecting health. Methods: In the present qualitative content analysis study, semi-structured open interviews were conducted through targeted sampling of young volunteers aged 18–30 who were selected from Tehran Province. Interviews were recorded, transcribed, and analyzed. The inclusion criteria for participants were willingness to participate in the study and ability to express their personal experiences. Twenty-one data were collected through collection was done with individual in-depth interviews. Results: Using this qualitative approach, the present study was conducted to identify factors affecting social health from the perspective of young adults. The analysis led to the extraction of three main categories, each with two or three subcategories: expectations regarding the community, expectations regarding the family, and expectations regarding infrastructures. Conclusions: Our findings shown that social support considered as effective elements in providing social health of young adults. The evidence on controlling factors should be considered in promoting the social health of specific target groups. The results of the present study could be used for better planning of interventions in youth social health domains.

The objective of this study was to evaluate the varicella zoster virus (VZV) immunity in Iranian adolescents. It was conducted as a primary study for vaccine implementation, and to investigate the association of climatic and socioeconomic factors with the epidemiology of this infection. In this cross- sectional study, anti VZV antibodies were measured in serum samples obtained in a national school-based health survey (CASPIAN- III). Association of demographic, socio-economic, and climate of the living region with the frequency of VZV was investigated by multivariate multilevel analysis. Overall, sera of 2753 individuals aged 10-18 were tested for VZV antibodies, from those 87.4% were positive. The prevalence was statistically different in four socio-geographic regions (P

Metabolic syndrome (MetS) and its contributing factors are considered important health problems in the pediatric age group. This study was designed to assess the joint association of ST and PA with cardiometabolic risk factors among Iranian adolescents. A representative sample of 5625 (50.2% boys) school students with a mean age of 14.73 (SD: 2.41) were selected through multistage random cluster sampling method from urban and rural areas of 27 provinces in Iran. ST and PA were assessed by self-administered validated questionnaires. Anthropometric measures (height, weight and waist circumference (WC)) and MetS components (abdominal obesity, elevated blood pressure (BP), low high-density lipoprotein cholesterol (HDL-C), elevated triglycerides (TG) and high fasting blood sugar (FBG)) were measured according to standardized protocols. MetS was defined according to the Adult Treatment Panel III criteria modified for the pediatric age group. Moreover, elevated total cholesterol (TC), elevated low-density lipoprotein cholesterol (LDL-C), and generalized obesity were considered as other cardiometabolic risk factors. Students with high ST levels had significantly higher body mass index z-score (BMI z-score), WC, TG, LDL-C, and BP as well as lower HDL-C level; whereas those with high PA levels had significantly higher HDL-C levels as well as lower BMI z-score, TC, and BP. Adolescents with low PA/ high ST levels had significantly higher BMI, WC, LDL-C levels, as well as higher SBP and DBP compared to their other counterparts. In Multivariate model, joint effect of low PA/ high ST (compared to the high PA/low ST group) increased the odds of overweight, abdominal obesity and low HDL-C and decreased the odds of elevated TC. The findings of this study showed that joint association of high ST and low PA have direct association with abdominal obesity, overweight and low HDL-C and indirect association with elevated TC.

Background: Factors affecting lifestyle become one of the most priorities of the research field, especially in adolescents and youth. Using a qualitative approach, this study aimed to understand what factors are affecting young people's healthy lifestyle. Methods: Using the conventional content analysis, and used the semi-structured in-depth interviews, we conducted a qualitative study to elicit the youth opinion considering their lifestyle affecting factors. Initially, purposeful sampling method was considered for data collection. Participants were selected from volunteered youths 18–30 years whom were selected from the Tehran city. Inclusion criteria for the participants were; (a) willingness to participate in the study, and (b) ability to express experiences. Results: According to findings, although the majority of participants agreed on the important role of lifestyle related behaviors in their healthy life, the lack of essential motivation and the pressure of educational assignments remove it from their daily program priorities. The most important barrier to observing the healthy lifestyle was expressed as; the acceptance of the concept by the individual and the social and economic potential of the individual. It was also suggested that practical interventions should focus on improving more participator engagement of all of the related stakeholders. Conclusions: We proposed the participatory strategies for youth healthy lifestyle promotion. Through which based on a specific needs the assessment of different target groups, designing, development, and implementation of health programs led to more effective interventions.

Background: Iran is a vast country with great variability in ethnicity and geographical regions as well as higher diversity in socioeconomic and demographic factors in different provinces. All these differences could influence the growth indicators of children and may result in a substantial inequality in the distribution of growth indexes across Iranian provinces. This study aimed to determine the distribution of growth disorders of Iranian children according to the geographical and climatic conditions. Methods: In this nationwide cross-sectional study, students aged 6-18 years, living in urban and rural areas of 30 provinces in Iran, were studied. The prevalence of underweight, overweight, obesity, abdominal obesity and short stature were determined in different geographical regions of Iran using the geographic information system (GIS) and ArcGIS software. Results: Overall, 13486 children with mean age of 12.5 (CI: 12.3 - 12.6) years were studied. The prevalence of overweight and obesity as well as underweight ranged between 5-15%, in most provinces. Underweight was more prevalent in very hot and hot regions than in cold regions. The prevalence of overweight and obesity was higher in regions with cold and rainy weather. The prevalence of short stature in most of the provinces ranged between 5-15%. Conclusion: The findings provide geographic disparities of growth disorders among Iranian pediatrics population. They could be used as baseline information for planning further studies to determine the causal pathway for reported wide range of reported growth disorders and their association with different geographical and climatic regions. Keywords: Obesity, Overweight, Underweight, Short stature, Children, Adolescents, Iran

Background: The aim of this study was to evaluate the association of Socioeconomic Status (SES) with anthropometric measures and BP in Iranian children and adolescents. Methods: This nationwide study was conducted in 2011-2012 among 14,880 students, aged 6-18 years, selected by multistage, cluster-sampling method from rural and urban areas of 30 provinces of Iran. Anthropometric indexes and BP were measured by standard protocols and with calibrated instruments. SES was estimated based on family assets and parents’ job and education using principle component analysis method. SES was considered as “low”, “intermediate” and “high” in the statistical analysis. Results: Overall, 13486 children and adolescents out of 14,880 invited students (response rate 90.6%) participated in this study. They consisted of 50.8% boys, 75.6% urban residents, with a mean age of 12.47 ±3.36 years. The prevalence of overweight, obesity and abdominal obesity and also mean of all anthropometric measures increased linearly with increasing SES. Inversely, underweight decreased linearly with increasing SES. Association of BP measures with SES was not statistically significant. After adjustment for potential confounders, association of anthropometric measures and BP with SES did not change significantly. Conclusion: We found that obesity, overweight and abdominal obesity was prevalent in high SES group and underweight in low SES group. Our findings serve as confirmatory evidence that contrary to developed countries, in developing countries childhood obesity is more prevalent in families with higher SES. Keywords: Anthropometric measures, Blood pressure, Socio-economic status, Children and adolescents, Iran

Background: This study was aimed to investigate the association of consuming white rice and potato, as well as the bread type with anthropometric measures and blood pressure (BP) in a national sample of Iranian children and adolescents. Methods: This nationwide study was conducted in 2011-2012 among 14,880 students, aged 6-18 years, selected by multistage cluster sampling from 30 provinces of Iran. Weight, height, waist circumference (WC), hip circumference (HC), waist -to-hip ratio (WHR), waist-to- height ratio (WHtR), as well as systolic and diastolic blood pressure (SBP, DBP) were measured. The self-reported frequency consumption of white rice and potato (daily or non-daily), as well as consumed bread type were asked. Results: The mean (SD) age of participants was 12.47 (3.36). They were consisted of 50.76% girls and 75.57% urban residents. The intake of white rice had significant positive association with anthropometric indices and SBP levels (P-value

Background: This study aimed to assess the frequency of consuming different types of snacks among Iranian students according to socio-economic status (SES) of their living region. Methods: Data were obtained from the fourth national school-based surveillance survey entitled CASPIAN-IV study. Overall, 14880 school students, aged 6-18 years, were selected through multistage, cluster sampling from rural and urban areas of the of 30 provinces of Iran. The World Health Organization Global School Student Health Survey (WHO-GSHS) was used. Data were compared at national/sub-national levels by survey data analysis methods. Results: The participation rate was 90.6%, 13486 students (49.2% girls), mean (SD) age of 12.50 (3.36) years completed the study. At national level, fresh fruits were the most common used category of healthy snacks (55.74%, 95% CI: 54.51, 56.96). Boys had more daily consumption of milk (48.65% vs. 43.27%), and girls had more daily consumption of fresh fruits (58.07% vs. 53.47%). Urban residents had lower consumption of vegetables (30.53% vs. 37.55%), dried fruits (18.29% vs. 23.02%), and fresh fruits (45.33% vs. 50.09%) than their rural counterparts. Among unhealthy snacks, sweets had the highest daily consumption (34.15%, 95% CI: 33.04, 35.28). Boys had higher consumption of sweetened beverages (22.57% vs. 17.6%) and fast foods (3.51% vs. 2.17%). At national level, except than salty snacks (16.24% rural vs.11.83% urban), consumption of other junk snacks had no significant difference between urban and rural residents. Conclusion: Differences in the frequency of consuming healthy and unhealthy snacks according to the SES of the living region, and the choice differences between genders should be considered in planning national health programs. Keywords: Snack, Healthy snack, Junk food, Socio-economic status, Iran

Background: Among chronic non-communicable diseases (CNCDs), the occurrence of cardiovascular diseases and diabetes is more prominent. CNCDs origin in early life; with sedentary habits, notably prolonged screen time (ST), leisure time spent on watching TV and working computer, suggested as one of their risk factors. We aimed to investigate the relationship between ST and cardiometabolic risk factors in a nationally representative sample of Iranian children and adolescents. Methods: In this analytical cross-sectional study, 5,625 school students aged 10-18 were studied in the third national survey of a school-based surveillance program. For ensuring representativeness of sample, subjects were selected using multistage random cluster sampling method from urban and rural areas of 27 provinces in Iran (2009-10). ST was assessed through validated self-administered questionnaire, and cardiometabolic factors were determined. In addition, metabolic syndrome components were defined based on the Adult Treatment Panel III criteria modified for the pediatric age group. In addition, high total cholesterol (TC), high low-density lipoprotein cholesterol (LDL-C), and generalized obesity were assessed as other cardiometabolic risk factors. Results: Mean age was 14.73±2.41. While, positive significant association was found between ST and abdominal obesity, blood pressure, levels of LDL-C and triglycerides (P

Background: This study aims to assess the pattern of meal frequency consumption of Iranian children and adolescents at national and subnational levels according to the socioeconomic status (SES) of the living region. Methods: This multi-centric study was conducted in 2011-2012 among 14,880 students, aged 6-18 years, who were selected by multistage random cluster sampling from 30 provinces. Meal frequency was assessed by the World Health Organization Global School-based student Health Survey (WHO- GSHS) questionnaire. Data were compared at national and sub-national levels according to the SES of the living region. Results: Overall, 13486 students completed this study (participation rate: 90.6%). The frequency of breakfast, lunch, and dinner skipping was 32.08% (95% CI: 30.99, 33.2), 8.58% (95% CI: 7.71, 9.54), and 10.90% (95% CI: 10.21, 11.62), respectively. The frequency of consuming 1 meal, 2 meals, and 3 meals a day was 9.60% (95%CI: 8.94, 10.31), 29.28% (95% CI: 28.31, 30.26), and 61.12 % (95% CI: 59.89, 62.34), respectively. The mean number of days per week of breakfast consumption was 5.14 (95% CI: 5.08, 5.20), the corresponding figure was 6.39 (95%CI: 6.35, 6.42), and 6.24 (95%CI: 6.21, 6.28) for lunch and dinner, respectively. These frequencies had no significant difference according to the SES of the living region. Conclusion: Most Iranian children and adolescents consumed all three main meals, however irrespective of SES; in general skipping breakfast was more frequent than skipping lunch and dinner. Regular meal intake, notably breakfast, should be considered in health promoting programs for all children and adolescents. Keywords: Meal frequency, Skipping meals, Children and adolescents, Prevention, Health promotion, Iran

Background: Behavioral disorders are common in the pediatric age group. This study aims to assess the relationship between the frequency of behavioral and mental disorders and counseling with family members and friends in a representative sample of Iranian children and adolescents. Methods: In this nationwide study, 14880 school students, aged 6-18 years, were selected by cluster and stratified multi-stage sampling method from 30 provinces in Iran. The World Health Organization Global School-based Health Survey questionnaire was used. Results: Overall, 13486 students (49.2% girls) with the mean (standard deviation) age of 12.47 (3.36) years completed the study. According to the students′ self-report, 56.1% of boys and 42.2% of girls shared their problems with their fathers. All behavioral disorders were less prevalent in children and adolescents who consulted with their father compared with those who did not (P < 0.001). In addition, 84.6% of boys and 84.0% of girls shared their problem with their mother. All behavioral disorders were less prevalent in children and adolescents who consulted with their mother compared with those who did not (P < 0.001). 45.6% of boys and 44.8% of girls shared their problem with their brother or sister. Some behavioral disorders were less prevalent in children and adolescents who consulted with their brother or sister (P < 0.01); however, the prevalence was not statistically different for most disorders (P > 0.05). Moreover, 60.4% of boys and 66.0% of girls shared their problems with their friends. The prevalence of most behavioral disorders was lower in those who consulted with their friends (P < 0.001). Conclusions: Children and adolescents should be encouraged to consult with their parents and friends about their problems. Parents should offer their children an opportunity to express their views and wishes about their problems.

Background: This study aims to explore the frequency of aggressive behaviors among a nationally representative sample of Iranian children and adolescents. Methods: This nationwide study was performed on a multi-stage sample of 6-18 years students, living in 30 provinces in Iran. Students were asked to confidentially report the frequency of aggressive behaviors including physical fighting, bullying and being bullied in the previous 12 months, using the questionnaire of the World Health Organization Global School Health Survey. Results: In this cross-sectional study, 13,486 students completed the study (90.6% participation rate); they consisted of 49.2% girls and 75.6% urban residents. The mean age of participants was 12.47 years (95% confidence interval: 12.29, 12.65). In total, physical fight was more prevalent among boys than girls (48% vs. 31%, P < 0.001). Higher rates of involvement in two other behaviors namely being bullied and bulling to other classmates had a higher frequency among boys compared to girls (29% vs. 25%, P < 0.001 for being bullied) and (20% vs. 14%, P < 0.001 for bulling to others). Physical fighting was more prevalent among rural residents (40% vs. 39%, respectively, P = 0.61), while being bullied was more common among urban students (27% vs. 26%, respectively, P = 0.69). Conclusions: Although in this study the frequency of aggressive behaviors was lower than many other populations, still these findings emphasize on the importance of designing preventive interventions that target the students, especially in early adolescence, and to increase their awareness toward aggressive behaviors. Implications for future research and aggression prevention programming are recommended.

Background: This paper presents the methodology and primary findings of a national project on determinants of weight disorders among Iranian children and adolescents at national and sub-national levels. Methods: This nationwide study was conducted in 2011-2012 in Iran as part of the fourth phase of a national surveillance program entitled Childhood and Adolescence Surveillance and PreventIon of Adult Noncommunicable disease-IV study. It had two phases of qualitative and quantitative study. This multicentric study was conducted among 25,000 students aged 6-18 years, living in urban and rural areas of 30 provinces of Iran. Students were selected by multistage cluster sampling method. Data regarding weight disorders including sociodemographic variables, perinatal factors, lifestyle factors, family and student dietary habits, quality of life, and family history of chronic diseases as well as body image were gathered via validated questionnaires. Results: Overall, 23043 students completed the survey (participation rate: 92.17%). The mean age of participants was 12.55 ± 3.31 years; 50.8% were boys, and 73.4% were from urban areas. Underweight was found in 10.4% of boys and 9.2% of girls, the corresponding figure for overweight and obesity was 21% and 18.3%. Abdominal obesity was found in 17.6% of students. Among parents, obesity was more frequent than other weight disorders, with higher prevalence in parents of girls than boys (24.5% vs. 21.5%, respectively, P < 0.001). Overweight and obesity were more prevalent in urban than in rural parents (66.7% vs. 59.7%, respectively, P < 0.001). Conclusions: This survey serves as confirmatory evidence on the prevalence of dual burden of weight disorders in Iran. Its findings on determinants of weight disorders would help policymakers to implement relevant programs at national and sub-national levels.

Background: Mental health is considered as an integral and essential component of overall health. Its determinants and related factors are one of the most important research priorities, especially in adolescents and young people. Using a qualitative approach, the present study aimed to identify factors affecting the mental health of youth in Iran. Methods: In 2017, following content analysis principles, and using semi-structured in-depth interviews, we conducted a qualitative study exploring the opinions of young people about mental health. A targeted sampling method was used, and participants were young volunteers aged 18 to 30 who were selected from Tehran province, Iran. Inclusion criteria for participants was willingness to participate in the study, and ability to express their experiences. Data collection was done with individual in-depth interviews. According to the explanatory model, the interviews were directed toward the concept of mental health and path of causality and auxiliary behaviors. Results: 21 young adults participated, who met the study inclusion criteria, of whom 12 participants were male. Their mean age was 24.4 ± 0.41 years and their education varied from primary school to Master’s degree. Mental health was considered as mental well-being and a sense of satisfaction and efficacy, not only the presence of a disease or mental disorder. Based on the opinions of the interviewees, three factors of personal characteristics, family and society are involved in mental health. Individual factors were associated with behavioral and physical problems. One of the most important issues was revealed as tensions in societal and family conflicts. Economic problems and unemployment of young people were also extracted from the social factor. Conclusion: In Iran, social factors such as jobs for the unemployed and job security are considered as important determinants in the mental health of young people.