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It is well established that obesity is associated with an increased risk of elevated and high blood pressure (BP) in children and adolescents. However, it is uncertain whether there is an increase in the risk of elevated and high BP associated with an increase of body mass index (BMI) among children and adolescents whose BMI is in the accepted normal range. Data were available for 58 899 children and adolescents aged 6-17 years from seven national cross-sectional surveys in China, India, Iran, Korea, Poland, Tunisia, and the United States. The subjects were divided into eight percentile subgroups according to their BMI levels based on the World Health Organization recommendations. Elevated BP and high BP were defined using the 2016 international child BP criteria. Compared with the reference subgroup of the 5th-24th percentiles, the odds ratios (ORs) for high BP were 1.27 (95% confidence interval [CI], 1.14-1.41; P < 0.001) in the 25th-49th percentile subgroup, 1.55 (95% CI, 1.39-1.73; P < 0.001) in the 50th-74th percentile subgroup, and 2.17 (95% CI, 1.92-2.46; P < 0.001) in the 75th-84th percentile subgroup, respectively, after adjustment for sex, age, race/ethnicity, height and country. Additionally, the corresponding ORs for elevated BP were 1.21 (95% CI, 1.10-1.32; P < 0.001), 1.55 (95% CI, 1.42-1.69; P < 0.001), and 1.80 (95% CI, 1.62-2.01; P < 0.001), respectively. In conclusion, a BMI in the 25th-84th percentiles, within the accepted normal weight range, was associated with an increased risk of elevated and high BP among children and adolescents. It is important for children and adolescents to keep a BMI at a low level in order to prevent and control hypertension.

Background: Excess weight may be associated with mental distress and this relationship varies according to the socio-cultural background of different populations. This study aims to assess the relationship of overweight and obesity with some psychological disorders in a nationally representative sample of Iranian adolescents. Methods: This nationwide study was conducted in 2009-2010 among 5570 students, aged 10-18 years, living in 27 provinces in Iran. Data were collected by using the translated and validated questionnaire of the World Health Organization Global School-based Health Survey. Results: Data of 5528 students (49.7% girls) were complete for this study. Their mean age was 14.7 (2.4) years. Overall 7.9% of participants were overweight and 8.8% were obese. 58.7% of students had anxiety, without significant association of overweight (odds ratio [OR]: 0.86, 95% confidence interval [CI]: 0.68-1.09) and obesity (OR: 1.11, 95% CI: 0.88-1.40) with an anxiety. Nearly 62.6% of students reported to have depression, there was no significant relationship between overweight (OR: 1.11, 95% CI: 0.86-1.43) obesity and (OR: 1.01, 95% CI: 0.79-1.29) with the depression. About 49.4% of students had insomnia, without significant association of overweight (OR: 1.17, 95% CI:, 0.91-1.51) and obesity (OR: 0.91, 95% CI: 0.71-1.17) with the insomnia. Conclusions: In Iranian adolescents, excess weight did not increase the risk of psychological distress. This finding might be due to the positive attitude of family and peers to fatness in adolescence.

Background: In this study, we aim to compare insulin and leptin levels in adolescents with or without excess weight and in those with or without abdominal obesity. Materials and Methods : This case-control study was conducted among 486 samples. We randomly selected 243 overweight and an equal number of normal-weight adolescents from among participants of the third survey of a national surveillance program entitled "Childhood and Adolescence Surveillance and PreventIon of Adult Non-communicable diseases study." Serum insulin and leptin were compared between two groups and their correlation was determined with other variables. Results: The mean age and body mass index (BMI) of participants were 14.10 ± 2.82 years and 22.12 ± 6.49 kg/m 2 , respectively. Leptin and insulin levels were higher in overweight than in normal-weight adolescents (P < 0.05). Leptin level was higher in children with abdominal obesity than in their other counterparts (P < 0.001). Leptin level was correlated with age, fasting blood glucose, BMI, and insulin level. Conclusion: Insulin and leptin levels were higher among overweight and obese children, which may reflect insulin and leptin-resistance. Given the complications of excess weight from early life, prevention and controlling childhood obesity should be considered as a health priority.

Background: Screening of students´ health problems could lead to timely prevention and control of many health disorders. This study aimed to determine the nationwide prevalence of common disorders through school health screening program in Iran Methods: This cross-sectional national screening program was conducted in 2007-2008 among first- and third-grade- students in primary schools, first- grade-students of middle and high schools of all provinces in Iran.Results: Data were obtained from 3,124,021 (81.9%) students reported from the whole country classified into 33 geographical zones. Of total students studied, 12.48% had weight abnormalities, 4.77%had visual disorders, 3.95 % had head lice, 2.24% had behavioral disorders, and 0.6% had hearing disorders. Among students studied, 0.4%, 0.7%, 0.4% and0.8% had endocrine, psychological, neurological and genitourinary disorders, respectively. In addition, 2.1%, 1.9%, 1.8%, 0.8%0.5%, 0.3% and 0.3% of students had ear, nose & pharynx disorder, anemia ,skin & hair , cardiac ,abdominal, vertebral and lung problems, respectively. In elementary schools;57.6% of first-grade- students with at least one disorder were managed in outpatient settings and 6% of them were hospitalized for more investigation. Among third- grade- students of elementary schools, these values corresponded to 13.2% and 1.1%, respectively. Among first grade students of middle and high schools, this prevalence was 58.5% and 44.6% and 1.2% and 0.3% of students were hospitalized for more investigation.Conclusion: This integrated school screening program revealed a considerably high prevalence of health disorders among school students. These results might help health policy makers to design future health promoting programs.

"nBackground: The health status of children in the Iran has improved in many areas such as lower rates of infectious diseases and declines in malnutrition. However rapid lifestyle changes might make them prone to chronic diseases in adulthood. Be­cause of the importance of collecting national information about related risk behaviors and risk factors, this national project was conducted for the first time in the Eastern Mediterranean region."nMethods: The baseline survey was conducted among 21111 school students aged 6-18 years, and their parents living in 23 provinces; biochemical tests were obtained from 4811 students."nResults: Underweight and overweight had similar prevalence (13.9% underweight, 13.4% overweight).The most prevalent type of dyslipidemia was low HDL-C and hypertriglyceridemia. In addition to providing national percentiles and reference curves for weight, height and body mass index, this study provided the first reference curves for waist circumference and blood pressure of children, as well as the first national prevalence of pediatric metabolic syndrome in Asia. Unhealthy nutri­tion and low physical activity were associated with most risk factors."nConclusion: Close monitoring of children and adolescents for risk factors and risk behaviors should be considered as a public health priority, thus a national school-based surveillance program is being established in this regard in Iran. &nbsp

Mental health problems including emotional and behavioral problems during puberty may be under influence of different risk factors including cultures, living in urban or rural areas and ethnic factors which may vary between different countries. The main aim of this study is to investigate the profile of emotional and behavioral problems and the role of factors such as age, stage of puberty, ethnicity, rurality and living in urban area, as risk factors in Iranian girls. As a part of a large national study we evaluated the emotional and behavioral problems in different stages of puberty in a community sample of Iranian adolescent girls from public schools that were selected by clustered random sampling method. In all subjects, demographic characteristics, and pubertal stages were measured. Emotional and behavioral problems were evaluated using Strength and Difficulties Questionnaire (SDQ). The associations of age, pubertal development indices, socioeconomic and demographic factors with the behavioral problems were assessed. A total number of 4576 students enrolled the study and responded to the questions. The mean age of participants was 13.83 ± 2.19 years. The mean total score of difficulties in participants was 14.34 ± 5.81. According to these results 813 (17.8%) adolescents had total problem scores higher than Goodman's cutoff points and the most frequent problem domain was conduct problems (20.5%). According to the results the most related variable with the total difficulty score of SDQ were ethnicity, residency in urban areas and development of menstrual cycle respectively. The results of this study showed that the most correlated factors with mental health problems in Iranian girls during puberty are ethnicity, urbanity and development of menstrual cycle.

Background: The fourth survey of the surveillance system named ′′childhood and adolescence surveillance and prevention of adult non-communicable disease′′ (CASPIAN-IV study), was conducted among a national representative sample of Iranian students. This paper describes the methods and early findings of this survey. Methods: This nationwide school-based study was conducted in 2011-2012 in 30 provinces of Iran among 13,486 students, 6-18 years (6640 girls, 75.6% from urban areas) and one of their parents. Results: Mean age of students was 12.5 years. Based on the World Health Organization growth curves, 12.2% were underweight, 9.7% overweight and 11.9% were obese. Abdominal obesity was observed in 19.1% of students. The dominant type of cooking oil in urban families was liquid oil and hydrogenated fat (39% and 32%), most rural families used hydrogenated fat (53%), respectively. A total of 18% of students had at least 30 min of daily physical activity; 41% of students used computer in weekdays and 44% used it in weekends. Almost 34.5% of students reported to have at least one cigarette smoker and 21.5% reported to have a waterpipe smoker in their relatives. Moreover, 20.3% of students reported that they had suffered an injury needing the help of school health providers during the year prior to the study. Conclusions: Current evidence on the health risky behaviors among Iranian children and adolescents confirms the importance of conducting comprehensive surveillance surveys to identify health risk behaviors. Data of this survey and the trend of variables provide necessary information for health policy makers to implement action-oriented interventions.

Regular physical activity (PA) is an underlying factor since childhood and adolescence for having a healthy and active future for life. The aim of this stud y was to review the evidence on increasing the youth PA to develop the national program at country level. At first, the databases were searched using the sensitive keywords, and systematic reviews of the relevant databases were extracted. The studies were evaluated in terms of relevance and methodological quality for effective interventions that were detected. These cases were also identified in the effective interventions: disadvantages, benefits, costs, methods, and limitations of early studies, which were based on systematic review of the studies. Three interventions were identified as physical education curriculum reform, the creation of extra-curricular activities, as well as approaches to environmental and social support. Evidences showed that the relative impact of these interventions were not high. Thus, a combination of all three options of integrated approach is recommended for reducing the sedentary lifestyle of youths.

Background: This study aims to assess the frequency of some hygienic behaviors that is, tooth brushing and hand-washing, in Iranian school students at national level. Methods: This nationwide study was conducted in 2011-2012 among 14,880 elementary, secondary and high school students who were selected by random cluster stratified multistage sampling from 30 provinces in Iran. We used the global school-based health survey questionnaire of the World Health Organization. Results: The population of this survey consisted of 13,486 children and adolescents (participation rate of 90.6%) including 49.2% girls and 75.6% urban inhabitants. The mean age of participants was 12.5 years (12.3-12.6, 95% confidence interval) According to the self-report of students, 26.9% of them (20.2% of boys and 33.9% of girls) brushed their teeth more than once a day, 37.8% of boys and 42.1% of girls brushed their teeth once a day. In general, girls brushed their teeth more than boys. The frequency of those students who never brushed their teeth was twice in rural than in urban students (11.4% vs. 6.2%, respectively). In total, 3.4% of the students stated that their school had not an appropriate place for washing hands after toilet, with three-fold higher frequency in rural than in urban schools (6.8% vs. 2.3%, respectively). 85% of students (87% of girls vs. 83% of boys) reported that they had always washed their hands after toilet, 10.1% did it occasionally and 4.1% did not. Conclusions: This nationwide survey revealed that Iranian students have an acceptable level of hygienic behaviors both in urban and rural areas; however, still it is necessary to improve school health facilities and hygienic habits in Iranian students.

Background: Regular physical activity (PA) is an underlying factor since childhood and adolescence for having a healthy and active future in life. The aim of this study was to review the evidence on increasing the youth PA to develop the national program at country level. Methods: At first, the databases were searched using the sensitive keywords, and systematic reviews of the relevant databases were extracted. The studies were evaluated in terms of relevance and methodological quality for effective interventions that were detected. These cases were also identified in the effective interventions as disadvantages, benefits, costs, methods, and limitations of early studies, based on systematic review of the studies. Findings: Three interventions were identified as physical education curriculum reform, the creation of extra-curricular activities, as well as approaches to environmental and social support. Evidence showed that the relative impact of these interventions were not high. Conclusion: Thus, a combination of all three options of integrated approach is recommended for reducing the sedentary lifestyle of youths.

"nBackground: Screening program in schools are designed to identify children who have early signs of health problems. This study provides information about the findings of national screening program in Iran."nMethods: This national program is conducted by the Ministry of Health& Medical Education (MOHME) with collaboration of the Ministry of Education & Training. This program had two major parts including 1) screening of behavioral, hearing and visual disorders, pediculosis and calculating body mass index and 2) physical examination of students, conducted by pri­mary care physicians. All services are offered free of charge. The students' parents are informed about the health status of their children."nResults: The screening program conducted in 2007-2008 included 3,124,021 students from 33 cities who were studying in the first- and third- grade- students in elementary schools, first- grade- students in middle and high schools. Of total students stud­ied, 12.48% had weight disorders, i.e. body mass index 95th percentile. 4.77%had visual disorders, 3.95 % had head lice, 2.24% had behavioral disorders, and 0.6% had hearing disorders."nConclusion: In addition to its benefits to the students' health status, the results of this screening program help health policy mak­ers to design interventions for prevention and or early detection and treatment of the most common disorders docu­mented among school students. "n&nbsp

Objective We estimated pubertal development of 7,493 normal Iranian girls aged 6 to 20 years in a cross-sectional study. Methods Pubertal stages were assessed according to Tanner. The mean ages to achieve secondary sexual characteristics as well as the mean age at menarche were estimated. Weight and height were measured and body mass index (BMI) was calculated. Reference curves for different breast stages and menarche were constructed. The percentiles for attaining each stage were compared to data proposed by Tanner. Findings The mean age at breast bud stage (B2) was 10.10, pubic hair stage (P2) was 9.83, and menarche age was 12.55 years. The anthropometric variables were interpreted in different maturity stages. The mean age at attainment of puberty was compared with those of other populations. Conclusion Not only the onset of puberty in Iranian girls but also the duration of puberty is similar to data from most other countries. A lower age limit for the definition of precocious puberty than the traditional 8 years is documented for Iranian girls. However, it should be noted that considering the rate of evolution of pubertal findings is more important than the age of their appearance.

Background: Socioeconomic status (SES) is a major determinant of health inequality in children and adolescents. The aim of this study was to evaluate the association of SES of family and living region with self-rated health (SRH) and life satisfaction (LS) among children and adolescents. Methods: This study was a part of the fourth survey of a national surveillance program, which was conducted in 30 provinces of Iran in 2011-2012. LS and SRH were assessed by a questionnaire based on the World Health Organization-Global School-based student Health Survey (WHO-GSHS). Family SES was estimated using principal component analysis (PCA) and based on family assets, parental education and occupation, and type of school. Region SES was calculated using PCA and some variables including literacy rate, family assets and employment rate. Results: Out of 14,880 invited students, 13,486 (participation rate: 90.6%) completed the survey; of whom, 49.2% were girls, and 75.6% were from urban areas with the mean ± SD age of 12.47±3.36 years. In the multivariate model, SES of family and living region was associated with LS and good SRH. In the full models, in addition to all potential confounders, family and living region SES were included simultaneously. However, only the association of family SES with LS, and good SRH remained statistically significant. Conclusion: The effect of families’ SES on SRH and LS is more important than regional SES. The presented patterns of SRH and LS may be useful in developing better health policies and conducting complementary studies in this field.

Objective: To evaluate predictive factors of adolescents’ appraisal of their health. Methods: The nationwide study, entitled “Childhood and Adolescence Surveillance and Prevention of Adult Non-communicable Diseases (CASPIAN) study”, was conducted in 2010 among Iranian school students, aged 10-18. In addition to demographic factors and physical examination, variables as family structure, nutrition habits, physical activity, smoking, hygienic habits, violence, school attachment, family smoking, and family history of chronic diseases were assessed. The dependent variable is the self-rated health (SRH) and it was measured by 12 items, which had already been combined through latent class analysis. We had taken a dichotomous variable, i.e. the higher values indicate better SRH. The dependent variable was regressed on all predictors by generalized additive models. Results: 75% of adolescents had a good SRH. The linear and smooth effects of independent variables on SRH were observed. Among all the variables, physical activity had a positive linear effect on SRH (β = 0.08, P value = 0.003). Smoking, violence, and family history of disease associated to SRH non-linearly (P value < 0.05). Family smoking (β = −0.01) and hygienic habits (β = 0.27) related to SRH both linearly and non-linearly. Conclusions: Physical health and high risk behavior, either of linear or non-linear effect, are factors, which seem to shape the adolescents’ perception of health.

Background: Leisure time activity is an important life-style habit. This study aims to determine the screen time of a nationally representative sample of Iranian children and adolescents. Methods: This nationwide cross-sectional study was conducted as part of the fourth survey of a surveillance system. The participants consisted of 14880 students, with aged range from 6 to 18 years, living in 30 provinces in Iran. Screen time, i.e. the time spent on watching television (TV)/video and computer games during leisure time, was assessed by using the questionnaire of the Globasl Student Health Survey of the World Health Organization. Results: The study participants were 13486 school students (participation rate of 90.6%) with a mean age of 12. 47 (3.36) years. Overall, 75.6% of students were from urban and 24.4% from rural areas and 50.8% were boys respectively. Overall, 33.4% and 53% of students watched TV/video more than 2 h a day in their leisure time during school days and holidays, respectively. Likewise, 6.3% and 10.9% of students used computer more than 2 h a day in their leisure time during the school days and holidays, respectively. Overall, 47.1% of urban students and 24.2% of rural students used personal computer in their leisure time during the school days. The corresponding figures were 50.8% and 27.2% in weekends and holidays, respectively. Conclusions: The time spent on screen activities is long in a considerably high number of Iranian children and adolescents. It should be reduced by increasing the public awareness and by providing facilities for regular daily physic activity for students′ leisure times.

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: Little experience exists on valid and reliable tools for assessment of the determinants of underweight and overweight in children and adolescents living in the Middle-East and North Africa (MENA). This study aimed to develop a valid and wideranging questionnaire for assessment of these parameters in a nationwide sample of Iranian children and adolescents. Methods : This national study was conducted in 31 provinces in Iran. The first phase consisted of focus group discussion with 275 children and adolescents and their parents. After a qualitative content analysis, the initial items were extracted. In the next step, the face validity was assessed by expert panelists using the quantitative method of the Impact Score. To assess the content validity, the content validity rate (CVR) and the content validity index (CVI) were determined. The internal consistency was examined by Cronbach alpha, and its test-retest reliability was determined. The socio-demographic variables, perinatal factors, lifestyle factors, family history, knowledge and attitude were assessed. Dietary intakes were assessed by a validated 168-item semi-quantitative food frequency questionnaire. A validated questionnaire for quality of life was filled in anonymously. Results: A team of expert researchers conducted the data analysis of 576 interviews by using qualitative content analysis method. The analysis process began by determining the semantic units about the concepts studied. The initial questionnaire was developed in four domains by including Likert scale questions. In the face validity step, all questions of the primary questionnaire obtained a score of more than 1.5. In the phase of CVR assessment, 6 questions obtained a score of less than 0.62, and were omitted. The rest of questions were assessed for CVI, and got a score of more than 0.75. Cronbach′s alpha coefficient of the whole questionnaire was 0.97, and the Pearson correlation coefficient of the test-retest phase was 0.94. Conclusion: The developed questionnaire is a valid and reliable tool for assessment of the determinants of weight disorders in a nationally representative sample of children and adolescents in the MENA.

Background: This study aims to assess the frequency, causes, and places of injuries in a nationally representative sample of Iranian children and adolescents, as well as the referral, places allocated for injured individuals. Methods: This nationwide study was conducted in 2011-2012 among 13486 elementary, secondary and high-school students who were selected by random cluster stratified multistage sampling from 30 provinces in Iran. The Global School-based Health Survey questionnaire of the World Health Organization was used. Results: The study participants consisted of 50.8% boys, 75.6% urban resident with a mean age of 12.5 years. Overall, 20.25% of participants reported that they were minimally injured once in the last 12 months; this prevalence was higher in boys than in girls (25.74% vs. 14.58%, respectively, P < 0.001), without significant difference in urban (20.11%) and rural (20.69%) areas. Most of them (39.92%) were injured at homes or house yards with higher prevalence in girls than in boys (48.61% vs. 35.17%, respectively, P < 0.001) and in rural than in urban areas (27.30% vs. 20.89%, respectively, P < 0.001). Schools were reported as the second prevalent site of injury occurrence (22.50%). Emergency departments and physician offices were the most prevalent referral places for injured individuals (32.31% and 22.38%, respectively). Most of the school injuries occurred during play or sport activities (45.92%). Conclusions: Prevention of unintentional injuries should be considered as a health priority. Appropriate preventive strategies should be enhanced at homes and schools.

Background: Risk taking behaviors have several negative consequences. This study aimed to identify the subgroups of students based on risk-taking behaviors and to assess the role of demographic characteristics, depression, anxiety, socioeconomic status (SES), physical inactivity and screen time on membership of specific subgroup. Study design: Cross-sectional study. Methods: This nationwide survey was conducted in 2011-2012 among 14880 students, aged 6-18 yr, selected by multistage, cluster-sampling method from 30 provinces of Iran. The students completed two sets of anonymous and validated questionnaires, obtained from the World Health Organization-Global School Health Survey questionnaires. Latent class analysis was performed to achieve the study objectives. Results: Overall, 13486 children and adolescents participated were enrolled (response rate 90.6%). They consisted of 50.8% boys, with a mean age of 12.47 ±3.36 year. The prevalence of physical fight, bullying, victimization, active smoking, passive hookah and passive cigarette smoking was 39.7%, 17.4%, 27.2%, 5.9%, 21.1 and 33.8%, respectively. Five latent classes were identified: (a) low risk (46.7%), (b) passive smoker (25.2%), (c violence and aggression taker with passive smoking (13.5%), (d) violence and aggression taker without passive smoking (10.8%) and (e) high risk (3.8%). Higher age (OR=1.41), being male (OR=5.21), depression (OR=4.58), anxiety (OR=3.38) and screen time (OR=3.11) were associated with high-risk class. Conclusion: The prevalence of some risk-taking behaviors among Iranian students is high. Our findings emphasize the importance of planning and evaluating preventive interventions by considering different high-risk behaviors simultaneously

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: 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: A school-based surveillance system entitled the childhood and adolescence surveillance and prevention of Adult Noncommunicable disease (CASPIAN) Study is implemented at national level in Iran. This paper presents the methods and primary findings of the third survey of this surveillance system. Methods: This national survey was performed in 2009-2010 in 27 provinces of Iran among 5570 students and one of their parents. In addition to physical examination, fasting serum was obtained. Body mass index was categorized based on the World Health Organization growth charts. Findings: Data of 5528 students (2726 girls, 69.37% urban, mean age 14.7 ± 2.4 years) were complete and are reported. Overall, 17.3% (17.3% of girls and 17.5% of boys) were underweight, and 17.7% (15.5% of girls and 19.9% of boys) were overweight or obese. Abdominal obesity was documented in 16.3% of students (17.8% of girls and 15% of boys). 57.6% of families consumed breads, the staple food for Iranians, prepared with white flour. Most families (43.8% in urban areas and 58.6% in rural areas) used solid hydrogenated fats. 22.7% of students did not add salt to the table food. 14.2% of students reported to have a regular daily physical activity for at least 30 min a day. Overall, 10.4% of students (11.7% in urban areas and 7.3% in rural areas) reported that they used tobacco products, often waterpipe. 32.8% of students experienced at least three times of bullying in the previous 3 months. During the year prior to the survey, 14.46% of students had an injury needing the interference by school health providers. Conclusion: This survey is confirmatory evidence on the importance of establishing surveillance systems for risk behaviors to implement action-oriented interventions.