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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.

مقدمه: آنمی یکی از مسایل شایع بهداشتی در دنیا است که به ویژه در کودکان و نوجوانان با اختلال رشد و تکامل، کاهش ضریب هوشی و افت تحصیلی، مشکلات خلقی و رفتاری همراه است. مطالعه‌ی حاضر جهت تعیین شیوع این بیماری در دانش‌آموزان و شناسایی افراد مبتلا و در معرض خطر در سراسر ایران انجام شد. روش‌ها: در این مطالعه‌ی توصیفی- مقطعی، در طی برنامه‌ی معاینات دانش‌آموزی، تمام دانش‌آموزان سال اول ابتدایی، راهنمایی و دبیرستان سراسر کشور از نظراختلالات مختلف از جمله آنمی معاینه شدند. وجود علایم بالینی و نشانه‌های آنمی در معاینه‌ی فیزیکی، ملاک آنمیک بودن فرد در نظر گرفته شد. گردآوری داده‌ها با استفاده از اطلاعات مندرج در شناسنامه‌ی سلامت دانش‌آموزان انجام گردید. یافته‌ها: این مطالعه، شیوع آنمی را در دانش‌آموزان 5/4 درصد نشان داد. شیوع آنمی در دختران 5/5 درصد، در پسران 5/3 درصد، در شهرها 6/4 درصد و در روستاها 1/4 درصد به دست آمد. شیوع آنمی در دانش‌آموزان سال اول ابتدایی، راهنمایی و دبیرستان به ترتیب 8/4، 5/4 و 1/4 درصد بود. نتیجه‌گیری: شیوع آنمی در دانش‌آموزان به ویژه سال اول ابتدایی، نگران کننده است و اهمیت بیماریابی دقیق و شناسایی افراد در معرض خطر با برنامه‌های غربالگری گسترده، مداوم و با حساسیت بالا را می‌رساند. همچنین طراحی و اجرای برنامه‌های مناسب جهت پیشگیری و درمان بیماری در جامعه و مدارس ضروری است.

OBJECTIVE: This study aimed to simplify the diagnostic criteria of pre-hypertension (pre-HTN) and hypertension (HTN) in the pediatric age group, and to determine the accuracy of these simple indexes in a nationally-representative sample of Iranian children and adolescents. METHOD: The diagnostic accuracy of the indexes of systolic blood pressure-to-height ratio (SBPHR) and diastolic BPHR (DBPHR) to define pre-HTN and HTN was determined by the area under the curve of the receiver operator characteristic curves. RESULTS: The study population consisted of 5,738 Iranian students (2,875 females) with mean (SD) age of 14.7 (2.4) years. The prevalences of pre-HTN and HTN were 6.9% and 5.6%. The optimal thresholds for defining pre-HTN were 0.73 in males and 0.71 in females for SBPHR, and 0.47 in males and 0.45 in females for DBPHR, respectively. The corresponding figures for HTNwere 0.73, 0.71, 0.48, and 0.46, respectively. In both genders, the accuracies of SBPHR and DBPHR in diagnosing pre-HTN and HTN were approximately 80%. CONCLUSIONS: BPHR is a valid, simple, inexpensive, and accurate tool to diagnose pre-HTN and HTN in adolescents. The optimal thresholds of SBPHR and DBPHR were consistent with the corresponding figures in other populations of children and adolescents with different racial and ethnic backgrounds. Thus, it is suggested that the use of these indexes can be generalized in programs aiming to screen elevated blood pressure in the pediatric age group.

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: This study aims to assess the relationship of serum Mg and vitamin D levels in a nationally-representative sample of Iranian adolescents. Methods: The study participants consisted of 330 students, aged range from 10 to 18 years, consisting of an equal number of individuals with and without hypovitaminosis D. The correlation between serum 25 hydroxy vitamin D (25(OH) D) and magnesium (Mg) concentrations was determined. Results: The mean age of participants was 14.74 ± 2.587 years, without significant difference between those with hypovitaminosis D and those without it. The mean 25(OH) D level was 6.34 ± 1.47 ng/ml in the group with hypovitaminosis D and 39.27 ± 6.42 ng/ml in the group without it. The mean Mg level was 0.80 ± 0.23 mg/dl with lower level in the group with hypovitaminosis D than in others (0.73 ± 0.22 mg/dl vs. 0.87 ± 0.22 mg/dl, respectively) and according to t-test analysis, significant lower levels in the deficient group was observed (P = 0.0001). The linear regression analysis showed the meaningful relationship between Mg and 25(OH) D serum levels (P = 0.0001). Conclusions: Our study revealed significant associations between serum Mg and 25(OH) D levels. This finding may be of use for further studies on the prevention and management of hypovitaminosis D in children and adolescents. Further longitudinal studies shall evaluate the underlying mechanisms and the clinical significance of the current findings.

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: The global health burden has faced toward non-communicable diseases (NCDs). It is suggested that adulthood blood pressure (BP) is tracked from childhood. This study aims to evaluate the mean BP and the prevalence of prehypertension and hypertension in the Iranian pediatric population. Methods: In a national survey as the 4 th phase of Childhood and Adolescence Surveillance and Prevention of Adult Non-communicable diseases study and through random multistage cluster sampling, a national sample of Iranian school students, aged 6-18 years, were recruited. Data gathered by means of modified World Health Organization Global school-based student health survey questionnaire, a weight disorders determinants questionnaire and anthropometric and BP measurements. Prehypertension (HTN) was defined as BP equal or greater than 90 th age and sex specific percentile or ≥120/80 mmHg and HTN was defined as BP ≥95 th percentile. Results: A total of 13486 students entered the study (49.2% girls, 75.6% urban). Mean age of participants was 11.47 ΁ 3.36 years. A total rate of 4.17% (3.84-4.52 95% CI) for high systolic BP (SBP), 4.33% (3.99-4.68) for high diastolic BP (DBP) and 6.88% (6.45-7.32) for high SBP and/or DBP was depicted. Conclusions: The prevalence rate of high BP (pre-HTN together with HTN) is substantially high in this population. It is needed to study the causative situations and implement relevant interventions.

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: 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: Reference percentile curves are usually used as a screening tool to determine growth disorders. Anthropometric indices are population-dependent and may differ according to ethnicity, dietary pattern and lifestyle habits. This study aims to compare the curves of anthropometric measures obtained in two national studies conducted among Iranian children and adolescents in 2003-2004 and 2009-2010. Materials and Methods: Anthropometric measures obtained in two nationwide surveys conducted in 10-18-year-old Iranian students were compared. Lambda-mu-sigma (LMS) Chart Maker Pro program was used to develop age- and gender-specific percentiles and to smooth and fit the model. Results: In 2003-2004, the mean and standard deviation (SD) of body mass index (BMI) and waist circumference (WC) were 18.98 ± 3.81 kg/m 2 and 67.50 ± 11.05 cm in boys; and 19.44 ± 3.78 kg/m 2 and 66.55 ± 9.89 cm in girls, respectively. In 2009-2010, the corresponding figures were 19.16 ± 4.07 kg/m 2 , 69.42 ± 11.43 cm, 19.63 ± 4.11 kg/m 2 , and 67.29 ± 9.69 cm, respectively. Height curves did not show considerable changes in two studies. Comparison of two series of studies showed that the weight, BMI, WC, and waist-to-height ratio were lower in adolescent girls than boys especially in higher percentiles. Moreover, in both genders, weight, BMI, and WC percentiles decreased. Conclusion: The growth charts of Iranian children and adolescents aged 10-18 years have changed over 5 years. The reference growth curves change over time in the pediatric age group, repeated surveys should be conducted to update the age- and gender-specific reference curves in different populations.

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: 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.

OBJETIVO: o objetivo deste estudo foi avaliar a associação do consumo de café da manhã com fatores de risco cardiometabólico em uma amostra representativa, em termos nacionais, de pacientes de pediatria iranianos. MÉTODOS: os participantes do estudo, composto de 5.625 alunos em idade escolar de 10-18 anos, participaram da terceira pesquisa do sistema nacional de vigilância nas escolas (CASPIAN-III). Eles foram classificados em três grupos, com base na quantidade de dias em que consumiam café da manhã: "indivíduos que consomem café da manhã regularmente" (6-7 dias/semana), "indivíduos que consomem café da manhã normalmente" (3-5 dias/semana) e "indivíduos que consomem café da manhã raramente" (0-2 dias/semana). A síndrome metabólica (SM) foi definida com base nos critérios do III Painel de Tratamento de Adultos (ATP III), adaptados para a faixa etária pediátrica. Ademais, o colesterol total elevado, a lipoproteína de baixa densidade-colesterol elevada (LDL-C) e a obesidade generalizada foram incluídos como outros fatores de risco cardiometabólico. As análises de regressão logística múltipla foram utilizadas para avaliar a associação entre a categoria consumo de café da manhã e fatores de risco cardiometabólico. RESULTADOS: a quantidade de pessoas classificadas como indivíduos que consomem café da manhã "regularmente", "normalmente" e "raramente" foram 2.653 (47,3%), 1.327 (23,7%) e 1.624 (29%), respectivamente. As médias de triglicerídeos (TG), LDL-C, pressão arterial sistólica (PAS) e índice de massa corporal (IMC) foram mais elevadas no grupo de "indivíduos que consomem café da manhã raramente" (P para tendência < 0,001), ao passo que a lipoproteína de alta densidade-colesterol (HDL-C) foi menor nesse grupo que nos outros. Os indivíduos que consomem café da manhã raramente apresentaram um aumento no risco de obesidade, TG e LDL-C elevados, bem como baixo HDL-C em comparação a "indivíduos que consomem café da manhã regularmente". O risco de SM foi significativamente maior nos indivíduos que consomem café da manhã raramente (RC 1,96, 95% IC 1,18-3,27). CONCLUSÕES: pular o café da manhã está relacionado a aumento no risco de SM e outros fatores cardiometabólicos em crianças e adolescentes. Promover o benefício do consumo do café da manhã pode ser uma implicação simples e importante para evitar esses fatores de risco.

Objective: this study aimed to evaluate the association of breakfast intake with cardiometabolic risk factors in a nationally-representative sample of Iranian pediatrics. Methods: the study participants considered of 5,625 school students aged 10-18 years, studied in the third survey of the national school-based surveillance system (CASPIAN-III). They were classified into three groups based on the number of days they ate breakfast: “regular breakfast eater” (6-7days/week), “often breakfast eater” (3-5days/week), and “seldom breakfast eater” (0-2 days/week). Metabolic syndrome (MetS) was defined based on the Adult Treatment Panel III (ATP III) criteria modified for the pediatric age group. Moreover, high total cholesterol, high low-density lipoprotein cholesterol (LDL-C) and generalized obesity were included as other cardiometabolic risk factors. Multiple logistic regression analyses were used to evaluate the association between the breakfast intake category and cardiometabolic risk factors. Results: the number of subjects classified as “regular”, “often” and “seldom” breakfast eaters were 2,653(47.3%), 1,327(23.7%) and 1,624(29.0%), respectively. The average of triglycerides (TG), LDL-C, systolic blood pressure (SBP) and body mass index (BMI) were higher in the “seldom breakfast eater” group (P for trend

Objective: This nationwide study was conducted to determine the association of anthropometric measures with cardiovascular risk factors and metabolic syndrome (MetS) in Iranian normal-weight children and adolescents. Methods: We analyzed the data of 3,565 children and adolescents (50.3% boys), aged 10-18 years, with a normal BMI (5th-84th percentile) obtained from the third survey of ‘Childhood and Adolescence Surveillance and Prevention of Adult Non-communicable Disease' (CASPIAN III) study. The diagnostic criteria for MetS were defined by the International Diabetes Federation consensus. Results: The prevalence of MetS for 10- to 13.9-year-old boys, 14- to 18-year-old boys, 10- to 13.9-year-old girls, and 14- to 18-year-old girls were 1.4, 2.8, 2.3, and 3.3%, respectively. After adjustment for age and sex, each unit increase in BMI (within normal range) and waist circumference increased the odds of MetS from 6 to 72% and from 1 to 20%, respectively. The dominant pattern of dyslipidemia among the participants was high triglycerides and low high-density lipoprotein cholesterol. Conclusion: This study complements recent research about the high frequency of metabolic risk factors among normal-weight individuals in the pediatric age group.

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.

Background : Obesity in accordance with metabolic syndrome (MetS) confronts populations at the higher risk of morbidity and mortality of chronic diseases including, chronic kidney diseases (CKD). The renal complication of obesity and MetS has been less debated in young adolescents. The objective of this study was to assess the kidney function in obese adolescents with or without MetS. Materials and Methods: The data used in this study were collected as part of a national study entitled Childhood and Adolescence Surveillance and Prevention of Adult Non-communicable disease Study. The present study was conducted on a sub-sample of 113 obese adolescents (body mass index >95 th percentile) aged between 10 years and 16 years selected by convenient sampling from the whole population studied. Anthropometric indexes and blood pressure were examined. A 12-h fasting serum was obtained for each participant to measure blood glucose, lipid profile, quantitative C-reactive protein (hs-CRP), Cystatin-c, urea, and creatinine. Fasting spot urine was collected to determine microalbumin and creatinine. Based on the study findings, participants were assigned into two groups with and without MetS. Results: The mean of microalbuminuria was in similar ranges in two groups and while the mean glomerular filtration rate (GFR) calculated by Bokenkamp′s, updated and combined Schwartz′s formulas were significantly lower in MetS + obese group in comparison with obese group. The similar result was not achieved by Filler′s formula. Among MetS components, waist circumference had a correlation with hs-CRP ( P = 0.04; r = 0.15). GFR was calculated based on the Schwartz formula and Cystatin-c formulas had no significant correlation with any MetS components. Conclusion: Our findings suggest that MetS can increase the risk of kidney dysfunction in obese adolescents. More studies are suggested in this regard in the pediatric population.

Background: A growing body of evidence supports an association between oral health and cardiovascular diseases and diabetes in adults. This study aimed to investigate the relationship between tooth brushing frequency and cardiometabolic risk factors in adolescents. Methods: This nationwide population-based study was conducted among 5258 Iranian students, aged 10-18 years, living in urban and rural areas of 27 provinces in Iran. The association of tooth brushing frequency was assessed with anthropometric indexes and cardiometabolic risk factors after adjustment for potential confounders. Results: Higher frequency of tooth brushing was associated with lower mean levels of low-density lipoprotein cholesterol (LDL-C) in both genders ( P < 0.0001) and lower frequency of elevated LDL-C in girls ( P = 0.03). The frequency of elevated blood pressure decreased with higher tooth brushing frequency in boys ( P = 0.03). After adjustment for many potential cofounders such as age, gender, anthropometric indexes, screen time, socioeconomic status, and family history of non-communicable diseases, participants who washed their teeth at least once a day had lower risk of high LDL-C and low high-density lipoprotein cholesterol (HDL-C) levels in comparison to those who reported lower frequency of tooth brushing; some different associations were observed among girls and boys. Conclusions: Our findings suggest an independent and protective role of teeth brushing frequency for some cardiometabolic risk factors in adolescents. Increasing both the general health awareness and improving oral health should be considered in primordial and primary prevention of non-communicable diseases.

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.

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.

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.

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 Goodmans 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: 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.

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.

Objective: To assess the national prevalence of clinical disorders in 6-year-old Iranian children before school entry using a national health assessment survey. Materials and Methods: In a cross-sectional nationwide survey, all Iranian children entering public and private elementary schools were asked to participate in a mandatory national screening program in Iran in 2009 in two levels of screening and diagnostic levels. Results: The study population consisted of 955388 children (48.5% girls and 76.1% urban). Of the whole children, 3.1% of the 6-year-old children had impaired vision. In addition, 1.2, 1.8, 1.4, 10, 10.9, 56.7, 0.7, 0.8 and 0.6% had color blindness, hearing impaired, speech disorder, height to age retardation, body mass index extremes, decayed teeth, having disease with special needs, spinal disorders, and hypertension, respectively. The distribution of these disorders was unequally distributed across provinces. Conclusions: Our results confirmed that the prevalence of clinical disorders among 6-year-old children across Iranian provinces was not similar. The observed burden of these distributions among young children needs a comprehensive national policy with evidence-based province programs to identify the reason for different distribution among provinces.

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.

Background: This study aimed to compare the timing of puberty between various geographic locations and different ethnicities. Methods: This national survey was conducted in 20 provinces in Iran. Healthy Iranian girls were selected from public schools using cluster random sampling. A total number of 30 clusters including 7493 girls, aged 6.0-20 years, were selected. In order to compare different areas, the national classification of the provinces based on climate, ethnicity, geographic locations, and socioeconomic variables were used. Accordingly, there are 11 regions in Iran. Analysis of variance was used to compare the mean ages of menarche, pubarche, and thelarche in different regions. Results: Tehranian girls, with 11.99 ± 1.35 years (mean ± SD), had the lowest age of menarche which was statistically significantly. The second region with lowest age at menarche was Fars (12.40 ± 1.27 years). The mean age at breast bud stage (B2) was significantly lower in Ghazvin-Zanjan region (8.97 ± 1.45 years). In Fars region, the mean age at B2 stage of breast development (11.01 ± 1.88 years) was higher than other regions except for Mazendran-Guilan and Tehran-related cities. The mean age at public hair development at Tanner stage 2 (PH2) in Kordestan-Lorestan-Ilam region (10.70 ± 1.23 years) was significantly higher than other regions. Conclusions: We found significant differences in the age of pubertal stages of girls living in various regions with different ethnicity and geographic characteristics. Considering the impact of pubertal age on general health, more studies should be done about the lifestyle and environmental factors affecting the onset of puberty.

Background: This study aimed to determine the secular trends in the national prevalence of overweight and obesity among 6-year-old Iranian children, and to compare the results in Northern, Central and Southern parts of the country. Methods: The data were collected as part of a routine and mandatory national screening program on children entering elementary schools in 2007, 2008 and 2009. Results: The study population comprised 2,600,065 children including 862,433 in 2007, 782,244 in 2008 and 955,388 in 2009. Of total children 12.8%, 13.5% and 10.9% were overweight in 2007, 2008 and 2009, respectively (P > 0.05). The corresponding figures for obesity were 3.4%, 3.5% and 3.4%, respectively (P > 0.05). In all surveys, the prevalence of overweight was higher in Southern region than in the other two regions. P for trend was not significant for prevalence rates of overweight and obesity in any of the regions. Conclusions: To the best of our knowledge, this study was the first of its kind in presenting the nationwide trend of overweight and obesity in young children living in a developing country. It showed a considerably high prevalence of overweight and obesity, but with a constant rate in three years. The higher prevalence of overweight in Southern region than in Central and Northern regions might be related to the lower socioeconomic position of this population. At a very young age, children′s lifestyle is more under control of parents. Primordial and primary prevention efforts against the overweight epidemic can be effective and shall be further strengthened.

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.

OBJECTIVE: To examine the relation of dietary and physical activity (PA) patterns with the body mass index (BMI), and the associations between these patterns among children. METHODS: A representative sample of 21 111 school students aged 6-18 years was selected by multistage random cluster sampling from 23 provinces in the Islamic Republic of Iran. PA and dietary pattern were assessed by self-administered validated questionnaires. FINDINGS: Fruit and vegetables, dairy products and snacks (salty, fatty or sweet) had a similar consumption frequency of approximately twice a day. The type of fat most frequently consumed was hydrogenated solid fat (consumed by 73.8% of families). The PA level was significantly higher among boys than girls, in rural than in urban residents, and in intermediate students than high-school students. Among boys, the frequency of consumption of vegetables and plant proteins (R² = 0.46); and among girls, the frequency of consumption of dairy products and fruits, as well as high PA level had a significant inverse association with BMI (R² = 0.57). Among boys, the low frequency of consumption of fruits, the time spent on PA and the energy expenditure; and among girls, the time spent on PA and the energy expenditure, had significant relationships with overweight. When controlling for covariates, PA levels had significant relationships with the frequency of consumption of all food groups. CONCLUSION: Unhealthy lifestyles make Iranian young people prone to chronic diseases later in life. When examining their health benefits, the interrelationship of dietary and PA behaviours should be considered.

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