Search

Background. Coronavirus disease 2019 (COVID-19), as a global epidemic, can cause widespread and irreparable disorders in the personal and social health. Although elderly people are more at risk, they receive less attention in this regard. This epidemic can affect the elderly in different ways, including the fear of contracting the virus and fear of death. This study aimed to determine the relationship between loneliness, locus of control, and intolerance of ambiguity with death anxiety in the elderly during the COVID-19 era. Methods. Using cluster random sampling, this cross-sectional and analytical study included 309 elderly people in Islamabad-e Gharb, Iran in 2022. Data was collected using questionnaires on demographic variables, loneliness, locus of control, intolerance of ambiguity, and death anxiety. The collected data were statistically analyzed using logistic regression. Results. The mean age of participants was 70.69±6.28 years. The prevalence of death anxiety was 71.20% and it was statistically related to gender. The results of regression analysis showed that loneliness, external source of control, high uncertainty intolerance and gender could significantly predict death in the elderly. Conclusion. According to our findings, more than half of the elderly experienced death anxiety. Loneliness, source of control, and intolerance of ambiguity play an important role in death anxiety of the elderly. Death anxiety among this population can be improved by designing psychological interventions based on the feeling of loneliness, source of control from external to internal, and intolerance of ambiguity from top to bottom. Practical Implications. Since death anxiety is a multi-dimensional structure affecting many aspects of the elderly's life and it is one of the most common mental health issues of the elderly, it is essential to investigate the related factors. This can help to take effective steps and improve the mental health of the elderly.

Objectives Andropause is the common term for menopause in older men, which is characterized by a decrease in testosterone levels. Many elderly men with andropause have difficulty or are embarrassed to talk about sexual topics, which causes a lack of information or wrong beliefs and attitudes towards this issue, especially among families. The existing studies in Iran have not had a deep and special attention on this issue. Therefore, this study aims to qualitatively investigate the factors affecting the quality of sexual life in Iranian elderly men with andropause. Methods & Materials This is a qualitative study conducted in 2022 using the content analysis method. Using a purposeful sampling method, 14 elderly men with andropause were selected from among those who visited five health centers in different areas of Mashhad city in Iran. Data were collected using a semi-structured interview. Data analysis was done at the same time as sampling by using the conventional content analysis method. MAXQD software was used for data management. Results The mean age of the participants was 70 years. Eight men had primary education, three had middle school education, one had a high school diploma, and two were illiterate. The findings included 290 codes, 19 subcategories, 9 categories, and 3 themes. The themes were perceived sexual impotence, non-sexual feelings and experiences, and the desire to have an active sexual life. Conclusion The result of in-depth interviews with the elderly with andropause showed the components that can be addressed by officials and researchers for facilitating appropriate planning in this area. The knowledge of the existing situation and how the affecting factors can be the basis of new studioes in this field.

Abstract Background The COVID-19 pandemic has brought about far more stressful conditions for people worldwide. As a vulnerable group, older adults have suffered various psychological problems, such as stress, because of this pandemic and have applied various strategies to cope with the dire consequences. This study aimed to synthesize qualitative evidence regarding coping strategies for stressful situations among older adults throughout the COVID-19 pandemic. Methods We searched electronic databases, including Scopus, Embase, PubMed, ProQuest, and the Cochrane Library, based on PRISMA standards. The protocol of this systematic review was registered on the PROSPERO (registration code: CRD42022364831). All relevant English-language articles published between 2019 and November 10, 2022, were searched. We reviewed the reference lists for all the included studies and key references. Two reviewers conducted screening, data extraction, and quality appraisal independently, with disagreements resolved by consensus with all team members. The Joanna Briggs Institute (JBI) checklist was used to assess the quality of studies. A thematic synthesis of the selected studies was conducted. Results We included 13 studies in our review. Most studies were conducted in the early months of the COVID-19 pandemic. The stress caused by the COVID-19 pandemic was classified into six categories: health management challenges, stress caused by quarantine, economic challenges, media and bad news stress, virus threats, and challenges related to the use of communication technologies. The strategies used by older adults to cope with these challenges were categorized into five categories: protective strategies, avoidance strategies, maintaining social connections, meaning-based strategies, and fun strategies. This research showed that depending on the situation and conditions, older adults use various strategies to cope with COVID-19. Conclusion Older adults experience much stress during the COVID-19 pandemic. In most cases, older adults can cope with these challenges with simple strategies from previous experiences and learnings. Older people require educational interventions in some cases, such as those involving communication skills. A better understanding of older adults coping strategies may enable policymakers to develop more effective policies and manage the problems of older adults in post-COVID situations.

Background: Proper elucidation of medication non-adherence reasoning especially in older adults might pave the way for an auspicious therapeutic outcome. The main of this study was to develop and psychometrically test the Medications Non-adherence Reasoning (MedNARS) questionnaire for application in research and probably practice settings. Methods: A mixed methods design was utilized to develop the MedNARS. The item pool was mainly generated based on a qualitative query and literature review. The expert panel approved version of the MedNARS was psychometrically assessed on a convenience sample of 220 older patients with chronic disease. The internal consistency, test-retest reliability, content and face validity of the scale were appraised and its construct validity was assed using exploratory and confirmatory factor analyses. Results: A nine-item version of the MedNARS was drafted based on the classical item analysis procedures and its estimated internal consistency measure of the Cronbach’s alpha (0.85) and test-retest reliability (0.96) were in the vicinity of acceptable range. The exploratory factor analysis (EFA) output revealed a unidimensional structure for the MedNARS and the conducted confirmatory factor analysis (CFA) indicated an acceptable data fit for the extracted one-factor model. The goodness of fit indices were as the followings: χ2 /df=1.63(90% CI: 0.02 to 0.11), root mean squared error of approximation (RMSEA)=(0.07), comparative fit index (CFI)=0.95, Tucker–Lewis index (TLI)=0.93 and standardized root mean squared residual (SRMSR)=(0.05). Conclusion: The study findings were indicative of MedNARS’s applicability and feasibility for use in assessment of medication non-adherence reasoning among the elderly patients with chronic diseases. The MedNARS as a brief and elder-friendly instrument can be applied both in research and practice settings to enhance efficiency, safety, and health outcomes of the therapeutic recommendations.

Lack of knowledge about COVID-19 and increased use of social networks contributed to the spread of misinformation about the disease in society, harming older adults’ health. In this review, we define misinformation and its condition during the COVID-19 pandemic and provide an overview of the characteristics of older adults and the impact of misinformation on this demographic group.

Background: Although mass vaccination is considered one of the most effective public health strategies during the pandemic, in the COVID-19 era, many people considered vaccines unnecessary and, or doubted the effectiveness of the COVID-19 vaccine. This review aimed to tabulate cognitive causes of COVID-19 vaccination hesitancy, which may help public health policymakers overcome the barriers to mass vaccinations in future pandemics. Methods: For this systematic review, studies pertaining to COVID-19 vaccine hesitancy published up to June 2022 were retrieved from six online databases (Cochrane Library, Google Scholar Medline through PubMed, Scopus, and Web of Science). Inclusion criteria were the studies conducted on people who had a delay in accepting or refusing COVID-19 vaccines, reported the impact of cognitive determinants on vaccine hesitancy, and were written in English in the timeframe of 2020–2022. Results: This systematic review initially reviewed 1171 records. From these 91 articles met the inclusion criteria. The vaccination hesitation rate was 29.72% on average. This systematic review identified several cognitive determinants influencing vaccination hesitancy. Lack of confidence and complacency were the most frequent factors that predicted vaccine hesitancy. Conclusion: The identified prevailing cognitive determinants for COVID-19 vaccine hesitancy indicated that using initiative and effective communication strategies would be a determinant factor in building people’s trust in vaccines during the pandemic and mass vaccinations.

BACKGROUND: Home-based care is affordable due to population aging, increased chronic disease, and higher hospitalization costs. The objective was to evaluate home-based supportive and health care services provided to older adults and identify possible associations between activities of daily living (ADLs), instrumental ADL (IADLs) classifications, sociodemographic variables, clinical characteristics, and perceived social support among older adults. MATERIALS AND METHODS: In this cross-sectional study, 700 people aged 60 years and older were selected by stratified cluster sampling. Areas of Tabriz City were selected as clusters, and 55 comprehensive urban health centers were selected as stratifies. Chi-square, Pearson’s and Spearman’s tests, and multiple linear regression were used for statistical analyses. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS 24.0, SPSS Inc., Chicago, USA). The study instrument included demographic characteristics of older adults and caregivers, health services provided at home, and two valid questionnaires, including the KATZ index of independence in (instrumental) activities of daily living and a multidimensional scale of perceived social support. Scores on scales and demographic variables were collected during telephone interviews. The study lasted from April 25, 2022, to October 30, 2022. RESULTS: A high level of perceived social support was 56.6%. The study found that 51.3% of participants had family caregivers. Most participants had ADL independence (85.4%), while 22.9% and 24.3% were dependent and needed assistance with IADL, respectively. Women had a lower ADL score and a higher IADL score than men (P < 0.05). The obtained results of multiple regression analysis revealed a negative and significant association between unemployment, illiteracy, increasing age, five and more medications, and ADL and IADL dependency (P < 0.05). CONCLUSION: Empowering older adults to reduce dependency, and designing a formal home-based care system is recommended.

Background & aim: Evidence now indicates insufficient knowledge about the quality of sexual life of older adults with symptoms of andropause. This study was therefore performed to measure the quality of sexual life of older adults with symptoms of andropause and its relationship with some socio-demographic characteristics.Methods: This cross-sectional study was performed on 271 older adults with symptoms of andropause, who were selected by convenience sampling from health centers in Mashhad, Iran in 2021. The data was collected using a demographic questionnaire and the Men's Sexual Quality of Life Questionnaire. Data were analyzed using correlation tests, independent t-tests, and one-way analysis of variance.Results: The mean age of older men with andropause was 73.37±8.08 years. The quality of sexual life had a significant relationship with the underlying variables including age, education, type of employment, duration of marriage, age of spouse, education of spouse, type of spouse employment, type of sexual attitude of the spouse, number of sexual intercourse and chronic diseases (P

Available evidence indicates insufficient knowledge about the status of andropause and sexual quality of life among Iranian older men. The study aimed to investigate the prevalence of andropause and its relationship with sexual quality among older adults. This descriptive-analytical study was conducted among 576 older people referred to urban health centers in Mashhad, Iran. The eligible samples were selected through the cluster sampling method. To collect data, the male andropause symptoms’ self-assessment questionnaire and the sexual quality of life-male were used. Forty-seven of the respondents ( n = 271) were diagnosed with a “moderate” level of andropause. A strong negative correlation was identified between the sexual quality of life and the severity of andropause ( r = −.366, p < .001). Sexual quality of life and andropause was also affected by age, marital status, health status, and exercise. Thirty-six percent of the changes in the quality of sexual life of older men were influenced by the independent variables (adjusted R 2 = .36; R 2 = .40; R = .63). The findings indicated that andropause has highly prevailed among the participants. There was a meaningful association between andropause and sexual quality of life among older men. Further studies are recommended to investigate sexual orientation qualitatively and to discover other factors influencing andropause among adult men.

Identifying retained activity participation to old age can improve age-related changes in balance and cognition function. Subjects ≥ 60 years were enrolled in this study. Balance and Cognitive function include working memory, executive function, and sustained and divided attention was evaluated with “Fullerton advanced balance”, “n-back”, “Wisconsin card sort”, “sustain and divided attention test”, respectively. In addition, retained activity participation was measured using the Activity Card Sort questionnaire. The univariate and multivariate regression analyses of different domains of retained activity participation were used as independent variables, including instrumental activity, low-effort leisure, high-effort leisure, and social activity on balance and specific domains of cognition. Seventy-seven subjects (65.3 ± 4.4 years, 61% female) were included. About 47% of older adults had a college education, 32.3% had a diploma, and 20.7% had elementary–middle education. These results show that retained instrumental activity had a relationship with working memory (β = 0.079, p < 0.05). In addition, we found that retained high-effort leisure activity can increase balance, divided attention, and executive function score (β = 0.1, β = 0.05, β = 0.02, p < 0.05). Moreover, there was a positive relationship between retained low-effort activity and sustained attention (β = 0.08, p < 0.05). In addition, the coefficient of determination (R2) for balance, working memory, executive function, sustained, and divided attention were 0.45, 0.25, 0.13, 0.11 and 0.18, respectively. The study suggests that retained activity participation types may have various effects on balance and some selective cognitive components in older people.

Abstract Background Early Marriage (EM) and associated Stressful Life Events (SLEs) and consequences such as psychological and physical well-being issues can lead to suicide and suicide attempts (SA). The study aimed to investigate the risk of suicide and SA among early married people who experienced SLEs. Methods A case–control study was conducted based on the registry for suicide in Malekan county in Iran during 2016–18. Cases included 154 SAs and 32 suicides. Simultaneously, 201 outpatients from the emergency department were chosen as controls. Holms and Rahe life event questionnaire was used to assess SLEs. Sub-group analysis (Mantel–Haenszel) by sex and age groups and multiple logistic regression were used to calculate adjusted Odds Ratios (ORs) with 95% Confidence Intervals (CIs) for the association between EM and suicide risk after adjusting for the potential confounders. Results The proportion (female vs male) of EM among suicides, controls, and SAs was 31.25% (18.7 vs 12.5%), 15.92% (11.9 vs 4.0%), and 13.0% (11.7 vs 1.3%), respectively. In subgroup analyses by sex, EM was associated with an increased risk of suicide in both females and males 2.64 and 2.36 times, respectively. Likewise, subgroup analysis by age groups revealed that EM increased suicide risk in subjects aged 10–15 years, while no association was found for age groups of 26–40 and > 40. After adjusting for the potential confounders, EM (OR: 3.01; 95% CI: 1.15 -7.29), financial problems (OR = 4.50; 95% CI: 1.83 -9.07), and family problems (OR = 2.60; 95% CI: 1.19—9.59), were associated with an increased risk of suicide. However, no association was found between EM, various types of SLEs, and the risk of SA. Conclusions We found EM and SLEs were correlated with suicide risk, while no evidence found that EM increased the risk of SA. Progress in reducing EM and addressing its serious consequences can occur by a stronger political commitment and by sharing the experiences and voices of the early married. Our study provided preliminary findings to guide future studies; however, methodological and longitudinal studies are needed to understand and address the effect of EM on suicidal behaviors.

Abstract Background Pregnancy is a high-risk period for vitamin D (Vit D) deficiency, and there is a direct relationship between Vit D deficiency during this period and maternal and fetal complications. Therefore, this study aimed to assess the knowledge, attitude, and practice of pregnant women concerning the adoption of behaviors to prevent Vit D deficiency and identify the determinant factors of such behaviors. Methods In this cross-sectional study, 185 pregnant women with a mean age of 27.52 ± 5.9 years were selected from the Health Centers in Tabriz, Iran, using the stratified random sampling between 2018 September 23 and 2019 June 21. Data were collected using a researcher-made questionnaires comprising demographic information, knowledge, attitude, and practice of pregnant women towards Vit D deficiency. The chi-square test and Fisher’s exact test were used to determine the relationship between the demographics of pregnant women and their knowledge and attitude. Moreover, the general linear model test was used to determine the predictors of performance. The p-value

Introduction Patients with a type D personality have worse social functioning and mental health and more affective constraints than non-type D personalities. They have a negative outlook on life and health-related issues. The aim of this study was to examine the mediating role of stress and anxiety in the relationship between type D personality and COVID-19 by adjustment of the effect of demographic characteristics and perceived symptoms as confounder variables. Material and methods A total of 196 patients out of those suspected of having COVID-19 and visiting the reference hospitals were selected. They had completed the type D personality and the anxiety and stress scales along with their hospital admission form before undergoing COVID-19 testing. After their COVID-19 test, the participants were divided into two groups based on their disease, an infected group (n = 90) and a non-infected group (n = 106). Results Type D personality has no significant direct effect on infection with the disease, but taking into account the mediating variable of stress, the odds of an event in those with type D personality is 2.21 times higher than those without this personality (p = .027) and, taking into account the mediating variable of anxiety, having a type D personality increases the odds of an event by 2.62 times (p = .011), holding demographic characteristics and perceived symptoms constant. Conclusions Given the indirect relationship between COVID-19 and type D personality, the mediating variables of stress and anxiety can be considered full mediating variables.

Adolescence is a period of transition for developmental and social domains that may also be accompanied by behavioral problems. Aggressive behavior may be a mental health concern for young teens and is defined as a behavioral and emotional trait that may be distressing for others. This study aimed to understand the factors associated with aggressiveness among young teenage girls. A cross-sectional study was conducted among a sample of 707 female middle school-aged students using multistage random sampling in Tabriz, Iran. The variables of interest were aggressiveness, general health status, happiness, social acceptance, and feelings of loneliness. Structural equation modeling was employed to analyze the data. Low parental support, low satisfaction with body image, high sense of loneliness, and lower perceived social acceptance were found to be the factors influencing aggressiveness. The current study found that the school environment, home environment, individual and interpersonal factors all play a part in aggressiveness. As a result, the contributing elements must be considered when creating and executing successful interventions to improve this population’s psychological well-being.

Abstract Background There is a lack of scientific literature on the application of fear appeals theories to evaluate lung cancer risk perception among smokers. The aim of the present study is to apply the Extended Parallel Process Model (EPPM) to discover the perception of the smokers about their lifetime risk of developing lung cancer (perceived susceptibility), their perception of lung cancer survival (perceived severity), response efficacy, self-efficacy, and readiness to quit. Methods In this cross-sectional study, 215 eligible smokers (aged 45 years and over who have smoked at least 1 pack per day in the last 5 years) were recruited. The data collection tool was designed using validate self-report questionnaires and it was contained items on the perceived risk of a smoker contracting lung cancer and perceived lung cancer survival rate. It also had questions to measure the main constructs of the EPPM and Readiness to quit (“Low_Readiness”, and “High_Readiness”). To test how the data support conceptual EPPM to data, Generalized Structural Equation Modeling (GSEM) was used. Results Findings showed a significant relationship between Perceived_Susceptibility and Perceived_Response Efficacy; (B = 1.16, P 0.05). Conclusion Perceived_threat and Perceived_efficacy were important for smokers with low readiness to quit, while Perceived_efficacy was most important for smokers with high readiness to quit. These findings could be used in promoting lung cancer awareness and designing smoking cessation programs based on smokers’ stages of change.

(1) Background: The older adult population of society is exposed to multiple stressors daily, such as the loss of loved ones, dysfunctional mobility, financial dependence, and suffering from numerous chronic illnesses. The present study aimed to assess the psychometric properties of the Anxiety about Aging Scale among older adults in Iran. (2) Methods: A sample of 703 community-dwelling older adults was recruited and screened using a standardized tool. The mean age of participants was 69.4 ± 8.1 years. The majority of participants were male (59.2%), married (66.6%), and illiterate (79.7%). A ‘forward-backward’ translation method was used in developing the Iranian version of the AAS for assessing the psychometric properties among older adults. Confirmatory factor analysis (CFA) and the Rasch model were used for construct validity. (3) Results: Applying CFA indicated that the model’s four original factors are the best solution, representing 55% of the total variance. The result of the CFA showed that this four-factor model had a good fit for the data. The findings were also confirmed by Rasch analysis. (4) Conclusions: The Persian version of the AAS is valid and reliable for measuring aging anxiety among Iranian older adults.

Abstract Background The aspects of marriage and relationship and their effect on couples’ satisfaction are essential and critical aspects to be explored in this globalized and contemporary world. Since there are no reported meta-analysis and systematic reviews conducted in the last two decades in this area, we aimed to investigate the effect of marriage and relationship programs (MRP) on couples’ relationship satisfaction (CRS) and couples’ relationship communication (CRC) and also to determine the gender differences if any. Method In this systematic review and meta-analysis, the randomized clinical trials (RCTs) published between 2000 and July 26, 2019, were retrieved from several online electronic databases such as Medline, Embase, ProQuest, and Cochrane Library. Inclusion and exclusion criteria were developed using the PICO (Population, Intervention, Comparison, Outcome) framework of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The mean differences (MDs) and 95% confidence intervals (CIs) were calculated. The reported summary statistics were calculated as random effects models based on the heterogeneity between the studies model. Funnel plots and the Egger regression test was used to confirm the presence of any publication bias. Results Of the total 12 intervention studies included, five (5) are education/communication skills programs, three (3) enrichment programs, and four (4) therapy programs. The impact of these programs was investigated on CRS and CRC. Therapy programs had a larger effect than other programs (pooled MD: 0.53 (95% CI = 0.35 to 0.71, I2 = 71.5% p = 0.0001) and had a larger effect size on wives (pooled MD: 0.53 (95% CI 0.25 to 0.80, I2 = 74.1% p = 0.0001) than husbands RS (pooled MD: 0.26 (95% CI 0.25 to 0.76, I2 = 72.4% p = 0.0001). In RC (relationship communication) area, the Enhancement programs showed the small to large effect on CRC (pooled MD: 1.31 (95% CI = 0.13 to 2.50, I2 = 94.7% p = 0.0001)) and educational programs showed small to medium effect (pooled MD: 0.32 (95% CI = 0.13 to 0.50, I2 = 74.5% p = 0.0001) on women and no effect on men. Conclusion Due to the high effect of the therapy programs on CRS and enhancement program on CRC in the current meta-analysis, the priority of their utilizations in interventions, especially by psychologists and mental health professionals, should be emphasized. Therefore, mental health planning in communities to develop MRP and care for couples’ health should be given special attention to men’s health. Due to the high heterogeneity of the results and with scanty literature in this specific domain, we are uncertain about their actual effect. However, well-designed RCTs with a larger sample size would be beneficial in closely examining the effect of MRPs on CRS and CRC.

Background: To end the COVID-19 pandemic, a large part of the world must be immune to the virus by vaccination. Therefore, this study aimed to gauge intent to be vaccinated against COVID-19 among ordinary people and to identify attitudes towards vaccines and barriers for vaccine acceptance. Methods: The study population comprises 1880 people residing in different countries that answer a prepared questionnaire. The questionnaire topics are demographics, historical issues, participants’ attitudes and beliefs regarding vaccines, concerns, and vaccine hesitancy. Results: Attitudes and beliefs relating to vaccines in general, and the COVID-19 vaccine, were ascertained. Overall, 66.81% of the contributors would like to be vaccinated against COVID-19, while %33.19 did not intend to be vaccinated. Reasons for COVID-19 vaccine hesitancy included concern regarding vaccine side effects, fear of getting sick from the uptake of the vaccine, and the absence of accurate vaccine promotion news. Individuals with higher education believe that India (68.6%) produces the best vaccine (P

Global health diplomacy has gained significant importance and undoubtedly remained high on the agendas of many nations, regional and global platforms amid the coronavirus disease 2019 (COVID-19) pandemic. Many countries have realized the importance of the health sector and the value of a healthy workforce. However, there is little control on issues related to trade that impact on human health due to the dominance of profit-oriented business lobbies. A balance, however, needs to be struck between economic profits and a healthy global population. This paper aimed to highlight the importance of building capacity in global health diplomacy, especially during the COVID-19 pandemic so that health personnel may effectively negotiate on the multisectoral stage to secure the resources they need. The recent proposal to waive off certain provisions of the Trade-Related Aspects of Intellectual Property Rights (TRIPS) agreement for the prevention, containment and treatment of COVID-19 by India and South Africa at the World Trade Organization (WTO) presents an important opportunity for all governments to unite and stand up for public health, global solidarity, and equitable access at the international level so that both developed and developing nations may enjoy improved health outcomes related to the COVID-19 pandemic.

Sexual exploitation and abuse (SEA) is one of the most depraved crimes against humanity. When carried out by peacekeepers and humanitarian aid workers, it depicts a catastrophic failure of protection bringing harm to the very people the United Nations and international organizations vow to protect. This paper has highlighted the various allegations and incidents of SEA repeatedly happening in conflict-affected countries. Allegations of SEA have since surfaced related to operations in Bosnia, Cambodia, Somalia, Sierra Leone, Liberia, Kosovo, Cote d'Ivoire, Haiti, Sudan, Guinea and the Democratic Republic of Congo. The symptoms of abuse survivors generally resemble those of Post-Traumatic Stress Disorder, and SEA has significant health consequences and poses a severe threat to public health advancement. Based on the literature review, we propose that international and humanitarian organizations must ensure that these offences do not happen in the future by taking appropriate measures. These organizations must prioritize rigorous training on gender equality and values and include a basic mandatory test on gender equality before joining humanitarian missions. Since humanitarian diplomacy encompasses actions carried out by the humanitarian organizations to acquire space from military and political authorities within to function with integrity, we emphasize that strengthening humanitarian diplomacy can play a pivotal role to train the humanitarian workforce on best practices to reduce SEA. Besides, we further propose that women should be allowed to lead from the front; otherwise, true gender equality and issues relevant to gender, including SEA, will be challenging to attain.

Objectives: Elder abuse is a phenomenon that has become more apparent with the increase in aging population, but there are insufficient evidences about the prevalence of elder abuse and gender differences in this area. Therefore, this study aims to investigate the prevalence of elder abuse and its gender differences among community-dwelling older adults in Tabriz, Iran. Methods & Materials: In this cross-sectional study, 414 older adults aged ≥60 years were recruited from health complexes and centers in Tabriz, Iran in 2018 by using random sampling method. Data collection tools were a demographic form and the Domestic Elder Abuse Questionnaire which were completed through interview. The collected data were analyzed in SPSS V. 22 software. Results: It was reported that 52.6% had experienced abuse by family members. Emotional neglect was the most common type of elder abuse (26.6%) followed by financial abuse (17.6%). Physical abuse was the least common type of elder abuse. Except for financial abuse, older women had experienced more abuse than older men. Of those who were abused, only 31.7% recognized it as elder abuse. Conclusion: Most of older adults experience emotional neglect and financial abuse from family members and perceive them as their normal behaviors. Older women experience more abuse than older men. It is necessary to prevent elder abuse and familiarize older adults with different types of elder abuse.

Background: Physical activity (PA) programs are inexpensive, non-pharmaceutical and universally accessible options with demonstrated efficacy in reducing menopausal symptoms. The purpose of this study was to determine the effectiveness of a behavioral strategy for initiating and sustaining PA with the hope to reduce or eliminate menopausal symptoms. Methods: Menopausal and perimenopausal women (n=190) were randomly assigned to intervention (n=95) and non-intervention (n=95) groups using a random-numbers table. The intervention group consisted of 18 neighborhood network subgroups, each consisting of five to six women known to one another. They participated in a 12-week regular PA program, augmented by eight interactive group education and discussion sessions. The Menopause Rating Scale (MRS) self-report instrument was used to determine perceived severity of menopausal symptoms. Results: The intervention group showed a significant reduction in the frequency and severity of menopausal symptoms (P < 0.001). Those whose symptoms rated severe/very severe for hot flushes were reduced from 30.1% to 11.8%. Also, participants whose sleep problems and joint discomfort rated severe/very severe declined from 28% to 6.5% and joint discomfort rated severe or very severe was reduced from 52.7% to 4.4%, respectively. Conversely in the nonintervention group, hot flushes, sleep problems and joint problems got significantly worse(P < 0.05). Conclusion: Implementing educational program that increases awareness of PA benefits in combination with existing neighborhood networks that facilitate communication and cooperation may increase PA levels and decrease menopausal symptoms. Such networks offer alow-cost means of improving quality of life (QOL) for perimenopausal and menopausal women.

Abstract Background Poor mental health is common among adolescents. Given the increasing burden of poor mental health among adolescents in developing countries, it seems necessary to identify the effective interventions. The main purpose of this study was to investigate the effects of a school-based mental health promotion program (SMHPP) on mental health parameters among female adolescents in Tabriz, Iran. Method In this experimental study, a random sample of female high-school students of grade nine was recruited. The subjects were then randomly allocated to intervention (n = 145) and control (n = 139) groups. The three-stage SMHPP was designed based on the shortages and unmet needs of the students as reported in the pretest stage. All subjects in the intervention group were provided with a stress management skill training program of six sessions using McNamara Model. Coincided with making environmental changes, a joyful intervention program was carried out. After 2 months, post-test data were collected. Results A total of 284 students completed their participation in the study. The groups did not differ in none of socio-demographic characteristics and mental health parameters, at baseline. The number of subjects reporting medium-level of happiness was increased by 32.6% among intervention group. Moreover, upon sign test and pre-post comparison, the group-wise distribution changed between the intervention and control groups for the parameters of life satisfaction (p ≤ 0.001) and psychological well-being (p ≤ 0.01). Conclusion The implementation of SMHPP as a low-cost, needs-based and multifaceted program, showed promise in promoting adolescents’ mental health, particularly in the parameters of happiness, life satisfaction and psychological well-being. This was an important evidence for the development and implementation of interventions and policies in the field of mental health promotion among adolescents. Our work provided means for reducing burden of poor mental health among adolescents in a non-western cultural context. Further larger studies are required to evaluate the effectiveness of such school-based mental health promotion interventions in students.

Abstract Background e-health literacy can facilitate the uptake of benefits of health for older adults. In this review, we aimed to tabulate the types and outcomes of the theory-based e-health interventions that had been applied to improve the e-health literacy of older adults. Methods In this systematic review, theory-based e-health literacy interventions that published up to April 2020 were retrieved from several online electronic databases, including Medline via PubMed, Cochrane Library, ProQuest, and EMBASE. The published papers were included in this study, if the study had been conducted on older adults, a theory-based intervention aimed at promoting e-health literacy, and had been written in English language in the timeframe of 2008–2020. Results A total of 1658 records were identified initially, of which, 12 articles met the inclusion criteria. The systematic review identified the using of variety of intrapersonal, interpersonal, and societal level conceptual models in enhancing of e-health literacy in older adults, and the concept of self-efficacy was applied in the most of interventions as the main conceptual theoretical framework. Conclusions Despite the paucity of conceptual models, which are specifically designed for e-health literacy interventions, based on our findings, we recommend self-efficacy as a powerful concept that can play an important role in improving e-health literacy in older adults.

Background: The worldwide trend of hookah use among adolescents is increasing, and literature shows arelationship between obscenity and adolescents’ tendency toward hookah smoking. As there is a lack ofappropriate instruments to measure the obscenity of hookah smoking, in the present study, we aimed todevelop an instrument to measure hookah smoking obscenity among adolescents.Methods: In this methodological study, a sequential exploratory design was used to conduct the study fromFebruary 2017 to July 2018 on adolescents in Tabriz, Iran. In the qualitative phase, we conducted semistructured individual interviews (with 18 students) and a focus group discussion (FGD) (with 13 students) toexplain the concept of obscenity and develop the items of hookah smoking obscenity scale (HSOS). We thenexamined the psychometric properties of the HSOS based on face, content, construct and predictive validitiesas well as internal consistency and repeatability.Findings: The HSOS was developed with 21 items based on the results of qualitative data analysis. Applyingconfirmatory factor analysis (CFA), the χ2/degree of freedom (df) ratio was found to be 3.792 for the fourfactor structure of the questionnaire and the fit indices of this structural model were satisfactory. The valuesof Cronbach’s alpha and the intraclass correlation coefficient (ICC) for the constructs in the HSOS ranged0.81-0.93 and 0.79-0.92, respectively.Conclusion: We found the HSOS with a good level of fit indices, validity, and reliability. The HSOS may beapplied by school healthcare providers and health practitioners to find valid and reliable data on theobscenity of hookah smoking when developing hookah smoking prevention/cessation interventions amongadolescents.

Introduction: Women health volunteers are the link between people and healthcare workers. They play an important role in health education activities, following up families under coverage, and updating the demographic data to health centers. This study was performed to uncover women health volunteers’ activities, reasons for joining and leaving from the program. Methods: A qualitative study design was used to conduct the study. Through purposive sampling technique, twenty -four in-depth semi-structured individual interviews and two focused group discussions with women health volunteers and their supervisors were conducted in Tabriz, Iran. Data analysis implemented thematic analysis, using MAXQDA10. Results: The findings were generally categorized into three major themes, participation in promoting health, perceived benefit, and perceptual- environmental inhibitors. Participation in promoting health consisted of the sub-themes participation in educational programs, participation in health care. The sub-themes of perceived benefit included benefits from health care services and interest in having an active role in the community. The theme perceptual- environmental inhibitors involved the subthemes participation barriers and lack of innovation and inconsistency with social changes. Conclusion: Culture-building about the role of health volunteers, the valuing on their activities in the community, and informing program supervisors about the health volunteer’s duties would help to retain health volunteers and also sustain their activities at the community level.

Background: This study aimed to investigate the asthma profile among children/adolescents and the relationship of the prevalence of air pollution profiles using latent class analysis (LCA). Objectives: In this cross-sectional study, a case rural community was selected in an industrial area, and two rural control communities were selected in unexposed areas. Methods: Hourly concentrations of PM10, SO2, NO2, and total volatile organic compounds were obtained from the records of a fixed air quality monitoring station, and the concentrations of benzene, toluene, xylenes styrene were measured during six campaigns. Asthma data was collected using the International Study of Asthma and Allergies in Childhood in 7–18 years old children/adolescents. The modeling was conducted using LCA. Results: A higher amount of air pollution indices were observed in the case than both control communities. LCA divided the participants into three clusters; ''healthy'' (92.8%), ''moderate'' (2.8%), and ''severe'' (4.4%). A higher probability of severe asthma (6.8%) was observed in the case than control communities (2.6% and 1.8%). Additionally, after adjusting for possible confounders, the odds of asthma was lower in the control communities than the case in both moderate and sever classes (Odds Ratios in the range of 0.135–0.697). Conclusions: This study indicates asthma profiles of children/adolescents and the higher prevalence of severe class in the area, explaining the possible effect of air pollution.

Dear Editor The international community has been faced with one of the most critical health conditions in recent decades due to the Coronavirus disease (COVID-19) pandemic which experience hundreds of thousands of infected cases and tens of thousands of deaths. Alongside of COVID-19 pandemic we have been faced a new phenomenon of "Infodemic" or “epidemic of false information” about COVID-19. Currently, a huge of unverified information is being disseminated about various aspects of COVID-19 disease, the methods of control and prevention of disease, and about its consequences through social media, television networks, and news agencies. In this regard, the Director General of the World Health Organization (WHO), Mr Tedros, at the Munich Security Conference on February 15, stated that '' We are not just fighting the COVID-19 epidemic,concurrently, we are also struggling with an "infodemic" which it can be a serious problem [1]. In other words, false information is rapidly circulating on social media, and countering fake news is likely to continue as long as the coronavirus spreading. As a result, the WHO is working with social media such as Twitter, Facebook, Tencent, Pinterest, and TikTok to publish the verified news about COVID-19 [2]. To provide verified accurate information, after announcing of COVID-19’s outbreak by China's Public Health Emergency Department, the World Health Organization amid to develop and build a series of mechanisms as a new information platform which it is called "WHO Information Network for Epidemics (EPI-WIN)", to share accurate information to specific target groups. Despite the WHO's efforts to control coronavirus, the international community is now witnessing numerous unverified news about COVID-19 that have led to a global confusion [1]. So that, WHO’s Director of Infectious Diseases, Sylvie Briand stated that “we know that with the spread of any disease, a tsunami of information dissemination occurs and in this published information, there is always false and rumors information [2]. The information tsunami phenomenon has existed even in the Middle Ages, but the difference between the present and the past is another phenomenon which we know it as "social media". Social media is like viruses that travel with people and move even faster and further, which is itself a new challenge, which can have adverse effects alongside the consequences of the COVID-19 epidemic [1]. As Alexandra Kozmanovic, director of social media at WHO Communications, stated "Combating infodemia and the spread of inaccurate information is a common effort between the WHO’s Risk Communications Division and the EPI-WIN platform to produce and disseminate verified information about COID-19. For this reason, as soon as some questions or rumors information are circulated, the WHO's Communications Division seeks to prevent gossip and inaccurate information by finding evidence-based answers and contributing to transparency and accurate information. This seems it's a role that the Bureau of Health Education of the Iranian Ministry of Health must be taken this responsibility. In fact, after the COVID-19 epidemic in China, misleading rumors and false theories about the origin of coronavirus, ways of transmission, methods of controlling and treatment of active cases came up, which was lead to outcomes such as being worried and nervous, shopping and food storage, all of which reflect the impact of a new information ecosystem called "Infodemia" that is a 21st century feature of social media [3]. This crisis is characterized by the simultaneous spread of the virus and the relevant information. In other words, not only the virus is spreading very fast, but also false information about the outbreak of the disease also spread rapidly and as a result of the panic it caused among people. It seems, social media is moving faster than the spread of COVID-19 [3]. However, in Iran, some people, without being worried about this disease, do not attempt to protect him/herself and others. It is also important to distinguish between the use of fear-based theories in the development of health risk messages about COVID-19 and the dissemination of unprofessional authored messages disseminated by social media. Therefore, the key issue that could affect health professionals' efforts to control COVID-19 infection is to counteract the spread of inaccurate and unnecessary information worldwide [4]. In addition to taking urgent steps to cut the transmission chain and provide public health services to tackle this outbreak, health systems must also take the necessary measures to tackle fears circulating on social media. Obviously, governments must also help people by adopting compensatory economic policies and providing financial support, especially to the populations who are faced with economic problems. To counter the spread of large amounts of inaccurate information, the health education bureau of states Ministries and health education Professionals must quickly take appropriate, useful, and necessary measures to control public rumors, misconceptions, false beliefs and inappropriate behaviors surrounding COVID-19 [5]. They also put an end to the rumors and concerns about the spread of Coronavirus worldwide by creating an interactive dashboard, so, public health professionals can rapidly reduce misinformation through appropriate and well-designed health information [1]. The bureau of health education of Ministry of health in all countries can also, in partnership with social media such as the World Health Organization, utilize social media's capacity to disseminate health information that helps break the transmission chain of COVID-19. According to the letter of the Iranian Health Education Scientific Association dated February 25, 2020, the Minister of Health has been advised that, given the prevalence of COVID-19, the largest responsibility of the COVID-19’s National committee and Ministry of Health is transparency, accountability and community outreach to the needed information alongside community awareness and promoting the patterns of preventive behaviors and skills of self-care against COVID-19. This statement also stated that the Iranian Ministry of Health is expected to step in with the support of the formation of committee on health education and promotion , to provide accurate information at all levels , to provide evidence-based information about COVID-19 outbreak, and finally to develop appropriate interventions as the National health priority [6]. In fact, in the present situation, where we have not another choice except than non-pharmacological interventions such as quarantine and social distancing, we must use social media information to reinforce the information needed by the community to follow these procedures. Staying at home, public quarantine, being self-protect not only stop the COVID-19 transmission but also will prevent the transmission of false and unnecessary information. In principle, only by working with communities and citizens and providing accurate guidance and information from credible channels for public participation we can ensure about the effectiveness of interventions, especially quarantine and social distancing, against COVID-19. AS a result, striving to empower people and having informed people who can decide and act from a more informed and confident situation requires the provision of sound and coherent information from the health system and more importantly, to gain public trust.

Abstract Background Women’s sexuality may be adversely affected during the menopausal transition. This exploratory qualitative study was conducted to explore how women assign meaning to and process sexual motivation during the menopausal transition. Methods We purposefully approached 22 married women ages 44–59 (52.81 ± 3.6 years) in urban health care centers and workplaces in Tabriz city, located in northwest Iran. Individual face-to-face interviews were performed at a place and time convenient to the women. All interviews were audio recorded and then transcribed to create verbatim written accounts. Inspiring Graneheim and Lundman approach, we employed conventional content analysis to derive coding categories directly from our row data. Findings Four main themes emerged from data analysis: “Diminished sexual capacity” (effect of menopause, Illnesses associated with mid-life, desire discrepancy); “intimate coupling” (lack of physical and/or emotional intimacy, couple communication and romance); “sociocultural scripts” (sexual script, parental responsibilities); and “sense of youthfulness” (having an active and happy life, maintaining physically attractiveness). Conclusion The qualitative findings suggest that providing sexual health education and counseling, to encourage critical discussions regarding current sociocultural scripts and to create an environment that would enable men and women alike to adopt a healthy and happy lifestyle for eliminating barriers and preserving and enhancing motivational factors associated with sexuality.

Objective To explore the obstacles of community participation in rural health education programmes from the viewpoints of Iranian rural inhabitants.Design This was a qualitative study with conventional content analysis approach which was carried out March to October 2016.Setting Data collected using semistructured interviews that were digitally recorded, transcribed and analysed until data saturation. MAXQDA 10 software was used to manage the textual data.Participant Participants were twenty-two seven clients from a rural community in Ardabil, Iran who were receiving health services from health centres.Result The main obstacles to participate in health education programmes in rural settings were ‘Lack of trust to the rural health workers’, ‘Adherence to neighbourhood social networks in seeking health information’ and ‘Lack of understanding on the importance of health education’.Conclusion Rural health education programmes in Iran are encountered with a variety of obstacles. We need to enhancing mutual trust between the rural health workers and villagers, and developing community-based education programmes to promote health information seeking behaviours among villagers. The finding of this study will be a referential evidence for the qualitative improvement of local health education programmes for rural inhabitants.

Background:A Based on the World Health Organization’s reporting, over 1.25 million people die annually in traffic accidents worldwide. Traffic accidents are the ninth main cause of death worldwide, with an average age range of victims of 15 to 29. Broadly speaking, 90% of traffic accidents happen in the lowand middle-income countries that comprise 82% of the global population, and these countries account for half of the world’s vehicles. One of the goals of the National Road Traffic Knowledge Development Trustee is to plan and implement training courses (content design, design and implementation and evaluation) for target groups. To achieve this goal and due to the lack of academic programs on traffic safety in Iran, a single-credit course, “Safety and Traffic,” was developed to be run as a compulsory academic course in all universities across the country. Methods: This course was administered as a national pilot study in four phases and in 17 medical universities across the country. All experts and national authorities in the Ministry of Science and the Ministry of Health and Medical Education were requested to provide feedback. Afterwards, the results and comments were forwarded to the Supreme Council of Cultural Revolution for further investigation. Upon approval of the Council, the course will be implemented in all universities across the country. Results: Results from the pre-test showed that the level of students’ knowledge was low before attending the training courses. Surveys also revealed that the two items of “pedestrian safety” and “first aids in RTCs” were the most useful and applicable subjects. The percentage of wrong answers ranged from 61 to 98%. Conclusion: Considering the importance of traffic accidents and people’s role in traffic-related issues, it seems that it is necessary to provide university courses for traffic safety education.

Background: Health promoting schools (HPS) project is currently being used in Iran but many challenges still lie ahead. The present study aimed, to test feasibility of implementing a comprehensive advocacy program (CAP) to overcome the obstacles and problems associated with the consummation of school health programs based on the HPS framework. Methods: This quasi-experimental study was performed through recruiting all schools that were enrolled in the national HPS program and located in Jolfa as the intervention group and all of the schools situated in the East Azerbaijan province as control. In order to collect data, Iranian Ministry of Health’s checklists and external audit guidelines for HPS were utilized. In addition, to plan a CAP required data for coordinating fund raising activities including current rules and regulations regarding implementation of local health promotion interventions were collected. Results: Findings of the study revealed that the implemented CAP had improved all HPS dimensions’ mean score in the intervention group. The observed change in the pre- and post-test score in the intervention group was significant (P < 0.05). The intervention was also successful in encouraging signing of an agreement among the participated organizations to be committed to pursue the adopted policies in facilitation of progress towards full implementation of the local HPS project. Conclusion: Commencing changes in the recruited schools’ structure through coordinated multi-level activities is feasible and this must be considered as a priority where contextual determinants exist to motivate progress towards providing healthier educational settings for school aged children in Iran.

Background: One of the most important effects of many drying lakes in the world is increasing the emergence and outbreak of different diseases. For this sake, the present study aimed to systematically review the effects of lakes drying on human health. Methods: The present systematic review was designed and conducted in 2017. Data were gathered by searching the Science Direct, Cochrane Library, Google Scholar, Scopus, PubMed, and Web of Knowledge databases, along with hand search of key journals and unpublished resources and contact with experts. There was no specific time span for the search. Results: Overall, 22 articles were selected with 20 articles about Aral Lake drying. Almost all studies were cross-sectional and retrospective. In 8 studies, the participants were children. Seventeen articles lakes drying have adverse effects on human health. Based on the type of effect, the studies were classified into 7 categories (respiratory problems, reproductive system problems, kidney and urological diseases, cancers, anemia, and diarrhea). Conclusion: Most studies depicted the harmful effects of lakes draught on human health; they had low level of evidence as they were mostly retrospective and cross-sectional. There is not enough evidence to accept or reject with high level of certainty the very effects of lakes drying on human health. To provide such evidence we suggest conducting middle and long term cohort and observational studies with scientific bases.

Introduction: Despite the beginnings of preconception care (PCC) delivery around a decade ago in Iran, there are still significant gaps in its service delivery. The purpose of this study was to explore the perceptions and experiences of women as well as midwives toward gaps in PCC delivery in the Iranian reproductive health care system. Methods: In this exploratory qualitative study, 27 married women and 13 midwives were recruited using purposive sampling from five health centers in Mashhad, Northeast of Iran. Respondents participated in semi- structured, in-depth, individual and focus-group interviews to express their perceptions and experiences about gaps in PCC. Data were analyzed using conventional content analysis adopted by of Graneheim and Lundman (2004) with MAXQDA software. Results: Analysis of data revealed four themes: 1) missing men and adolescents from PCC; 2) insufficient PCC package; 3) inadequate PCC strategies; and 4) health care providers’ incompetency. Conclusion: It is recommended to deliver gender-sensitive PCC through addressing couples’ instead of just women’s PCC and to take into account the adolescent girls’ health in order to improve their preconception health. Standardization of protocols and attention of health professionals toward occupational–environmental hazards and sexual and reproductive issues as well as enhancing professional capability of health care providers could improve PCC service delivery

Background and Objectives: Application of effective strategies for prevention of tobacco smoking in developing countries seems to be necessary. Therefore, the present study aimed to determine the effectiveness of web-based educational intervention on prevention of tobacco smoking among male adolescents in Hamadan, Iran based on prototype willingness model (PWM). Materials and Methods: In this interventional study, 114male adolescents were randomly divided into two experimental and control groups in Hamadan, west of Iran. Data was collected using a questionnaire, including the PWM constructs and demographic variables. The intervention comprised 11web-based sessions applied in the experimental group during two months. Both groups were followed for six months after the intervention. Data were then analyzed in SPSS18-using chi-squared, independent t-test, paired t-test and Kappa. Results: After the educational intervention, significant differences were observed in average scores of attitude, subjective norms, perceived behavioral control, behavioral intention, prototype and behavioral willingness between the experimental and control groups (P > 0.05). Tobacco smoking was reduced in the experimental group, but this decrease was not statistically significant (P = 0.392). Conclusions: The results showed that the application of web-based interventions would be considered as an efficient educational strategy for the prevention of possible increase in tobacco smoking among male adolescents

Background: Recently, a national breast cancer screening program has been introduced in Iran.The aim of this study was to examine the determinants of breast cancer screening uptake among Kurdish women, in order to identify those characteristics that may be potentially associated with the screening uptake. Methods: Through a cross sectional study, in 2014, a random sample of 561 women aged 40 years and older without the history of breast cancer and identified with Kurdish background in Baneh county, Iran, were recruited and interviewed by two trained interviewers. Data were collected using a valid and reliable researcher made questionnaire. Univariate and multivariate logistic regression models with self-reported screening history as the dependent variable were used to estimate the odds ratios (ORs) with 95% of CI. Results: The mean age of women was 43.64 (SD = 5.17). The participation rate in the mammography program was 16.8% (95% CI: 13.7-19.8%). The lowest level of participation was found among women aged 60 and older (OR = 0.30, 95% CI: 0.14-0.69), illiterate (OR = 0.63,95% CI: 0.40-0.99) and post-menopausal (OR = 0.56, 95% CI: 0.35-0.91) women. Conclusion: It was found that the level of breast screening uptake was low among Kurdish women compared to those reported in the previous studies. Designing participation enhancing interventions with a specific focus on older, illiterate and post-menopausal women are recommended.

Background: To investigate the determinants of smoking behavior among Iranian adolescents applying the Prototype/Willingness (P/W) Model. Methods: In this cross-sectional study, a self-administered P/W model-based questionnaire was completed between 760 randomly selected adolescents (high school students and dropouts) in Hamadan, Iran, in 2015. Generalized structural equation modeling (GSEM) was applied to analyze data. Results: Significant associations were found between subjective norms and positive attitudes toward smoking (P

OBJECTIVES Substance abuse behaviors among university freshmen in Iran are poorly understood. This study aimed to identify, for the first time, subgroups of university freshmen in Iran on the basis of substance abuse behaviors. Moreover, it examined the effects of socio-demographic characteristics on membership in each specific subgroup. METHODS Data for the study were collected cross-sectionally in December 2013 and January 2014 from 4 major cities in Iran: Tabriz, Qazvin, Karaj, and Khoramabad. A total of 5,252 first-semester freshmen were randomly selected using a proportional cluster sampling methodology. A survey questionnaire was used to collect data. Latent class analysis (LCA) was performed to identify subgroups of students on the basis of substance abuse behaviors and to examine the effects of students’ socio-demographic characteristics on membership in each specific subgroup. RESULTS The LCA procedure identified 3 latent classes: the healthy group; the hookah experimenter group; and the unhealthy group. Approximately 82.8, 16.1, and 2.1% of students were classified into the healthy, hookah experimenter, and unhealthy groups, respectively. Older age, being male, and having a family member or a close friend who smoked increased the risk of membership in classes 2 and 3, compared to class 1. CONCLUSIONS Approximately 2.1% of freshmen exhibited unhealthy substance abuse behaviors. In addition, we found that older age, being male, and having a close friend or family member who smoked may serve as risk factors for substance abuse behaviors.

Background: The main aim of this study was to accumulate research evidence that introduce validated scales to measure suicidal attitudes and ideation and provide an empirical framework for adopting a relevant assessment tool in studies on suicide and suicidal behaviors. Methods: Medical Subject Headings’ (MeSH) terms were used to search Ovid Medline, PROQUEST, Wiley online library, Science Direct and PubMed for the published articles in English that reported application of an scale to measure suicidal attitudes and ideation from January 1974 onward. Results: Fourteen suicidal attitude scale and 15 scales for assessing suicidal ideation were identified in this systematic review. No gold standard approach was recognized to study suicide related attitudes and ideations. Conclusion: Special focus on generally agreed dimensions of suicidal ideation and attitudes and cross-cultural validation of the introduced scales to be applicable in different ethnic and socially diverse populations could be a promising area of research for scholars.

Introduction & Objective: Regarding increasing the rate of cell phones use and its' subsequent dependency in such instrument among young people and also considering the important role of self-regulation and self-control traits on health related issues and the roles of such issues in problematic and addictive behaviors, this study has been designed to evaluate the predictive role of self-regulation and self-control on the intemperate use of cell phone and its related de-pendencies. Materials & Methods: This study was a cross-sectional study with analytical and descriptive orientation which has been carried out the students of universities which were located in the Tabriz city, Iran in 2013. Data were gathered through a questionnaire that was filled by 476 students (190 male and 286 female). Participants were selected through a multi-stage cluster sampling method from 9 universities in Tabriz. Data analysis was performed by SPSS version 21 and Mplus software version 6.2. Results: Results showed that the predictive effect of self-regulation (P= 0.19) and self-control (P=0.41) on intemperate cell phone use was not significant, hence the increase of one unit in self-regulation and self-control respectively reduced 42.0, 87.0 dependency in cell phone. Conclusion: The present study could not demonstrate the predictive effect of self-regulation and self-control on intemperate cell phones use, however, the results showed that the meas-ures were relatively correlated with dependency in cell phone and therefore further researches seem to be necessary in this field.

Background: Experience of tobacco use in early ages will increase probability of addiction to nicotine therefore, efficient tobacco control programs for teenagers are crucial. This study was conducted to recognize elements of successful integrated inside and outside of school based smoking prevention programs. Methods: MeSH terms and related keywords were used to search PubMed, Cochrane, Medline, EMBASE, ERIC, SID databases from inception to 29th October 2013. Trials with random and non-random designs, systematic reviews and cohort studies that assessed or reported application of integrated tobacco control programs were included. Quality of the retrieved publications was checked independently by the authors and any disagreement was resolved by consensus. Result: Among the 745 identified publications, only 15 studies had the inclusion criteria with a considerable methodological heterogeneity. While, precise out-come of integrated out of school/school-based interventions were not percepti-ble but this study’s findings implied that outside of school intervention could strengthen school-based tobacco prevention programs. No study was found to examine school-based interventions integrated with primary health care such as anti-tobacco consultations, high-risk students screening and their referral to special centers. Conclusion: Integration of outside and inside of school-based programs may boost probability of obtaining favorable outcomes and success rate in practice.

Background: The Behavioral Intention Model is one of the best and most widely models used regarding attitude of behavioral of pregnancy and decrease the rate of cesarean section (CS) among pregnant women, except effect of atti-tude and subjective norms on behavioral intention. Two variables of self-efficacy, and outcome expectation, relate to individual’s behavior in an upcoming situation, and both of them are important at the development of behavior. The purpose of the present study was to develop a model to explain women’s inten-tion to choose natural vaginal delivery (NVD). The variables of self-efficacy and outcome expectations, derived from Bandura’s Social Cognitive Theory, and Behavioral Intention Model constructs were used to define the model.Methods: The study was descriptive and cross-sectional in nature and took place in Pars Abad, Iran in 2014. The non-probability sample consisted of 200 pregnant women who voluntarily participated in the study and provided the data. SPSS 21 and MPLUS 6.8 were employed to analyze the data.Results: Self-efficacy, outcome expectations, and attitude toward NVD were associated with intention to choose the NVD.Conclusion: The study findings may play a role in designing educational inter-ventions aimed at influencing the NVD and improving childbirth programs.