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

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

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