Inequality in mammography uptake: results from recruitment phase of first cohort study among Iranian Kurdish population.

BACKGROUND: Breast cancer is the most common malignant disease in women and is the leading cause of cancer deaths among women. Mammography is the best and the most available diagnostic method for breast cancer early detection. The aim of this study was to investigate the prevalence and inequality in the mammography uptake among Kurdish women in the west of Iran. METHODS: This cohort study was conducted using data extracted from the Ravansar Non-communicable Cohort Study among Kurdish women in the west of Iran from 2014 to 2018. The sample included 5289 women aged 35-65 years. The relative and generalized (absolute) concentration index (RC and GC, respectively) was used to quantify and decompose socioeconomic inequalities in mammography uptake. RESULTS: Overall concentration index for mammography was 0.2107, indicating that the mammography uptake concentration was greater in women with a higher socioeconomic status (SES). The predictor variables accounted for 44.6% of the inequality in the mammography uptake. Higher SES, living in urban areas, and age group of 51-55 years old increased the chance of having a mammogram. Available evidence supports the inequality of mammography uptake in favor of women with higher SES. CONCLUSIONS: Cost-free screening services for low SES women, and the development of breast cancer prevention campaigns focusing on disadvantaged women could have an important role in mammography uptake and in the reduction of inequalities.

Socio-Economic Status and Clinical Breast Examination Screening Uptake: Findings from the First Cohort Study among Iranian Kurdish Women.

Clinical Breast Examination (CBE) is utilized as a screening modality in many low income countries without widespread mammography capability. The aim of the current study was to evaluate the impact of socio-economic status (SES) on CBE screening rates in Iranian Kurdish women. A cross-sectional study was conducted in the western region of Iran. A sample of 5,289 Iranian Kurdish women aged 35-65 years old was analyzed. Data were collected from July 2014 to September 2018. The Concentration Index-CI and Concentration Curve were used to estimate the socioeconomic inequalities in CBE rate. The analysis of data was done by STATA software (Version 14). 12.3% of the women had received CBE at least once. CBE rates in the 46-50 age group were higher than in other age groups (OR = 2.06; 95% CI = 1.56-2.71). Women with 6-9 years of education had higher odds ratio of receiving CBE (OR = 1.41; 95% CI = 1.02-1.94). Women living in rural areas were less likely to have received CBE compared to those living in urban areas (OR=0.54; 95% CI = 0.42-0.61). The overall concentration index for receipt of CBE was 0.188. In countries without widespread mammography programs, strategies for the promotion of CBE should focus on the lower SES population.
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Using intervention mapping for hookah smoking cessation: a quasi-experimental evaluation.

BACKGROUND: The present study aimed to evaluate the results of a theory-based and systematic intervention on Hookah Tobacco Smoking (HTS) cessation in women local to Bandar Abbas, Iran. METHODS: In the present quasi-experimental research, we used an intervention mapping approach to develop, implement, and evaluate an education and training course as our intervention. Applying the results of a systematic review and two prior local qualitative studies, we identified six HTS determinants and set goals for the intervention. We selected 212 eligible women through systematic stratified random sampling and enrolled them in control and intervention groups. The course was presented to the intervention group in 17 sessions for four months. The educational material was developed to address the goals of the intervention, improve HTS determinants, and change the HTS behavior. We used a questionnaire to collect data on participants' characteristics, HTS behavior, and detailed determinants of HTS in the control and intervention groups at the beginning of the study, at the end of the intervention, and at three- and six- months follow-up. All work done in the study was guided by ethical considerations. RESULTS: The results showed no significant difference between women enrolled in control and intervention groups regarding participants' characteristics and HTS behavior. At baseline, there were no differences between groups for six determinants of HTS (knowledge, attitude, social norms, self-efficacy, habit, and intention). At the end of the intervention and at three and six months follow-up, the women in the intervention group had significantly better results in all six domains, compared with those in the control group. The rate of HTS abstinence at the end of the intervention and at the three- and six-month follow-ups was 61.3%, 48.5%, and 45.5% for the intervention and 16%, 14.4%, and 10% for the control groups, respectively. CONCLUSIONS: HTS is a complicated behavior, and its cessation is hard. However, Intervention Mapping (IM) can be a powerful integrative, purposeful, theory-based, and participation-based method to reduce or cease HTS. This method should be tested in other settings. TRIAL REGISTRATION: IRCT20190126042494N1, Registered 3.3.2019. https://en.irct.ir/trial/37129.

What are the intervention goals of women's hookah cessation? A systematic, evidence-based and participatory study.

This Study was designed to answer the question: what are the intervention goals of women for ceasing to smoke. The present research was part of a larger study and was a pioneering systematic research conducted between September 23, 2018 and September 26, 2019 through an intervention mapping in southern Iran among professional hookah Smoking (HS) women. In order to know more about the HS among women, the behavioral and environmental correlates of HS/cessation and the determiners or fundamental causes of these factors were extracted via a systematic review and a local qualitative study. As the results revealed, the expected outcomes of the educational program concerning hookah cessation were achieved. As the realization of these outcomes requires certain changes to the behavioral and environmental dimensions, in the next step, the intervention goals of hookah cessation were identified. As the results showed, four behavioral factors involved in the unhealthy HS behavior were individual HS, Being in the Company of hookah smokers, Visiting tempting and contaminated places and Physical and mental dependence on HS (habit), In addition, four effective environmental factors were found at different interpersonal, organizational, community and policy levels. These include, respectively: recommendation and motivation for cessation by influential figures, care providers' poor inadequate knowledge and skill, Easy acceptance of hookah in society, and the lack of effective rules. Knowledge, awareness, social norms, Motivation to comply, skill and self-efficacy, habit, were among the determining factors of hookah cessation. Employment of a systematic is based on evidence and cooperation and is guided by a assessing the needs of the target population. Such a method can suggest more purposive and relevant intervention goals so as to cease HS. The aim would be to intervene in the purposes of the above-mentioned change, as compared in predetermined interventions, and increase the chances of HS cessation among women.

Predictors of hookah smoking frequency among women in the South of Iran: A cross-sectional study.

The prevalence of hookah smoking has grown over the past decades in Iran especially in the south of the country. This study aimed to determine the behavioral and socio-demographic predictors of the hookah smoking frequency among women in southern Iran. This research was conducted on 400 women hookah smokers selected through multi-stage sampling method. Data were collected from October 2018 to September 2019 using a questionnaire guided by literature. Ordinal logistic regression analysis was run to determine the influential behavioral and socio-demographic predictors involved in the frequency of hookah smoking. Variables with a P-value of less than 0.05 in the final fitting model were associated with the outcome variable (frequency of hookah smoking per day1 = once a day, 2 = twice a day, 3 = three times a day, 4 = more than three times a day). We found that the longer duration of hookah smoking, family usage of hookah smoking, beginning to smoke hookah with peers, absence of either parent in family (single-parent families and a lack of prior intention to cease smoking), ever-married women and low socio-economic status (SES) predicted the frequency of hookah smoking. To prevent the behavior and make effective interventions to reduce hookah smoking, policy-makers should stay focused on factors other than internal motivations. Focus on the companies surrounding women smokers, quitting the habit of hookah smoking and effective interventions to decrease one's intention to smoke hookah can help reduce such unhealthy behaviors.

Prostate specific antigen test uptake: a cross sectional study on elderly men in Western Iran.

BACKGROUND: Prostate cancer (PCa) is the second most common malignancy in men worldwide and the incidence rate of PCa has been increasing in recent years. The aim of the current study was to determine beliefs elderly men towards prostate-specific antigen (PSA) test uptake. METHODS: This cross-sectional study conducted among 352 elderly men (60-74 years old age) in the west of Iran. The Health Belief Model (HBM) was applied as a study framework to evaluation of beliefs towards PSA test uptake. Data were analyzed by SPSS version 16 using appropriate statistical tests including t-test, chi-square, bivariate correlations, and logistic regression at 95% significant level. RESULT: The mean age of participants was 65.55 years [SD: 3.90]. Almost 16.9% of the elderly men had uptake PSA during last year. There was significant association between PSA test uptake with older age (P = 0.013), better economic status (P = 0.023), higher education level (P = 0.004), positive family history of prostate cancer (P = 0.018), and number of family members more than four (P = 0.032). The best determinants predictors for PSA test uptake were cues to action [OR: 1.967 and 95% CI: 1.546, 2.504], perceived severity [OR: 1.140 and 95% CI: 1.008, 1.290], and perceived benefits towards PSA test uptake [OR: 1.133 and 95% CI: 1.024, 1.253]. CONCLUSIONS: It seems that development of health promotion programs to increase cues to action and positive beliefs toward PSA test uptake and also perceived treat about side effect of PCa could be beneficial to increase PSA test uptake.

Prevalence of drug use, alcohol consumption, cigarette smoking and measure of socioeconomic-related inequalities of drug use among Iranian people: findings from a national survey.

BACKGROUND: Drug use can lead to several psychological, medical and social complications. The current study aimed to measure and decomposes socioeconomic-related inequalities in drug use among adults in Iran. METHODS: This was a cross-sectional study The PERSIAN Cohort is the largest and most important cohort among 18 distinct areas of Iran. This study was conducted on 130,570 adults 35 years and older. A structured questionnaire was applied to collect data. The concentration index (C) was used to quantify and decompose socioeconomic inequalities in drug use. RESULTS: The prevalence experience of drug use was 11.9%. The estimated C for drug use was - 0.021. The corresponding value of the C for women and men were - 0.171 and - 0.134, respectively. The negative values of the C suggest that drug use is more concentrated among the population with low socioeconomic status in Iran (p < 0.001). For women, socioeconomic status (SES) (26.37%), province residence (- 22.38%) and age (9.76%) had the most significant contribution to socioeconomic inequality in drug use, respectively. For men, SES (80.04%), smoking (32.04%) and alcohol consumption (- 12.37%) were the main contributors to socioeconomic inequality in drug use. CONCLUSIONS: Our study indicated that drug use prevention programs in Iran should focus on socioeconomically disadvantaged population. Our finding could be useful for health policy maker to design and implement effective preventative programs to protect Iranian population against the drug use.

Extension of the Theory of Planned Behavior (TPB) to Predict Patterns of Marijuana Use among Young Iranian Adults.

Background: Marijuana use is increasing among adolescents and young adults. Long-term marijuana use magnifies the risk of a wide variety of behavioral, cognitive-emotional, and neurological problems, and can be a gateway to use of other drugs. In the present study, we investigated the cognitive-emotional and behavioral predictors of marijuana use. To this end, young Iranian adults answered questions based on an extended Theory of Planned Behavior (TPB) and related it to marijuana use. We hypothesized that cognitive-emotional and behavioral factors would predict intention to use marijuana, and that this, in turn, would predict actual consumption. Methods: A total of 166 young Iranian adults (mean age: 20.51 years; 15.7% females) attending a walk-in center for drug use took part in this cross-sectional study. Participants completed questionnaires covering sociodemographic information, frequency of marijuana use per week, along with questionnaires assessing the following dimensions of the TPB: attitude towards marijuana use, subjective norms, self-efficacy to resist marijuana use, environmental constraints, problem-solving skills, and behavioral intention for marijuana use. Results: Mean marijuana use was found to be 4.6 times/week. Attitude towards marijuana use, subjective norms, environmental constraints, and behavioral intention to use marijuana were positively correlated to each other and with marijuana use/week. In contrast, higher self-efficacy and problem-solving skills were associated with lower marijuana use/week. The multiple regression analysis showed that a positive attitude to marijuana use, lower self-efficacy in resisting its use, higher behavioral intention, and poorer problem-solving skills predicted actual use. Conclusion: The pattern of results suggests that dimensions of TPB can explain marijuana use among young Iranian adults self-admitted to a walk-in center for drug use. Specifically, poor problem-solving skills, low self-efficacy in resisting marijuana use, and positive labelling of its use appeared to be the best predictors of actual use. It follows that prevention programs aimed at improving problem-solving skills and raising self-efficacy, along with educational interventions aimed at highlighting the negative effects of marijuana might decrease the risk of its use among young adults in Iran.

Skin Cancer Prevention: Psychosocial Predictors of Sunscreen Use in University Students.

Skin cancer has the most prevention potential among all cancers. Sunscreen use is an effective method in reducing the risk prevalence of skin cancer. The aim of this study was to determine the cognitive determinants of sunscreen use among university students based on the health belief model (HBM). This cross-sectional study was conducted among 301 university students in the west of Iran. Students were randomly selected to participate voluntarily in the study. Participants filled out a self-administered questionnaire. Data were analyzed by SPSS version 16 using appropriate statistical tests including correlation and logistic regression at 95% significance level. Our results indicated 44.2% of participants reported had always sunscreen use. Among the HBM constructs, cues to action with odds ratio estimate of 1.146 (95% CI 1.061, 1.239) and perceived self-efficacy with odds ratio estimate of 1.131 (95% CI 1.036, 1.234) were the more influential predictors on always sunscreen use. Female students and high levels of mother's education were significant predictors of sunscreen use. It seems these findings are useful in planning health promotion programs aimed at increasing self-efficacy for sunscreen use.

Correction to: Skin Care Prevention: Psychosocial Predictors of Sunscreen Use in University Students.

The article Skin Cancer Prevention: Psychosocial Predictors of Sunscreen Usein University Students, written by Mehdi Mirzaei-Alavijeh, Hassan Gharibnavaz and Farzad Jalilian, was originally published electronically on the publisher's internet portal (currently SpringerLink) on July 23, 2019 with open access.

Socio-cognitive determinants of colorectal cancer screening uptake: An application of intervention mapping approach.

Background: Fecal occult blood test (FOBT) is one of the common screening tests for colorectal cancer. This study was designed to determine the socio-cognitive determinants related to FOBT uptake for colorectal cancer screening based on intervention mapping (IM). Methods: A total of 500 individuals aged over 50 years were randomly selected to participate in this study in Kermanshah, Iran, in 2016. Data were collected by interviews based on a questionnaire and analyzed by SPSS16 using bivariate correlation, linear, and logistic regression models. Results: Of the 500 respondents, 468 (93.6%) signed the consent form and voluntarily participated in the study. Almost 11.1% of the participants had a history of FOBT uptake. Socio-cognitive variables accounted for 38% of the variation in the outcome measure of the intention to uptake FOBT. Perceived self-efficacy (OR = 3.345 & 95% CI: 1.342, 8.339), perceived susceptibility (OR = 2.204& 95% CI: 1.320, 3.680), attitude (OR = 1.674& 95% CI: 1.270, 2.137), and perceived severity (OR = 1.457& 95% CI: 0.954, 2.224) were the strongest predictors of fecal occult blood test uptake. Conclusion: IM-based analysis of behavior may provide insights to design interventions for modifying individuals' beliefs about the usefulness of FOBT uptake to prevent colorectal cancer.

Stage of Breast Cancer Screening Adoption; The Role of Cognitive Predictors.

Breast cancer is the most common cancer among women. The present study investigated the stage of breast cancer screening adoption and the role of some of the cognitive predictors in a sample of Iranian married women. There were a total of 334 married women clients of eight health centers in Kermanshah city, the west of Iran, were randomly selected to participate voluntarily. Women filled out a self-report questionnaire. Data were analyzed by SPSS version 20 using One-way ANOVA, χ2-test, Fisher's exact test, and bivariate correlations statistical tests at 95% significant level. The mean age was 39.75 years [SD: 7.73]. Nearly 58.4%, 26.9%, 3%, 9.6%, and 2.1% of the respondents were reported pre-contemplation, contemplation, preparation, action, and maintenance of breast cancer screening adoption, respectively. There was a significant association between age (P=0.005), and positive family history of breast cancer (P=0.037), perceived susceptibility (P=0.005), perceived severity (P=0.001) and knowledge of symptoms (P=0.018) with breast cancer stage of screening adoption. Our findings can provide better knowledge for the development and implementing of stage-targeted breast cancer screening adoption promotion programs. We conclude that it seems that the focus of health planner should be to rise to perceived severity; perceived susceptibility and knowledge of symptoms of breast cancer about the promotion of breast cancer screening adoption an Iranian woman.

Information Needs Assessment among Parents of Children with Cancer.

Background: Parents of children with leukemia should be receiving an extensive amount of information about the care of their child; the aim of this study was to determine the parents' information needs of children with leukemia. Methods: A cross-sectional study design was used to describe medical, physical, mental and lifestyle information needs among parents of children with leukemia. 209 parents of children diagnosed with leukemia in the west of Iran, during winter 2018, voluntarily participated in individual interviews. Data were analyzed by SPSS version 16 using t-test, One-way ANOVA and bivariate correlations statistical tests at 95% significant level. Results: The mean age of participants was 39.45 years [95% CI: 38.35, 40.55], ranged from 27 to 58 years. Participants achieved 55.6% score of information needs. There was a significant relationship between higher education level (P< 0.001), better economic status (P=0.008) and more family size member (P=0.003) with information needs. Conclusion: Findings suggest that parents of children with leukemia need the information to learn how to take care of their childhood and could be useful for guiding implementers to planning and implement effective programs to promotion information of parents towards children with cancer.

Socio-Cognitive Determinants of the Mammography Screening Uptake among Iranian Women

Background: Mammography screening uptake is the most effective method in breast cancer screening. The aim of this study was to determine the determinants related to mammography screening uptake among Iranian women based on the theory of planned behavior. Materials and Methods: This cross-sectional study was conducted among 408 women who referred to health centers in Kermanshah city, the western of Iran, during 2016. Participants filled out a self-administered questionnaire. Data were analyzed by SPSS version 21 using Pearson correlation, linear and logistic regression statistical tests at 95% significant level. Results: The mean age of participants was 39.61 years [SD: 8.28], ranged from 30 to 60 years. Almost 13% of the participants had already mammography screening uptake at least once. Perceived behavioral control (OR=1.229) and behavioral intention (OR=1.283) were the more influential predictors on mammography screening uptake. Conclusions: Based on result, it seems increase perceived behavior control toward mammography screening uptake may be usefulness in promotion of mammography screening uptake among Iranian women.

Prevalence, Cognitive and Socio-Demographic Determinants of Prostate Cancer Screening

Screening may be effective for reducing deaths due to prostate cancer. The aim of this study was determine the prevalence and determinants influencing prostate cancer early detection behaviors based on the theory planned behavior (TPB). In this cross-sectional study, conducted in the west of Iran, a total of 250 men aged 50 to 70 years old were randomly selected to participate. Of these, 200 (80%) signed the consent form and voluntarily agreed to take part. A structured questionnaire based on TPB constructs was applied for collecting data by interview. Analyses were conducted with SPSS version 16 using bivariate correlations, and logistic and linear regression. Some 26.5% of the participants demonstrated prostate cancer early detection behavior. Age higher than 60 (OR: 5.969), academic education (OR: 2.904), number of family members more than four (OR: 3.144), and knowledge about prostate cancer (OR: 3.693) were the most influential predictive factors for early detection behavior. Furthermore, among the TPB constructs, attitude (OR=1.090) and subjective norms (OR=1.280) were the most influential predictors. Attitude, subjective norms, and perceived behavioral control accounted for 43% of the variation in the outcome measure of the intention to screen for prostate cancer (adjusted R squared= 0.43, F= 49.270 and P < 0.001). Designing and implementation programs to increase positive attitudes and encourage subjective norms towards prostate cancer screening behavior may be useful for promotion of early detection.

Socio-demographic characteristics associated with cigarettes smoking, drug abuse and alcohol drinking among male medical university students in Iran.

BACKGROUND: Substance abuse is one of the most complicated social problems. Understanding socio-demographic characteristics of those who abuse substances could help deal with this problem more efficiently. The main objective of this study was to determine socio-demographic characteristics associated with alcohol drinking, cigarettes smoking and drug abuse among a sample of male medical university students in Iran. METHODS: This cross-sectional study was conducted in 2014 among 425 male medical college students randomly selected with the proportional to size among different faculties in Isfahan and Kermanshah medical universities in Iran. A self-report written questionnaire was applied to collect data. Data were analyzed by the SPSS-20. RESULTS: Mean age of the respondents was 19.9 yr (ranging from 18 to 22 yr). About 19.4%, 3.9%, and 10.1% of the respondents had history of cigarette smoking, drug use, and alcohol drinking during the past three months, respectively. Logistic regression showed that mother's educational level, living place, economic status, and parents' divorce were the most influential predictive factors on substance abuse. CONCLUSIONS: Considering the high prevalence of substance abuse (especially smoking and alcohol drinking), it seems essential to design educational interventions to prevent substance abuse, paying attention to predictive factors mentioned above, among college students.