Development and validation of the geriatrics health behavior questionnaire (GHBQ).

BACKGROUND: Considering the importance of health behaviors in health outcomes, it is necessary to assess health behaviors precisely. This study aimed to develop and validate The Geriatrics Health Behavior Questionnaire among Iranian older adults. METHODS: This cross-sectional and methodological study was conducted on 420 community older adults (age ≥ 60) through random multi-stage sampling. The initial questionnaire has been developed with 22 items and seven subscales based on an extensive literature review, evaluation of related questionnaires, and experts' opinions. Face and content validity were evaluated by interviewing 10 older adults and 18 specialists. The construct validity was evaluated via Known-groups validity and convergent validity. The reliability of the questionnaire was calculated by internal consistency, test-retest, and absolute reliability. RESULTS: The face validity was conducted by using interviews with older adults and gathering the specialists' opinions. The items were grammatically and lexically corrected accordingly. Two items were deleted due to CVR < 0.44. Modified Kappa statistic (K*) and I-CVI for all items were higher than 0.88. The average content validity index (S-CVI/Ave) value was 0.94. Three items were deleted to improve the internal consistency; the final GHBQ consisted of 17 items with Cronbach α = 0.72. Acceptable convergent validity was approved by a significant correlation between GHBQ and SF8™ health survey (r = 0.613, P value< 0.001). Independent t-test showed that older adults with education level ≥ high school have significantly higher health behavior scores than those with education level < high school (11.93 ± 2.27 vs. 9.87 ± 2.35, t = - 9.08, p < 0.001). Intra-class correlation coefficient (ICC) for the total questionnaire was 0.92 (95% CI =0.84 to 0.96). Standard Error Measurement (SEM) and Minimal Detectable Change (MDC95) were 0.71 and 1.98, respectively. CONCLUSION: The present study results showed that the Geriatrics Health Behavior Questionnaire had suitable validity and reliability among Iranian older adults. It is recommended to consider its comprehensiveness and yet its briefness in other populations after passing validation.

Social Support Associated with Condom Use Behavior Among Female Sex Workers in Iran.

BACKGROUND: Despite the widespread knowledge about social support and health, there is little information about the association between social support and HIV risk behaviors such as condom use among female sex workers (FSWs) in Iran. This study aimed to determine the association between social support and frequency of condom use among FSWs in Tehran, Iran. METHODS: Using mixed sampling methods, we recruited 170 FSWs in Tehran in 2017. We measured self-reported social support by face-to-face interviews using a standardized questionnaire. Linear regression was used to assess the association between socio-demographic characteristics (age, education level, marital status, and place of living), transactional sex characteristics (age at first transactional sex and frequency of transactional sex in the last month), HIV knowledge, social support network characteristics (social network size, duration of tie, intimacy, social support), and condom use behavior. RESULTS: Of the total of 1193 persons in FSW's social networks, 615 (51%) were sexual partners, 529 (44%) were peer sex workers, and 36 (5%) were family members. The participants perceived moderate social support from sexual partners, low from peer sex workers, and very low from family members. Adjusted for individual and other network characteristics, peer sex worker social support (b = 0.28, 95%CI 0.06, 0.50), and family support (b = 1.12, 95%CI 0.028, 2.23) were significantly associated with condom use. CONCLUSION: Family and peer sex worker social support are associated with condom use, but less strongly than HIV knowledge or place of living. However, very few FSWs are socially connected with families. Interventions to promote condom use among this vulnerable population should also consider social and familial support.

Psychometric properties of modified MOS social support survey 5-item (MSSS-5-item) among Iranian older adults.

BACKGROUND: Social support is a key factor in public health. Since the precise evaluation of it is critical, the current study has been developed to evaluate the psychometric properties of the MOS-SSS questionnaire's abbreviated form (MSSS-5-item) among the Iranian older adults. METHODS: This cross-sectional and methodological study was conducted on 420 community older adults (age ≥ 60) through random multi-stage sampling. The questionnaire was first translated into Persian through the Forward & Backward method based on WHO guidelines. Next, the validity of scales was investigated by calculating face validity, content validity, Known-group validity, explanatory factor analysis, and confirmatory factor analysis indices. The reliability of the questionnaire was calculated by internal consistency, test-retest, and absolute reliability. Moreover, the scalability of the questionnaire was checked through the Mokken scale analysis. The software packages SPSS version 22, AMOS version 22, and R (Mokken package) were employed to analyze the data. RESULTS: the face validity was conducted using interviews with older adults and gathering the specialists' opinions. Then, the items were grammatically and lexically corrected accordingly. The CVI index of the overall scale was 0.94, and for every single item above 0.89. The results of the independent t-test showed that the current questionnaire well distinguished between the older adults who do and do not feel lonely (p < 0.001). Two components were recognized according to the explanatory factor analysis. They together explained 67.78% of the total variance of the questionnaire. The CFA showed that the two-factor model had acceptable fit indices. The questionnaire had desirable internal consistency (α = 0.78), stability (ICC = 0.98), and absolute reliability (SEM = 0.56, MDC = 1.57). Furthermore, the Mokken scale proved that MSSS-5-item was a strong scale (H = 0.51, se = 0.03). CONCLUSION: The present study results showed that the MSSS-5-item questionnaire had suitable validity and reliability to be used among Iranian older adults.

Determinants of safe sexual behavior of female sex workers in Tehran: the woman, her network, and the sexual partner.

BACKGROUND: Despite the steady growth of sexual transmission of HIV, there is little evidence about safe sexual behavior of FSWs, and social network effects on this behavior, in Iran. Our aim in this study was to determine the effect of social network characteristics on condom use among FSWs, considering individual characteristics of the FSWs and of their sexual partners, characteristics of their relationship, and the FSW's personal network. METHODS: A cross-sectional ego-centric network survey of 170 FSWs was carried out in Tehran between January and June 2017. A multilevel ordered logistic regression analysis was conducted to examine the effects of individual and relational characteristics simultaneously. RESULTS: Condom use in sexual relationships of the FSWs on average was rather low. Important determinants of safe sexual behavior were found both at the level of the individual FSW and at the level of the sexual partner. The main determinants at the level of the individual FSW were FSWs' age and HIV knowledge. At the level of the sexual partner, age and education of sexual partners, as well as intimacy, duration of tie, frequency of contacts with a given partner, frequency of contact, perceived social support, and perceived safe sex norms were significantly associated with condom use. CONCLUSIONS: The findings highlighted that considering only the individual characteristics of female sex workers is not sufficient for effectively promoting condom use. Factors at the network and dyadic level should also be considered, especially the role of sexual partners. Network-based interventions may be useful which modify social relationships to create a social environment that can facilitate changes in sexual behavior.

Decomposing socioeconomic inequality in poor mental health among Iranian adult population: results from the PERSIAN cohort study.

BACKGROUND: Socioeconomic inequality in mental health in Iran is poorly understood. This study aimed to assess socioeconomic inequality in poor mental health among Iranian adults. METHODS: The study used the baseline data of PERSIAN cohort study including 131,813 participants from 17 geographically distinct areas of Iran. The Erreygers Concentration index (E) was used to quantify the socioeconomic inequalities in poor mental health. Moreover, we decomposed the E to identify factors contributing to the observed socioeconomic inequality in poor mental health in Iran. RESULTS: The estimated E for poor mental health was - 0.012 (95% CI: - 0.0144, - 0.0089), indicating slightly higher concentration of mental health problem among socioeconomically disadvantaged adults in Iran. Socioeconomic inequality in poor mental health was mainly explained by gender (19.93%) and age (12.70%). Region, SES itself, and physical activity were other important factors that contributed to the concentration of poor mental health among adults with low socioeconomic status. CONCLUSION: There exists nearly equitable distribution in poor mental health among Iranian adults, but with important variations by gender, SES, and geography. These results suggested that interventional programs in Iran should focus on should focus more on socioeconomically disadvantaged people as a whole, with particular attention to the needs of women and those living in more socially disadvantaged regions.

HIV risk perception and sexual behaviors among female sex workers in Tehran, Iran.

Background: An adequate perception of the degree to which one is at risk of having or contracting HIV is necessary for behavioural change and the adoption of safe behaviours. There are limited data regarding HIV risk perceptions among female sex workers in Iran. This study aimed to determine the HIV risk perception status and its association with sexual behaviours among female sex workers in Tehran. Methods: A cross sectional study was conducted among 170 female sex workers in Tehran. Participants were recruited using a combination of snowball, purposeful, and convenience sampling methods. Multiple logistic regression was used to identify adjusted associations between background factors, sexual behaviours, and HIV risk perception. The analysis was conducted by the "logistf" package in the R statistical system. P-value less than .05 was considered as statistically significant. Results: Among the participants, 122 (77%) reported high HIV risk perception. Most female sex workers with high HIV risk perception reported that they did not consistently use condoms (n=120, 98%. Female sex workers with a higher frequency of sex work (AOR=1.18, 95% CI: 1.08, 1.31), inconsistent condom use (AOR=0.15, 95% CI: 0.02, 0.66), a history of HIV testing (AOR=5.1, 95% CI: 1.2, 26.0), and low HIV knowledge (AOR=0.97, 95% CI=0.95, 0.996) were more likely to report high HIV risk perception. Conclusion: Most female sex workers with risky sexual behaviours had a high HIV risk perception. Effective educational programs are suggested to enable female sex workers to correctly assess their own HIV risk and change risk behaviors based on self-assessment of actual risk.

Comparing Characteristics of Early-Onset Injection Drug Users to Those With Late-Onset Injection in Kermanshah, Iran.

BACKGROUND: Characteristics and behaviors of early-onset injection drug users are under studied topics in Iran. This study aimed to identify and compare the demographic characteristics as well as the drug using behaviors of early-onset and late-onset injection drug users in Kermanshah, West Iran. METHODS: In this cross-sectional study using snowball and convenience sampling, we recruited 450 people during the Fall of 2014 from two drop in centers in Kermanshah, Iran. We collected data through face-to-face interviews. Early-onset injection is defined as whether the person reported their first injection at 22 years of age or younger. Subsequently, late-onset injection is defined as 23 years of age or older. We compared the characteristics of the two groups through both univariate and multiple logistic analyses. RESULTS: Overall, 54% (CI 95%: 44.3%, 62.2%) were early injectors. After controlling for low socioeconomic status, initiation of drug use at a young age, multiple drug use and methamphetamine use were all significantly associated with a higher likelihood of early-onset injection. Additionally, early-onset injection was associated with recent syringe borrowing (OR = 2.6, p = 0.001), recent syringe lending (OR = 1.4, p = 0.01), recent cooker sharing (OR = 3.2, p = 0.01) and injecting two or more times a day (OR = 2.2, p = 0.04). CONCLUSION: Early-onset injectors were more likely to report a lower socioeconomic status, initiation of first drug use at a younger age, using methamphetamine alongside polydrug use, and engaging in higher risk taking behaviors like borrowing needles. With these associations, the study emphasizes the need for drug-prevention programs to focus on the transition to injection drug use at younger ages.

What explains gender inequality in HIV infection among high-risk people? A Blinder-Oaxaca decomposition.

BACKGROUND: Despite clear evidence on role of gender in vulnerability and exposure to HIV infection, information on gender-related inequalities in HIV and related factors are rarely documented. The aim of this study was to measure gender inequality in HIV infection and its determinates in Tehran city, the capital of Iran. METHODS: The study used the data of 20,156 medical records of high-risk people who were admitted to Imam Khomeini Voluntary Counseling and Testing site in Tehran from 2004 to 2018. The Blinder-Oaxaca decomposition was used to quantify the contribution of explanatory variables to the gap in the prevalence of HIV infection between female and male. RESULTS: The age-adjusted proportion of HIV infection was 9.45% (95%Cl: 9.02, 9.87). The absolute gap in the prevalence of HIV infection between male and female was 4.50% (95% CI: - 5.33, - 3.70%). The Blinder-Oaxaca decomposition indicated that most explanatory factors affecting the differences in HIV infection were job exposure, drug abuse, history of imprisonment, injection drug, heterosexual unsafe sex, and having an HIV-positive spouse. CONCLUSION: The results can provide evidence for health policymakers to better planning and conducting gender-based preventive and screening programs. Policies aiming at promoting HIV preventive behaviors among male may reduce the gap in HIV infection between female and male in Iran.

Social Determinants of Adherence to COVID-19 Preventive Guidelines in Iran: A Qualitative Study.

INTRODUCTION: Adherence to COVID-19 preventative guidelines may be influenced by a variety of factors at the individual, societal, and institutional levels. The current study sought to investigate the social factors of adherence to those preventive measures from the perspective of health professionals. METHODS: In October 2020, we performed qualitative research in Tehran, Iran, using the directed content analysis method. For the preparation of our interview guide and data analysis, we employed the WHO conceptual framework of socioeconomic determinants of health. Semi-structured interviews were conducted with 15 health professionals and policymakers who were chosen using a purposive sampling approach. MAXQDA-18 software was used to analyze the data. The Goba and Lincoln criteria were used to assess the quality of the results. RESULTS: There are 23 subcategories and 9 categories, which include socio-economic and political context (unstable macroeconomic environment, poor management of the pandemic, media and knowledge transfer), cultural and social values (fatalism, cultural norms, value conflicts, social customs), socio-economic positions (livelihood conditions), social capital (social cohesion, low trust), living conditions (housing conditions), occupational conditions (precarious employment), individual characteristics (demographic characteristics, personality traits, COVID-19 knowledge, and attitude), psycho-social factors (normalization of the disease, social pressure, and stigma), and health system leadership (health system problems, not taking evidence-based decisions, non-comprehensive preventive guidelines, non-operational guidelines, inadequate executive committee) were obtained. CONCLUSION: To limit the new COVID-19 transmission, people must be encouraged to follow COVID-19 prevention instructions. Improving adherence to COVID-19 preventive guidelines necessitates dealing with the complexities of responding to social determinants of those guidelines. Increasing public health literacy and knowledge of COVID-19, informing people about the consequences of social interactions and cultural customs in the spread of COVID-19, strengthening regulatory lockdown laws, improving guarantees for adhering to preventive guidelines, providing easy access to preventive supplies, and strengthening financial support for households with precarious employment are all important.

Incidence of HIV and HCV in people who inject drugs: a systematic and meta-analysis review protocol.

INTRODUCTION: HIV and hepatitis C virus (HCV) are major health concerns globally. This systematic review and meta-analysis protocol study aims to estimate the incidence of HIV and HCV among people who inject drugs (PWIDs) by reviewing studies that have applied mathematical modelling. The primary purpose of this systematic review is to identify and review mathematical modelling studies of HIV and HCV incidence in PWIDs.Methods and analysis cohort, cross-sectional and clinical trial studies conducted to estimate the incidence of HIV and HCV based on mathematical models or have evaluated the effectiveness of mathematical models will be considered for inclusion in the review. A comprehensive search applying a Cochrane approach will be used to identify relevant primary studies, published between January 2000 and July 2020, and indexed in PubMed, EMBASE, Opengrey, WOS, SCOPUS and Cochrane Library with no restriction on language. This protocol was prepared according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). Study selection and data extraction will be performed by two independent reviewers. Assessment of risk of bias will be implemented using forms of the Critical Appraisal Skills Programme. Publication bias will be assessed by funnel plots, Begg's and Egger's tests. A meta-analysis will be conducted to answer the first research question, 'What is the incidence of HIV and HCV when applying mathematical model in PWID?'. Clinical heterogeneity will be assessed by looking at the characteristics of participants, method of diagnosis and case definitions in the included primary studies. In addition, subgroup analyses will be conducted for population and secondary outcomes. ETHICS AND DISSEMINATION: There are no ethical issues related to this study. The findings will be published in peer-reviewed scientific journals and presented at international and national conferences. PROSPERO REGISTRATION NUMBER: CRD42019126476.

An indirect estimation of the population size of students with high-risk behaviors in select universities of medical sciences: A network scale-up study.

BACKGROUND: Network scale-up is one of the most important indirect methods of estimating the size of clandestine populations and people with high-risk behaviors. The present study is an indirect estimation of the population size of students with high-risk behaviors in select universities of medical sciences. METHODS: A total of 801 students from two University of Medical Sciences at Tehran and Alborz University of Medical Sciences were selected through convenience sampling. Six subgroups of high-risk behaviors were examined in the study, including Tramadol use, cannabis use, opium use, alcohol consumption, extramarital heterosexual intercourse, and heterosexual intercourse in return for money. To estimate the social network size in the study population, each participant was asked to name their close student friends from the two select universities. Data were collected using a checklist designed for this purpose. RESULTS: The participants' mean number of close friends from the selected medical universities was C = 8.14 (CI: 7.54-8.75). Within these social networks, friends with extramarital heterosexual intercourse (5.53%) and friends who consumed alcohol (4.92%) had the highest frequency, and friends who used opium (0.33%) had the lowest frequency. The variables of age, gender, marital status, type of residence and academic degree were significantly related to the likelihood of having close friends with certain high-risk behaviors (P<0.001). CONCLUSION: According to the results obtained, alcohol consumption and extramarital heterosexual intercourse are very common among students. Special HIV prevention programs are therefore necessary for this age group.

Sibling cigarette smoking and peer network influences on substance use potential among adolescent: a population based study.

Background Peer and parental substance use are established predictors for substance use among adolescent, little is known about influence of sibling cigarette smoking and its interaction with peer network on substance use potential that can introduce an important way for substance use prevention programs. Objective The aim of present study was to explore the association of sibling cigarette smoking and peer network with substance use potential among high school students in Tehran. Subjects Data were drawn from the population-based cross-sectional study of among 650 high schools students. Methods Multiple linear regression was used in order to determine the adjusted association between cigarette smoking among family members, peer network, their interaction and substance use potential. Result Having a sister who smokes (B = 3.19; p < 0.01) and peer network quality were associated with substance use potential (B = -0.1; p < 0.05). The increase in mean of substance use potential associated with decreases in peer network quality score is much more than in who have a sister with a cigarette smoking habit. Conclusion Having a sister who smokes interacts with peer network quality; appears to be one of the important mechanisms for adolescents' tendency to substance use. These findings can help in a better understanding of substance use potential mechanisms, screening efforts and the formulation of prevention programs.

Injecting and Sexual Networks and Sociodemographic Factors and Dual HIV Risk among People Who Inject Drugs: A Cross-sectional Study in Kermanshah Province, Iran.

BACKGROUND: Few studies suggest that social network factors, including size of sexual network may associate with drug-related and sexual high-risk behaviors. The objective of this study is to investigate injecting and sexual networks and sociodemographic factors that might be associated with dual HIV risk (DHR) among people who inject drug (PWID). METHODS: The data from a cross-sectional study of 455 PWID that were recruited through peer-referral sampling were used in this study. The data were collected using a structured questionnaire consisted of modules on sociodemographic characteristics, sexual and injection-related risk behaviors during 12 months before the interview. DHR was defined as engaged in both using a syringe previously used by other PWIDs and unprotected sex during last 12 months. Data analysis was performed with descriptive and logistic regression. In final model, we considered variables with P < 0.500 as statistically significant. Finally, reported adjusted odds ratio (AOR) and confidence interval (95% CI) for variables that were significant in the final model. FINDINGS: A total of 455 men who injected drugs participated in this study. The mean age ± standard deviation (SD) was 33.2 ± 7.3 (range 19-58) years. Overall, the prevalence of DHR In the last 12 months, 38% (95% CI: 18.3-51.2%). Multivariate model showed that regular visit to needle, syringe programs (NSPs) reduced odd of HDR to 50% when adjusted for other covariates, but still remained statistically significant (P < 0.050). The odds of reporting DHR was significantly higher in those ≥ 2 sex partners and injection partner (P < 0.010). Odds of DHR was higher (AOR: 2.3) among participants who had more than 2 injection per day but was not statistically significant (P > 0.050). CONCLUSION: DHR was common in PWID in Kermanshah, Iran. Having multiple injecting and sexual partners increased the odds of engaging in dual risk behaviors, but regular visit of NSPs can reduce the DHR among PWID.

Disclosure of HIV Status and Social Support Among People Living With HIV.

BACKGROUND: Disclosure of HIV is important for improving self-care behaviors, psychological well-being, commitment to the treatment, and reducing risk of transmission. One of the major benefits of disclosure is social support, which is an essential resource for effective coping with HIV infection. However, receiving any social support requires disclosing of HIV status. OBJECTIVES: This study aimed to determine the disclosure of HIV status and its related factors such as social support in addition to demographic and disease characteristics among people living with HIV in Iran. PATIENTS AND METHODS: This cross-sectional study, using simple random sampling, was carried out on 175 people with HIV/AIDS who referred to Behavioral Counseling Centers. The self-administrated, Norbeck Social Support Questionnaire was used to measure social support. Disclosure of HIV status was assessed with an investigator-designed questions. Multiple logistic regression analysis with backward Likelihood Ratio method was applied to identify the adjusted odds ratio between disclosure as dependent variable and demographic variables, social support as independent variables. RESULTS: Participants were often disclosed their HIV status to family members. But there were differences about disclosure of HIV status within the context of the family. Family members were perceived as more supportive. Multiple logistic regression analysis demonstrates that the gender (adjusted OR = 0.181; 95% CI .068-0.479), CD4 cell count (adjusted OR = 0.997; 95% CI 0.994-0.999), route of transmission (injection-drug user [adjusted OR = 9.366; 95% CI 3.358-26.123] and other routes [tattooing, mother to child, dental services, etc.], [adjusted OR = 3.752; 95% CI 1.157-12.167]), and functional support variable (adjusted OR = 1.007; 95% CI 1.001-1.013) remained in the model as significant predictors for disclosure. CONCLUSIONS: The results of this study regarding disclosure of HIV status and its relations to social support and some demographic variables can provide an understanding based on the evidence for promotion of knowledge and coping interventions about people living with HIV/AIDS and their perceived social support status.

Social Support Network among People Living with HIV/AIDS in Iran.

This study considers social network interactions as a potential source of support for individuals living with HIV/AIDS in Iran. This cross-sectional study was conducted on 224 people with HIV/AIDS who refer to behavioral counseling centers. Participants were randomly selected among all people with HIV/AIDS from these centers. Relatives were more reported as sources of support than nonrelatives. They were closer to participants, but there was difference between the closest type among relative and nonrelative supporters (P = 0.01). Mean of functional support with considering the attainable range 0-384 was low (126.74 (SD = 76.97)). Social support of participants has been found to be associated with CD4 cell count (P = 0.000), sex (P = 0.049), and network size (P = 0.000) after adjusted for other variables in the final model. Totally, in this study, many of participants had the static social support network that contained large proportions of family and relatives. The findings contribute to the evidence for promotion of knowledge about social support network and social support of people living with HIV/AIDS.

Perceived social support among people with physical disability.

BACKGROUND: Disability is more based on social, rather than medical aspects. Lack of attention and social support may impact on participation of people with physical disability in various aspects and their return to normal life in the society. OBJECTIVES: This study was conducted to determine perceived social support and related factors among physically disabled in the city of Tehran. PATIENTS AND METHODS: This cross-sectional study by using simple random sampling was conducted on 136 people with physically disabled who were covered by Welfare Organization of Tehran. The Norbeck social support questionnaire was used .Multiple linear regression analysis with the backward method was used to identify the adjusted association between perceived social support as dependent variable and demographic variables as independent variables. RESULTS: The present sample comprised of 68 (50%) male and 68 (50%) female with the mean age of 33 (SD = 8.9) years. Based on the results, mean of functional support was 135. 57 (SD = 98.77) and mean of structural support was 77.37 (SD = 52.37). Regression analysis model, demonstrates that variables of age and marital status remained in the model as significant predictors of functional support (P = 0.003, P = 0.004, respectively) and structural support (P = 0.002, P = 0.006, respectively). CONCLUSIONS: Based on the results, participants in the study didn't have favorable status with respect to perceived social support (in all dimensions) from their social network members. While, social support as one of the social determinants of health, plays an important role in improving psychological conditions in people's lives; therefore, being aware of social support and designing effective interventions to improve it for the disabled is very important.