Designing, implementing and evaluating an educational program regarding the effects of second-hand smoke in pregnancy on the knowledge, attitude and performance of male smokers.

INTRODUCTION: Contact with second-hand cigarette smoke includes inhalation of cigarette smoke caused by the burning of the cigarette itself and inhalation of smoke exhaled by the smoker. Wife's pregnancy can be a motivating factor to change the behavior of men who smoke. Therefore, this study was conducted with the aim of designing, implementing and evaluating an educational program regarding the effects of second-hand smoke in pregnancy on the knowledge, attitude and performance of male smokers. METHODOLOGY: The present study is an interventional type of pre-test and post-test. In this phase, sampling from health centers in Isfahan was done randomly between March and July 2019, the participants were 140 smoking spouses of pregnant women, who visited health centers to receive pregnancy care, and were divided into two intervention groups and control were divided. The data collection tool was a researcher-made questionnaire on men's awareness, attitude and performance regarding second-hand smoke. All data were analyzed with SPSS18 software and Chi-score, Fisher, t-test. RESULTS: The average age of the participants was 34 years. There was no significant difference between the comparison of demographic variables in the intervention and control groups (p > 0.05). The results of the paired t-test for comparing before and after the training showed that the average score of the emotional dimension of attitude in the two groups of intervention (p < 0.001) and control (p < 0.001), awareness (p < 0.001) and behavior (p < 0.001) was significantly increased in the intervention group after the training, and according to the independent t-test, the average score of the items mentioned after the training in the intervention group was higher than the control group (p < 0.05). Regarding perceived sensitivity (p = 0.066) and perceived severity (p = 0.065), no significant difference was observed. CONCLUSION: The awareness, emotional aspect of men's attitude and behavior regarding secondhand smoke increased, but the perceived sensitivity and severity in this regard was not significant despite the increase, so the current training package is effective in training, but considering more training sessions It is necessary with more concrete training with model or training videos in order to improve the sensitivity and perceived intensity of men. TRIAL REGISTRATION: Registration of this randomized control trial has been completed with the Iranian Registry of Clinical Trials, IRCT20180722040555N1.

Incentives to Reduce Salt Intake Resulting From Women's Experiences: A Qualitative Study.

INTRODUCTION: Over consumption of salt adversely affects health and is associated with some diseases. Salt over consumption has been reported to be higher in Asian countries including Iran. This research aimed to identify the facilitative factors of reduced salt consumption among 20-65 year-old women to develop effective educational interventions. Methods: This research used qualitative content analysis. We included 42 (31 women aged 20-65 years residing in Hamidia, Yazd and 11 healthcare providers) using Purposeful sampling method. Data were collected through focal group discussions (three groups of 6) and in-depth semi-structured individual interviews with 24 Participants. Data analysis was done using Graneheim and Lundman's approach. Results: Motivators and facilitators were extracted. The former consisted of sub-categories: physical fitness and healthcare, obtaining others' approval, family cooperation and support, internal motivators, contextual motivators and healthcare staff support. Sub-categories of the latter were gaining more information from different instructions, willingness to acquire self-protection skills and nutritional advice. These factors affected to reduce the salt intake among women. Conclusion: In the light of the qualitative results of motivating and facilitating factors, it is essential to enhance internal motivators and increase access to information via different communicative channels in community including schools, medical care providers and public associations. It is also necessary to pave the way for more family and medical staff support, provide appropriate educational and advertising programs, raise women's awareness and change their attitude and behavior with this concern.

Hookah is the enemy of health campaign: a campaign for prevention of hookah smoking among youth.

Hookah smoking is now a serious health threat especially for adolescents. Implementation of planned interventions can help reduce hookah smoking. This study was conducted to investigate the effect of a campaign Hookah is the Enemy of Health Campaign (HEHC) based on the protection motivation theory to prevent hookah smoking among the youth in Sirjan city, in 2018. This was a pre- and post-intervention study. Participants were 280 male and female youth who were selected randomly through the health centers of Sirjan. The educational campaign was conducted during 3 months and participants were trained through interpersonal, group, organizational and community channels and mass media. Data were collected by filling out a questionnaire (containing 64 questions) by the participant before the intervention and 3 months after. Data were analyzed by descriptive statistics (frequency and percentage), chi-square and Wilcoxon signed-rank test by SPSS20 software. The prevalence of hookah smoking was 44.3% in the target group. There was a significant change in the mean scores of knowledge and perceived susceptibility, perceived severity, response efficiency, self-efficacy, rewards, fear and protection motivation after the HEHC (p < 0.05), but there was no significant difference in the structure of perceived cost (p > 0.05). Also, the prevalence of hookah smoking among the target group for those who had ever consumed decreased from 8.9 to 4% and for those who used it occasionally decreased from 35 to 19.4%. The HEHC was effective in reducing hookah smoking, raising knowledge and improving the constructs of the protection motivation theory among the youth of Sirjan.

The application of geographic information systems (ArcGIS) in selecting locations for installing banners and billboards in a health campaign.

In recent years, the geographic information system (GIS) application has used the latest spatial data to help researchers make the right decisions in the shortest time. This study was conducted with the aim of using geographic information systems (ArcGIS) for selecting the best location for installing banners and billboards in a health campaign. This research was an analytical and applied research conducted in Sirjan city, Iran in 2018. In this research, GIS and fuzzy logic methods were used. In order to implement the fuzzy operator in the GIS environment, initially, the main influencing criteria in location selection were determined. Then the weighted layers were put on top of each other and, by considering the sub criteria, the most suitable places to install banners and billboards were identified in the final map. The final map showed the best places to install billboards and educational banners for the 'hookah is the enemy of health' campaign. The final number of these places was 30 according to the main criteria, and the number was reduced to 25 places, after considering the sub criteria. ArcGIS can be used in selecting the best locations for installing banners and billboards in a health campaign.

Designing an educational intervention on second-hand smoke in smoker men on the exposure of pregnant wives: a protocol for a randomized controlled trial.

BACKGROUND: Complications of exposure to second-hand smoke (SHS) are known to affect the health of pregnant women; it requires designing an educational program to reduce the exposure of pregnant women to smoke. Therefore, the purpose of this study was to design an educational program to reduce the exposure of pregnant women with the second-hand smoke of their husband. METHODS: This research-based program is designed in three phases, in the first phase of the study, the level of knowledge, attitude, and practice of men regarding SHS will be measured using a questionnaire. The questionnaire will be based on a literature review and experts opinions. In the next phase the educational program will be designed based on the results of the first phase of the study on the level of knowledge, attitude, self-efficacy, and practice of men, as well as a literature review and experts opinions, and the research team will finalize it according to priorities. To follow up the training will be sent reminders messages. Pregnant women will also be trained to protect themselves and support their husbands to quit smoking. The third phase includes the implementation of educational intervention with pretest-posttest with two intervention and control groups. DISCUSSION: The present study provides strong information and data regarding the needs and strategies for reducing the exposure to second-hand smoke in pregnant women. Therefore, designing a program, and a review article and updated evidences can lead to avoid pregnant women the exposure to second hand smoke and reducing smoking in smoker husbands. It can also reduce their medical and treatment costs. TRIAL REGISTRATION: Registration of this randomized control trial has been completed with the Iranian Registry of Clinical Trials, IRCT20180722040555N1 .

The effect of social class on the amount of salt intake in patients with hypertension.

Reducing salt intake is a factor related to life style which can influence the prevention of blood pressure. This study was conducted to assess the impact of social class on the amount of salt intake in patients with hypertension in Iran. This was an observational on the intake of salt, as estimated by Kawasaki formula in a sample from Iranian population, stratified for social background characteristics. The finding in general was that the estimated salt intake was somewhat higher in subjects from a lower social background, while the opposite was true for lipid levels (LDL and HDL cholesterol). There was also a significant correlation between salt intake and the level of systolic blood pressure, but not the level of diastolic blood pressure. Considering high salt intake (almost double the standard amount in Iran), especially in patients with low-social class and the effects of salt on human health, it is suggested to design and perform suitable educational programs based on theories and models of health education in order to reduce salt intake.

Investigation of Factors Related to Stillbirth.

The stillbirth rate is among the most important indicators of access to and quality of care during pregnancy. This study investigated the factors related to the stillbirth rate in the Yazd province, Iran. The current research is descriptive and cross-sectional and the results of Shahdieh city cohort study which was conducted on 4756 women were used. Data related to the history of stillbirth, demographic characteristics, fertility history and, various female diseases were extracted from the results of the cohort study. The result shows that 7.2% of studied women had a history of stillbirth. Among the multiple variables, predictor variables including education level, marriage age, age of the first conception, number of children, consanguineous marriage, Employment status, and diseases like diabetes, hypertension, and history of depression had a significant relationship with a history of stillbirth (P ≤ .05). The stillbirth rate in Shahedieh is high compared to the global stillbirth Rate, but it is comparable with the stillbirth Rate in Yazd province. Although Yazd province, as one of the industrial hubs of Iran, has relatively acceptable indicators of income, employment, and medical and health facilities and welfare compared to other provinces, this study showed that factors such as diabetes, hypertension, low level of women's education, consanguineous marriage, and women's employment status and social welfare can affect Stillbirth Rate.

Analysis of capability, motivation and opportunity to prevent substance abuse in sensation seeking students on the outskirts of a city in Eastern Iran: a qualitative study.

BACKGROUND: Usually, substance abuse begins in adolescence in Iran. Young people who score high on the sensation-seeking trait tend to be more prone to substance abuse and an early experience in using. According to the COM_B model, substance abuse can be observed in situations where a person has the necessary physical and mental abilities, the necessary opportunities, and competing motivations. Therefore the study aimed to deeper understand of capability, motivation, and opportunities of substance abuse behavior to design educational programs. METHODS: This study was conducted based on content analysis approach. Data were collected through a focus group discussion with 18 participants (high school male students) from the outskirts of Birjand, who received a positive score from the Zuckerman Sensation Seeking Questionnaires' summary form. The group discussion was conducted using a guide to semi-structured questions based on COM-B model constructs. RESULTS: Students' knowledge of substance cognition, side effects, and consequences of addiction were incomplete. Some students believed that substance use was a way to control or vent emotions and that smoking was a sedative, and private spaces and uncrowded public places were physical environments that students cited for engaging in substance use. In the analysis, 24 subcategories and 11 categories were identified for the capability analysis section, 16 subcategories and 7 categories for the motivation section, and 21 subcategories and 6 categories for the opportunity section. CONCLUSIONS: In order to achieve more precise prevention interventions against adolescents' tendency for substance abuse and to have a more significant impact on their behaviors, it is beneficial to study the three identified factors in some of the target individuals before intervention.

Association between Socioeconomic Status and Homeostasis Model Assessment-Insulin Resistance Index and Mediating Variables at the First Trimester of Pregnancy.

Background: Some studies have shown that Socioeconomic Status (SES) is positively related to insulin resistance among different population groups, except for pregnant women. Therefore, we examined the relationship between SES and Homeostasis Model Assessment-Insulin Resistance (HOMA-IR) index as well as mediating variables. Materials and Methods: This study was performed on 138 primiparous healthy women at 6-10 weeks of pregnancy. The association between SES and HOMA-IR was analyzed by regression analysis, and mediating variables were determined by mediation analysis. Results: SES score was positively correlated with HOMA-IR index [ß = 0.02, t101 = 2.20, p = 0.03, 95% CI: (0.00-0.05]. The higher percentage of mediation was related to maternal weigh (70.80%). Job activity had a protective effect on the association between SES and HOMA-IR (-62.50%). The total percentage of two mediators was 25%. Conclusions: The positive relationship between SES and (HOMA-IR) in early pregnancy may provide a way to control this condition.

Prevention of Postpartum Weight Retention during One Year after Childbirth by Prenatal Nutrition Education: A Randomized Controlled Trial.

BACKGROUND: It seems that 14-25% of the women retain at least 5 kg weight from 6 to 12 months after delivery and gestational weight gain is the most important reason of weight retention. Thus, we assessed the effect of prenatal nutrition education program on the retained weights at 8, 26, and 52 weeks after delivery in primiparous women. METHODS: This randomized controlled trial was implemented among 192 primiparous pregnant women in five hospitals, fifteen community health centers, and fifteen private offices. Self-developed questionnaire was used to collect the participants' characteristics. A 72-hr dietary recall was applied to evaluate the food intakes before and after intervention. The pregnancy physical activity questionnaire determined the physical activity score. The participants' weights at 8, 26, and 52 weeks after delivery were measured by a digital beam. RESULTS: The means of postpartum weight decreased in both groups, but nutrition education was significantly effective on reducing postpartum weight in intervention group (ß = -3.112, SE =. 7384, P < 0.001). Also, the women in intervention group had less retained weight compared to control during the follow-up (ß = -3.35, SE = 0.75, p < 0.001). The proportion of pregnant women in intervention group who reached to their pre-gravid weight was more than control during the follow-up (OR = 2.86, 95% CI: 1.62, 5.07). CONCLUSIONS: Nutrition education considering an individualized calorie-appropriate diet for each pregnant woman and based on the national guideline is effective on postpartum weight retention and reaching to pre-gravid weight.

A survey on the enablers and nurturers of physical activity in women with prediabetes.

BACKGROUND AND OBJECTIVE: Metabolic syndrome, especially prediabetes, is one of the most common health problems due to incomplete glucose metabolism that has a direct relationship with lifestyle. This study was conducted to determine the factors that enable and nurture physical activity in women with prediabetes based on the PEN-3 model. MATERIAL AND METHOD: This descriptive-analytical study was conducted on 41 prediabetic women aged 30-65 years and 9 service providers in health centers. Data were collected from a semi-structured individual interview based on the PEN-3 model. The Graneheim and Lundman method was used to analyze the data. RESULTS: During data analysis, two main themes that include enabling factors and nurturing factors in the domain of physical activity and 6 classes including enablers (positive, negative, and existential) and nurturers (positive, negative, and existential) were extracted from the data content. CONCLUSION: By determining enablers and nurturers, the providers of services can facilitate the participation of prediabetic women in physical activity by applying positive social and structural effects and also to eliminate negative environmental conditions.

Determining Skin Cancer Protective Behaviors in the Light of the Protection Motivation Theory among Sailors in Bandar-Bushehr in the South of Iran.

BACKGROUND: Skin cancer is among the most prevalent cancers in Iran and worldwide. Due to the nature of work, sailors are constantly exposed to the ultraviolet rays of the sun, which in the long run damages their skin and raises the chances of skin cancer. Thus, the present research aimed to predict the skin cancer protective behaviors among sailors in the south of Iran in the light of the protection motivation theory. MATERIALS AND METHODS: The present analytical, cross-sectional research was conducted on 360 sailors in Bandar-Bushehr selected randomly from 4 border healthcare centers. To collect the required data, a reliable and valid questionnaire based on the protection motivation theory was used. The data were analyzed in SPSS21 using descriptive and inferential statistics including Pearson correlation coefficient and linear regression analysis. RESULTS: Pearson correlation coefficient showed a statistically significant positive correlation between protection motivation, perceived severity, fear, reward on the one hand and a statistically significant negative correlation between protection motivation and rewards and response costs. All constructs of protection motivation explained 43% of the variance of skin cancer protective behaviors. Among the influential predictors, perceived self-efficacy showed to be the strongest (ß=0.328). CONCLUSION: Considering the effectiveness of the protection motivation theory in determining skin cancer preventive behaviors among sailors, it can be concluded that this theory can be used as a framework in planning health education and promotion programs to motivate sailors to adopt more skin cancer protective behaviors.

Self-efficacy and perceived barriers of pregnant women regarding exposure to second-hand smoke at home.

BACKGROUND AND AIM: The inability of women to demand from their husbands, for not smoking, has been reported as a factor in exposure to cigarette smoke. This study aimed to investigate the perceived barriers and self-efficacy of pregnant women regarding second-hand smoke (SHS) at home. MATERIALS AND METHODS: This was a cross-sectional study, and the sample size was 255 pregnant women who visited the health-care centers in Isfahan, Iran, from July 2018 to September 2018, and were selected randomly and voluntarily. A questionnaire was designed to collect the data about the exposure to smoke, perceived barriers, and self-efficacy. The data were analyzed using descriptive statistics (mean score and standard deviation), inferential statistics (nonparametric Mann-Whitney and Kendall test), and Spearman's correlation and regression. RESULTS: The mean score of self-efficacy in the exposure group was lower than that the other group (P = 0.000). The mean score of perceived barrier was not a significant difference (P = 0.449). Personal perceived barriers are the most important predictor of self-efficacy of pregnant women in exposure to SHS (95% confidence interval: 0.013-0.262) (P = 0.030). Kendall test comparing items within the group and Mann-Whitney test comparing the two groups showed that personal factors such as "Unaware of the dangers of SHS and protective measures" for notexposed women and environmental factor "the lack of ban smoking law at home" for exposed women are considered the most important barriers (P = 0.000). "Not being together a husband" (P = 0.293) and "going to another place when smoking a husband" (P = 0.000) are the highest self-efficacy items. CONCLUSIONS: It is necessary to develop training programs to increase self-efficacy to avoid exposure to SHS and for both pregnant women and their husbands. It is also necessary to educate and inform about SHS and protective measures against it and to set up "smoking ban law" at home in our country to protect pregnant women.

The physical activity level and aerobic capacity estimation (VO2max) among the administrative staff of the Pars Special Economic Energy Zone (Assaluyeh, Iran) with different BMIs.

Background The purpose of this study was to examine the level of physical activity (PA) and maximal aerobic capacity (VO2max) among office workers of the Pars Special Economic Energy Zone in Iran with different body mass indexes (BMIs). Materials and methods This research was descriptive, and a correlation of variables was applied as its execution method. Administrative staff of two centers were randomly selected from 20 to 30 administrative centers of the Pars Special Economic Energy Zone, Assaluyeh, Iran, and included 294 male employees who were willing to participate in this research and who met the inclusion criteria (being in the age range of 20-60 years, lacking specific diseases, and who had enough physical fitness to do PA) who were purposefully selected. Results The age-adjusted means for the PA score (7.93 ± 1.12) and VO2max (48.66 ± 6.95) mL/min/kg were calculated. After adjusting for other variables, significant difference was found between BMI and age (ß = 0.20; p = 0.005), BMI and VO2max (ß = 0.302; p = 0.001), as well as BMI and the total PA score (ß = -0.304; p = 0.045). Conclusions The results of this study showed low levels of PA (work, exercise and leisure) and respiratory capacity in the administrative staff of the oil and gas industry, which is associated with overweight and obesity.

Predictive factors for preventing hookah smoking and health promotion among young people based on the protection motivation theory.

BACKGROUND: Smoking hookahs is one of the most preventable risk factors for non communicable diseases. It is also considered as the gateway to youth addiction. Planning and training to prevent this health problem is considered an important priority. The aim of this study was to determine the predictive factors for preventing hookah smoking (PHS) in the youth of Sirjan city, based on the protection motivation theory (PMT). MATERIALS AND METHODS: This research was a cross-sectional study conducted in 2018, and participants were chosen by simple random sampling. Data were collected by a researcher-made questionnaire which was valid and reliable and was designed based on the PMT constructs. This questionnaire was completed by 280 young people in Sirjan, Iran. Data were analyzed through descriptive statistics, Pearson correlation coefficients, and linear regression. RESULTS: Pearson correlation coefficients showed that there was a significant correlation between protection motivation and the structures of the PMT, except for the response cost structure. The strongest correlation was between protection motivation and self-efficacy (r = 0.502) and fear (r = 0.470). The structures of the PMT predicted 36.5% of PHS, and fear (ß =0.27) was the strongest predictor of PHS. CONCLUSION: The results of this study show that the constructs of the PMT can partially predict PHS. This theory can be used as a tool for designing and implementing educational interventions to prevent hookah smoking among the youth.

Evaluating perceived threat of skin cancer and preventive measures in South Iranian sailors: A qualitative study.

BACKGROUND: Sailors are exposed to sunlight as their job requires and are, in the long run, more prone to different types of skin cancer. This study aimed to explore sailors' experience of perceived threat and to show protective behaviors against sunlight in the south of Iran. MATERIALS AND METHODS: The present follows a qualitative approach and directed content analysis in 2018-2019 among sailors who were selected purposively through an interview procedure. Finally, 22 sailors and 3 patients with skin cancer with an experience of sailing were interviewed until data satiation occurred. The data were collected through a semi-structured interview based on two constructs, perceived susceptibility and perceived severity of protection motivation theory, and were instantly transcribed and read more than once by the present researcher. Simultaneously, the data were entered into MAXQDA 10 for the primary categorization. RESULTS: Data analysis results were classified into 5 categories and 12 subcategories: protective attempts (change of work time and use of protectives), passivity in self-protection (not showing protective behaviors and not examining skin), inadequate perception of affliction risk (beliefs hindering preventive behaviors and low sensitivity), perceived threat to personal and familial conditions (loss of peace and loss of occupational-familial positions), and threat to health (incurable disease and perceived skin disease). CONCLUSIONS: Awareness of these factors helps planners to choose the best preventive strategies with a focus on correcting beliefs and promoting protective behaviors as well as examining and screening sailors regularly to diagnose skin cancer. Moreover, to develop practical measures of protective strategies against sunlight among sailors, the required steps should be taken. This can help to reduce the rate of work-related risks while exposed to sunlight in this population.

Relationship between Religious Orientation, Anxiety, and Depression among College Students: A Systematic Review and Meta-Analysis.

BACKGROUND: Religious obligation helps people to develop mental health by creating internal commitment to special rules. This meta-analysis aimed to determine the relationship between religious orientation and anxiety among college students. METHODS: Major scientific databases including PubMed, Web of Science, Science Direct, EBSCO, ProQuest and PsycINFO were searched for original research articles published 1987-2016. A random effect model was used to combine Correlation coefficient. All analyses were performed using Stata MP. RESULTS: After screening of 7235 documents, 13 articles including 5620 participants met inclusion criteria in this meta-analysis. Correlation coefficient was -0.08 (95% CI= -0.19, -0.03) which indicated with increasing religious orientation, anxiety and depression reduced (P<0.001). Characteristics such as sex, geographic region, and type of religions were potential sources of heterogeneity. Based on fill-and-trim method the adjusted pooled r was obtained, -0.06 (95% CI= -0.16, -0.04). CONCLUSION: There was a weakness relationship between religious orientation and mental anxiety and depression. Therefore, it needs to improve knowledge of student about advantages of religious orientation.

Iranian Women's Breast Health-Seeking Behaviors: Husband's Role.

BACKGROUND: Breast cancer has become the most common cancer among Yazdi women in Iran. Thus, it is necessary to encourage these women to participate in breast health-seeking behaviors. In this regard, husbands can play an effective role. OBJECTIVE: The aim of this study was to explore women's perceptions about the effect of their husband's role on breast health-seeking protection motivation. METHODS: This study used a directed qualitative content analysis approach based on the Protection Motivation Theory. Participants were selected using purposive sampling; in-depth semistructured interviews with 14 Yazdi women were completed. RESULTS: One major category named "motivator role of husband" emerged from the analysis. The following subcategories underlying this category were "indifference and a lack of support as long as the women can continue with expected duties," "what women want for support," "facilitating and restrictive factors of husband's supportive role," "public health education needed," and "husband's agreement with preventive actions." CONCLUSIONS: Voluntary participation in breast health-seeking behaviors is a culturally sensitive topic. The qualitative methodology allowed this sensitive topic and its different aspects to be explored. The findings indicated that the major source of support for women was their husband's behavior toward breast health-seeking actions. Family cohesion and love among couples were identified as strong determinant factors pertaining to husband's supportive behaviors. IMPLICATIONS FOR PRACTICE: The study findings provided deeper understanding about the effective factors related to a husband's role in motivating a wife to practice breast cancer prevention. These new findings are relevant for health educators and practitioners to develop culturally based interventions.

The effect of educational intervention on weight loss in adolescents with overweight and obesity: Application of the theory of planned behavior.

BACKGROUND: The increased prevalence of overweight and obesity in children and adolescents is associated with type 2 diabetes, hypertension, dyslipidemia, and cardiovascular diseases. The theory of planned behavior (TPB) efficiently explains the ability of perceived behavioral control and possibly attitude to enhance the motivations of the obese people to lose weight. Our aim was to investigate the effect of TPB-based education on weight loss in obese and overweight adolescents. METHODS: In an interventional study, simple random sampling was used to select 86 overweight and obese adolescents aged 13-18 years in the pediatric clinic at the Isfahan Cardiovascular Research Institute. Anthropometric measures and TPB constructs were collected using a researcher-made questionnaire. The questionnaires were filled out before and six weeks after the intervention. Participants received 5 sessions of training based on the constructs of the TPB. RESULTS: A significant increase was observed in the mean score for knowledge and TPB constructs (attitudes, subjective norms, perceived behavioral control, intention, and behavior) six weeks after the educational intervention (P < 0.001). Moreover, significant decrease in body mass index (P < 0.001), weight (P = 0.001), and waist circumference (P < 0.001) of adolescents were found after the educational intervention. CONCLUSION: The TPB-based interventions seem to be effective in losing weight in obese and overweight adolescents. This theory serves as a helpful theoretical framework for health-related behaviors and can be an appropriate pattern to plan for educational interventions.

Prevention of Insulin Resistance by Dietary Intervention among Pregnant Mothers: A Randomized Controlled Trial.

BACKGROUND: Chronic insulin resistance (IR) is a basic part of the pathophysiology of gestational diabetes mellitus. Nutrition significantly impacts IR and weight loss reduces insulin levels, whereas weight gain increases the concentrations. Therefore, we surveyed the effect of nutrition intervention on IR in pregnant women and whether this effect is irrespective of weight gaining in accordance with Institute of Medicine limits. METHODS: This prospective, randomized clinical trial was carried out among 150 primiparous pregnant mothers in fifteen health centers, five hospitals, and 15 private obstetrical offices in Isfahan. The nutrition intervention included education of healthy diet with emphasize on 50%-55% of total energy intake from carbohydrate (especially complex carbohydrates), 25%-30% from fat (to increase mono unsaturated fatty acids and decrease saturated and trans-fatty acids), and 15%-20% from protein during pregnancy for experimental group. The controls received the usual prenatal care by their health-care providers. RESULTS: This trial decreased pregnancy-induced insulin increases (P = 0.01) and IR marginally (P = 0.05). ANCOVA demonstrated that control of gestational weight gaining was more effective to decrease IR (P = 0.02) while insulin values decreased by nutrition intervention and irrespective of weight control (P = 0.06). Fasting plasma glucose (FPG) concentrations did not decrease by intervention (P = 0.56) or weight management (P = 0.15). CONCLUSIONS: The current intervention was effective to decrease pregnancy-induced insulin increases and IR. Considering study results on FPG levels and incidence of GDM, we suggest repeat of study design in a larger sample.