Utilization and Determinants of Postnatal Care Services in Ethiopia: A Systematic Review and Meta-Analysis.

BACKGROUND: Postnatal care use is vital in saving mother and newborn lives which is a continuum of care for maternal, neonatal and child health. This review aimed to determine the utilization and determinants of postnatal care use in Ethiopia. METHODS: PubMed, Scopus, Web of Science, and Embase databases were searched on June 25, 2017. The study screening, data extraction and quality assessment were done independently by two reviewers. Effect sizes were pooled using a random-effects model. RESULTS: Nine articles were included in the review. The pooled estimate for utilization of the service was 32% (95% CI: 21%, 43%). The pooled results of determinants of postnatal care use was statistically significant among those mothers who had ability to make decisions (1.89; 1.25, 2.54), had a history of antenatal care utilization (2.55; 1.42, 3.68), received more than two antenatal care visits (1.84; 1.28, 2.40), and received the service from skilled service provider (3.16; 1.62, 4.70). It was also found that mothers who gave birth in health faciliteis (2.13; 1.14, 3.12), had middle monthly income, richer, were from urban areas, and had knowledge of obstetric danger signs were significantly associated with increased odds of postnatal care use. CONCLUSION: Utilization of the services is low in Ethiopia. Antenatal care utilization, skilled service provider, being from urban area and delivery in health facility had a significant effect on postnatal care utilization. More rigorous studies are needed to identify determinant with the causal association to postnatal care utilization. The review was registered on PROSPERO CRD42017060266.

The association of household food insecurity with the risk of type 2 diabetes mellitus in adults: a systematic review and meta-analysis.

BACKGROUND: The link between household food insecurity and risk of type 2 diabetes mellitus still remains controversial. Therefore, we performed a systematic review and meta-analysis to clarify the association between household food insecurity and type 2 diabetes mellitus. METHODS: EMBASE, PubMed, ISI Web of Science and Scopus databases were searched up to March 2017. The selection of studies, data extraction and assessing the risk of bias in the included studies were carried out by two reviewers independently. Study-specific odds ratios (ORs) were pooled using a random effects model. RESULTS: A total of 18 articles including a total of 55,353,915 adult participants were included in the meta-analysis. The pooled ORs of the cross-sectional studies revealed that household food insecurity was significantly associated with the odds of T2DM (OR 1.27, 95% CI 1.11-1.42) with no evidence of publication bias (p = 0.63) but heterogeneity between studies (I2 = 61.1%). Similarly, subgroup analyses showed that the country where the study conducted and household food insecurity assessment tool used to influence the effect of household food insecurity on the odds of T2DM. However, the pooled ORs for two case-control and one cohort studies were not significantly associated between household food insecurity and T2DM in adults. CONCLUSION: This study strengthens the hypothesis of the household food insecurity effect on the odds of T2DM among adults. Further longitudinal studies based on larger, and more representative samples are needed to identify the underlying relationships between food insecurity and type 2 diabetes mellitus.

Utilization and determinants of postnatal care services in Ethiopia: a systematic review and meta-analysis

BACKGROUND: Postnatal care use is vital in saving mother and newborn lives which is a continuum of care for maternal, neonatal and child health. This reviewaimed to determine the utilization and determinants of postnatal care use in Ethiopia. METHODS: PubMed, Scopus, Web of Science, and Embase databases were searched on June 25, 2017. The study screening, data extraction and quality assessment were done independently by two reviewers. Effect sizes were pooled using a random-effects model. RESULTS: Nine articles were included in the review. The pooled estimate for utilization of the service was 32% (95% CI: 21%, 43%). The pooled results of determinants of postnatal care use was statistically significant among those mothers who had ability to make decisions (1.89; 1.25, 2.54), had a history of antenatal care utilization (2.55; 1.42, 3.68), received more than two antenatal care visits (1.84; 1.28, 2.40), and received the service from skilled service provider (3.16; 1.62, 4.70). It was also found that mothers who gave birth in health faciliteis (2.13; 1.14, 3.12), had middle monthly income, richer, were from urban areas, and had knowledge of obstetric danger signs were significantly associated with increased odds of postnatal care use. CONCLUSION: Utilization of the services is low in Ethiopia. Antenatal care utilization, skilled service provider, being from urban area and delivery in health facility had a significant effect on postnatal care utilization. More rigorous studies are needed to identify determinant with the causal association to postnatal care utilization. The reviewwas registered on PROSPERO CRD42017060266

Infectious exposure, antibiotic use, and multiple sclerosis: A population-based incident case-control study.

BACKGROUND: The existing reports regarding the potential role of infections as well as antibiotic use in multiple sclerosis (MS) etiology are inconclusive. OBJECTIVES: We aimed to investigate the association of viral infections as well as antibiotic use and the risk of developing MS. MATERIALS & METHODS: This was a population-based incident case-control study of 547 incident cases and 1057 general population controls obtained from 22 municipality areas of Tehran (7/8/2013-17/2/2015). Multiple logistic regression models were used to determine the adjusted associations. RESULTS: Overall antibiotic use for ≥14 days during 3 years before the index date, significantly decreased the odds of MS OR 0.69 (95%CI: 0.53-0.91, P = .008). The results were consistent for different types of antibiotics, including penicillin OR 0.50 (95%CI: 0.34-0.75, P = .001) and cephalosporins OR 0.25 (95%CI: 0.12-0.50, P < .001). History of IM was associated with a more than 5fold increased risk of MS OR = 5.7 (95%CI, 1.28-25.37). There was no statistically significant association between any other single or cumulative number of viral infections with subsequent risk of MS (P > .05). CONCLUSIONS: Considering the possibility of reverse causation, the results of this large case-control study suggest that use of antibiotics may be associated with a decreased risk of MS. However, viral disease other than infectious mononucleosis was not associated with MS risk.

Self-reported versus proxy reported quality of life for breast cancer patients in the Islamic Republic of Iran.

Since quality of life (QoL) is subjective, self-reported QoL is the main source of assessment; however, in some situations the patient cannot evaluate his/her own status. In this cross-sectional study, 148 patients with breast cancer referred to the Cancer Institute of the Islamic Republic of Iran and their caregivers were selected through the consecutive sampling method. Five oncologists from this centre also evaluated the QoL of these patients. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire was completed by these 3 groups and the results compared. The patient-caregiver intra-class correlation coefficient (ICC) for all 15 QLQ.C30 domains was moderate to good (ICC = 0.41-0.76). Agreements between QoL scores of patients and those of oncologists were moderate to good, except in the 4 domains. In the patient-caregiver comparison there was 55% exact agreement, and for the patient-physician comparison agreement was 45%. The findings can be used in the patients' decision-making process and care planning when patients with breast cancer are unable to self-report the QoL.

Self-reported versus proxy reported quality of life for breast cancer patients in the Islamic Republic of Iran

Since quality of life [QoL] is subjective, self-reported QoL is the main source of assessment; however, in some situations the patient cannot evaluate his/her own status. In this cross-sectional study, 148 patients with breast cancer referred to the Cancer Institute of the Islamic Republic of Iran and their caregivers were selected through the consecutive sampling method. Five oncologists from this centre also evaluated the QoL of these patients. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire was completed by these 3 groups and the results compared. The patient-caregiver intra-class correlation coefficient [ICC] for all 15 QLQ.C30 domains was moderate to good [ICC = 0.41-0.76]. Agreements between QoL scores of patients and those of oncologists were moderate to good, except in the 4 domains. In the patient-caregiver comparison there was 55% exact agreement, and for the patient-physician comparison agreement was 45%. The findings can be used in the patients' decision-making process and care planning when patients with breast cancer are unable to self-report the QoL

La qualité de vie étant de nature subjective, l'auto-évaluation constitue l'instrument de choix pour la mesure de celle-ci. Pour autant, dans certaines circonstances, le patient n'est pas capable d'évaluer sa situation. Au cours de cette étude transversale, 148 patients adressés à l'Institut du Cancer de République islamique d'Iran pour un cancer du sein ont été sélectionnés avec leurs aidants à l'aide d'une méthode d'échantillonnage consécutif. Cinq oncologues travaillant dans ce centre ont également évalué la qualité de vie de ces patients. Le questionnaire Qualité de vie [QLQ] de l'Organisation européenne pour la Recherche et le Traitement du Cancer a été rempli par ces trois groupes et les résultats ont fait l'objet d'une comparaison. Le coefficient intra-classe [CIC] patient-aidant pour les 15 domaines du QLQ-C30 allait de modéré à bon [CIC= 0,41-0,76]. La concordance entre les scores des patients portant sur la qualité de vie et ceux des oncologues étaient compris entre [ modéré ] et [ bon ], excepté dans quatre domaines. La comparaison patient-aidant donnait une concordance exacte dans 55%, et la comparaison patient-médecin une concordance de 45%. Les résultats peuvent être utilisés au cours du processus de décision clinique et de planification des soins quand les patients atteints d'un cancer du sein ne sont pas en mesure d'évaluer eux-mêmes leur niveau de qualité de vie

Predictors of Iranian women's intention to first papanicolaou test practice: An application of protection motivation theory.

BACKGROUND AND AIM: Given the importance of papanicolaou (Pap) test in the early detection and timely treatment of cervical cancer, present study was designed to determine predictors of a sample of Iranian women's intention to first Pap test practice based on the protection motivation theory (PMT) variables. MATERIALS AND METHODS: In this cross-sectional study, a total of 240 women referral to the 30 primary health care clinics were selected. They completed a developed scale based on PMT variables including intention, perceived vulnerability and severity, fear, response costs, response efficacy and self-efficacy. Path analysis was used to determine the association between predictive factors and intention. RESULTS: The results showed that PMT had goodness of fit with a χ2/df = 2.37, df = 28, P= 0.001 and RMSEA = 0.076. PMT explained 42% of the variance in women's intention to get first Pap smear test. Self-efficacy (b = 0.55, P< 0.001) and response efficacy (b = 0.19, P< 0.001) were found to be the predictors of intention. CONCLUSION: These findings may be used to develop tailored, theory-based educational interventions associated with Pap testing among women.

Socioeconomic inequality and child maltreatment in Iranian schoolchildren.

Socioeconomic inequality and child maltreatment have not been studied using the concentration index as an indicator of inequality. The study aimed to assess the association of child maltreatment with socioeconomic status among schoolchildren in Qazvin province, Islamic Republic of Iran. In this cross-sectional study a questionnaire based on the ISPCAN Child Maltreatment Screening Tool-Children's Version and the Juvenile Victimization Questionnaire was filled by 1028 children aged 9-14 years, selected through multistage stratified random sampling. The concentration indices for economic inequality were -0.086 for any type of child maltreatment and -0.155, -0.098 and -0.139 for the physical, psychological and neglect subtypes of maltreatment respectively. The number of children and the economic status of the family also showed a significant association with child maltreatment in all 3 subtypes. Appropriate planning for effective interventions for at-risk children of lower socioeconomic status should be considered by the relevant decision-makers.

Socioeconomic status and prevalence of self-reported diabetes among adults in Tehran: results from a large population-based cross-sectional study (Urban HEART-2).

INTRODUCTION: Diabetes mellitus is an important public health challenge worldwide. The prevalence of type 2 diabetes varies across countries. The aim of this study is to estimate the prevalence of type 2 diabetes and to determine related factors including socioeconomic factors in a large random sample of Tehran population in 2011. METHODS: In this cross-sectional study, 91,814 individuals aged over 20 years were selected randomly based on a multistage, cluster sampling. All participants were interviewed by trained personnel using standard questionnaires. Prevalence and Townsend deprivation indexes were calculated. Principal component analysis (PCA) was used to construct wealth index. Logistic regression model was used in multivariate analysis. RESULTS: The estimated prevalence of self-reported diabetes was 4.98 % overall, 4.76 %in men and 5.19 % in women (P < 0.003). In multivariate analysis, age, marital status (married and divorced/widow) and BMI were positively associated with the prevalence of self-reported diabetes. Of the socioeconomic variables, educational level and wealth status were negatively and Townsend Index was positively associated with diabetes. CONCLUSION: Our study findings highlight low reported prevalence of diabetes among adults in Tehran. Subjects with low socioeconomic status (SES) had a higher prevalence of type 2 diabetes. Weight gain and obesity were the most important risk factors associated with type 2 diabetes. Wealth index and educational level were better socioeconomic indicators for presenting the inequality in diabetes prevalence in relation to Townsend deprivation index.

Social capital of Iranian patients living with acquired immune deficiency syndrome and associated factors.

This study investigated the social capital of Iranian patients living with acquired immune deficiency syndrome (AIDS) and the associated factors. In a cross-sectional study the Integrated Social Capital Questionnaire was filled by a sequential sample of 300 patients visiting a referral counselling centre in Tehran. The patients' social capital scores were around 50% in the trust, social cohesion, collective action and cooperation and political empowerment domains. The groups and networks membership domain scored the lowest (27.1%). In regression analysis, employment status was significantly associated with groups and networks membership; age, marital status and financial status were associated with collective action and cooperation; period of disease awareness and marital status affected social cohesion and inclusion; and having risky behaviour affected empowerment and political action. Efforts are needed to enhance the social capital of those patients living with AIDS who are younger, unemployed, divorced/widowed, with risky behaviours and shorter disease awareness.

Predictors of transition in smoking stages in Iranian adolescents: latent transition analysis.

This study determined the prevalence of smoking stages in adolescents, the probability of transition across stages and the personal and environmental predictors of transition. A school-based study was conducted in 2010-11 using a random sample of 5197 students (mean age 15.7 years) in Tabriz city. The students were evaluated twice, 12-months apart. The latent transition analysis model revealed 9 interpretable statuses for the measurement of smoking stages. Prevalence data showed that at the first and second assessments 75.1% and 66.8% of students respectively were in the committer stage, while 4.8% and 7.1% respectively were daily smokers. Over 12 months, 10.1% of the never smokers became experimenters and 1.7% became regular smokers, while 17.0% of experimenters became regular smokers. The analysis also showed factors associated with transitions in cigarette smoking stages. Although the prevalence of smoking was low in our adolescents, the rate of becoming a smoker over 1 year was high.

Predictors of transition in smoking stages in Iranian adolescents: latent transition analysis

يحدد الباحثون في هذه الدراسة معدل انتشار مراحل التدخين لدى المراهقين، واحتال التحول من مرحلة إلى أخرى، والعوامل الشخصية والبيئية المنبئة بالتحول. وقد أجرى الباحثون دراسة في المدارس في عامي 2010 - 2011 واستخدموا عينة تتألف من 5197 تلميذا [العمر الوسطي 15.7 عاما]في مدينة تبريز. وقيم الباحثون التلاميذ مرتين يفصل بينها 12 شهرا. وقد أظهر نموذج تحليل التحول الخافي تسع حالات يمكن تفسرها لقياس مراحل التدخين. كما أوضحت بيانات معدلات الانتشار أن نسبة الطلاب الذين كانوا في مرحلة الملتزمين بلغت في التقييم الأول 75.1 % وفي التقييم الثاني 66.8 %، وأن نسبة المدخنين يوميا في التقييم الأول 4.8 % وفي التقييم الثاني 7.1 %.وعلى مدى الأشهر الاثني عشر كان 10.1 % من التلاميذ الذين لم يسبق لهم التدخين قد أصبحوا من المجربين، كما أصبح 1.7 % منهم من المدخنين الاعتيادين، في حين أصبح 17 % من المجربين مدخنين اعتيادين. كما أوضح التحليل العوامل التي رافقت التحولات في مراحل تدخين السجائر، فرغم أن معدل انتشار التدخين كان منخفضا لدى هؤلاء المراهقين، فإن معدل التحول إلى المدخنين على مدى سنة كان معدلا مرتفعا

ABSTRACT This study determined the prevalence of smoking stages in adolescents, the probability of transition across stages and the personal and environmental predictors of transition. A school-based study was conducted in 2010–11 using a random sample of 5197 students (mean age 15.7 years) in Tabriz city. The students were evaluated twice, 12-months apart. The latent transition analysis model revealed 9 interpretable statuses for the measurement of smoking stages. Prevalence data showed that at the first and second assessments 75.1% and 66.8% of students respectively were in the committer stage, while 4.8% and 7.1% respectively were daily smokers. Over 12 months, 10.1% of the never smokers became experimenters and 1.7% became regular smokers, while 17.0% of experimenters became regular smokers. The analysis also showed factors associated with transitions in cigarette smoking stages. Although the prevalence of smoking was low in our adolescents, the rate of becoming a smoker over 1 year was high.

RÉSUMÉ La présente étude a déterminé la prévalence des stades de consommation du tabac chez des adolescents, la probabilité de transition entre les différents stades et les facteurs prédictifs de transition personnels et environnementaux. Une étude a été menée en milieu scolaire en 2010 et 2011 à partir d'un échantillon aléatoire de 5197 élèves (âge moyen : 15,7 ans) dans la ville de Tabriz. Les élèves ont été évalués à deux reprises, à 12 mois d'intervalle. Le modèle d'analyse des transitions latentes a permis de dégager neuf statuts interprétables afin de mesurer les stades de consommation de tabac. Les données sur la prévalence ont révélé que lors de la première et de la deuxième évaluation, 75,1 % et 66,8 % des élèves respectivement étaient des non-fumeurs décidée à ne pas commencer, tandis que 4,8 % et 7,1 % respectivement étaient des fumeurs quotidiens. Sur une période de 12 mois, 10,1 % des personnes n'ayant jamais fumé ont expérimenté le tabac et 1,7 % sont devenus des fumeurs réguliers, tandis que 17,0 % des personnes ayant expérimenté le tabac sont devenus des fumeurs réguliers. L'analyse a mis en évidence des facteurs associés aux transitions entre les stades de consommation de tabac. Si la prévalence du tabagisme était faible chez nos adolescents, le taux de transition vers le statut de fumeur sur une période d'un an était en revanche élevé.

Factors influencing women's willingness to volunteer in the healthcare system: evidence from the Islamic Republic of Iran.

This case-control study evaluated the factors influencing volunteering in the Islamic Republic of Iran's Women's Health Volunteer (WHV) programme, which is implemented in 150 centres in Khorasan-e-Razavi Province. We recruited 145 cases (volunteers) and 146 controls (non-volunteers) from the centres. Data were collected by questionnaire. Sociodemographic variables included were: length of residence in neighbourhood, number of siblings, husband's age and education and job, family size, quality of life, self-rated health status, neighbourhood intimacy, child under 2 years, house ownership, wealth index. Social network variables included were: ego network size, type of acquaintance, intimacy with others, relationship communication, relationship duration, emotional support, advisory support, monetary support, physical support, time support. There were significant associations (P<0.05) between women's propensity to volunteer and family size, presence of a child under 2 years in the family, neighbourhood intimacy, social network composition, and emotional and advisory support.

Determining appropriate strategies for improving women's health promoting behaviours: using the nominal group technique.

Women's health constitutes a major aspect of development in societies and is considered a health-related priority. The aim of the present study was to determine appropriate strategies for improving health promoting behaviours in women of reproductive age in the Islamic Republic of Iran. Using the nominal group technique, a panel discussion was held in October 2011 with 12 health specialists who were selected through purposive sampling. In the first round, panel members generated 81 strategies; after eliminating irrelevant items and merging items with similar concepts, 44 strategies remained. After group discussion and voting, the following 4 items had the highest scores: improving physical activity, with a social support approach; empowering women; promoting and improving men's role in women's health; and promoting social support. The strategies presented in this study may be utilized by policy-makers, managers and health care providers to improve women's health promoting behaviours, and thus contribute to their wellbeing.

Lifetime and current waterpipe use among adolescents in Tehran, Islamic Republic of Iran.

Waterpipe use among Iranian adolescents has become a matter for concern. A descriptive, cross-sectional community-based survey was performed in 2010 to determine the prevalence of waterpipe use and associated factors among Iranian adolescents in Tehran, Islamic Republic of Iran. After multi-stage, random cluster sampling 1201 adolescents aged 15-18 years old responded to a questionnaire based on the Youth Risk Behavior Surveillance. The prevalence of current waterpipe smoking (at least once in the previous 30 days) was 28.0%, significantly higher among males (34.8%) than females (21.4%). A total of 45.1% of adolescents reported lifetime use (ever use) of waterpipes and 34.2% had ever shared a waterpipe. In multivariate logistic regression analysis the significant correlates of current waterpipe use for both males and females were having smokers among friends and family members, while for males, older age and educational failure were also risk factors.

Factors influencing women's willingness to volunteer in the healthcare system: evidence from the Islamic Republic of Iran

This case-control study evaluated the factors influencing volunteering in the Islamic Republic of Iran's Women's Health Volunteer [WHV] programme/which is implemented in 150 centres in Khorasan-e-Razavi Province. We recruited 145 cases [volunteers] and 146 controls [non-volunteers] from the centres. Data were collected by questionnaire. Sociodemographic variables included were: length of residence in neighbourhood, number of siblings, husband's age and education and job, family size, quality of life, self-rated health status, neighbourhood intimacy, child under 2 years, house ownership, wealth index. Social network variables included were: ego network size, type of acquaintance, intimacy with others, relationship communication, relationship duration, emotional support, advisory support, monetary support, physical support, time support. There were significant associations [P < 0.05] between women's propensity to volunteer and family size, presence of a child under 2 years in the family, neighbourhood Intimacy, social network composition, and emotional and advisory support

Determining appropriate strategies for improving women's health promoting behaviours: using the nominal group technique

Women's health constitutes a major aspect of development in societies and is considered a health-related priority. The aim of the present study was to determine appropriate strategies for improving health promoting behaviours in women of reproductive age in the Islamic Republic of Iran. Using the nominal group technique, a panel discussion was held in October 2011 with 12 health specialists who were selected through purposive sampling. In the first round, panel members generated 81 strategies; after eliminating irrelevant items and merging items with similar concepts, 44 strategies remained. After group discussion and voting, the following 4 items had the highest scores: improving physical activity, with a social support approach; empowering women; promoting and improving men's role in women's health; and promoting social support. The strategies presented in this study may be utilized by policy-makers, managers and health care providers to improve women's health promoting behaviours, and thus contribute to their wellbeing

Psychometric properties of the persian version of the youth risk behavior survey questionnaire.

BACKGROUND: Adolescents may get involved in high-risk behaviors. Surveys are the primary, and sometimes the sole source of data collection for many high-risk health behaviours. We examined the reliability and validity of the psychometric properties of the self-administered Persian version of the 2009 Youth Risk Behavior Surveillance System (YRBSS) questionnaire. METHODS: In a methodological study in summer 2010, 100 Iranian adolescents aged 15-18 years were recruited through convenience sampling. The face and content validity were used for the questionnaire validity. In order to evaluate the questionnaire's reliability, the Intraclass Correlation Coefficient (ICC) and Cronbach's α were calculated for domains and 89 items. RESULTS: Among 89 items, the ICC values were below 0.4 (weak reliability) for 2 items (2.25%), 0.4-0.6 (moderate reliability) for 10 items (11.24%), 0.6-0.8 (good reliability) for 32 items (35.96%) and 0.8-1 (excellent reliability) for 45 items (50.56%). The prevalence of most high-risk behaviors was constant in the first and second survey. The value of Cronbach's α was 0.73 for intentional and unintentional injuries, 0.77 for tobacco use, 0.86 for alcohol and other drug use, and 0.79 for unsafe sexual behaviors. No domain had a mean ICC of below 0.6. Furthermore, 97.75% of the items had moderate to excellent reliability. Thus, the Persian YRBSS questionnaire had an acceptable reliability. CONCLUSION: Over the 2-week period, sexual behaviors were reported with less consistency compared to other behaviors. In any case, researchers must be aware of the limitation of the data collected through this questionnaire, particularly in comparison to the domain of sexual behaviors. Overall, 97.75% of the items had moderate to excellent reliability. Thus, the Persian YRBSS questionnaire had an acceptable reliability.

Substance abuse in high school students in association with socio-demographic variables in northwest of iran.

BACKGROUND: Substance abuse in adolescents and its often tragic consequences, including addiction, is one of the preventable major public health problems. The aims of this paper were to estimate the prevalence of substance abuse and to evaluate its some associated factors in adolescents of Tabriz City (northwest of Iran). METHODS: A self-administered questionnaire was completed in 4903 randomly selected students with mean age of 15.7 years old. The aim of the questionnaire was obtaining information on substance abuse, socio-economical information, cigarette smoking behavior, general risk taking behavior, self-esteem, attitude towards smoking and self-injury as well as demographical characteristics. RESULTS: Prevalence of substance abuse was 1.4% (95% CI: 1.1-1.7) which was different statistically significant between boys (2.4%) and girls (0.6%) (P<0.001). Older age (OR=1.43), not living with parents (OR=2.34), having general risk taking behavior (OR=2.26), higher smoking stage (OR=2.39), lower self-esteem (OR=1.09) and positive attitude toward smoking (OR=1.08) were factors associated with student's ever use of substance. CONCLUSION: The result has shown low prevalence of substance abuse in Iranian adolescents. Our findings showed some associated factors such as lower self-esteem with adolescent's substance abuse.

Evidence-based approach to HIV/AIDS policy and research prioritization in the Islamic Republic of Iran.

In formulating the second national strategic plan for prevention of HIV/AIDS in the Islamic Republic of Iran a more evidence-based approach was needed. This paper reports on a systematic review of the local evidence about the determinants of HIV/AIDS transmission in 3 categories: poor knowledge and negative attitudes about HIV transmission; injection drug use; and sexual promiscuity. Of 93 reports reviewed, 53 met the inclusion criteria. Information about the prevalence and magnitude of effect for the 3 risk determinants at the national and regional level was scarce. Heterogeneity between studies, even in the same sub-population, was significant. An improved research base and better sharing of information are needed within countries of the Eastern Mediterranean Region.