Obesity Incidence in U.S. Children and Young Adults: A Pooled Analysis.

INTRODUCTION: Obesity prevalence among children and adolescents has risen sharply, yet there is a limited understanding of the age-specific dynamics of obesity as there is no single nationally representative cohort following children into young adulthood. Investigators constructed a pooled data set of 5 nationally representative panels and modeled age-specific obesity incidence from childhood into young adulthood. METHODS: This longitudinal prospective follow-up used 718,560 person-years of observation in a pooled data set of 5 high-quality nationally representative panels-National Longitudinal Survey of Youth 1979 and 1997, National Longitudinal Study of Adolescent Health, and Early Childhood Longitudinal Study-Kindergarten cohorts of 1998 and 2011-constructed by the authors, covering 1980-2016. Differences in obesity incidence across birth cohorts and disparities in obesity incidence by sex and race/ethnicity (non-Hispanic Black, Hispanic, and non-Hispanic White) were tested in multivariate models. Data were analyzed from September 2018 to October 2021. RESULTS: Obesity incidence increased by approximately 6% for each 1 year of age (hazard ratio=1.06, 95% CI=1.05, 1.07); however, incidence was nonlinear, exhibiting an inverted "U"-shaped pattern before 15 years of age and then rising from adolescence through 30 years. Obesity incidence more than doubled between the cohorts born in 1957-1965 and those born in 1974-1985 during adolescence. There was no significant change among those born in 1991-1994 and 2003-2006 up to age 15 years. Compared with non-Hispanic White children, non-Hispanic Black and Hispanic children had higher obesity incidence in all study cohorts. The magnitude of these disparities on the relative scale remained stable throughout the study period. CONCLUSIONS: Although many children become obese before the age of 10, obesity incidence rises from about 15 years into early adulthood, suggesting that interventions are required at multiple developmental stages.

Age, Period and Cohort Analysis of Smoking Prevalence in Iranian Population over a 25-Year Period.

BACKGROUND: Current and daily smoking prevalence rates have been have investigated in several cross-sectional studies. However, analyses in terms of age-period-cohort (APC) have not been carried out. We assessed daily smoking dynamics over a 25-year period using the APC model. METHODS: In our analyses, we used data from 214,652 people aged 15 to 64 years, collected by national health surveys conducted in 1990-1991, 1999, 2005, 2007, 2011 and 2016. The Intrinsic Estimator model was used to analyze the impact of APC on daily smoking prevalence. RESULTS: Males were found to exhibit a higher prevalence of smoking compared to females (26.0% against 2.7%). Prevalence of smoking increased by age, peaking at the age groups of 40-44 in men and 45-49 in women, followed by a decreasing trend. The 1990 period had the highest prevalence in both genders, and the 2016 period had the lowest. The coefficients of birth cohort effects showed different patter19s of fluctuations in the two genders with the maximum and minimum coefficients for men calculated in the 1966-1970 and 1991-95 birth cohorts, and for females the 1931-1935 and 1971-1975 birth cohorts, respectively. CONCLUSION: We showed the impact of APC on daily tobacco smoking prevalence, and these factors should be considered when dealing with smoking.

Discriminatory Accuracy of the Gail Model for Breast Cancer Risk Assessment among Iranian Women.

BACKGROUND: The Gail model is the most well-known tool for breast cancer risk assessment worldwide. Although it was validated in various Western populations, inconsistent results were reported from Asian populations. We used data from a large case-control study and evaluated the discriminatory accuracy of the Gail model for breast cancer risk assessment among the Iranian female population. METHODS: We used data from 942 breast cancer patients and 975 healthy controls at the Cancer Institute of Iran, Tehran, Iran, in 2016. We refitted the Gail model to our case-control data (the IR-Gail model). We compared the discriminatory power of the IR-Gail with the original Gail model, using ROC curve analyses and estimation of the area under the ROC curve (AUC). RESULTS: Except for the history of biopsies that showed an extremely high relative risk (OR=9.1), the observed ORs were similar to the estimates observed in Gail's study. Incidence rates of breast cancer were extremely lower in Iran than in the USA, leading to a lower average absolute risk among the Iranian population (2.78, ±SD 2.45). The AUC was significantly improved after refitting the model, but it remained modest (0.636 vs. 0.627, ΔAUC = 0.009, bootstrapped P=0.008). We reported that the cut-point of 1.67 suggested in the Gail study did not discriminate between breast cancer patients and controls among the Iranian female population. CONCLUSION: Although the coefficients from the local study improved the discriminatory accuracy of the model, it remained modest. Cohort studies are warranted to evaluate the validity of the model for Iranian women.

Prevalence of high blood pressure in Iranian adults based on the 2017 ACC/AHA guideline.

Background: : In 2017, American College of Cardiology (ACC) and the American Heart Association (AHA) presented a new guideline for assessing blood pressure in adults. This study aimed to assess the prevalence of hypertension in Iranian adults based on ACC/AHA 2017 guideline. Methods: Data from 9801 Iranian adults (59.2% women) aged between 20-69 years were obtained from the sixth round of National Surveillance of Risk Factors of Non-Communicable Diseases (SuRFNCD) performed in 2011. Blood pressure was classified as normal, elevated blood pressure, and stage 1 and 2 hypertension using a weighted analysis and 2017 ACC/AHA guidelines. Data were presented as prevalence and 95% confidence interval (95% CI). All analyses were performed in Stata/SE 14.0. Results: Overall prevalence of hypertension in Iranian men was 52.0%. Also, 32.9% (95% CI: 29.9-36.0) and 19.1% (95% CI: 16.9-21.6) of men had stage 1 and 2 hypertension, respectively. In addition, 44.3% of women had hypertension, of whom 26.3% (95% CI: 24.5 - 28.2) had stage 1 and 18.0% (95% CI: 16.1-20.1) stage 2 hypertension. Furthermore, 16.5% (95% CI: 14.4-18.9) and 9.6% (95% CI: 7.86-11.7) of men and women had elevated blood pressure, respectively. Conclusion: The findings of this study indicated that adopting the 2017 ACC/AHA guidelines showed a higher prevalence of adult hypertension (48.2%) in Iran. In this study, the prevalence of hypertension in men was higher than in women, which was steadily increased by age in older adults in both sexes.

Validation of Diet History Questionnaire in Assessing Energy and Nutrient Intakes of Iranian Population.

BACKGROUND: This study described validity of Diet History Questionnaire (DHQ) for assessing energy and nutrient intake among Iranian population. METHODS: A group of experienced nutritionists translated the DHQ to Farsi language and modified it based on Iranian food habits and cooking methods. We recruited 244 healthy adults with a mean age of 42.83 ± 0.75 yrs. from healthy individuals who were friends or relatives of patients in the Cancer Institute of Iran from April 2011 to February 2012. We used the DHQ to assess dietary intakes through interviews as well as at least four 24-h recalls one in every season. Reliability was estimated by comparing data of DHQ with mean intake from 24-hour recalls using deattenuated and energy-adjusted Spearman correlation coefficients. We classified dietary intakes of two methods into three groups to probe if DHQ correctly allocates subjects into different intake groups compared to reference method. The results are reported as percent of disagreement, adjacent agreement, and complete agreement. RESULTS: Deattenuated spearman correlation ranged from 0.18 for vitamin B12 and fat to 0.60 for sugar. It ranged from 0.13 for pantothenic acid to 0.60 for sugar in men and from 0.07 for fat to 0.58 for sugar in females. The complete agreement of methods ranged from 51% for selenium to 36% for carotene in the entire sample, from 50% for energy to 31% for niacin in males and from 49% for sugar to 27% for vitamin B12 in females. CONCLUSION: The DHQ is a valid tool for assessing most nutrients intake among Iranian population. In addition, it is a proper instrument in categorizing individuals based on their dietary intakes.

Age, period and cohort analysis of high cholesterol levels in Iranian adults over a 20-year period.

PURPOSE: Hypercholesterolemia is one of the most important modifiable risk factors of non-communicable diseases and data on their values in different societies and their trend of changes should be updated every couple of years. Many studies have focused on assessing the prevalence of high cholesterol. We must emphasise that most of these studies were cross-sectional and did not directly investigate the temporal trends of change for age, period and birth cohort (APC). The aim of this study is to evaluate the effect of age, period and birth cohort on the prevalence of borderline to high cholesterol levels in Iranian adult population. METHODS: The data were collected from 110,302 subjects between 25 and 69 years of age over the period of 1990-2011. Data from these subjects were collected by using five national cross-sectional surveys conducted in 1990-91, 1999, 2003, 2007 and 2011. The APC effect on the prevalence of borderline and high cholesterol levels was assessed using the Intrinsic Estimator model. RESULTS: The overall prevalence of borderline cholesterol level among male subjects was found to be lower than that of females (39.8% vs. 46.3%). Similarly, the prevalence of high cholesterol level in men was reported to be 13.1%, which was lower than the 18.0% calculated in women. The prevalence of borderline and high cholesterol levels increased with age in men between the ages of 45-49. Then it stayed quite steady and eventually declined. Then it stayed quite steady and eventually declined. The prevalence in women also increased with age, with its maximum rise after the ages of menopause and a slight decline at the ages of 65-69. As for the birth cohorts, the prevalence of borderline and high cholesterol levels followed a declining trend by going from earlier birth cohorts to the later ones. CONCLUSION: The present study provides evidence that age, period and birth cohort affect the prevalence of borderline and high cholesterol levels. Thus, these factors should be considered when developing and implementing care plans for people with hypercholesterolemia.

The Gap of Cigarette and Hookah Smoking Between Socioeconomic Groups in Iran: Effect of Inequalities on Socioeconomic Position.

BACKGROUND: Hookah and cigarette smoking have adverse effects on individuals' health and therefore place a great burden on public health. The aim of this study was to measure inequalities in socioeconomic position to determine contributing factors on cigarette and hookah smoking in Iran. METHODS: In this study, secondary analysis of the Iran's sixth national Surveillance of Risk Factors of Non-Communicable Diseases (SuRFNCD-2011) was conducted for 10,572 individuals aged 15 to 70 years old. Subjects were categorized into three groups according to their socioeconomic status (low, middle and high) in order to assess their inequalities using principal component analysis. At the end, the gap between the low and high socioeconomic groups was decomposed using Blinder-Oaxaca decomposition technique. RESULTS: The prevalence of cigarette and hookah smoking in high, middle, and low socioeconomic groups was 11.8%, 13.2%, and 13.1% (P=0.158), and 2.6%, 3.3% and 4.3%, (P<0.001), respectively. Blinder-Oaxaca decomposition technique showed a lower prevalence of hookah smoking in high socioeconomic group compared to low socioeconomic group (P<0.001). The gap between the two mentioned groups was measured to be 1.7%. However, this gap for cigarette smoking (1.5%) was not significant (P=0.093). CONCLUSION: The finding indicates the importance of socioeconomic status in hookah smoking. After decomposition of the gap between the 2 socioeconomic groups, age, gender and education level were reported to be the major contributors to the differences observed between the 2 groups.

National Prevalence of Self-Reported Coronary Heart Disease and Chronic Stable Angina Pectoris: Factor Analysis of the Underlying Cardiometabolic Risk Factors in the SuRFNCD-2011.

BACKGROUND: Coronary heart disease (CHD) is one of the most common causes of mortality worldwide. The national prevalence remains unclear in most of the developing countries. OBJECTIVE: This study sought to estimate national prevalence of self-reported CHD and chronic stable angina pectoris in the general adult population of Iran using data from the fourth round of the Surveillance of Risk Factors of Non-Communicable Diseases (SuRFNCD-2011) survey. METHODS: The analysis comprised data of 11,867 civilian, nonhospitalized and noninstitutionalized residents ages 6 to 70 years of age. The calculated prevalence of self-reported CHD and chronic stable angina pectoris were extrapolated to the Iranian adult population who were >20 years old using the complex sample analysis. The factor analysis was performed for clustering of the associated cardiometabolic risk factors among people ages >40 years of age. RESULTS: The estimated national prevalence of self-reported CHD and chronic stable angina pectoris were 5.3% (95% confidence interval: 4.6 to 5.9) and 7.7% (95% confidence interval: 4.6 to 8.7), respectively. Higher prevalence of these conditions were observed among the older people, urban residents, and women. Factor analysis generated 4 distinct factors that were mainly indicators of dyslipidemia, hypertension, central obesity, hyperglycemia, and tobacco smoking. The factor incorporating hypertension was a significant correlate of self-reported CHD. CONCLUSIONS: We report concerning prevalence of self-reported CHD and chronic stable angina pectoris in the adult population of Iran. The constellation of raised systolic and diastolic blood pressures was significantly predictive of the presence of self-reported CHD.

Zero and Five End-Digit Preference and Blood Pressure Quality of Care Revisited.

BACKGROUND: To determine the rate of zero and five end-digit preference (EDP) for systolic and diastolic blood pressures (SBP and DBP, respectively) and risk factors amongst a representative sample of Iranian adults in the year 2011. METHODS: Data gathered from 7997 Iranian adults aged 25-70 were extracted from the database of the sixth Survey of Surveillance of Risk Factors of Non-communicable Diseases, which surveyed a total of 11,864 individuals aged 6 to 70 years. Multilevel multiple logistic regression was used to identify the independent factors associated with zero or five EDP. RESULTS: The prevalence of three serial zero or five EDP for SBP and DBP were 18.5% (95% CI: 11.3%-25.7%). SBP ≥140 mmHg (OR = 0.78; 95% CI: 0.65-0.95), DBP ≥90 mmHg (OR = 0.71; 95% CI: 0.58-0.88), and a positive family history of diabetes (OR = 0.77; 95% CI: 0.66-0.9) were found as protective factors against zero or five EDP in blood pressure recording the male gender (OR = 1.18; 95% CI: 1.04-1.35) was found to be its independent risk factor. CONCLUSION: Sex, SBP, DBP and family history of diabetes were found to be the main independent determinants of EDP in our country which underscores the importance of assessing the many patient-related factors in the studies involving EDP as part of BP monitoring in public health care.

Cigarette and Water-Pipe Use in Iran: Geographical Distribution and Time Trends among the Adult Population; A Pooled Analysis of National STEPS Surveys, 2006-2009.

OBJECTIVE: To assess the geographical distribution and time trends of manufactured cigarette and water-pipe use among Iranian adult population. METHOD: Pooled data from four consecutive nationally and provincially representative STEPS surveys, 2006-2009, were analyzed. Prevalence of current daily manufactured cigarette smokers, current daily water-pipe and current daily dual users and associated 95%CIs were estimated using complex sample analysis techniques. RESULTS: Overall, the prevalence of current daily tobacco use, including cigarette and water-pipe, was estimated 23.7% for men and 3.0% for women, in which 20.2% of men and 0.8% of women were exclusively cigarette smokers, 2.7% and 2.2% were exclusively water-pipe users, and 0.6% and 0.01% smoked both cigarettes and water-pipes. The prevalence of cigarette smoking ranged from 12.3% to 27.7% in men and 0.1% to 1.8% in women, and was generally highest in the northwest of the country. Conversely, the prevalence of water-pipe smoking ranged from 1.7% to 10.9% in men and 0% to 16.8% in women, and was highest in the south and southeast. No secular trends were observed for daily cigarette smoking in either men (P = 0.637) or women (P = 0.308) from 2006 to 2009. However, the prevalence of water-pipe decreased slightly in women (P = 0.012) and men (P = 0.055), though the later was not statistically significant. CONCLUSION: In Iran, widespread geographical variation in the use of different types of tobacco products should be taken into account when planning for tobacco prevention policies and programs. Iran may serve as an important setting for etiological studies to examine the effects of long-term water pipe use on diseases.

Diseases and Health Outcomes Registry Systems in I.R. Iran: Successful Initiative to Improve Public Health Programs, Quality of Care, and Biomedical Research.

Registration systems for diseases and other health outcomes provide important resource for biomedical research, as well as tools for public health surveillance and improvement of quality of care. The Ministry of Health and Medical Education (MOHME) of Iran launched a national program to establish registration systems for different diseases and health outcomes. Based on the national program, we organized several workshops and training programs and disseminated the concepts and knowledge of the registration systems. Following a call for proposals, we received 100 applications and after thorough evaluation and corrections by the principal investigators, we approved and granted about 80 registries for three years. Having strong steering committee, committed executive and scientific group, establishing national and international collaboration, stating clear objectives, applying feasible software, and considering stable financing were key components for a successful registry and were considered in the evaluation processes. We paid particulate attention to non-communicable diseases, which constitute an emerging public health problem. We prioritized establishment of regional population-based cancer registries (PBCRs) in 10 provinces in collaboration with the International Agency for Research on Cancer. This initiative was successful and registry programs became popular among researchers and research centers and created several national and international collaborations in different areas to answer important public health and clinical questions. In this paper, we report the details of the program and list of registries that were granted in the first round.

Prevalence of Chronic Neck Pain, Low Back Pain, and Knee Pain and Their Related Factors in Community-Dwelling Adults in Iran: A Population-based National Study.

BACKGROUND: Chronic musculoskeletal pain (CMP) is increasing in prevalence rapidly. Over the past 2 decades low back pain has been ranked globally as the primary cause of years lived with disability. The primary objective of this study was to investigate the prevalence of chronic neck pain (CNP), chronic low back pain (CLBP), and chronic knee pain (CKP) and their related risk factors in the national Iranian population. METHODS: We analyzed data obtained through a cross-sectional, population-based survey of 7889 Iranians who were aged between 30 and 70 years. RESULTS: The prevalence of CNP, CLBP, and CKP was 15.34%, 27.18%, and 29.97%, respectively. Female sex, aging, body mass index≥25, Lur or Arab ethnicity, illiteracy, passive smoking, positive osteoporosis history, and low or high physical activity levels were risk factors for CLBP, CNP, and CKP after adjustment for potential confounders. For example, in participants with a body mass index≥30, odds ratios for CNP, CLBP, and CKP adjusted for age, sex, ethnicity, living area, education, employment status, smoking, and physical activity levels were 1.26 (95% confidence interval [CI], 1.04-1.52), 1.37 (95% CI, 1.17-1.59), and 1.64 (95% CI, 1.41-1.91), respectively. CONCLUSIONS: This is the first study investigating the prevalence of CNP, CLBP, and CKP in the national population of Iran. It shows some modifiable risk factors for CMP, and suggests that affordable planning for these risk factors can be valuable in preventing CMP globally. However, this is a cross-sectional study and future longitudinal studies in this field are necessary.

Prevalence of metabolic syndrome in Iran: A 2011 update.

BACKGROUND: The aim of the present study was to determine the prevalence of metabolic syndrome and its individual components among the Iranian adult population in 2011 and to investigate changes between 2007 and 2011. METHODS: Data from two rounds of the Surveillance of Risk Factors of Non-communicable Diseases national surveys conducted in 2007 and 2011 were pooled. Metabolic syndrome was defined according to International Diabetes Federation criteria. RESULTS: In 2007, the prevalence of metabolic syndrome among adults aged 25-64 years was 35.95 (95% confidence interval [CI] 34.27-37.63), which decreased to 32.96 (95% CI 30.73-35.18) in 2011 (P = 0.0108). Despite this overall decline, the prevalence of central obesity (P = 0.1383), raised triglycerides (P = 0.3058), and reduced high-density lipoprotein cholesterol (HDL-C; P = 0.5595) remained constant. There was a trend towards a decline in the proportion of individuals with increased blood pressure (P = 0.0978), and the proportion of adults with increased fasting plasma glucose (FPG) increased (P < 0.0001). In 2011, the prevalence of central obesity, raised triglycerides, reduced HDL-C, increased blood pressure and increased FPG was 51.88 (95% CI 48.97-54.79), 36.99 (95% CI 34.52-39.45), 54.72 (95% CI 50.87-58.57), 38.92 (95% CI 36.19-41.64), and 24.97 (95% CI 22.02-27.93) respectively. CONCLUSIONS: Over the period 2007-11, the prevalence of metabolic syndrome has decreased slightly in Iran, although prevalence of increased FPG has increased significantly. One-third of the Iranian adult population is diagnosed with metabolic syndrome.

Awareness, Treatment and Control of Pre-hypertension and Hypertension among Adults in Iran.

BACKGROUND: Hypertension is a major risk factor for non-communicable diseases. Yet, Nation-wide prevalence and trend reports in developing countries are sparsely available. METHODS: Data from three cycles of Survey of Risk Factors of Non-communicable Diseases (SuRFNCD) 2005 - 2011 were aggregated. In 2011, 8218 adults aged 25 - 70 years were enrolled. For trend analysis 68850, 4184, and 7416 adults aged 25 - 64 years were included from 2005, 2007, and 2011 surveys, respectively. Hypertension was defined as systolic blood pressure (SBP) ≥ 140 mmHg, diastolic blood pressure (DBP) ≥ 90 mmHg, or receiving anti-hypertensive medication. Pre-hypertension was defined as SBP between 120 - 139 or DBP between 80 - 89 mmHg. The status of awareness, non-pharmacologic treatment (management), pharmacologic treatment, and control (SBP < 140 mmHg, and DBP < 90 mmHg) among hypertensive individuals were also determined. RESULTS: 25.6% (95%CI: 23.5 - 27.5) of the adults aged 25 - 70 years had hypertension and 39.8% (95%CI: 37.8 - 41.9) had pre-hypertension. The prevalence of hypertension was greater among older adults (P < 0.001), women (P = 0.013), and urban-dwellers (P = 0.027). In 2005 - 2011, the proportion of adults with hypertension (25.7% to 24.1%) and pre-hypertension (45.5% to 40.4%) significantly decreased. In 2011, rates for awareness, management, treatment, and control among hypertensives were 43.2% (95%CI: 40.0 - 46.4), 40.3% (95%CI: 37.0 - 43.6), 34.8% (95%CI: 31.5 - 38.2), and 38.6% (95%CI: 33.1 - 44.2), respectively. Over time, status of awareness, management, treatment and control was significantly improved and was more salient among men (P < 0.05 for all analyses). CONCLUSIONS: The prevalence of hypertension and pre-hypertension is gradually declining. Despite improvements in awareness, management, treatment and control, these decline rates are still low and initiative strategies need to be implemented to further improve the current status.

Twenty-year dynamics of hypertension in Iranian adults: age, period, and cohort analysis.

Hypertension is a well-known health problem all over the world. Many studies have assessed its prevalence and associated risk factors, but all were cross-sectional and did not evaluate the trend of hypertension through all three different temporal dimensions including age, period, and cohort. So, we aimed to assess the 20-year dynamics of hypertension via the age-period-cohort model. Data from 74,155 subjects aged 25-60 years gathered through five national health surveys (1990-91, 1999, 2003, 2007, and 2011) were used in this study. The age-period-cohort effect on hypertension was analyzed using the intrinsic estimator model. The prevalence of hypertension increased with age for both genders except for males in 2003 and 2011 periods with drops of 3.5% for ages 55-60 and 8.1% for ages 50-60, respectively. As for the period effect, the prevalence of hypertension was almost constant in all age groups for both genders from 1990-1999. The cohort-based prevalence of hypertension showed a declining trend in all cohorts for females except for 2011 in birth cohort of 1950-1955 which remains stationary. The trend of prevalence for males also follows a decreasing trend except for periods of 2003, 2007, and 2011; birth cohorts of 1945-1949, 1975-1980, and 1950-1960 increase by 3.5%, 1.9%, and 8.1%, respectively. The age effect on the prevalence of hypertension showed an almost monotonic increasing trend. The period effect increased the total prevalence of hypertension from 1992 to 1997. The cohort effect also showed a monotonic decrease in hypertension prevalence except for a few discrepancies.

Blood pressure percentiles by age and body mass index for adults.

Since no comprehensive study has been conducted on blood pressure (BP) percentiles established upon nationally representative sample population of adults, the present study aimed to construct the blood pressure percentiles by age, sex and body mass index (BMI) of the subjects. Analyses were based on data collected in 2011 from 8,425 adults aged 25 to 69 years old. Data on demographic characteristics, anthropometric measurements, and blood pressure was recorded for each subject. Linear Regression analysis was used to assess the adjusted relationship of age-sex-specific standard deviation scores of BMI, height, and weight with blood pressure. Four separate models for systolic blood pressure (SBP) and diastolic blood pressure (DBP) of men and women were constructed for BP percentiles according to age and BMI. Blood pressure increased with the rise in BMI and weight, but showed a negative correlation with height. SBP and DBP rose steadily with increasing age, but the rise in SBP was greater than DBP. Overweight and obese population, seem to fall into the category of hypertensive. The findings of present study show that BP percentiles are steadily increased by age and BMI. In addition, most obese or overweight adults are hypertensive.

Obesity and Related Factors in Iran: The STEPS Survey, 2011.

BACKGROUND: To date, no study has addressed the association between race/ethnicity and obesity considering other sociodemographic and lifestyle factors in Iran. OBJECTIVES: The current study aimed to study lifestyle and the environmental factors affecting obesity in the Iranian subjects of the STEPS Survey, 2011. PATIENTS AND METHODS: The study was conducted on 8639 subjects (aged ≥ 20 years) in the STEPS Survey 2011 in Iran under supervision of the World Health Organization (WHO). Height and body weight were measured following the standardized procedures. Generalized Estimating Equations (GEE) method was used to examine factors associated with obesity. The examined variables were age, gender, race/ethnicity, place of residence, employment status, physical activity, smoking status, and educational level. RESULTS: Overall, 22.3% of the subjects were obese. In a GEE model, a healthy weight status among adults was associated with being younger, male, in a rural residence, employees, spending more time engaged in physical activity, being a smoker and having a moderate or high level of education. These associations were statistically significant after adjusting for other variables. CONCLUSIONS: The study results suggest a need for targeted interventions and continued surveillance for the Iranian adults.

Oral hygiene status in a general population of Iran, 2011: a key lifestyle marker in relation to common risk factors of non-communicable diseases.

BACKGROUND: To estimate Oral Hygiene (OH) status in the Iranian population in 2011, and to determine the influence of socio-economic characteristics on OH, and its interrelation with common risk factors of Non-Communicable Diseases (NCDs). METHODS: Data including a total of 12,105 individuals aged 6-70 years were obtained from the sixth round of the surveys of NCDs risk factors in Iran. OH was recorded through a structured questionnaire measuring daily frequencies of tooth brushing and dental flossing. Descriptive analyses were performed on demographic characteristics in the complex sample survey setting. We also employed weighted binary logistic regression to compute Odds Ratio (OR) as a measure of association between the response and explanatory factors. Furthermore, to construct an asset index, we utilized Principal Component Analysis (PCA). RESULTS: The percentage with minimum recommended daily OH practices was 3.7% among men and 7.7% among women (OR= 2.3; P<0.001). Urban citizens were more likely to have their teeth cleaned compared to rural people (OR= 2.8; P<0.001). For both genders, a relatively better condition was observed in the 25-34 age group (male: 5.6%; female: 10.3%). In addition, OH status improved significantly by increase in both level of education (P<0.001) and economic status (P<0.001). There were also apparent associations between self-care practices and specific behavioral risk factors, though the correlation with dietary habits and tobacco use could be largely explained by socio-economic factors. CONCLUSION: OH situation in Iran calls for urgent need to assign proper interventions and strategies toward raising public awareness and reducing disparities in access to health facilities.

A warning threshold for monitoring tuberculosis surveillance data: an alternative to hidden Markov model.

OBJECTIVES: Although hidden Markov model (HMM) is known as a powerful tool for the detection of epidemics based on the historical data, the frequent use of such a model poses some limitation especially when decision-making is required for new observations. This study was aimed to address a warning threshold for monitoring the weekly incidences of tuberculosis as an alternative to HMM. METHODS: We extracted the weekly counts of newly diagnosed patients with sputum smear-positive pulmonary TB from 2005 to 2011 nationwide. To detect unexpected incidences of the disease, two approaches: Serfling and HMM, were applied in presence/absence of linear, seasonal and autoregressive components. Models were subsequently evaluated in terms of goodness of fit, and their results were compared in detection of the disease phases. Then, multiple hypothetical thresholds were constructed based on the estimate of models and the optimal one was revealed through ROC curve analysis. RESULTS: Findings from both adjusted R-square (R~2) and Bayesian information criterion (BIC) presented a higher goodness of fit for periodic autoregressive HMM (BIC = -1323.6; R~2=0.74) than other models. According to ROC analysis, better values for both Youden's index and area under curve (0. 96 and 0. 98 respectively) were obtained by the threshold based on the estimate of periodic autoregressive model. CONCLUSIONS: As the optimal threshold presented in this study is simple in concept and has no limitation in practice, especially for monitoring new observations, we would recommend such a threshold to be used for monitoring of TB incidence data in the surveillance system.