Health Promotion Interventions on Helmet Use: A Systematic Review and Meta-Analysis of Pre-Test and Post-Test Studies.

Background: We aimed to review the effectiveness of health promotion interventions in the use of helmet and to identify the types of effective health promotion strategies among the examined studies. Methods: A systematic search was performed on the PubMed, Scopus, Cochrane, and Embase databases up to 1 Aug 2022 to find the studies evaluated the effectiveness of health promotion interventions for helmet use among target population. In this systematic review and meta-analysis, interventions with pre- post-test design were included. The dependent variable of the study is the percentage of participants who responded positively toward helmet use in the baseline and after the interventions. Random-effects models were used to pool study results. Results: Overall, 1,675 articles were found in the initial search and entered into the Endnote software. Of these, 917 duplicate articles were removed, leaving 758 articles were screened based on title and abstract. Finally, 12 eligible articles were included in the review and five with pre and post-test design were included in the meta-analysis. The overall random-effects pooled estimation of persons wearing helmets before and after interventions was 70% (95%CI 21 -119; P<0.001), without a heterogeneity (I2 =0%; P=0.94), which means that the average percentage of changing to helmet use is 70%. Community-based education program was the most commonly applied for interventional studies. The next most commonly used approaches were campaign designing. Conclusion: Wearing helmet approximately increased 70% among participant. Health promotion strategies may target helmet-wearing behavior to reduce head injuries in motorcyclist road traffic accidents.

Parents' knowledge and socio-demographic determinants toward child's restraint system use.

BACKGROUND: Lack of protection or improper protection, is one of the most important reasons of child passenger's death and injury in traffic crashes. Based on what we see on the roads, Iranian children are unrestrained inside the car. The aim of this study was to investigate children restrained system (CRS) use rate, its socio-demographic determinants and parents' knowledge toward CRS use among Iranian parents. METHODS: Using multi-stage cluster sampling and direct in filed method of observation, the behavior of 700 children in cars was observed in the current cross-sectional study. Socio-demographic determinants and parents' knowledge, toward using the CRS were evaluated using questionnaires. The study was performed from July to August 2019 in Tabriz city, northwestern Iran. RESULTS: The rate of child safety seat (CSS) use was 15.1% CI 95%:(12.5%,18.0%), and the rate of booster use was 0.6%; CI 95%:(4.3%,8.0%). The majority of parents [e.g. 64.3%; CI 95%: (60.7%,67.9%)], had low knowledge about the use of CRS. The most important reasons for not using CRS was lack of laws and policies [e.g. 59.7%; CI 95%:(12.5%,18.0%)], lack of knowledge [e.g.59.6%; CI 95%:(57.9%, 63.3%)] and the high cost of CRS [e.g. 57.6%; CI 95%:(53.81%,61.2%)]. The most important predictors of not using CRS were the child's age, parental knowledge, and the socioeconomic status of the household (p < 0.05). CONCLUSIONS: Most children did not have CRS. The parents with higher education and those with higher socioeconomic status had higher rate of CRS use. Based on the low rate of CRS use and poor parental knowledge about it, education of parents toward boosters use and benefits of using CRS, enforcing mandatory laws and ploicies for CRS use in Iran, and allocation of government subsidies to low-income families for purchasing CRS are suggeted as essential strategies to increase CRS use.

The effect of counseling on women's coping with unplanned pregnancy.

INTRODUCTION: The responses to a life-changing event can be different. The study aimed to determine the effect of counseling on coping strategies among women facing unplanned pregnancy. METHODS: This quasi-experimental study was conducted on 70 unplanned pregnant women with a gestational age <10 weeks, who scored ≥ 15 in the avoidance pattern of Revised Prenatal Coping Inventory (NU-PCI). The participants were randomly assigned into the intervention and control groups. Three counseling sessions were held for the intervention group. Data were gathered using questionnaires of the women's perceptions of unplanned pregnancy, decision-making style and strategies, NU-PCI, and the checklist for the type of decision. Independent t-tests, ANCOVA, and Chi-square were used. RESULTS: After intervention, the mean score of the avoidance pattern in the intervention group was significantly lower than that in the control group [AMD: - 4.35, 95% CI: -8.7 to -0.13, P=0.03]. In addition, the continuation rate of pregnancy in the intervention group, 28 subjects (80%), was significantly higher than that in the control group, 21 (60%) (P = 0.03). CONCLUSION: The counseling leads to a decrease in the use of avoidance strategies among women facing unplanned pregnancies. Development of supportive interventions for women experiencing unplanned pregnancies is recommended specially in societies with induced abortion restrictions.

A Fuzzy Clustering Approach to Identify Pedestrians' Traffic Behavior Patterns.

BACKGROUND: Pattern recognition of pedestrians' traffic behavior can enhance the management efficiency of interested groups by targeting access to them and facilitating planning via more specific surveys. This study aimed to evaluate the pedestrians' traffic behavior pattern by fuzzy clustering algorithm and assess the factors related to higher-risk traffic behavior of pedestrians. Study Design: This study is a secondary methodological study based on the data from a cross-sectional study. METHODS: The fuzzy c-means (FCM), as a machine learning clustering method, was conducted to identify the pattern of traffic behaviors by collecting data from 600 pedestrians in Urmia, Iran via "the Pedestrian Behavior Questionnaire" (PBQ) and using 5 domains of PBQ. Multiple logistic regression was fitted to identify risk factors of traffic behaviors. RESULTS: Results revealed two clusters consisting of lower-risk and higher-risk behaviors. The majority of pedestrians (64.33%) were in the lower-risk cluster. Subjects≤33 years old (Odds ratio [OR]=1.92, P<0.001), subjects with≤6 years of education (OR=1.74, P=0.010), males (OR=1.90, P=0.001), unmarried pedestrians (OR=3.61, P=0.007), and users of public transportation (OR=2.01, P=0.002) were more likely to have higher-risk traffic behavior. CONCLUSION: We identified traffic behavior patterns of Urmia pedestrians with lower-risk and higher-risk behaviors via FCM. The findings from this study would be helpful for policymakers to promote safety measures and train pedestrians.

Drivers' unsafe behaviors in Iran: An investigation in West Azerbaijan.

Background: The present study aims to investigate one of the major causes of traffic accidents: drivers' unsafe behaviors while driving. Methods: In this cross-sectional study, the behaviors of 946 drivers at traffic lights were observed in the morning, at noon, and in the evening using direct in-field observation. The unsafe behaviors of the drivers included not fastening the seat belt, using a cellphone or handsfree device, smoking, being distracted by a child, talking with passengers, not observing the stop line, eating and drinking, and getting out of the car, letting out a passenger, or arguing with a passenger at the traffic light. Results: Of the drivers at the traffic light, 60% did not obey the stop line, and 72% did not fasten their seat belt. Also, 13.6% used their cellphones, and 22% talked with passengers. The frequency of the other unsafe behaviors was <3%. For wearing seat belts, drivers aged 41-50 years wore seat belts almost five times more than drivers under 25 years of age (4.94 [2.36-10.320]; p < 0.001), and drivers aged 50 years and older were almost three times likelier to wear seat belts than drivers under 25 years of age (2.8 [1.31-6.08]; p < 0.001). The results showed that the drivers were significantly likelier to wear seat belts on Saturdays (after the weekend) (0.56 [0.40-0.78]; p = 0.001). Regarding using mobile phones while driving, women were twice as likely to use mobile phones as men (2.20 [1.30-3.72]; p < 0.001). Drivers aged 26-40 years used mobile phones significantly less than drivers under 25 years of age (0.24 [0.14-0.43]; p < 0.001) and drivers aged 41-50 years were significantly less likely to use mobile phones than drivers under 25 years of age (0.19 [1.31-6.08]; p < 0.001). Conclusion: The results showed that the occurrence of wearing a seat belt in Shahin Dej was low. We observed a significant association between wearing a seat belt, age, whether it was Saturday (a day after weekend for Iranians). Additionally, similar associations were observed between using mobile phones and gender, age, and day of the week.

Psychometric properties of the Last-7-Day Sedentary Time Questionnaire (SIT-Q-7d): Testing the validity and reliability among general population.

BACKGROUNDS: Sedentary behavior (SB) is an independent risk factor causing chronic diseases. Previous studies compared sitting time mostly with physical activity. The present study aimed to evaluate the validity and reliability of the Last-7-Day Sedentary Time Questionnaire (SIT-Q-7d) in Iran. Moreover, SB was assessed among the study participants. METHODS: The current validity study was conducted among 290 subjects (51.7% males vs. 48.3% females) with a mean age of 34.81 ± 9.63 years in Poldasht, Iran. Sampling was done using simple random sampling and the data were collected using the SIT-Q-7d. To confirm the validity of the questionnaire, forward-backward translation method, content validity, and construct validity were used. Furthermore, temporal stability was calculated by the test-retest method and internal consistency coefficient (ICC). RESULTS: Our results confirmed the content validity of the questionnaire (content validity score: 0.90 and content validity index: 0.80). Using exploratory factor analysis (EFA), seven factors of SB were identified as follows: eating while sitting down, doing domestic affairs, screen time, leisure time, studying books, watching TV, and attending family gatherings. The reliability of the questionnaire was confirmed using Cronbach's alpha (α = 0.7). In addition, temporal stability was confirmed by test-retest method and ICC was 0.9 (95% CI: 83-97). CONCLUSION: Our results confirmed that the Persian version of SIT-Q-7d is a reliable and valid tool for assessing SB.

Developing a national road traffic safety education program in Iran.

BACKGROUND: Education is a pivot included Decade of Action for Road Safety initiative, which has reduced deaths caused by accidents in developed countries. Given the circumstances of each country, a proper education program is necessary. Thus, the aim of this study was to develop the National Road Traffic Safety Education Program (NRTSEP) and reduce Road Traffic Injuries (RTIs). METHODS: This study used a qualitative approach and was conducted in Iran. Data were obtained through sixteen semi-structured in-depth interviews from indifferent road safety and health promotion field experts as well as eleven focus group discussion (FGD) sessions conducted with participants from general population. Inductive qualitative content analysis was used to converge and compare themes through data. The initial pattern of the program was developed and subsequently, the designed program was validated and finalized by two-step Delphi method for the consensus of expert opinion. RESULTS: The following six main themes emerged from the analysis: target groups, program content, educational methods, instructors, resources and evaluation. The target group consisted of children, youth, parents, teachers, elderly, motorcyclists, cyclists, pedestrians, drivers, driver license applicants, instructors and administrators of driving schools, and specific groups such as the disabled, managers at different levels, and policymakers. The content of the program consisted of 27 items, including traffic laws and regulations, first aid, and medical emergencies. Educational practices and authorities were determined based on the target group and educational content. The most important resources of the program were human force and other cases, which can be managed in case of a lead agency. In the evaluation dimension, the cases such as mortality rate, hospitalization, behavioral changes, and other cases can be considered. CONCLUSIONS: The designed program should be implemented for all target groups for road safety promotion. The proper content was provided with proper educational methods and instructors for the target groups. A lead agency is needed to provide the resources and funding to run the program.

Challenges related to pedestrian safety: a qualitative study identifying Iranian residents' perspectives.

The pedestrians are among the most vulnerable group. This study was conducted to explain the challenges associated with pedestrian safety by taking into account the perspectives of Iranian residents in Tabriz. In this qualitative study, applying purposeful sampling approach, we recruited 49 residents to participate in structured qualitative interviews. To collect data, 3 Focus Group Discussions (FGDs) with 28 participants, and 21 individual interviews were conducted. Data analysis was performed applying conventional content analysis. MAXQDA10 was applied for the purpose of data management. After data analysis, six themes emerged including: (a) Pedestrians' own obstacles and challenges, (b) Driver' related obstacles and challenges, (c) Penal system related obstacles and challenges, (d) Advocacy-related obstacles and challenges, (e) Infrastructural obstacles and challenges, and (f) Management obstacles and challenges. Pedestrian safety was identified as a major but extremely intricate urban traffic and transportation issue. To promote pedestrian safety, it is essential for the municipal agencies to focus on the public's convenience through providing need-based infrastructures especially suiting to the elderlies. The agencies, here, must also introduce pedestrian penal system, penalty for using phone while driving, or superior road crossing mechanisms such as those discussed inside. The agencies should also focus on gross political commitment, and a broad strategy involving education, engineering and enforcement, institutional co-ordination within and between different levels of government and with private actors.

The "Cooperative-Supportive" Intervention for Improving Mental Health Status among Pregnant Women.

Introduction: Maternal mental health during pregnancy has a major impact on fetal growth and consequently, child health. The objective of this study was to assess the effect of "Cooperative-Supportive" Intervention Program on Pregnancy. Methods: The present before and after interventional research was conducted on 114 pregnant women referring to Khoy health centers in 2014. Pregnant women were randomly divided into intervention (n=57) and control groups (n=57). The data collection tool in this research was the researcher-made questionnaire based on the Predisposing, Reinforcing and Enabling Constructs in Educational Diagnosis and Evaluation (PRECEDE) model which assessed the participants' predisposing, enabling, and reinforcing factors. The educational interventions for enhancing pregnant women's stress controlling skills were conducted and also practical pacifying lessons were held for the intervention group during five weeks with relaxation exercises. In order to assess health status among pregnant women, knowledge, attitude, depression, anxiety and self-efficacy were investigated by applying different scales and questioners. The questionnaires were completed before and after the interventional program. The data were analyzed, using suitable statistical tests. Results: After the intervention, the mean score of PRECEDE major components significantly increased and the total anxiety and depression scores decreased in the intervention group in comparison to those of the control group. Conclusion: The present study showed the positive impact of educational intervention programs based on PRECEED model and major components on reducing anxiety and depression, and finally mental health promotion in the studied population.

Psychometric evaluation of a self-reported physical activity questionnarie used in the pilot phase of the AZAR Cohort Study.

BACKGROUND: The purpose of this study was to assess the psychometric properties of a self-reported physical activity (PA) questionnaire based on data from the pilot phase of the AZAR Cohort Study. METHODS: In this cross-sectional study, all 35-70 years old people living in Khameneh, a city in East Azarbaijan, Iran were invited to take part in the pilot phase of the AZAR Cohort Study. A total of 952 people completed the self-reported PA questionnaire and the International Physical Activity Questionnaire (IPAQ). Construct validity was evaluated by exploratory and confirmatory factor analyses (EFA and CFA). Spearman's correlation coefficient between the scores of the two instruments was used to examine the concurrent validity. Reliability was measured using intraclass correlation coefficient (ICC) and Cronbach's alpha coefficient. RESULTS: In EFA applying principal component analysis with varimax rotation, four factors were identified including recreational leisure time (variance = 52.73%), sedentary leisure time (variance = 38.68%), household/gardening work (variance = 38.66%), and occupation work (variance = 12.67%). The extracted factors were also supported by the CFA (CFI = 0.98, GFI =0.936, RMSEA=0.057). The results indicated moderate concurrent validity (ρ = 0.62, P < 0.001). ICC and Cronbach's alpha were 0.59 and 0.7, respectively. CONCLUSION: These results showed acceptable and moderate psychometric properties for the self-reported PA questionnaire to assess PA in this population-based study.

The Effect of a Pedometer-based Program Improvement of Physical Activity in Tabriz University Employees.

BACKGROUND: Regular physical activity (PA) has been shown to reduce risk of morbidity and overall mortality. A study has displayed that achieving 10,000 steps/day is associated with important health outcomes and have been used to promote PA. Pedometers are a popular tool for PA interventions in different setting. This study investigated the effects on pedometer-based and self-reported PA among Tabriz University employees. METHODS: This experimental study assessed the effects of 16 weeks pedometer-based workplace intervention. Participants (n = 154) were employees of two worksites. Pedometer-based and self-reported PA from one intervention worksite was compared with the data of a comparison workplace. International Physical Activity Questionnaire (IPAQ) for self-reported measure of PA, and demographic (age, marital status, educational level, employment status, and stage of change) variables were obtained. To measure PA objectively pedometer was used. RESULTS: Participants reported to increase the step counts from baseline (end of summer) to posttest (winter). The intervention effect revealed significant increase in the intervention group (8279 ± 2759 steps/day than in the comparison work place (4118 ± 1136). Self-reported based on IPAQ concluded women in intervention worksite had a significant increase in the leisure time domain, but similar finding was not found in the comparison worksite. CONCLUSIONS: Pedometer used might rather benefit those individuals who want feedback on their current PA, also walking should be considered to increase PA in employee women.

The effect of maternal employment on the elementary and junior high school students' mental health in Maku.

BACKGROUND & OBJECTIVE: Most experts view the childhood period as a foundation for shaping the individuals' fundamental future characteristics and behaviors. They believe that parents' personality and behavior quality exert a greater effect on the development of a child's personality than other factors. Given the mothers' role in children's mental health and considering the fact that children are a nation's future makers, the present study was designed to investigate the impact of maternal employment on students' mental health in Maku. MATERIALS & METHODS: The present study is descriptive and cross-sectional, and the population of the study encompasses all students in the fifth, sixth, and seventh grades (n=583) who are studying in 2013-2014 academic year in Maku. General Heath Questionnaire was employed for gathering data, and the SPSS software was used for analyzing the data. FINDINGS: The results of the study indicated that there was a significant difference between the mental health problems, somatic problems, social functioning, anxiety, and depression of the students with employed and non-employed mothers. In other words, the students with non-working mothers experienced greater mental disorders than those with working mothers. CONCLUSION: According to the findings of this study, it can be concluded that children with working mothers showed a better mental health than non-working mothers' children.

Explaining the role of personal, social and physical environment factors on employed women's physical activity: a structural equation analysis.

BACKGROUND AND OBJECTIVES: PA is a multi-factorial behavior that is affected by interpersonal, intra personal, environmental and social factors. In this study we applied explanatory model to determine the total, indirect and direct impact of physical environment, personal factors and social support on PA among employed women. METHODS: This study was a correlational cross-sectional study which was conducted to model total, indirect and direct impact of environmental, psychological and social factors on PA. A total of 200 women were chosen from Tabriz University by using convenience sampling method. Data about demographic characteristics, psychological variables, social and physical environment were gathered by using self-reported questionnaire and also the PA was measured by using the International PA Questionnaire and pedometer. RESULTS: personal factors, physical and social environment, showed direct effects on PA. Social factors could be seen to have indirect effects on PA through their influence on personal factors such as pros, cons and self-efficacy; also physical environment had indirect effects on PA through social environment. The total effects of physical and social environment on PA type were respectively 0.17, 0.16 on walking, 0.05, 0.07 on moderate activity and 0.15, 0.18 on vigorous activity. CONCLUSIONS: Findings from this study indicated that social factors had indirect effects on walking, moderate and vigorous activity, especially through the effects on these factors of self-efficacy, physical environment, pros and cons, and the interactive role of individual, environmental and social impacts on PA. The current study identifies that psychological, physical and social factors could be shown to have direct and indirect influences on all forms of activity. The barriers of PA were the most predictor of this behavior, and based on results, it can be concluded that decreasing the barriers along with improving social and physical environment can lead to increasing PA and health promotion.