A model to explain smokeless tobacco consumption in adults: A grounded theory study.

Introduction: Smokeless tobacco use remains a significant public health concern, necessitating the acquisition of comprehensive and extensive data to effectively address and control its consumption. Understanding the underlying patterns of consumption is crucial for this purpose. Objective: This study aimed to develop a model that explains smokeless tobacco consumption among adults in the southeastern province of Iran, specifically in the city of Chabahar. Methods: A qualitative study was conducted using a grounded theory approach with inductive processes. The participants consisted of 30 adults aged 18-64 years from Chabahar City in southeastern Iran. Purposive sampling was used to select participants, and data collection continued until theoretical saturation was achieved. Data analysis followed Strauss and Corbin's perspective, involving four stages: Analyzing Data for Concepts, Analyzing Data for Context, Bringing Process into the Analysis, and Integrating Categories. Results: The analysis of data yielded three main categories: "starting to use," "continued use," and "cessation attempts," each with their respective subcategories. Additionally, two main categories related to the consequences of smokeless tobacco consumption were identified: "addiction and efforts to overcome addiction," also with their respective subcategories. Conclusion: The Dependency Cycle Model in Consumption provides a comprehensive understanding of the contextual factors, processes, and consequences associated with smokeless tobacco consumption. This model serves as a valuable tool for researchers aiming to develop effective interventions in the field of smokeless tobacco consumption.

The relationship between social support and happiness in older adults referred to health centers in Zarrin Shahr, Iran.

BACKGROUND: Creasing the older adult population has become a major public health challenge. Social support plays an important role in people's health. Social support helps improve the living conditions of the elderly and brings happiness into the lives of the elderly. This study aimed to investigate the relationship between social support and happiness status in 60-75-year-olds referred to health centers of Zarrin Shahr, Iran in 2019. METHODS: In this cross-sectional study, 584 samples (female: 62.2%, men: 37.8%) participated in this study. To collect data for this study, Oxford Happiness, and Social Support questionnaires were used. The older adults of the target group were selected through simple multistage random sampling from the health centers of Zarrin Shahr. The collected data were entered into SPSS software version 22. They were described and analyzed by inferential statistics and regressions at a 95% confidence level. RESULTS: Sex, marital status, and level of education influenced total social support (P < 0.05). Moreover, age, marital status, and level of education affected happiness (P < 0.05). There was a significant positive correlation between total social support and components of social support with happiness (P < 0.05). Also, the multi-stage regression test showed emotional social support and education level were highly correlated with happiness (R2 = 0.265). CONCLUSION: The results highlight the need to increase social support for older adults because it can increase the level of happiness in this age group. In interventions to improve the social support and happiness of older adults, low-educated, unmarried, divorced, or deceased spouses should be prioritized.

Comparison of Perceived Self-efficacy, Benefits, and Barriers of Hypertension Control between Male and Female Patients Referred to Rajaie Cardiovascular Medical and Research Center in Tehran.

Background: Hypertension is a health problem. The purpose of the present study was to compare perceived self-efficacy, benefits, and barriers of hypertension control between male and female patients. Methods: This cross-sectional study was carried out on 400 patients referred to Rajaie Cardiovascular Medical and Research Center in Tehran from August 2020 through March 2021. The convenience sampling method was used. The data collection tools consisted of a digital sphygmomanometer, a demographic form, and a researcher-made questionnaire of perceived benefits, barriers, and self-efficacy of hypertension control, whose validity and reliability were obtained. Results: The mean age of the male and female patients was 54.02±12.93 years and 56.48±12.10 years, respectively. The mean score of perceived barriers in women was lower than that in men, and the mean perceived self-efficacy in women was higher than that in men (P<0.001). According to the regression test, history of smoking in men and family history of hypertension and age in women were predictors of perceived benefits. Further, occupation and history of smoking in men and education level, family history of hypertension, and history of smoking in women were predictors of perceived barriers. Additionally, marital status, education level, and disease duration in men and education level, family history of hypertension, history of smoking, and age in women were predictors of perceived self-efficacy (P<0.050). Conclusion: In men, the mean score of perceived barriers was higher and the mean score of perceived self-efficacy was lower. Additionally, the predictors of each of these perceptions were determined.

Exploring the Consequences of Early Marriage: A Conventional Content Analysis.

Early marriage is one of the most important social issues for young women and can have many consequences. The present study aimed to explore the consequences of early marriage among Kurdish women in western Iran who were married under the age of 18. This qualitative study was conducted with the approach of conventional content analysis. The data were collected through semi-structured interviews with 30 women selected by purposeful sampling. Data analysis was performed using Graneheim and Lundman's method. A total of 389 codes, 12 subcategories, 4 sub-categories, and 2 main categories were extracted from the data analysis. Negative consequences of early marriage include: 1-physical and psychological problems (high-risk pregnancy and childbirth, physical illnesses, depression, and emotional distress); 2-family problems (dissatisfaction with married life, experience of having lots of responsibility, lack of independence in family life); 3-social problems (risky social behaviors, lack of access to social and health services, social isolation, lack of access to a job, and educational opportunities); and 4-positive consequences, including receiving intra-family support, improving living conditions, and opportunities for progress and empowerment. It is possible to reduce problems and challenges after early marriage by increasing the awareness and knowledge of young women about contraceptives and providing appropriate social and health facilities, and services during pregnancy. Providing the necessary training and psychological counseling for them and their husbands on how to deal with personal problems and marital life will be effective to a great extent.

Adolescents' Perspectives on Facilitators and Barriers to Social Health in the Family: A Qualitative Study.

BACKGROUND: Family plays the most fundamental role in the adolescent's health. A deep understanding of family characteristics, beliefs, and function about the adolescent social health provides a framework, relying on which one can perceive how this dimension of health is developed and promoted in this setting. In this study, we aimed to understand the family context that facilitates or limits adolescent social health. METHODS: Fifty-four adolescents and fifteen parents participated using a purposive sampling method. The findings were collected through semi-structured interviews and group discussions. The data was analyzed through conventional content analysis by the MAXQDA10 software. RESULTS: Healthy and unhealthy family reactions are the two main categories that facilitate and limit the adolescents' social health. Sub-categories of healthy reactions included effective guidance, cultural safeguard, and accountable interactions. The unhealthy family reactions included sub-categories of poor intergenerational perception and passive parenting. CONCLUSION: Our findings revealed that the family context of the adolescent's social health ranged from healthy to unhealthy responses. These results can contribute to improving and designing interventions for promoting the adolescent's social health. It is essential for policymakers and health experts to pay attention to the family empowerment approaches.

Dimensions of Preparation for Aging: A Systematic Review.

Background: A deeper understanding of the dimensions of preparation for aging at the personal level may provide new perspectives for healthy aging promotion policies. Therefore, the present study was conducted to investigate the dimensions of preparation for old age and retirement. Methods: This was a systematic review. The search was performed in the following databases: PubMed, Embase, Scopus, Web of Science, PsycINFO, and Google Scholar up to June 2020. This search was done based on the following keywords: "prepare*", "preparation", "plan* ", "Aged", "Ageing", "Aging", "older people", "senior", "retirement", "older adults", and "elderly" through the AND/OR operators. In the preliminary search, 2032 papers were identified. After removing the duplicated articles and screening the title and abstract, the full text of 141 papers were investigated. Finally, 42 papers were eligible for inclusion in the systematic review. Results: The results indicated that preparation for aging is propounded in the 6 dimensions: (1) health preparation; (2) psychological preparation; (3) financial preparation; (4) housing; (5) social preparation; and (6) active leisure. Conclusion: The findings of the present study indicated that planning for aging requires coverage of all dimensions of old age preparations to achieve healthy aging. The preparation planning should be performed before later life and during the young or middle-age years.

Development of an Instrument to Measure Dietary Supplement Health Literacy.

BACKGROUND: Health literacy is one of the important social determinants of health. OBJECTIVE: The aim of this study was to develop an instrument to measure Dietary Supplement Health Literacy (DSHL) of Iranian women. METHODS: In this psychometrics study, an initial nine-factor instrument was developed. Face validity and content validity of the instrument were evaluated. The factor structure of the instrument was explored by the Exploratory Factor Analysis (EFA) among 400 women taking Dietary supplement. Confirmatory Factor Analysis (CFA) was done to determine the underlying factor structure of the instrument in this population. The internal and external reliability of the instrument was evaluated. KEY RESULTS: According to expert panel opinions, 16 items were deleted. The results of the EFA showed that the Kaiser-Meyer-Olkin and Bartlett's test of sphericity were significant. EFA showed that 30 items could be grouped into nine factors that accounted for 60.84% of the variance. Since two items in the ability to actively engage with health care providers factor were loaded in factor 1, this factor was labeled Engaging in receiving informational supports from health care providers. In addition, one item of the dimension was loaded in factor 3. Given that the one item of factor 5 and 1 item of factor 6 were loaded in a new factor 9, this factor was labeled Applying information to decision-making. The CFA indicated that the nine-factor structure of the DSHL instrument had a poor fit. To modify indices, factor 9 with 2 items and 1 item of factor 6 were deleted. The Cronbach's alpha and intraclass correlation coefficient of the instrument were acceptable. Finally, a 27-item instrument with 8 dimensions was confirmed. CONCLUSIONS: The results of the study showed that the instrument developed was a valid tool for identifying the DSHL of Iranian women. [HLRP: Health Literacy Research and Practice. 2022;6(2):e159-e166.] Plain Language Summary: This study sought to develop and validate a multidimensional instrument to measure the health literacy of Iranian women about dietary supplements that was performed from July 2019 to May 2020 in Iran. Findings showed that the 30-item instrument developed in this study is a valid instrument to be used for identifying the health literacy of Iranian women about dietary supplements.

Perspectives on healthy aging in middle age: Evidence for health promotion interventions.

CONTEXT: Understanding how middle-aged people perceive healthy aging and what they need to do to stay healthy as they age can help public policy planning to enhance the lifestyles of middle-aged and elderly people. AIMS: The purpose of this study was to clarify the concept of healthy aging and strategies to achieve it from the perspective of middle-aged people in Tehran, Iran. SETTING AND DESIGN: This qualitative study was performed on 21 middle-aged people aged 45-59 years of Tehran in 2019. SUBJECTS AND METHODS: The data collection was carried out through semi-structured and in-depth interviews; the interviews were audiotaped, transcribed. Sampling was carried out gradually until data saturation through purposive sampling was achieved. STATISTICAL ANALYSIS USED: Data collection and analysis were performed simultaneously. Data were analyzed using conventional content analysis. To establish the reliability and validity of findings, Graneheim and Landman criteria were considered. RESULTS: The middle-aged perspective on healthy aging was included in four main themes: having good physical and mental health, having financial well-being, having social support. Strategies for achieving healthy aging were included in five themes: future financial planning, promoting physical health, promoting psychological health, maintaining and improving communication. CONCLUSION: From the middle-aged perspective, healthy aging and strategies to achieve it are multidimensional. Planning for promotional interventions to have a healthy old age should be including all dimensions and done from the years before old age.

Middle-aged preparation for healthy aging: a qualitative study.

BACKGROUND: Preparing for aging is investing resources in preparing to cope with the challenges that are expected to happen in older age. This will lead to an increase in the quality and well-being in aging. The present study was conducted to elucidate the preparation of the middle-aged people for healthy older age in Tehran, Iran. METHODS: The present study was performed with a qualitative approach and using semi-structured interviews with 23 Iranian middle-aged people (45 to 59 years old), selected by purposive sampling, and the interviews continued until theoretical saturation. Data were analyzed using the content analysis technique with MAXQDA 10 software. RESULTS: The preparation of the middle-aged people was examined in four main categories including staying healthy, financial perspective for the future, outlook on aging, and planning for use time productively. The middle-aged people paid more attention to Staying healthy than other dimensions and the saw their future financially as very dark. Outlook on aging and planning for use time productively dimensions were less considered by the subjects. DISCUSSION: Preparing for healthy aging is a multidimensional concept. The results of the study showed that the middle-aged studied in Iranian society rarely had the necessary preparation and planning to have healthy aging, also preparation is outside the individual behavioral factors and is more affected by the economic situation of the society. So, interventions and the country's macro-policy are needed to plan for healthy aging these people.

Exploration of the primary needs of health care services for earthquake victims in the west of Iran.

BACKGROUND: Natural disasters always have significant effects on social infrastructures, living conditions, and health care systems. This study aims to explain the needs of victims in the west of Iran for primary health care services. MATERIALS AND METHODS: This thematic content analysis and qualitative study was done from September 2020 to June 2021 in the west of Iran. Participants were selected using purposive sampling method. The data were extracted through semi-structured interviews with 17 earthquake victims and then examined through thematic content analysis. RESULTS: By analyzing and coding the data, the primary needs of victims post an earthquake in the west of Iran were classified into four main categories) health services, mental health, social health, and health management (and 14 subcategories. CONCLUSION: Regarding the primary needs (health services, mental health, social health, and health management), establishing a headquarters to meet the immediate and special health care needs seems to be required. It was recommended to create institutions for monitoring and supporting the health care needs at the level of the community and even policymaking, as well as guiding earthquake-stricken areas such as the eco-village.

Development and psychometric properties of a questionnaire to evaluate sustainable waste separation behavior and environmental health promotion.

BACKGROUND: Assessment of benefits and barriers of waste separation at source is necessary to identify the effective factors in this field. This study aims at designing and validation of a questionnaire assessing the barriers and benefits of waste separation at source from the viewpoint of women based on the community-based social marketing model in Genaveh Township, Bushehr, Iran METHODS: In phase 1, a literature review and focus group discussion were conducted to identify the barriers and benefits of waste separation at the source and to design the items and questionnaires. In phase 2, a psychometric evaluation was performed, including face validity, content validity, structural validity, and reliability. Data were analyzed by SPSS and R software. RESULTS: Out of 56 initial items, seven items with the content validity ratio less than 0.56 were removed, and one with the content validity index less than 0.79 was reviewed. Content validity ratio of the questionnaire was 0.782 and content validity index 0.957. The results of exploratory factor analysis showed that the five and seven-factor models showed good fit. Considering the possible existence of some items in several factors, confirmatory factor analysis was used in the next step. Finally, two items were removed and two others were displaced. The reliability of the instrument was confirmed by internal consistency (α = 0.92) and its stability by the test-retest (ICC = 0.83). CONCLUSIONS: The valid and reliable 48-item questionnaire is a suitable instrument for assessing the barriers and benefits of waste separation at source from the viewpoint of women based on the community-based social marketing model in Genaveh Township, Bushehr.

Students' beliefs about smokeless tobacco use in Chabahar city: A qualitative study using focus groups.

BACKGROUND: Smokeless tobacco use is a public health problem. This study explored students' beliefs about smokeless tobacco use in Chabahar, Iran. MATERIALS AND METHODS: The qualitative study was conducted using three Focused Group Discussions among 24 students aged 12-14 years in Chabahar City. Focus Group Guide Morgan was used. Qualitative Content Analysis was used to explore and extract codes and themes. The data analysis process was carried out in accordance with the stages of proposed by Graneheim and Lundman. Guba and Lincoln criteria were used for evaluating research transferability. RESULTS: Two main themes emerged from the analysis including; beliefs of being useful and harmful. Each of these themes is divided into subthemes with useful or harmful physical and psychological beliefs. Four subthemes included: beliefs of being useful physically, beliefs of being useful psychologically, harmful beliefs physically, and harmful beliefs psychologically. CONCLUSIONS: One of the more significant findings to emerge from this study is that many students mentioned the benefits of using smokeless tobacco to reduce toothache, relieve headaches, and bad breath. This information can be used to develop targeted interventions aimed at reducing smokeless tobacco consumption. However, more research on this topic needs to be undertaken before the association between kinds of beliefs and smokeless tobacco consumption is more clearly understood.

The Reasons for Using Smokeless Tobacco: A Review.

BACKGROUND: Smokeless tobacco use is a public health problem in some parts of the world. The major objective of this study was to investigate the reasons and factors of consumption. METHODS: A content analysis was conducted on articles for the past thirty years (1989-2019). We reviewed and selected 400 abstracts of original articles from PubMed databases by the search strategy, and reviewed one by one. Among these, 45 abstracts were selected, in which the patterns of use, the reasons for using, and the determinants and predictors were described. Eleven papers were selected based on the results and related to the research objectives. The results of these articles were evaluated precisely word by word and phrase by phrase with content analysis method and inductive approach. RESULTS: The reasons for the use of smokeless tobacco fell in two main themes: socio-cultural structure; and, beliefs, each contained Sub-themes such as "culture and living conditions", "laws", "family and peer relationships", "beliefs related to psychological" and "beliefs related to physical influences", "beliefs", "The role of harm perceptions ". CONCLUSION: There was a difference between beliefs, cultures and social conditions among the people about using of smokeless tobacco and the association of these factors is investigated in future studies. We also suggest for the prevention and control of smokeless tobacco use, cultural norms and beliefs will need to address adequately.

Determinants of mammography screening in Tehranian women in 2018 based on the health belief model: A cross-sectional study.

BACKGROUND: Breast cancer is the most common type of cancer among women. Mammography is the most sensitive and important method for screening and early diagnosis of breast cancer. Considering the importance of using mammography in breast cancer screening, this study was performed to evaluate mammographic determinants. MATERIALS AND METHODS: In the cross-sectional study, we surveyed 985 women over 40 years in Tehran concerning demographic characteristics: age, socioeconomic status, a problem in the breast, alcohol use, drug use, and health belief model. Logistic regression was used to identify determinant factors associated with mammography performance. RESULTS: The results of this study showed that 42.1% (95% confidence interval [CI]: 38, 45) participant performed mammography at least once during their lifetime. Age (odds ratio [OR] = 4.252; 95% CI = 2.041-8.857); housing situation (OR = 1.706; 95% CI = 1.178-2.469); having breast problems (OR = 5.224; 95% CI = 3.501-7.795); socioeconomic status (OR = 1.855; 95% CI = 1.035-3.325); family income level (OR = 1.998; 95% CI = 1.028-3.884); alcohol consumption (OR = 2.676; 95% CI = 1.344-5.328); smoking (OR = 2.824; 95% CI = 1.418-5.623); self-efficacy (OR = 1.935; 95% CI = 1.242-3.015); perceived barriers (OR = 2.017; 95% CI = 1.348-3.019); self-care (OR = 4.901; 95% CI = 3.152-7.620); perceived susceptibility (OR = 1.971; 95% CI = 1.271-3.057) and perceived severity (OR = 1.830; 95% CI = 1.170-2.860) were mammography behaviors determinants. CONCLUSION: The findings indicated that the rate of mammography screening among Tehranian women is low and highlights the need for developing a comprehensive national breast cancer control program, which should be considered as the priority for health-care providers. Furthermore, the identification of these factors can help to design an appropriate educational intervention that focuses on the benefits of mammography screening.

Qualitative exploration of the factors influencing the use of dietary supplements in Iranian women: introduction to areas of focus for developing interventions.

BACKGROUND: Literature shows that the consumption of Dietary Supplements (DS) is more common in Iran. This study aimed to explore the experiences of a sample of Iranian women regarding the factors influencing the use of DS. METHODS: This qualitative content analysis study was conducted in Qods city, Tehran province, Iran from January to March 2020. Forty-two semi-structured in-depth interviews were performed with women. The participants were asked about their experiences about the determinants of the consumption of DS. After the first round of the interviews was done, we performed content analysis of the data and continued up to data saturation. RESULTS: Two main themes including personal factors (with 5 subthemes including sociodemographic characteristics, perceived benefits of DS, history of illness, physiological conditions, and lifestyle factors) and socio-economic factors (with 3 subthemes including subjective norms, the price of food and commercial considerations of the sectors involved in the production and sale of DS) emerged as the experiences of the participants as to the intake of DS. CONCLUSIONS: These variables may suggest areas which need to be focused on for performing more effective interventions to affect appropriate consumption of DS in Iran.

Causes and Grounds of Childbirth Fear and Coping Strategies Used by Kurdish Adolescent Pregnant Women in Iran: A Qualitative Study.

BACKGROUND: Fear of childbirth is one of the most common problems among pregnant women that can threaten their and their baby's health. Therefore, the purpose of this study was to explore the causes and grounds of childbirth fear and the strategies used by pregnant adolescent women in Iran to overcome such fears. METHODS: In this study, which was conducted among primiparous Kurdish women in Iran, conventional qualitative content analysis was used. Data were selected through purposive sampling and semi-structured interviews. Data saturation was reached with 15 participants. The Lincoln and Guba criteria were used to strengthen the research. RESULTS: After analyzing the data, two main categories were resulted. The first category was fear of childbirth with subcategories of fear of child health, fear of childbirth process, fears about inappropriate medical staff performance, fears about hospital environment, and postpartum fears. The second category was strategies to reduce childbirth fear with subcategories of choosing appropriate medical centers, increasing information on childbirth, avoiding stressful sources, improving self-care, getting prepared for delivery day in advance, and resorting to spirituality. CONCLUSION: Pregnancy in adult age is better than adolescent age. The women's fear can be reduced by increasing their assurance about child health, providing appropriate training during pregnancy, explaining the whole process of childbirth and making it easier, improving the hospital environment and medical staff specialization, as well as providing appropriate conditions for further care and support after birth.

The prevalence of burnout and its relationship with capital types among university staff in Tehran, Iran: A cross-sectional study.

BACKGROUND: Burnout is a job-related syndrome that is common among university staff, and it is caused by various factors. The purpose of this study was to investigate the prevalence of burnout and its relationship with capital types among university staff in Tehran, Iran. METHODS: A cross-sectional descriptive-analytical design was used in which 420 staff were randomly sampled from the Iran University of Medical Sciences. For data collection, the researchers used the Burnout Inventory of Maslach and Jackson and Capital Types Questionnaire. The data were entered into SPSS software (Version 22) and analyzed by descriptive and inferential statistics and regressions. RESULTS: The mean burnout of staff was 84.42, and 45.9% of them had high burnout. A significant relationship was found among capital types, work experience, gender, education, and burnout. Multiple linear regressions also showed that independent variables estimated about 32% of the variance of the dependent variable, social capital, gender, and work experience, contributed more to explaining and predicting burnout index. CONCLUSION: Regarding the relationship between burnout and capital types (economic, cultural, and social), it is necessary to increase capital by increasing cultural activities, staff's knowledge level, income levels, informal groups, and finally, strengthening interpersonal relationships among staff.

Can adopting skin cancer preventive behaviors among seafarers be increased via a theory-based mobile phone-based text message intervention? A randomized clinical trial.

BACKGROUND: One of the main occupational hazards for seafarers is the long exposure to sunlight. This study aimed to determine the efficacy of a mobile phone-based text message intervention in adopting skin cancer preventive behaviors among a sample of seafarers in Genaveh port located in Bushehr province, Iran. METHODS: In this randomized controlled trial, 136 seafarers were randomly selected and assigned to the intervention (n = 68) or a control groups (n = 68). As a theoretical basis, we followed the Protection Motivation Theory (PMT) variables to develop the text messages. The data related to PMT variables and skin cancer preventive behaviors were collected through a questionnaire. Forty-five text messages were designed, pre-tested and sent to the seafarers' phones in the intervention group in 45 days. Both groups were followed up 1 month after the intervention. Data collected in the two stages were analyzed using paired-samples t-test, ANCOVA, and Chi-square tests. RESULTS: Following the intervention, the mean scores of adopting skin cancer preventive behaviors (p = 0.001), perceived self-efficacy (p = 0.01), protection motivation (p = 0.02), and fear (p = 0.001) were significantly higher in the intervention group than the control group. There was significant reduction in the response costs (p = 0.05) and perceived rewards (p = 0.01) scores in the intervention group compared with the control group after the intervention. However, there were no significant differences in the perceived vulnerability (p = 0.14), perceived severity (p = 0.09), and response efficacy (p = 0.64) between the two groups after the intervention. CONCLUSIONS: The results of the study indicated the effectiveness of mobile phone-based text message intervention for increasing skin cancer preventive behaviors in Iranian seafarers. TRIAL REGISTRATION: Iranian Registry for Clinical Trial (the link to trial: https://www.irct.ir/trial/7572 ). Registered 16 July, 2016. Prospectively registered.

Experiences and challenges of Prostitute Women in Iran: A phenomenological qualitative study.

BACKGROUND: Prostitutes in Iran are faced with many challenges and problems that pose risks to their health. OBJECTIVE: The present study is an attempt to identify and narrate the challenges and experiences of Iranian prostitutes based on a qualitative approach. METHODS: This qualitative study was conducted with a phenomenological approach in (2018) in Tehran, Iran. The data were collected through semi-structured interviews with 22 prostitutes who were selected using a snowball sampling method and analyzed with Colaizzi's method. In order to examine the quality of findings, Guba and Lincoln's measures were used. RESULTS: Data analysis results were classified into five main categories and 14 subcategories. The main issues are: The experience of violence, Heath risk, social ostracism, objectifying, and lack of social and legal supporting structures. CONCLUSION: Prostitutes in Iran experience numerous problems at personal and social levels. By providing social, economic, and legal supports for them such as social services (e.g. educations on how to use contraceptives, how to have safe sexual intercourse, and free counseling services for mental support), we can improve their health and welfare.

Qualitative study of social determinants of child marriage in Kurdish regions of Iran: Evidence for health promotion interventions.

INTRODUCTION: One of the most thought-provoking problems in the world is child marriage that is affected by various factors. Therefore, the purpose of this study is to identify the social determinants of child marriage in Kurdish regions of Iran. MATERIALS AND METHODS: This qualitative study was conducted using conventional content analysis approach. The participants of the study were 30 Iranian-Kurdish women married under the age of 18 who were selected through purposeful and snowballing sampling. Data collection was conducted through semi-structured interviews and face-to-face interviews and continued until the saturation of concepts was achieved. Graneheim and Lundman method was used to analyze the data, and Guba and Lincoln criteria were used to strengthen the research. RESULTS: In general, findings include 5 categories and 17 subcategories: 1 - economic factors (financial problems and economic benefits); 2 - sociocultural factors (social customs, cultural beliefs, community encouragement, social learning, gaining prestige, and social support); 3 - individual factors (physical characteristics, personality traits, lack of awareness of the damaging consequences of early marriage, and fear of the future); 4 - family factors (dysfunctional family, weak awareness of parents, and harm prevention); and 5 - structural factors (high demand, limited access to educational services, and the lack of supportive social and legal structures). CONCLUSION: By raising the level of awareness and attitude of girls and their families about the consequences of early marriage, creating the culture of correcting cultural beliefs and social misconceptions, passing appropriate laws, and the use of local and national media to prevent child marriage, this social harm can be reduced.