Cost-effectiveness of pretreatment HIV drug resistance testing in people living with HIV in Iran.

INTRODUCTION: HIV drug resistance (HIVDR) is an important challenge in the fight against HIV/AIDS and can threaten progress toward achieving the target of HIV elimination by 2030. Genotyping pretreatment HIVDR testing (DRT) has been proposed as a potential solution. However, the cost-effectiveness of this intervention needs to be evaluated to determine its feasibility and potential impact on healthcare systems. This study aimed to assess the cost-effectiveness of DRT among people living with HIV (PLHIV) in Iran. METHODS: 1000 hypothetical PLHIV were simulated in terms of cost and effectiveness based on quality-adjusted life Years (QALY). The Markov Model was developed to calculate incremental cost-effectiveness ratio (ICER) using TreeAge Pro 2020. Deterministic and probabilistic analyses were performed for sensitivity analyses. RESULTS: Results showed that compared to not performing pretreatment HIVDR testing, this intervention gained 0.035999 QALY with an incremental cost of 1,695.32 USD. The ICER was calculated as 47,093.53 USD, indicating that pretreatment DRT was not cost-effective. The probability of opportunistic infection (OI) in people with viral failure, the effectiveness of Dolutegravir in people without drug resistance, and the quality of life (QoL) of people in the AIDS stage were found to be the most important variables affecting ICER. With an increasing willingness to pay more than 53,000 USD, pretreatment DRT testing will become cost-effective. CONCLUSION: Based on our findings, pretreatment HIVDR testing is not currently cost-effective in Iran as it imposes high costs on healthcare systems with few benefits for People living with HIV (PLHIV). However, if resources are available, drug resistance testing can be a valuable tool in generating HIV molecular data and molecular surveillance of HIV.

Is opium use related to the increased risk of oral cavity cancers? A case-control study in Iran.

BACKGROUND: Oral cavity cancers (OCCs) are the sixth most prevalent cancers in the world. There are strong evidences showing the risk of the cigarette smoking, alcohol use, poor oral hygiene and some types of diets in OCCs; however, few studies explored the relationship between opium and its derivatives (O&D) use and OCCs incidence. The aim of this study was to investigate the relationship between consumption of O&D and the incidence of OCCs. METHODS: In a case-control; 133 patients with OCCs and 266 healthy controls matched by age, sex, and place of residence were included. Data, including cigarette smoking, O&D, alcohol and others tobacco (Nass, pipe and hookah) use and diet, were collected using a structured questionnaire. The relation between the use of O&D and OCCs was evaluated using conditional logistic regression. RESULTS: Opium ever-use was associated with an increased risk of OCCs (Adjusted Odds Ratio (AOR) =2.36, 95 % CI: 1.16-4.78). A dose-response relation was observed between the amount of daily O&D use and OCCs; and the relation was stronger in high users (AOR for low users = 1.38, 95 %CI: 0.58-3.24 and AOR for high users = 4.85, 95 % CI:1.79-13.11). Those who used opium for more than 18 years were highly at risk of OCCs (AOR= 5.04, 95 % CI, 2.00-12.68). Also, OCCs was higher among subjects starting the use of O&D at younger ages (≤ 50 years old vs never users AOR = 3.32, 95 % CI: 1.19-9.23). The smoking method of consuming O&D increased the odds of getting OCCs more than twice (AOR= 2.02, 95 % CI, 1.03-3.94), and using both smoking and oral consumption simultaneously, increased the odds of getting OCCs more than 8 times (AOR= 8.57, 95 % CI, 1.68-43.70). Also, the use of other tobacco products (Nass, pipe and hookah) increases the odds of getting OCCs by 4 times (AOR= 3.90, 95 % CI, 1.12-13.57) CONCLUSIONS: The results showed that opium use is probably a dose related risk factor for oral cavity cancers. Therefore, it is necessary to implement preventive policies to control the use of opioids.

The effectiveness of court-mandated compulsory treatment in promoting abstinence among people with substance use disorders in Iran.

BACKGROUND: In Iran, people living with substance use disorders who engage in public drug use may be subjected to court-mandated treatment in compulsory drug detention and rehabilitation centers (CDDRC). This study aims to assess residential CDDRC's effectiveness in promoting sustained abstinence among people who use drugs (PWUD) in Kerman, Iran. METHODS: Between October 1, 2021, and September 30, 2022, 1,083 adult male PWUD with a diagnosis of substance use disorders and a history of engagement in public drug use were admitted to the CDDRC in Kerman. They were followed-up for 12 months after discharge. The relationship between baseline variables and abstinence, assessed using rapid urine tests, was examined using crude logistic regression models. RESULTS: Most PWUD were 30 or older (n = 876, 80.9 %) and had a history of previous CDDRC admission (n = 638, 58.9 %). At the end of the 12-month follow-up, only 2.6 % (95 % confidence intervals: 1.7-3.7) were abstinent. Individuals with limited education (Odds ratio [OR] = 3.43; 1.50-7.95) and those with a prior history of admission to the CDDRC (OR = 3.73; 1.55-9.89) had increased odds of relapse. CONCLUSIONS: The effectiveness of CDDRC in promoting abstinence among the participants was minimal. This highlights the necessity of reassessing support and investment in these interventions and considering more evidence-informed alternative approaches in Iran.

Correlates of quality of life and mental health among youth experiencing homelessness in Iran.

BACKGROUND: Quality of life (QOL) and mental health among marginalized populations, including people experiencing homelessness in Iran, are understudied. We assessed the QOL and mental health status as well as their associated factors among youth experiencing homelessness in Kerman, Iran. METHOD: We recruited 202 participants using a convenience sampling method from 11 locations, including six homeless shelters, three street outreach sites, and two drop-in service centers, from September to December 2017. Data were collected using a standardized questionnaire that included QOL, mental health, demographics, drug use, and sexual behaviors questions. Scores in each domain were indexed with a weight of 0-100. The higher score indicated a higher QOL and mental health status. Bivariable and multivariable linear regression models were performed to examine correlates of QOL and mental health. RESULT: The mean (SD) score of QOL and mental health were 73.1 (25.8) and 65.1 (22.3), respectively. Multivariable analysis showed that youth experiencing homelessness who were aged 25-29 years old (ß = -5.4; 95% CI: -10.51; -0.30), and lived on the streets (ß = -12.1; 95% CI: -18.19; -6.07) had a lower mental health score. Moreover, those who had higher education (ß = 5.4; 95% CI: 0.58; 10.38), had no history of carrying weapons (ß = 12.8; 95% CI: 6.86; 18.76), and had a higher QOL score (ß = 0.41; 95% CI: 0.31; 0.50) had a higher mental health score. CONCLUSION: This study highlights that QOL and mental health among youth experiencing homelessness in Iran are concerning, particularly among those who were older, were less educated, were living on the street, and had a history of carrying a weapon. Community-based programs, including mental health care and affordable housing are needed to improve QOL and mental health among this population in Iran.

Factors related to earthquake preparedness of households based on social-cognitive theory constructs: A systematic review.

Background: Earthquakes cause many casualties worldwide. Taking preventive measures and improving community preparedness is critical to reducing earthquake damage. The social cognitive theory explains how individual and environmental factors cause behavior. This review was conducted to identify the social cognitive theory structures, in research on the preparedness of households against earthquakes. Materials and methods: This systematic review was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search was conducted from January 1, 2000, to October 30, 2021 in Web of Science, Scopus, PubMed, and Google Scholar. Studies were selected based on inclusion and exclusion criteria. The initial search yielded 9,225 articles, and finally, 18 articles were selected. Articles were assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist. Results: Eighteen articles about disaster preparedness behaviors based on the socio-cognitive constructs were identified and reviewed. The essential constructs used in the reviewed studies included self-efficacy, collective efficacy, knowledge, outcome expectations, social support, and normative beliefs. Conclusion: By identifying the dominant structures that have been used in studies related to the preparedness of households against earthquakes, researchers can implement appropriate and more cost-effective interventions by focusing on improving suitable structures.

Development and Psychometric Properties of a health-promoting self-care behavior scale (HPSCB-S) in recovered patients from Drug Addiction.

BACKGROUND AND OBJECTIVES: Drug addiction is a chronic and relapsing brain disease. Practicing self-care is one of the rules offered by therapists to improve the withdrawal process and prevent relapse. Based on the evidence, health beliefs, including Pender's proposed model, are significantly effective in adopting self-care behaviors in patients. On the other hand, in order to evaluate preventive interventions regarding drug use and relapse of drug use; Having a good and appropriate tool is a special priority. Therefore, the present study aims to design and determine the psychometric characteristics of the questionnaire for measuring health-promoting self-care behaviors in patients recovered from drug addiction has been carried out in the west of Mazandaran province. METHODS: The current study is a cross-sectional descriptive methodological research. In the first stage, the items and primary classes of the new tool were extracted based on the review of studies consistent with Pender's self-care promotion and a questionnaire was designed. In the second stage, the psychometric characteristics of the designed questionnaire were examined using face validity, content validity, construct validity and reliability. In the construct validity, the number of participants was 245 for exploratory factor analysis and 203 for confirmatory factor analysis. In the reliability test, 25 people participated to check internal consistency and test-retest. Random sampling was done from 12 drug addiction treatment clinics in two cities of Tonkabon and Ramsar in the west of Mazandaran province during 2021-2022. Data were analyzed using SPSS and AMOS software version 23. RESULTS: The exploratory factor analysis revealed 7 factors containing 29 item explained more than 61% of the total observed variance. The results of confirmatory factor analysis showed that the data fit the model. In the reliability test, Cronbach's alpha coefficient indicated the appropriate internal consistency of the tool and retesting the tool with an interval of 2 weeks showed acceptable stability of the tool. CONCLUSION: The present study showed that the researcher-made questionnaire has good validity and reliability and can be used to measure self-care behaviors of patients who have recovered from addiction in order to provide appropriate solutions to prevent the relapse of drug use.

Investigating the relationship between high-risk behaviors and mental health in adolescents in Rabor city, Iran.

OBJECTIVES: High-risk behaviors (HRBs) represent significant health threats for adolescents and significantly affect adolescents' mental health. Adolescents often engage in risky behaviors. The present study was conducted to investigate the relationship between high-risk behaviors (HRBs) and mental health in adolescents in Rabor. CONTENT: The present study was a cross-sectional analytical study that was performed on 334 girl and boy students aged 12-18 years in Rabor city in 2021. In this study, adolescents answered high risk behaviors and mental health questionnaires. Data were analyzed using SPSS-26 software and the spearman correlation coefficient and linear regression analysis (univariate and multivariate analysis) were used to analyze the data. SUMMARY AND OUTLOOK: In this study, the mean age was 15.25 ± 1.78. The findings indicate that smoking and hookah use were higher in boys than girls. Among the demographic variables, age and level of education had a positive and significant relationship with HRBs and mental health (p<0.05). The mean score of total mental health for all subjects was 12.83 ± 10.82. The variables of age, sex, marital status of parents, the number of children in the family, educational level, smoking, hookah, and alcohol have been determined as influential and facilitating factors in HRBs of adolescents. Father's literacy was considered as a facilitator and age variables, alcohol consumption and parents' marital status were considered as deterrents to mental health. The present study showed that the male gender is one of the risk factors for alcohol, smoking and other substances, the tendency to high-risk sexual behaviors, depression, and suicide in adolescents. Among the determinants of the tendency to HRBs in adolescents, psychological variables are of particular importance at the individual, social, and family levels. Good mental health can improve quality of life, while poor mental health can make it worse.

Teacher violence from the perspectives of teachers and students and related factors: A survey in Southern Iran.

Introduction: Teacher violence is defined as the intentional use of power by teachers against students in a variety of ways, including physical, verbal, psychological, and sexual assault. Victims of school violence are more anxious and insecure than other students. An in-depth and comprehensive study on the prevention of violence in schools is urgent and necessary. We conducted this study to determine teacher violence from the perspectives of schoolteachers and students and related factors. Methods: We conducted this descriptive-analytical study on 313 teachers and 400 students in Ardestan, southern Iran, in 2019. We selected teachers and students using a census method and stratified random sampling, respectively. The research instrument was the school violence questionnaire. Results: From the perspective of teachers, the mean score of teacher violence (5.7) was significantly lower than that of students (18.3). Male, young, single teachers with diploma and less work experience had significantly higher violence scores than other teachers (P < 0.001). We witnessed this trend in public boys' schools as well (p < 0.001). The total mean score for teacher violence was not significantly different between male and female students. From the perspective of students, the mean score of teacher violence was significantly different (P < 0.001). Conclusion: Our results suggest that education authorities and school principals should supervise public school teachers with less education, younger students, and boys' schools and provide practical training to improve the communication and emotional skills among these teachers.

Breastfeeding Duration and Its Effective Factors in Kerman Province, Iran.

Introduction: Complete cessation of breastfeeding (CCB) at the right time is as important as starting breastfeeding, as well as identifying the factors that affect the duration of breastfeeding, so that breastfeeding promotion programs focus on these causes, to increase mothers' ability and desire to breastfeed. This study aimed to determine the time of CCB and its related factors. Methods: This analytical cross-sectional study was conducted in 2020. This study was performed at all health centers and health homes affiliated to Kerman University of Medical Sciences, in Kerman province, Iran. A total of 802 urban and rural mothers with children aged from 30 to 36 months completed the questionnaire. The validity and reliability of the questionnaire were confirmed by Cronbach's alpha of 85%. Data were analyzed using SPSS software version 16. Results: The mean time of breastfeeding was 19.23 ± 7.09 months and the median was 22-month-year. About 41% of children were breastfed until 24-month. There was a significant relationship between the time of CCB with contraception, number of households, place of residence, and weight at 6-month at the level of 0.05. Conclusion: Duration of breastfeeding is influenced by some demographic and cultural factors. The timing of the CCB is near to the suggestions of the World Health Organization (WHO) and religious teachings.

Communication barriers to education to referrals from the perspective of referrals to health centers and health care providers.

Introduction: One of the most important factors affecting the increase of clients' satisfaction is how health care providers (HCP) communicate with clients. On the other hand, different factors can hinder proper communication and thus education, which is one of the main tasks of HCP. Therefore, the purpose of this study was to investigate communication barriers to education to referrals from the perspective of referrals to health centers (RHC) and HCP. Method: This descriptive-analytical study was conducted on RHC and HCP in Kerman in 2021. Using a multi-stage sampling method, 162 HCP and 414 RHC were included in the study. The data collection tool was two researcher-made questionnaires. Data were analyzed using SPSS 16. Findings: From the perspective of RHC and HCP, most communication barriers were related to environmental and then socio-cultural factors. Among the demographic variables of HCP, level of education showed a significant relationship with the physical-psychological, verbal-non-verbal, and informational domains. And in relation to RHC, a significant relationship was found between education and job in the socio-cultural field and environmental barriers (p < 0.05). Conclusion: HCP face a variety of barriers in educating people, most of which are related to environmental factors. Given the cost-effectiveness of education to the public, it is essential that planners and policymakers use strategies to eliminate environmental factors as well as the placement of indigenous HCP in health facilities to reduce communication barriers.

Quality of Life and Its Association With HIV-Related Stigma Among People Living With HIV in Kerman, Iran: A Cross-Sectional Study.

ABSTRACT: This study aimed to evaluate the quality of life (QoL) and its association with HIV-related stigma among people living with HIV (PLHIV) in Kerman province, southeast Iran. A convenience sample of 104 PLHIV was recruited. Data on QoL were collected using the HIV/AIDS-Targeted QoL instrument. Internal and external stigma were measured using an instrument developed by UNAIDS. The average QoL score was 52.5 ( SD =13.9). In multivariable model, PLHIV who experienced higher external stigma score (B = -1.9; 95% confidence interval [CI]: -2.6 to -1.1) and higher internal stigma score (B = -1.1; 95% CI: -1.5 to -0.6) had lower level of QoL. The low level of QoL among PLHIV in Iran indicates the need for initiatives to increase QoL among this population. Our data suggest that QoL in PLHIV could be improved by interventions aimed at reducing stigma in both community and health care settings.

Estimating the Number of COVID-19 Cases and Impact of New COVID-19 Variants and Vaccination on the Population in Kerman, Iran: A Mathematical Modeling Study.

COVID-19 is spreading all over Iran, and Kerman is one of the most affected cities. We conducted this study to predict COVID-19-related deaths, hospitalization, and infected cases under different scenarios (scenarios A, B, and C) by 31 December 2021 in Kerman. We also aimed to assess the impact of new COVID-19 variants and vaccination on the total number of COVID-19 cases, deaths, and hospitalizations (scenarios D, E, and F) using the modified susceptible-exposed-infected-removed (SEIR) model. We calibrated the model using deaths reported from the start of the epidemic to August 30, 2021. A Monte Carlo Markov Chain (MCMC) uncertainty analysis was used to estimate 95% uncertainty intervals (UI). We also calculated the time-varying reproductive number (R t) following time-dependent methods. Under the worst-case scenario (scenario A; contact rate = 10, self-isolation rate = 30%, and average vaccination shots per day = 5,000), the total number of infections by December 31, 2021, would be 1,625,000 (95% UI: 1,112,000-1,898,000) with 6,700 deaths (95% UI: 5,200-8,700). With the presence of alpha and delta variants without vaccine (scenario D), the total number of infected cases and the death toll were estimated to be 957,000 (95% UI: 208,000-1,463,000) and 4,500 (95% UI: 1,500-7,000), respectively. If 70% of the population were vaccinated when the alpha variant was dominant (scenario E), the total number of infected cases and deaths would be 608,000 (95% UI: 122,000-743,000) and 2,700 (95% UI: 700-4,000), respectively. The R t was ≥1 almost every day during the epidemic. Our results suggest that policymakers should concentrate on improving vaccination and interventions, such as reducing social contacts, stricter limitations for gathering, public education to promote social distancing, incensing case finding and contact tracing, effective isolation, and quarantine to prevent more COVID-19 cases, hospitalizations, and deaths in Kerman.

Lonely, harassed and abandoned in society: the lived experiences of Iranian homeless youth.

INTRODUCTION: Homelessness is increasing among young adults in large cities. According to the United Nations, there are more than one billion absolute or relative homeless people in the world. This study was conducted to explain the lived experiences of homeless youth in southeastern Iran. MATERIALS AND METHODS: In this qualitative study, we recruited 13 participants in a big city, southeast Iran, in 2020. The participant was young homeless adults aged 18-29 years who were using homeless shelters provided by the municipality, sleeping in parks or on streets. Data were collected through in-depth and semi-structured interviews and three focus group discussions. Data were analyzed by conventional qualitative content analysis. RESULTS: The main category of "lonely, annoyed, and abandoned in society" and three subcategories of avoidance of/by society, comprehensive harassment, and lack of comprehensive support were extracted. The experiences of young homeless adults showed that they escaped from the community due to addiction, feeling like a burden to others, and social isolation, and not only have they been left without support in society, but they have also suffered from all kinds of physical and psychological harassments. CONCLUSION: The lived experiences of homeless people show that in addition to appropriate facilities and living conditions, they require respect, reduced social stigma, discrimination, and favorable conditions for a return to life. Therefore, authorities should identify and settle their problems and needs.

Self-Care Practices and Related Factors in Patients with Multiple Sclerosis (MS) Based on the Health Belief Model.

Introduction: Self-care programs can raise health in patients with Multiple Sclerosis (MS). This study aimed to identify the self-care behaviors and determinants in patients with MS according to the Health Belief Model (HBM). Methods: In this cross-sectional study, we included 280 MS patients through convenience sampling method. The collection tool was a self-administered questionnaire based on HBM. The participants were the members of MS society in Kerman, Iran. The data were analyzed using descriptive statistics, path analysis, and multivariable linear regression in SPSS software Version 22. Results: The mean (SD) score for self-care practices was 2.86 (0.64), and medication adherence was the most conducted practice. The perceived benefits and cues to action exerted positive influence on self-care practices. The most frequent symptoms experienced by the participants were fatigue (82.5%), visual impairment (76.4%), headaches (72.1%), and muscle weakness (71.4%). The most important cues to action for self-care behavior were the physician (77%), media (52%), and other MS patients (32%). Conclusion: The quality of life (QOL) of MS patients is heavily influenced by self-care behaviors. In this study, only about half of the patients accomplished self-care behaviors, which seems to be insufficient. Since the perceived benefits and cues to action are the main predictors of self-care practices, intervention based on these two constructs can be utilized to promote self-care programs and QOL in MS patients. Health-care providers should pay more attention to these factors for promoting self-care behaviors.

"Students in public and private schools-which are at higher risk of drug use?": a survey from Iran.

BACKGROUND: Recent evidence from Western countries suggests that private school students are more prone to drug use. Such an evidence is lacking in Muslim countries. The aim of this study was to examine whether the risk of drug use is higher in private schools than public schools. METHODS: This cross sectional study was conducted on 650 tenth grade students of Kerman city, the center of largest province of Iran using cluster sampling. Well-validated questionnaires regarding current, lifetime substance use, and perceived use by classmates were utilized. Substances included in the questionnaire were waterpipe, cigarette, alcohol, marijuana, opium, methamphetamine, and Naas. Drug Use Tendency Scale was used to measure the attitudes of students towards drug use. RESULTS: The response rate was 93.7%. More than 82% of sample were public school students (n = 504). Current use of cigarette and marijuana was higher in private schools (12.2 and 3.0%, respectively) than public schools (4.4 and 0.5%, respectively) (P < 0.05). Perceived prevalence of cigarette smoking by classmates was higher among private school students. CONCLUSION: Despite the popular belief that private schools are better than public schools regarding the risk of substance use, students who attend private schools may be at a higher risk of turning to some drugs comparing to public schools in Iran.

Development and Validation of HIV/AIDS Stigma and Discrimination Scale in Southeast Iran: The General Population Viewpoint.

Stigma and discrimination are one of the important challenges in coping with HIV infection. Stigma and discrimination are universal phenomenon for the epidemic of HIV and exposure to people with HIV. The present study aimed to develop and measure psychometrically the HIV/AIDS Stigma and discrimination scale from the general population viewpoint in southeast Iran. Data collection lasted from May to September 2016. The results showed that the "HIV/AIDS Stigma and discrimination scale" had an acceptable internal consistency and stability (Cronbach's alpha coefficient = 0.69, omega coefficient = 0.7, and r = 0.57, p = 0.001). The scale had acceptable content and face validities. The Principal Axis Factoring (PAF) with varimax rotation analysis shows that the scale has 4 dimensions: "patient social position" (5 items), "social support" (4 items), "social disease perspective" (7 items), and "social harassment" (2 items). In general, the psychometric properties of "HIV/AIDS Stigma and discrimination scale" are acceptable, and this scale can be used in studies.

Gender-based differences in risk-taking behaviors among high school students in Southeast Iran.

OBJECTIVES: Risk-taking behaviors among adolescents can negatively affect different dimensions of their health. This study was conducted to identify the gender-based differences in risk-taking behaviors among high school students in a Muslim population. METHODS: Grade 10 students studying in high schools located in Kerman Province, Iran were enrolled through cluster sampling (n=2,676), and data were collected using a well-validated questionnaire about violence, sexual behaviors, and traffic-related conduct over the past 12 months. The tool also consisted questions regarding drug use over the past 30 days and over lifetime (i. e., current and ever use of drugs, respectively). RESULTS: The number of female participants was 1,407 (52.6%). The boys who had girlfriends (33.0%) were almost twice as many as the girls who had boyfriends (17.1%). Among the respondents, 27.8 and 12.0% of the boys and girls engaged in physical fighting, respectively. Overall, the prevalence of water pipe use in the last 30 days (18.7%) and over lifetime (43.5%) was higher than that of the consumption of other substances. The second and third most popular substances used in the past 30 days among boys and girls were alcohol and cigarettes and cigarettes and alcohol, respectively. On the whole, marijuana figured in the lowest lifetime use among the respondents. CONCLUSIONS: The rate of risk-taking behaviors in female students was lower than in males, and this difference was more evident than in Western countries. This discrepancy seems to be more obvious in cases where the religious prohibition of a behavior is greater such as extramarital intimacy.

HIV-Related Stigma Among Healthcare Providers in Different Healthcare Settings: A Cross-Sectional Study in Kerman, Iran.

BACKGROUND: Stigmatizing attitudes among healthcare providers are an important barrier to accessing services among people living with HIV (PLHIV). This cross-sectional study aimed to assess the status and correlates of HIV-related stigma among healthcare providers in Kerman, Iran. METHODS: Using a validated and pilot-tested stigma scale questionnaire, we measured HIV-related stigma among 400 healthcare providers recruited from three teaching hospitals (n=363), private sectors (n=28), and the only voluntary counseling and testing (VCT) center (n=9) in Kerman city. Data were gathered using self-administered questionnaires at participants' workplace during Fall 2016. To examine the correlates of stigmatizing attitudes, we constructed bivariable and multivariable linear regression models. RESULTS: The mean ± standard deviation (SD) of stigma score was 25.95 ± 7.20 out of the possible 50, with higher scores reflecting more stigmatizing attitudes. Paramedics, nurses' aides, and housekeeping staff had the highest, and VCT personnel had the lowest average stigma scores, respectively. Multivariable regression analyses showed that prior experience of working with PLHIV (ß=-2.48; P=.03), exposure to HIV-related educational courses (ß=-2.03; P=.02), and <10 years of work experience (ß=-2.70; P<.001) were associated with lower stigma scores. CONCLUSION: Our findings highlight the need for health managers to provide training opportunities for healthcare providers, including programs that focus on improving HIV-related knowledge for healthcare providers. Enforcing policies that aim to reduce HIV-related stigma and discrimination among healthcare providers in Iran are urgently needed.

Application of Social Cognitive Theory to Prevent Waterpipe Use in Male High-school Students in Kerman, Iran.

BACKGROUND: The growing supply and prevalence of waterpipe (WP) smoking among Iranian adolescents have become a concern for both families and policymakers. The aim of this study was to determine the factors underlying WP use and also to design an intervention program based on social cognitive theory (SCT) aimed to reduce the demand for WP smoking among male adolescents. METHODS: This quasi-experimental study involved 189 high-school students in Kerman, Iran, who were split into two groups, an intervention group and a control group. A validated questionnaire based on SCT constructs was used to collect data. The intervention was performed over four sessions with a focus on preventing WP smoking. RESULTS: Before intervention, the lifetime and current-use prevalence of WP smoking across both groups was 48.5% and 20.2%, respectively. In the intervention group, the most change was related to knowledge score from 10.70 ± 4.38 to 16.52 ± 3.89 (P < 0.0001) and outcome values score from 12.40 ± 3.81 to 13.53 ± 4.23 (P = 0.007); however, in the control group, no significant changes were seen in posttest scores. The scores for self-efficacy (P = 0.21), outcome expectations (P = 0.09), and environment constructs (P = 0.06) did not show any statistically significant changes after the intervention in both groups. Overall, there was no significant difference in the rate of WP smoking after the intervention. CONCLUSIONS: Based on the results of this study, although some construct scores showed significant differences after the intervention, there was no significant change in the prevalence of WP smoking. More effective educational interventions based on this theory but with a greater focus on self-efficacy and environmental influences may be warranted.