Priority strategic directions in adolescent health in Iran based on the WHO's Global Accelerated Action for the Health of Adolescents.

OBJECTIVES: In line with the World Health Organization's Global Accelerated Action for the Health of Adolescents (AA-HA!) guidance, the goal of the current research was to identify critical strategies for adolescents' health and to determine the role and distribution of responsibilities among the leading players in the field of adolescent health in Iran. METHODS: The current qualitative and applied study is part of the Ministry of Health and Medical Education's "Adolescent, Youth and School Health" plan to develop the "National Adolescent Health Plan Document" in 2020. First, stakeholder analysis was done, then a pool of nationally appropriate strategies was selected from the list of priority strategies recommended by the WHO in the AA-HA! through several group sessions. After that, the experts selected priority strategies based on the criteria of feasibility, acceptability, effectiveness, guaranteed resources, coordination with other plans and temporal priority, scoring, and executive priorities. Eventually, the priority strategies were assigned to different players/stakeholders in the field over several sessions bearing in mind the methods of implementation and the target groups. RESULTS: The experts identified 58 priority strategies/actions for adolescent health under the seven priority areas of positive development, sexual protection, reproductive health, mental health, substance abuse, self-harm, violence, unintentional injury, communicable and non-communicable diseases, nutrition, and physical activity. CONCLUSIONS: The highest identified priority areas were in the areas of vaccination; special health care package for service providers; training and education to promote health literacy and self-care, life skills, sexual awareness, and prevention/protection against violence; community-based mental health services, planning for adolescents' spare time, substance use prevention.

Association between meal frequency with anthropometric measures and blood pressure in Iranian children and adolescents.

BACKGROUND: This study aimed to assess the association of meal frequency with anthropometric measures and blood pressure in Iranian children and adolescents. METHODS: In this national survey, 14,880 students with 6-18 years of age were selected by stratified multistage sampling method from urban and rural regions of 30 provinces of Iran. Meal frequency was assessed by a questionnaire prepared based on global school-based student health survey. Physical measurements included height, weight, waist circumference, systolic blood pressure (SBP), and diastolic blood pressure (DBP). RESULTS: The participation rate was 90.6% including 49.24% girls and 75.5% urban residents. Skipping breakfast and dinner were more frequent in girls than in boys (71.6% vs. 64.1%, 91.2% vs. 86.9%, respectively, P<0.05). Overweight, obesity, and abdominal obesity were more prevalent in those who had two meals, one meal, or very low intake (P<0.001) than those had three meals. There were no significant differences in SBP, DBP, and blood pressure across to different meal frequency groups (P>0.05). Students who had very low intake and one meal per week had a higher risk of abdominal obesity compared with those who had three meals (OR 1.7, 95% CI: 1.3-2.3, and OR 1.6, 95% CI: 1.4-2.0, respectively). CONCLUSIONS: An inverse significant association between higher meal frequency and anthropometric indices was observed. Therefore, encouraging children and adolescents for regular meal intake should be considered as a health priority in the pediatric population.

Decomposition of socioeconomic inequality in growth disorders to its determinants in pediatric population: the CASPIAN IV study.

PURPOSE: The current study aims to evaluate socioeconomic inequality in growth disorders and its determinants in Iranian children and adolescents. METHODS: In this nationwide cross-sectional survey, 14,880 students aged 6-18 years were selected through multistage cluster sampling method from urban and rural areas of 30 provinces of Iran in 2011. Socioeconomic status (SES) was calculated using principle component analysis. Socioeconomic inequality in growth disorders (including; underweight, excess weight, overweight, general obesity, abdominal obesity, and short stature) was assessed using concentration index (C) and slope index of inequality (SII). The Oaxaca Blinder decomposition method was used to determine determinants of this inequality. RESULTS: Totally, 13,486 students participated in this study (participation rate: 90.6%), comprising 50.8% boys and 75.6% urban inhabitants. Their mean age was 12.47 ± 3.36 years with no significant gender difference. The prevalence of excess weight, overweight, and general and abdominal obesity increased linearly as SES increased, and the prevalence of underweight and short stature decreased linearly as SES increased. The C index for underweight and short stature was negative, which suggests that inequality was in favor of high SES groups, and regarding overweight, excess weight, general and abdominal obesity, the index was positive, indicating that inequality was in favor of in low SES groups. CONCLUSION: Our findings show a considerable inequality in prevalence of growth disorders in Iranian children and adolescents. These findings provide practical information for health policies and programs.

Evaluating Community-Based Programs in Promoting Traffic Behaviors and Safe Road Crossing Behaviors in Youth: An Application on Theory of Planned Behavior.

BACKGROUND: Today, one of the most serious causes of mortality and disability among youth is the traffic accidents. Regarding its importance, this paper aimed to investigate the community-based program to promote the safe traffic behaviors among youth. METHODS: This was a quasi-experimental conducted on 5000 youth in five Iranian cities named Lanjan, Gomishan, Fasa, Tehran, and Zahedan in 2015-2016. The questionnaire was based on the constructs of the theory of planned behavior as well as a questionnaire of pedestrian behavior and driving behavior, which was completed before and after the intervention. The educational intervention was carried out based on the theory of planned behavior. Finally, the obtained data were analyzed using STATA software. RESULTS: Six months after the intervention, the mean score of the theory of planned behavior and safe driving behavior in different cities was significantly increased. Here, regarding the safe crossing of the street, the most behavioral changes were observed in Gomishan (P = 0.000), Fasa (P = 0.001), and Tehran (P < 0.0001). The mean score of driving behaviors in Gomishan (P < 0.000), Fasa (P = 0.016), Lanjan (P = 0.047), and Tehran (P < 0.0001) scores was significantly higher. CONCLUSIONS: In most of the studied cities, it can be concluded that education based on the theory of planned behavior can improve the safe driving behaviors among youth. Therefore, it is recommended to be implemented this program in other cities using the theory of planned behavior.

Alcohol consumption in Iran: A systematic review and meta-analysis of the literature.

ISSUES: Alcohol production, marketing and consumption are illegal in Iran. This systematic review examines the lifetime and last 12-month prevalence of alcohol consumption among the general and young population in Iran. APPROACH: We searched Web of Science, PubMed, Embase, Scopus and Iranian scientific databases (i.e. Scientific Information Database and Magiran) for relevant publications in English and Persian from inception to 12 May 2019. Following a random-effects meta-analysis, we estimated the pooled prevalence of alcohol consumption among the general population and young people (<30 years old). Meta-regression was used to identify potential sources of heterogeneity. KEY FINDINGS: Of the 2400 identified records, 62 met the inclusion criteria. The overall pooled prevalence of lifetime alcohol consumption among the general population and young people was 13.0% [95% confidence intervals (CI) 10.0, 16.0]. The overall pooled prevalence of last 12-month alcohol consumption was 12.0% (95% CI 7.0, 18.0) for the general population and 15.0% (95% CI 9.0, 22.0) for young people. The prevalence of alcohol consumption varied from 0.03% to 68.0% in different regions, 0.3% to 66.6% among males and 0.2% to 21.0% among females. IMPLICATIONS: Our findings highlight the need for public health surveillance of alcohol use in Iran. CONCLUSION: These estimates show that, on average, one in eight people in the general population have ever consumed alcohol in Iran, indicating that alcohol consumption is not an uncommon practice in the country.

Body mass index percentiles and elevated blood pressure among children and adolescents.

It is well established that obesity is associated with an increased risk of elevated and high blood pressure (BP) in children and adolescents. However, it is uncertain whether there is an increase in the risk of elevated and high BP associated with an increase of body mass index (BMI) among children and adolescents whose BMI is in the accepted normal range. Data were available for 58 899 children and adolescents aged 6-17 years from seven national cross-sectional surveys in China, India, Iran, Korea, Poland, Tunisia, and the United States. The subjects were divided into eight percentile subgroups according to their BMI levels based on the World Health Organization recommendations. Elevated BP and high BP were defined using the 2016 international child BP criteria. Compared with the reference subgroup of the 5th-24th percentiles, the odds ratios (ORs) for high BP were 1.27 (95% confidence interval [CI], 1.14-1.41; P < 0.001) in the 25th-49th percentile subgroup, 1.55 (95% CI, 1.39-1.73; P < 0.001) in the 50th-74th percentile subgroup, and 2.17 (95% CI, 1.92-2.46; P < 0.001) in the 75th-84th percentile subgroup, respectively, after adjustment for sex, age, race/ethnicity, height and country. Additionally, the corresponding ORs for elevated BP were 1.21 (95% CI, 1.10-1.32; P < 0.001), 1.55 (95% CI, 1.42-1.69; P < 0.001), and 1.80 (95% CI, 1.62-2.01; P < 0.001), respectively. In conclusion, a BMI in the 25th-84th percentiles, within the accepted normal weight range, was associated with an increased risk of elevated and high BP among children and adolescents. It is important for children and adolescents to keep a BMI at a low level in order to prevent and control hypertension.

International Waist Circumference Percentile Cutoffs for Central Obesity in Children and Adolescents Aged 6 to 18 Years.

CONTEXT: No universal waist circumference (WC) percentile cutoffs used have been proposed for screening central obesity in children and adolescents. OBJECTIVE: To develop international WC percentile cutoffs for children and adolescents with normal weight based on data from 8 countries in different global regions and to examine the relation with cardiovascular risk. DESIGN AND SETTING: We used pooled data on WC in 113,453 children and adolescents (males 50.2%) aged 4 to 20 years from 8 countries in different regions (Bulgaria, China, Iran, Korea, Malaysia, Poland, Seychelles, and Switzerland). We calculated WC percentile cutoffs in samples including or excluding children with obesity, overweight, or underweight. WC percentiles were generated using the general additive model for location, scale, and shape (GAMLSS). We also estimated the predictive power of the WC 90th percentile cutoffs to predict cardiovascular risk using receiver operator characteristics curve analysis based on data from 3 countries that had available data (China, Iran, and Korea). We also examined which WC percentiles linked with WC cutoffs for central obesity in adults (at age of 18 years). MAIN OUTCOME MEASURE: WC measured based on recommendation by the World Health Organization. RESULTS: We validated the performance of the age- and sex-specific 90th percentile WC cutoffs calculated in children and adolescents (6-18 years of age) with normal weight (excluding youth with obesity, overweight, or underweight) by linking the percentile with cardiovascular risk (area under the curve [AUC]: 0.69 for boys; 0.63 for girls). In addition, WC percentile among normal weight children linked relatively well with established WC cutoffs for central obesity in adults (eg, AUC in US adolescents: 0.71 for boys; 0.68 for girls). CONCLUSION: The international WC cutoffs developed in this study could be useful to screen central obesity in children and adolescents aged 6 to 18 years and allow direct comparison of WC distributions between populations and over time.

Factors Affecting Social Health from Young Adults' Perspective: A Qualitative Study.

BACKGROUND: Factors affecting social health, especially in young adults, are among the most important research priorities. Knowledge of social factors affecting young adults' health will lead to understand them in the social context. The present study is aimed to explain the perspective of young adults on social factors affecting health. METHODS: In the present qualitative content analysis study, semi-structured open interviews were conducted through targeted sampling of young volunteers aged 18-30 who were selected from Tehran Province. Interviews were recorded, transcribed, and analyzed. The inclusion criteria for participants were willingness to participate in the study and ability to express their personal experiences. Twenty-one data were collected through collection was done with individual in-depth interviews. RESULTS: Using this qualitative approach, the present study was conducted to identify factors affecting social health from the perspective of young adults. The analysis led to the extraction of three main categories, each with two or three subcategories: expectations regarding the community, expectations regarding the family, and expectations regarding infrastructures. CONCLUSIONS: Our findings shown that social support considered as effective elements in providing social health of young adults. The evidence on controlling factors should be considered in promoting the social health of specific target groups. The results of the present study could be used for better planning of interventions in youth social health domains.

Impact of the 2017 American Academy of Pediatrics Guideline on Hypertension Prevalence Compared With the Fourth Report in an International Cohort.

In 2017, the American Academy of Pediatrics (AAP) updated the clinical practice guideline for high blood pressure (BP) in the pediatric population. In this study, we compared the difference in prevalence of elevated and hypertensive BP values defined by the 2017 AAP guideline and the 2004 Fourth Report and estimated the cardiovascular risk associated with the reclassification of BP status defined by the AAP guideline. A total of 47 200 children and adolescents aged 6 to 17 years from 6 countries (China, India, Iran, Korea, Poland, and Tunisia) were included in this study. Elevated BP and hypertension were defined according to 2 guidelines. In addition, 1606 children from China, Iran, and Korea who were reclassified upward by the AAP guideline compared with the Fourth Report and for whom laboratory data were available were 1:1 matched with children from the same countries who were normotensive by both guidelines. Compared with the Fourth Report, the prevalence of elevated BP defined by the AAP guideline was lower (14.9% versus 8.6%), whereas the prevalence of stages 1 and 2 hypertension was higher (stage 1, 6.6% versus 14.5%; stage 2, 0.4% versus 1.7%). Additionally, comparison of laboratory data in the case-control study showed that children who were reclassified upward were more likely to have adverse lipid profiles and high fasting blood glucose compared with normotensive children. In conclusion, the prevalence of elevated BP and hypertension varied significantly between both guidelines. Applying the new AAP guideline could identify more children with hypertension who are at increased cardiovascular risk.

Dinner consumption and cardiovascular disease risk factors among a nationally representative sample of Iranian adolescents: the CASPIAN-III Study.

Introduction: This cross-sectional study aimed to assess the association between cardiovascular disease (CVD) risk factors and dinner consumption in a nationally representative sample of Iranian adolescents. Methods: The present study was conducted on 5642 adolescents aged 10-18 years old in 27 provinces in Iran. The subjects were included applying by multistage random cluster sampling. Participants who ate ≥5 dinners during a week were considered as a dinner consumer. Results: Among 5642 subjects, 1412 (25%) did not consume dinner. Dinner consumers were less likely to be overweight or obese (P < 0.001) and abdominally obese (P < 0.001) as well as to have an abnormal level of HDL-C (P = 0.02). Dinner skipper youths had a higher risk for overweight or obesity (odds ratio [OR]: 1.62; 95% CI: 1.39-1.89) and abdominal obesity (OR: 1.59; 95% CI: 1.36-1.85) which remained significant after adjusting confounding factors (P <0001). No relationship was observed between dinner consumption and the rest of the CVD risk factors, neither in crude nor in adjusted models. A higher proportion of dinner-consumer adolescents had no CVD risk factors in comparison to dinner-skipper subjects (31.1% vs. 28%). Conclusion: Eating dinner might be inversely associated with some CVD risk factors among Iranian adolescents. Further prospective studies will need to prove this theory.

Socioeconomic inequality in cardio-metabolic risk factors in a nationally representative sample of Iranian adolescents using an Oaxaca-Blinder decomposition method: the CASPIAN-III study.

OBJECTIVES: The present research was conducted aiming at assessing the association of socioeconomic inequality in the prevalence of risk factors associated with cardio-metabolic disorders in a sample population of nationally representative Iranian adolescents and to identify its influencing factors. METHODS: This study was conducted as part of a national-based surveillance program performed on 5625 individuals aged 10-18 years in 27 provinces in Iran. To determine the socioeconomic status (SES) of participants, we defined a new variable by applying the principal component analysis. Doing so, the socioeconomic inequality in cardio-metabolic risk factors was examined over the tertiles of SES using concentration index (C). Then, Oaxaca-Blinder decomposition analysis was carried out in order to decide upon the roots of inequality in the health system. RESULTS: The mean (standard deviation) age of participants was 14.73 (2.41) years. The prevalence of cardio-metabolic parameters had considerable difference across SES tertiles. Elevated fasting blood glucose (FBG), elevated triglycerides (TG), abdominal obesity, elevated total cholesterol (TC), and metabolic syndrome (MetS) increased linearly by increasing SES tertiles. C index for depressed high density lipoprotein- cholesterol (HDL-C) was negative, which was suggestive of inequality in favor of high SES groups and for other cardio-metabolic parameters, it was positive, which indicate inequality was in favor of the lowest SES groups. The highest gap between the first and third tertiles of socioeconomic was for frequency of abdominal obesity; 13.18% of the lowest SES groups and 20.11% of the highest SES groups had abdominal obesity which accounts 6.93% gap in favor of the highest SES groups. The living area could be named as the main variables standing for the inequality of elevated FBS, elevated LDL-c, low HDL-c and abdominal obesity frequency between the first and the last SES group. In addition, BMI could stand as the main independent variable explaining the gap in elevated TG, elevated TC, elevated BP and MetS prevalence across the lowest and the highest SES group. CONCLUSIONS: The study revealed the considerable inequality in the prevalence of cardio-metabolic risk factors between the highest and the lowest SES groups of Iranian adolescents. Living area and BMI are the two main factors which explained inequality in prevalence of cardio metabolic risk factors between SES groups. These estimations could provide health policy markers with practical information for future complementary analyses.

Is the association of weight disorders with perceived health status and life satisfaction independent of physical activity in children and adolescents? The CASPIAN-IV Study.

BACKGROUND: Physical activity (PA) and weight status have been suggested as predictors of life satisfaction (LS) and perceived health status (PHS). Therefore the present study aims to investigate and compare the impacts of body mass index (BMI) and PA on LS and PHS in a population of Iranian children and adolescents. MATERIAL AND METHODS: This study was conducted in 2011-12 as a nationwide population-based study among 14 880 students of age 6-18 years. Students were selected via a multistage cluster sampling method from 30 provinces of Iran. Information on demographics, PA, PHS and LS was obtained using the World Health Organization Global School-based Student Health Survey (WHO-GSHS) questionnaire. PA values were considered as low (<2 /week), moderate (2-4 h/week) and high (>2 h/week). RESULTS: The current study has a participation rate of 90.6% (50.8% boys). PA was significantly associated with both LS and PHS [odds ratio (OR), 1.37 in both), while in BMI, this association was significant for only PHS (in underweight: OR, 0.65; 95% CI, 0.57-0.75; in excess weight: OR, 0.82; 95% CI, 0.73-0.93). In the combined group of BMI-PA, the influence of PA prevailed over the impact of BMI on PHS and LS, and therefore, PA was found to be the stronger factor. CONCLUSION: Although BMI and PA could both significantly impact LS and PHS, the stronger influence of PA on LS and PHS suggests that upgrading the 'activity level' of children and adolescents should be underscored and included on the agenda, rather than merely focusing on their BMI and weight status.

Association of adolescents' weight status with life satisfaction: role of self, peers, family and school perception; the CASPIAN-IV Study.

BACKGROUND: Although many public health programs have focused on prevention and control of obesity, their efficacy mostly depends on personal factors including perception of weight and personal understanding of the concept of being overweight. This study aims to investigate the association of adolescent's weight status with life satisfaction and explore the role of self, peers, family and school perception in this association. METHODS: Data were obtained from the fourth school-based survey entitled "Childhood and Adolescence Surveillance and Prevention of Adult Non-communicable Disease" (CASPIAN) Study. This survey was conducted among 14,880 urban and rural students aged 6-18 years. Two sets of valid and reliable questionnaire obtained from Global School Health Survey (GSHS) were completed by students and their parents. The students' questionnaire had several questions including life satisfaction and the perception of weight, peers, family and school. RESULTS: The study had a participation rate of 90.6% including 50.8% boys and 76% urban residents. Significant differences existed in Body Mass Index (BMI) and in perception of weight among girls and boys. Moreover, the prevalence of depression and being bullied were higher among girls and boys, respectively. Significant association was documented between life satisfaction and all variables including perception of weight, peers, family and school; the only exception was for BMI (P<0.05). In addition, students with normal weight had significantly higher life satisfaction in comparison with their obese counterparts (P<0.05). CONCLUSIONS: The present study documented significant association between life satisfaction and perception of self, peer, family and school with the exception of BMI in both genders.

Association of healthy foods intake with anthropometric measures and blood pressure in a national sample of Iranian children and adolescents: the CASPIAN-IV Study.

BACKGROUND: This study aims to evaluate the association of consuming healthy foods with anthropometric measures and blood pressure (BP) in a national sample of Iranian children and adolescents. METHODS: This nationwide study was conducted in 2011-2012 among 13,486 students, aged 6-18 years, selected by multistage cluster sampling from 30 provinces. Weight, height, waist circumference (WC), hip circumference (HC), wais to height ratio (WHtR), waist to hip ratio (WHR), as well as systolic and diastolic blood pressures (SBP, DBP) were measured. Healthy foods were considered as four categories including fresh fruits, dried fruits, vegetables, and dairy products. The frequency consumption of each of these foods was recorded as daily, weekly, and seldom. RESULTS: The intake of fruits was significantly associated with anthropometric indices. Moreover, a significant association was found between vegetables consumption, DBP levels, and anthropometric indices (except for WHtR and WHR). Milk consumption was significantly associated with anthropometric indices (except for WHtR and WHR). The odds of general obesity among participants who seldom consumed dried fruits was less than those who consumed daily (OR: 0.84, 95%CI: 0.74-0.96). We did not find any significant association for the frequency of fresh fruits and vegetables consumption with obesity, abdominal obesity, DBP and SBP. CONCLUSIONS: Consumption of dried fruits was associated with general obesity in children and adolescents. These results highlight the effect of dietary quality and food choices on weight control in children and adolescents.

Association of Physical Activity and Screen Time with Psychiatric Distress in Children and Adolescents: CASPIAN-IV Study.

BACKGROUND: There are limited studies about the association of physical activity (PA) and screen time (ST) with psychiatric distress (PD) among children and adolescents including Iranian populations. OBJECTIVE: We aimed to examine the independent and combined associations of PA and ST with PD among children and adolescents. METHOD: This school-based nationwide survey was carried out among 14 880 students (50.8% boys and 75.6% urban inhabitants), of age 6-18 years by cluster and the stratified multistage sampling method from 30 provinces of Iran. The students and their parents completed two sets of questionnaires obtained from Global School Health Survey with several questions about the PD. The time spent on watching TV/video and computer games and PA were assessed by self-administered validated questionnaires. RESULTS: The study had a participation rate of 90.6%. Of the studied students, 45.85%, 83.62%, 37.81% and 23.92% had depression, anger, insomnia and worthlessness, respectively. The prevalence of confusion, anxiety and worry was reported in 19.6%, 55.17% and 75.31% of the students, respectively. The combined effect of PA and that of ST showed that students with high PA and low ST had the lowest prevalence of PD, while the highest prevalence of these PD was observed among students with low PA combined with high ST (p < 0.05 for all). CONCLUSIONS: Increasing PA and reducing ST should both be considered for improving the mental health status of children and adolescents.

Height-specific blood pressure cutoffs for screening elevated and high blood pressure in children and adolescents: an International Study.

Pediatric blood pressure (BP) reference tables are generally based on sex, age, and height and tend to be cumbersome to use in routine clinical practice. In this study, we aimed to develop a new, height-specific simple BP table according to the international child BP reference table based on sex, age and height and to evaluate its performance using international data. We validated the simple table in a derivation cohort that included 58,899 children and adolescents aged 6-17 years from surveys in 7 countries (China, India, Iran, Korea, Poland, Tunisia, and the United States) and in a validation cohort that included 70,072 participants from three other surveys (China, Poland and Seychelles). The BP cutoff values for the simple table were calculated for eight height categories for both the 90th ("elevated BP") and 95th ("high BP") percentiles of BP. The simple table had a high performance to predict high BP compared to the reference table, with high values (boys/girls) of area under the curve (0.94/0.91), sensitivity (88.5%/82.9%), specificity (99.3%/99.7%), positive predictive values (93.9%/97.3%), and negative predictive values (98.5%/97.8%) in the pooled data from 10 studies. The simple table performed similarly well for predicting elevated BP. A simple table based on height only predicts elevated BP and high BP in children and adolescents nearly as well as the international table based on sex, age, and height. This has important implications for simplifying the detection of pediatric high BP in clinical practice.

Socioeconomic inequality in childhood obesity and its determinants: a Blinder-Oaxaca decomposition / Desigualdade socioeconômica na obesidade infantil e seus determinantes: decomposição de Oaxaca-Blinder

Abstract Objective Childhood obesity has become a priority health concern worldwide. Socioeconomic status is one of its main determinants. This study aimed to assess the socioeconomic inequality of obesity in children and adolescents at national and provincial levels in Iran. Methods This multicenter cross-sectional study was conducted in 2011-2012, as part of a national school-based surveillance program performed in 40,000 students, aged 6-18-years, from urban and rural areas of 30 provinces of Iran. Using principle component analysis, the socioeconomic status of participants was categorized to quintiles. Socioeconomic status inequality in excess weight was estimated by calculating the prevalence of excess weight (i.e., overweight, generalized obesity, and abdominal obesity) across the socioeconomic status quintiles, the concentration index, and slope index of inequality. The determinants of this inequality were determined by the Oaxaca Blinder decomposition. Results Overall, 36,529 students completed the study (response rate: 91.32%); 50.79% of whom were boys and 74.23% were urban inhabitants. The mean (standard deviation) age was 12.14 (3.36) years. The prevalence of overweight, generalized obesity, and abdominal obesity was 11.51%, 8.35%, and 17.87%, respectively. The SII for overweight, obesity and abdominal obesity was -0.1, -0.1 and -0.15, respectively. Concentration index for overweight, generalized obesity, and abdominal obesity was positive, which indicate inequality in favor of low socioeconomic status groups. Area of residence, family history of obesity, and age were the most contributing factors to the inequality of obesity prevalence observed between the highest and lowest socioeconomic status groups. Conclusion This study provides considerable information on the high prevalence of excess weight in families with higher socioeconomic status at national and provincial levels. These findings can be used for international comparisons and for healthcare policies, improving their programming by considering differences at provincial levels.

Resumo Objetivo A obesidade infantil se tornou uma preocupação de saúde prioritária em todo o mundo. A situação socioeconômica (SSE) é um de seus principais determinantes. Este estudo tem como objetivo avaliar a desigualdade socioeconômica com relação à obesidade entre crianças e adolescentes em nível nacional e subnacional no Irã. Métodos Este estudo transversal multicêntrico foi conduzido em 2011-2012 como parte de um programa nacional de vigilância escolar realizado com 40000 alunos, com idade entre 6-18 anos, de áreas urbanas e rurais de 30 províncias do Irã. Utilizando a análise de componentes principais, a SSE dos participantes foi categorizada em quintis. A desigualdade da SSE no excesso de peso foi estimada pelo cálculo da prevalência de excesso de peso (ou seja, sobrepeso, obesidade geral e obesidade abdominal) em todos os quintis da SSE, o índice de concentração (C) e o slope index of inequality (SII). Os determinantes dessa desigualdade foram determinados pela decomposição de Oaxaca-Blinder. Resultados No total, 36529 alunos completaram o estudo (taxa de resposta: 91,32%), dos quais 50,79% eram meninos e 74,23%, habitantes urbanos. A idade média (DP) foi 12,14 (3,36) anos. A prevalência de sobrepeso, obesidade geral e obesidade abdominal foi 11,51%, 8,35% e 17,87%, respectivamente. A SSE com relação a sobrepeso, obesidade e obesidade abdominal foi -0,1, -0,1 e -0,15, respectivamente. O índice C com relação a sobrepeso, obesidade geral e obesidade abdominal foi positivo, o que indica que a desigualdade estava em favor de grupos de baixa SSE. A área de residência, o histórico familiar de obesidade e a idade foram os fatores que mais contribuíram para a desigualdade da prevalência de obesidade observados entre os grupos em SSE mais alta e mais baixa. Conclusão Este estudo fornece informações consideráveis sobre a alta prevalência de excesso de peso em famílias em SSE mais alta em nível nacional e subnacional. Esses achados podem ser usados para comparações internacionais e políticas de saúde, melhorar a programação ao considerar as diferenças em nível subnacional.

An explanatory model for the concept of mental health in Iranian youth.

Background: Mental health is considered as an integral and essential component of overall health. Its determinants and related factors are one of the most important research priorities, especially in adolescents and young people. Using a qualitative approach, the present study aimed to identify factors affecting the mental health of youth in Iran. Methods: In 2017, following content analysis principles, and using semi-structured in-depth interviews, we conducted a qualitative study exploring the opinions of young people about mental health. A targeted sampling method was used, and participants were young volunteers aged 18 to 30 who were selected from Tehran province, Iran. Inclusion criteria for participants was willingness to participate in the study, and ability to express their experiences. Data collection was done with individual in-depth interviews. According to the explanatory model, the interviews were directed toward the concept of mental health and path of causality and auxiliary behaviors. Results: 21 young adults participated, who met the study inclusion criteria, of whom 12 participants were male. Their mean age was 24.4 ± 0.41 years and their education varied from primary school to Master's degree. Mental health was considered as mental well-being and a sense of satisfaction and efficacy, not only the presence of a disease or mental disorder. Based on the opinions of the interviewees, three factors of personal characteristics, family and society are involved in mental health. Individual factors were associated with behavioral and physical problems. One of the most important issues was revealed as tensions in societal and family conflicts. Economic problems and unemployment of young people were also extracted from the social factor. Conclusion: In Iran, social factors such as jobs for the unemployed and job security are considered as important determinants in the mental health of young people.

A Comprehensive Health Plan: The Lifestyle Affecting Factors in Iranian Youth.

BACKGROUND: Factors affecting lifestyle become one of the most priorities of the research field, especially in adolescents and youth. Using a qualitative approach, this study aimed to understand what factors are affecting young people's healthy lifestyle. METHODS: Using the conventional content analysis, and used the semi-structured in-depth interviews, we conducted a qualitative study to elicit the youth opinion considering their lifestyle affecting factors. Initially, purposeful sampling method was considered for data collection. Participants were selected from volunteered youths 18-30 years whom were selected from the Tehran city. Inclusion criteria for the participants were; (a) willingness to participate in the study, and (b) ability to express experiences. RESULTS: According to findings, although the majority of participants agreed on the important role of lifestyle related behaviors in their healthy life, the lack of essential motivation and the pressure of educational assignments remove it from their daily program priorities. The most important barrier to observing the healthy lifestyle was expressed as; the acceptance of the concept by the individual and the social and economic potential of the individual. It was also suggested that practical interventions should focus on improving more participator engagement of all of the related stakeholders. CONCLUSIONS: We proposed the participatory strategies for youth healthy lifestyle promotion. Through which based on a specific needs the assessment of different target groups, designing, development, and implementation of health programs led to more effective interventions.

Socioeconomic inequality in screen time frequency in children and adolescents: the weight disorders survey of the CASPIAN IV study.

BACKGROUND: This study aimed to assess the socioeconomic inequality and determinants of screen time (ST) frequency in Iranian children and adolescents. METHODS: This nationwide study was conducted as part of a national school-based surveillance program among 36,486 students consisting of 50.79% boys and 74.23% urban inhabitants, aged 6-18 years, living in urban and rural areas of 30 provinces of Iran. Socioeconomic inequality in ST, including the time spent for ST, watching TV and leisure-time working with computer, was assessed across quintiles of SES using concentration index (C) and slope index of inequality (SII). RESULTS: Overall, 36,486 students completed the study (response rate 91.25%). Their mean (SD) age was 12.14 (3.36) years. The national estimation of frequency of ST was 31.66% (95% CI 31.16-32.17) with ascending change from 20.80% (95% CI 19.81-21.82) to 36.66% (95% CI 35.47-37.87) from the first to the last quintal of SES. Estimated C value at national level was positive (0.08), which indicate inequality was in favor of low SES groups. Considering the SII values, at national level [- 0.16 (- 0.39, 0.06)], the absolute difference in ST frequency between the bottom and top of the socioeconomic groups had descending trends. In multivariate logistic regression model, family history of obesity, generalized obesity and age were the main significant determinants of prolonged ST, watching TV, and computer working (P < 0.001). CONCLUSIONS: Socioeconomic inequality in ST frequency was in favor of low SES groups. These findings are useful for health policies, better programming and future complementary analyses.