Persistent use of hookah smoking among Iranian women: A qualitative study.

INTRODUCTION: Hookah smoking is the most common method of tobacco smoking among Iranian women and its rate has significantly increased over the past few decades. This study aimed to explore reasons behind persistent use of hookah smoking among Iranian women. METHODS: This qualitative study was conducted from December 2014 to March 2016. Participants were 38 Iranian women living in Tehran, the capital of Iran. They were hookah smokers at the time of this study or at least had a history of its use. Data were collected using semi-structured face-to-face interviews and were analyzed using the qualitative content analysis method. RESULTS: The main factors for persistent use of hookah smoking from the perspective of women were entertainment, a pretext to gather with old friends and family members, and a method for the creation of social networks. Hookah smoking has been described as entertainment and fun. CONCLUSIONS: Strategies aimed to curb the social issue of hookah smoking by women need to focus on the provision of appropriate entertainment methods with the consideration of advantages, such as gathering with friends and family members and consolidating relationships.

Experiences of Cigarette Smoking among Iranian Educated Women: A Qualitative Study.

BACKGROUND: Smoking is a well-known public health problem in women as well as men. In many countries including Iran, there is an increase in tobacco use among women. Exploring the experience of smoking by educated women in order to develop effective tobacco prevention programs in these women is necessary. This study aimed to explore the experiences of smoking among Iranian educated women. METHODS: This study used a method of qualitative content analysis with the deep individual, semi-structured interviews on a sample of 14 educated female smokers, selected purposefully. Data were analyzed using qualitative content analysis with conventional approach while being collected. RESULTS: The data analysis led to 16 subcategories which were divided into four main categories: (1) Personal factors including subcategories of imitation, show-off and independence, inexperience and curiosity, personal interest and desire, improved mood, and social defiance; (2) family factors including smokers in the family, intrafamily conflicts, and family strictures and limitations; (3) social factors including subcategories of effects of work and school environment, gender equality symbols, peer pressure, and acceptance among friends; and (4) negative consequences of smoking including subcategories of a sense of being physically hurt, psychological and emotional stress, and being looked upon in a negative and judgmental manner. CONCLUSIONS: The findings of this study showed that smoking among Iranian educated women is a multifactorial problem. Thus, it is necessary to address smoking among educated women in a holistic approach that focuses on different determinants including personal, family, and social factors particularly the gender roles and stereotypes.

Risk and protective profile of tobacco and alcohol use among Iranian adolescents: a population- based study.

BACKGROUND: Identification of risk and protective factors is of great importance in designing preventive and interventional programs. The aim of the present study has been to investigate peer/individual, family, school, and community risk and protective factors as predictors of tobacco and alcohol use among Iranian adolescents. METHODS: In a cross-sectional population-based study, 870 Iranian adolescents aged 15-18 years old, filled out the adopted form of "Communities That Care Youth Survey". Thirty-two risk and protective factors were entered in adjusted logistic regression analyses to predict the lifetime cigarette and alcohol use. RESULTS: Sixteen risk and seven protective factors predicted both lifetime cigarette and alcohol use in the bivariate logistic regression analysis. In the multivariate logistic regression analysis 12 risk factors including friends' use of drugs, interaction with antisocial peers, sensation seeking, intention to use, perceived risks of drug use, family history of drug use, poor family management, parental attitudes favorable toward drug use, family conflict, academic failure, school low commitment, perceived availability of drugs predicted both lifetime cigarette and alcohol use as well as four protective factors including religiosity, self-esteem, family rewards for prosocial involvement, and school rewards for prosocial involvement. The highest OR were related to the risk factor of "Rewards for antisocial involvement" [3.9(1.5-10)], and protective factor of "Religiosity" [0.1(0.1-0.3)]. CONCLUSION: The present study has produced evidences about risk and protective factors related to adolescents substance use and can help designing and implementing of preventive interventions for maintaining and promoting adolescents health.

Psychometric properties of the Iranian version of 'Communities That Care Youth Survey'.

This article investigated the psychometric properties of 'Communities That Care Youth Survey' (CTC-YS) among Iranian adolescents. To prepare the CTC-YS for administration in Iran, it was translated from English to Persian and back translated to English. A total of 753 Iranian adolescents aged 15-18 years old filled out a CTC-YS questionnaire. Its reliability for Iranian youth was assessed using Cronbach's alpha coefficient and its construct validity was assessed using confirmatory factor analysis. After removing two items from individual/peer and community domains, a suitable internal reliability was found among items of the 29 sub-scales (0.66-0.89). The findings of construct validity suggest that existing measures of risk and protective factors have good construct validity. The validity and reliability of CTC-YS showed that this questionnaire has appropriate psychometric characteristics and can be made available to researchers in Iranian adolescent health as an appropriate tool for future research.

Iranian adolescents' insufficient physical activity: a mixed methods explanatory sequential study.

BACKGROUND: Adolescents' physical activity decreases from the stage of childhood to adulthood. This study was addressed to explain adolescents' insufficient physical activity (IPA) and its related factors. The subjects were 1201 adolescents in the quantitative phase and 25 adolescents in the quantitative phase. METHODS: An explanatory sequential mixed methods design with follow-up explanations variant was used, which involved collecting quantitative data (1201 adolescents) first and then explaining the quantitative results with in-depth interviews and written narrative (25 adolescents) during a qualitative study. RESULTS: The quantitative results showed that 98.8% of adolescents did not have the recommended physical activity. Five themes were extracted in the qualitative phase including the inhibitory effect of the school environment and peers, as well as the inhibitory effect of the family environment, lack of availability and cultural barriers for the presence of girls in the community, the effect of self-feeling and self-understanding, and physical and mental exhaustion and permutation. According to the qualitative findings of the study, physical and mental exhaustion expressed the fact that, although adolescents had an unfavorable sense of IPA, they were under the effects of the intrinsic and extrinsic factors. CONCLUSION: The comparison of these themes indicates that this behavior is imposable but not optional.

Health concerns of adolescents in Tehran, Iran.

BACKGROUND: Adolescent health concerns are an important source of information that should be considered when planning school and community health promotion policies, programs and services. Adolescence is a critical period of human development and the health concerns of adolescents can point to important issues that may be eclipsed by epidemiologic and other clinical sources of information. This study aimed to assess the health concerns of adolescents living in Tehran, Iran and to examine associations between selected demographics and the health concerns reported by participants. METHODS: This study was a population-based cross-sectional survey in 2011. Data were collected from a stratified random cluster sample of 915 adolescents, aged 14-18 years, living in Tehran, using the Persian version of the Adolescent Health Concern Inventory (AHCI-P). The data were analyzed using the χ2, Mann-Whitney and Kruskal-Wallis tests and logistic regression analysis. RESULTS: The mean numbers of health concerns in girls and boys were 48 (±27.6) and 44.5 (±27.4) respectively. The highest ranking health concern subscale for both girls and boys was The Future, and "being successful" was endorsed as the most prominent concern in the subscale. Female (OR: 1.42, CI 95%: 1.08-1.87), mother's educational level (OR: 2.23, CI 95%: 1.07-4.65) and living in northern (OR: 1.76, CI 95%: 1.13-2.74) and western (OR: 2.02, CI 95%: 1.30-3.16) regions of Tehran were significant predictors of a higher level of health concerns. CONCLUSION: Findings can be used to inform school and public health promotion policies, programs and supportive services designed to improve the overall health and well-being of adolescents.

Association between social capital and health in women of reproductive age: a population-based study.

Women's health is a public health priority. The origins of health inequalities are very complex. The present study was conducted to determine the association between social capital and health status in reproductive-age women in Tehran, Iran. In this population-based, cross-sectional study, the Social Capital Integrated Questionnaire, the SF-36 and socio-demographic questionnaires were used. Analysis of data by one-way ANOVA test and stepwise multiple linear regression showed that the manifestation dimensions of social capital (groups and networks, trust and solidarity, collective action and cooperation) can potentially lead to the outcome dimensions of social capital (social cohesion and inclusion, and empowerment and political action), which in turn affect health inequities after controlling for socio-demographic differences.

Psycho-social Needs Impact on Hookah Smoking Initiation among Women: A Qualitative Study from Iran.

BACKGROUND: In Iranian women, the use of hookah is the most common method of tobacco smoking. This study aimed to find the role of psycho-social needs and gaps as a possible risk factor for hookah smoking initiation in women. METHODS: This qualitative study was conducted during 2012-2013 in Tehran, Iran. Thirty-six women participated in the study. They were current or former users of hookah. Data were collected through in-depth individual interviews and was analyzed through content analysis. RESULTS: Four main categories were identified from the data. This study focused on the category: Psycho-social needs and gaps. This category has five sub-categories which explain why women begin to smoke hookah including curiosity; desire for non-feminine, forbidden, and negative activities; need for amusement and recreation; for others: To show off; attract attention; satisfy and join others and protection. CONCLUSIONS: From this study, a variety of factors which contribute to the initiation of hookah smoking among women have been identified. Keeping young girls and women away from seemingly happy gatherings of hookah smokers; Providing appropriate recreational facilities for young women and training families on how to help their children in the event of a crisis-like intention to take up smoking behavior, can be some effective ways for reducing hookah smoking initiation among women.

Social Capital as a Determinant of Self-Rated Health in Women of Reproductive Age: A Population-Based Study.

INTRODUCTION: Recognition of the factors related to women's health is necessary. Evidence is available that the social structure including social capital plays an important role in the shaping people's health. The aim of the current study was to investigate the association between self-rated health and social capital in women of reproductive age. METHODS: This study is a population-based cross-sectional survey on 770 women of reproductive age, residing in any one of the 22 municipality areas across Tehran (capital of Iran) with the multi stage sampling technique. Self-rated health (Dependent variable), social capital (Independent variable) and covariates were studied. Analysis of data was done by one-way ANOVA test and multiple linear regressions. RESULTS: Depending on logistic regression analyses, the significant associations were found between self-rated health and age, educational level, crowding index, sufficiency of income for expenses and social cohesion. Data show that women with higher score in social cohesion as an outcome dimension of social capital have better self-rated health (PV = 0.001). CONCLUSION: Given the findings of this study, the dimensions of social capital manifestations (groups and networks, trust and solidarity, collective action and cooperation) can potentially lead to the dimensions of social capital outcomes (social cohesion and inclusion, and empowerment and political action). Following that, social cohesion as a dimension of social capital outcomes has positively relationship with self- rated health after controlling covariates. Therefore, it is required to focus on the social capital role on health promotion and health policies.

Treatment of vitamin D deficiency is an effective method in the elimination of asymptomatic bacterial vaginosis: A placebo-controlled randomized clinical trial.

BACKGROUND & OBJECTIVES: Bacterial vaginosis (BV) is the most prevalent vaginal infection in women of reproductive age group which has been found to be associated with vitamin D deficiency. The purpose of this study was to investigate the effectiveness of the administration of 2000 IU/day edible vitamin D for 15 wk to eliminate asymptomatic BV among reproductive age women with vitamin D deficiency. METHODS: A total of 208 women with asymptomatic BV, who were found to be eligible after interviews and laboratory tests, were randomly assigned to a control group (n=106) or an intervention group (n=105). They used vitamin D drops daily for 105 days. Vaginal and blood samples were taken before and after the second intervention using identical methods (Nugent score for BV diagnosis, serum 25-hydroxyvitamin D for vitamin D determination). RESULTS: The cure rate of asymptomatic BV was 63.5 per cent in the intervention and 19.2 per cent in the control group (P <0.001). The results showed that being unmarried (P=0.02), being passive smoker (P<0.001), and being in the luteal phase of a menstrual cycle during sampling (P=0.01) were significantly associated with post-intervention BV positive results. After these elements were controlled, the odds of BV positive results in the control group was 10.8 times more than in the intervention group (P<0.001). INTERPRETATION & CONCLUSIONS: Among women in reproductive age group with vitamin D deficiency, the administration of 2000 IU/day edible vitamin D was effective in eliminating asymptomatic BV. This treatment could be useful in preventing the symptoms and side effects of BV.

The Role of Family on Hookah Smoking Initiation in Women: A Qualitative Study.

Hookah smoking has recently emerged as a popular alternative to cigarette smoking particularly among young adults and women. This study focused on the role of family members' smoking behaviours as a possible risk factor for initiation of hookah smoking in women. 36 in-depth interviews were conducted with Iranian women of diverse ages for understanding the factors contributing to the initiation of hookah smoking. Four main themes were identified from the data. This study focused on the role of family as a facilitator for hookah smoking initiation. The results of this study indicate that the entry of hookah into homes can be effective in the spread of hookah smoking among adult and young women, in three ways: Girls' participation in the preparation of hookah and the frequent observation of people who smoke hookah at home can be effective in hookah smoking initiation among young girls; the husband of a young woman has an important role in the initiation of smoking hookah; when parents invite children to smoke hookah at home, in order to protect them against public censure, the mother (a middle aged woman) may intend to start smoking hookah. Therefore, tobacco use prevention interventions should be focused on targeting the family as well.

Factors that Contribute in the First Hookah Smoking Trial by Women: A Qualitative Study from Iran.

BACKGROUND: Hookah smoking is growing in popularity especially among women but little is known about the determinants influencing on hookah smoking initiation. In order to address this emerging health risk, a qualitative study was conducted to explore the factors that contribute in the first hookah smoking trial by women. METHODS: This qualitative study was conducted during 2012 to 2013 in Tehran, Iran. Participants were recruited to represent diversity in smoking status, ethnicity, age groups and residence. Data was collected through in-depth individual interviews and was analyzed through content analysis. RESULTS: Four main themes were identified from the qualitative data including: Positive attitude toward hookah smoking; Social and family facilitators; Psychosocial needs and gaps and Sensory characteristic of hookah. CONCLUSION: From this study, a variety of factors which contribute to the initiation of hookah smoking among women have been identified. Since one of the major causes of increased hookah smoking may be its ordinary use, all factors causing the ordinary use should be eliminated, and efforts should be made in opposition to hookah smoking promotions.

The Social Determinants of Health in Association with Women's Health Status of Reproductive Age: A Population-Based Study.

BACKGROUND: Prioritizing women's health helps achievement of the 4(th) and 5(th) goals of Millennium Development Program. This study aimed to investigate association between social determinants of health and women's health of reproductive age. METHODS: This population-based cross-sectional study, using multi-stage sampling procedure was conducted on 770, 15 to 49-year-old women residing in any one of the 22 municipality zones across Tehran, Iran. Eligible women were interviewed at home with SF-36 (Short Form Health Survey) and socio-demographic questionnaires. Social determinants of health contains; ethnicity, education, job, income, and crowding index. Data were analyzed by ANOVA and Multiple Linear Regression using SPSS-16. The threshold of P.V was considered 0.05. RESULTS: Overall, 770 women with mean age 33.9±9.3 years were interviewed. Majority of them were married (72.27%), housewives (62.2%), of Persian ethnicity (64.3%), and educated to high school level (43.8%). Age with dimensions of health except role emotional, mental health, and social functioning had significant association with B from -0.65 to -0.16.educational level with dimensions of health except role emotional andsocial functioning had significant association with B from 3.61 to 6.43 (P<0.05). Income with dimensions of health except role physical had significant association with B from -9.97 to -4.42. CONCLUSION: Reflection of unfavorable economic conditions and low education level on negative women' health experiences are alarming. Interaction between social determinants of health and health status must be considered in policymaking, and there is a need for policies that would enhance health of women in the low education and income brackets.

The effects of secondhand smoke exposure on infant growth: a prospective cohort study.

Mother's and infant exposure to cigarette smoke is one of the most important public health problems. There is no study in Iran evaluating the impact of cigarette smoke on infant growth and development. The purpose of this study was to determine the effects of cigarette. This prospective cohort study was conducted on 51 cigarette smoke-exposed infants (exposed group) and 51 non-exposed infants (non-exposed group). They were evaluated for weight, height and head circumference three times; five to seven days, two months and four months after birth. Urine samples were also collected in each turn. Exposure to secondhand smoke was assessed through questionnaires and urinary cotinine levels. The analysis was performed using an independent t-test, Mann-Whitney U test, chi-square and Fisher's exact and Kappa tests. Mean urinary cotinine level in the exposed group was 38.57±2.85 ng/mg creatinine at baseline, 86.95±1.16 at two months and 63.32±2.08 at four months of age. These indicated a gradual reduction of exposure from two to four months. The weight and height of the exposed group were significantly lower than the non-exposed group (P< 0.001) at two and four months after birth. The results of the present study showed that the exposure to secondhand smoke during infancy may lead to weight and height growth reduction in the first four months of life.

A population-based study of health-promoting behaviors and their predictors in Iranian women of reproductive age.

Health-promoting behaviors have been recognized as major factors for maintenance and improvement of health. The objective of this study was to determine the status of health-promoting behaviors and their predicting factors in Iranian women of reproductive age. This was a population-based cross-sectional study in which 1359 Iranian women of reproductive age were selected by proportional random multistage cluster sampling in Tehran. Questionnaires including sociodemographic characteristics, Health-Promoting Lifestyle Profile-II (HPLP-II) and Personal Resource Questionnaire 85-Part 2 (PRQ85-Part 2) were completed by interview. The association between the dependent variables (HPLP-II and subscales) and the independent variables (social support and sociodemographic characteristics) was analyzed using the multivariable linear regression model. Among the six dimensions of health-promoting behaviors, women scored highest in interpersonal relations (3.08 ± 0.51) and lowest in physical activity (2.04 ± 0.64). The Pearson test indicated perceived social support to be significantly correlated with HPLP-II (r = 0.53; p < 0.001) and all its subscales (r = 0.12-0.60; p < 0.001). Multivariable regression analysis indicated social support to be a predictor of HPLP-II and all its subscales, except for physical activity. Social support and sociodemographic characteristics accounted for 29.8% of the variance in the HPLP-II score and 6.9-39.3 in the six subscales. The findings of the present study confirm the importance of social support and modifiable variables (sociodemographic) in the occurrence of health-promoting behaviors in women and accredit the theoretical relationships among the concepts of the health-promotion model.

Family and peer risk factors as predictors of lifetime tobacco use among Iranian adolescents: gender similarities and differences.

INTRODUCTION: Family and peer risk factors are considered as important predictors of tobacco use in adolescents. Furthermore, information regarding gender differences in lifetime tobacco use of adolescents is essential for designing gender-specific tobacco prevention policies. METHODS: In a cross-sectional population-based study, 870 Iranian adolescents (430 boys and 436 girls) aged 15-18 years old, filled out the adopted form of "Communities That Care Youth Survey". Four family and two peer risk factors were entered in adjusted logistic regression analyses to predict the lifetime tobacco use (cigarette and smokeless tobacco) in boys and girls, separately. RESULTS: Boys reported higher prevalence of lifetime cigarettes use compared to girls (22.8% vs. 17.8%, p = 0.04). However, the prevalence of lifetime smokeless tobacco use in girls was the same as boys, even slightly higher (7.9% vs. 7.1%, P=0.5). "Family history of drug use" and "Friends use of drugs" were common risk factors predicting cigarettes and smokeless tobacco use between both genders. On the other hand, other family risk factors included "Poor family management", "Parental attitude favorable toward drug use" and "Family conflict" were the predictors of lifetime tobacco use only in girls, but not in boys. CONCLUSION: Design and implementation of preventative programs for adolescents tobacco use should be conducted with emphasis on the role of smoker parents at home, and friendship with substance user peers with antisocial behaviors. It seems that family risk factors may have more value in prevention of tobacco use in female adolescents.

Health concerns of Iranian adolescents: protocol for a mixed methods study.

BACKGROUND: Adolescents have particular health and developmental needs that suggest they should neither be treated as older children nor younger adults. OBJECTIVES: The aim of this paper is to report the protocol for a mixed methods study that set out to investigate the health concerns of Iranian adolescents and their sources of health information with the goal of identifying suitable strategies to address their health concerns. MATERIALS AND METHODS: This mixed methods study consists of an explanatory sequential design to be conducted in two phases. The first phase was a population-based cross-sectional survey of 915, 14-18 year old adolescents who were selected by stratified cluster random sampling method from the 22 main municipal sectors of Tehran, Iran. They completed a series of self-administered questionnaires which were analyzed using quantitative approaches. The second phase was a qualitative study in which adolescents were selected using purposeful sampling for individual in-depth semi-structured interviews on the basis of the quantitative findings from the first phase. These data, together with a literature review and data obtained through nominal group technique, would then be used to in the development of strategies to reduce adolescents' health concerns. RESULTS: The findings of this mixed methods sequential explanatory study are expected to provide unique information about the health concerns of Iranian adolescents and their sources of information, which to date have received little attention. CONCLUSIONS: These data will provide a rich source of information that can be used by intervention programs, health professionals and policy makers in addressing the health concerns of adolescents, with the goal of facilitating a successful passage to adult life.

Social capital in association with health status of women in reproductive age: study protocol for a sequential explanatory mixed methods study.

BACKGROUND: Women's health is a general health priority. Preserving and improving women's health is not only a basic human right, but it is also essential for the health of all nations. Women's health in Reproductive age affects long-term health of theirs, their family members, and community. Origins of health inequalities are very complicated. Health outcomes are influenced by biological, social and political factors, so to improve women's health it is necessary to recognize all these factors. Social capital is one of the social determinants of health that might play a considerable role in health inequalities. The association between social capital and health varies according on the sample studied, the type of health outcome and the context in which it is studied. This mixed methods study was designed to determine and explore of relationship between social capital and health status of women of reproductive age in Tehran (capital city of Iran) with its specific social-cultural characteristics. METHODS/DESIGN: This study is sequential explanatory mixed methods study, follow-up explanations variant, with two strands (phases). This design will be implemented in two distinct phases. The first phase is a population-based cross-sectional survey on 770 women of reproductive age residing in any of the 22 municipal districts across Tehran. Based on a need to further understand the quantitative results, researchers will implement a second qualitative phase that is designed to help explain the initial quantitative results. Finally, the researchers will present an interpretation about explanation of quantitative results using the qualitative data. DISCUSSION: This study promotes women's health by determining the priorities and designing evidence-based interventions founded on the basic and insightful information provided on social capital and the status of the health of women.

The effects of maternal passive smoking on maternal milk lipid.

Passive smoking was long overlooked by those in the medical and legal professions as being harmful to one's health, but in recent years the negative effect of passive smoking has come to the fore in the media and laws have been changed so that less people are obliged to unwillingly suffer from passive smoking, particularly in the workplace and in indoor settings. To study the effects of environmental tobacco smoking exposure during the breast-feeding period on maternal milk lipids. This cohort study was conducted on 45 mothers environmental tobacco smoking exposure and 40 non-exposed post-partum mothers referred to the Shahid Ayat health center, Tehran, Iran. Socioeconomic conditions and the demographic characteristics of exposed and non-exposed groups were recorded. Milk samples were collected twice--at baseline (5-7 days after delivery) and four months after delivery. The samples were reserved at -20°C until assay. Milk lipids including cholesterol, triglyceride (TG), high density lipoprotein (HDL) and low density lipoprotein (LDL) were evaluated. Dietary intake assessment was performed by means of the 24-hour dietary recall questionnaire both times. Maternal occupation status and education levels were significantly different between the two groups. Lipids profiles of milk were significantly higher 5-7 days after delivery in the non-exposed group and four months after delivery. Dietary intake was not significantly different between the two groups. Maternal environmental tobacco smoking exposure affects milk lipids which are essential for infant growth.

Resolving Vitamin D Deficiency in the Preconception Period among High-Risk Reproductive Women: A Randomized Controlled Trial.

BACKGROUND: Although vitamin D deficiency has been linked to potential complications in reproductive women, the recommended intake dosage of this vitamin in populations with high incidence of deficiency in preconception period has not been defined. OBJECTIVES: The study investigated the effect of consuming a dosage of 2000 IU/day oral vitamin D for 105 days, on serum levels of this vitamin in reproductive women. MATERIALS AND METHODS: 229 women with 18-35 years old, who were confirmed to be vitamin D deficient (vitamin D < 75 nmol/L), were randomized into the intervention and control groups and after 15 weeks consumption of the supplement and placebo, their serum samples were obtained. RESULTS: At baseline the mean serum levels of vitamin D in the control group was 23.34 ± 15.87 nmol/L and in intervention group was 25.13 ± 18.46 nmol/L, that these values didn't have any significant difference (P = 0.43), while after intervention, significant differences between the two groups was noticed (P < 0.001). The affecting factors to achieve normal range of vitamin D in the intervention group included basal amounts of vitamin D and two underlying factors based on questionnaire data: use of oral supplements (except vitamin D and calcium) in daily life and perfect sun exposure. CONCLUSION: This study showed positive effect of the 2000 IU/day oral vitamin D on the serum level elevation of this vitamin in reproductive women.