Evaluation of the Psychometric Properties of the Lebanon Waterpipe Dependence Scale in a Sample of Iranian Waterpipe Smokers.

BACKGROUND: Waterpipe tobacco smoking (WTS) has recently increased in Iran. There is no valid instrument to measure the level of nicotine dependence among its consumers. This study was aimed to investigate the validity and reliability of the Lebanon Waterpipe Dependence Scale-11 (LWDS-11). METHODS: A cross-sectional study was conducted in the year 2017 whereby 367 waterpipe smokers were recruited from Golestan Province of Iran. LWDS-11 scale is composed of 4 subscales: 1) nicotine dependence, 2) negative reinforcement, 3) psychological craving, and 4) positive reinforcement. The validity of the questionnaire was examined using construct validity. Reliability of this scale was examined using test-retest reliability and internal consistency. FINDINGS: The four-factor model for LWDS [comparative fit index (CFI) = 0.985, Tucker-Lewis index (TLI) = 0.979, standardised root mean residual (SRMR) = 0.059, root mean square error of approximation (RMSEA) = 0.049 (0.031, 0.061)] demonstrated good fit to this data. Cronbach's α was 0.825 for total scale and it was 0.818, 0.746, 0.624, and 0.670 for each individual subscale. The test-retest reliability of the scale was 0.925. CONCLUSION: All goodness of fit indices (GFIs) represented a good fit of model. The LWDS-11 scale had an appropriate remarkable validity and reliability for waterpipe consumers to measure the level of nicotine dependence and it appeared to be likely useful for utilizing in the clinical and epidemiological studies.

The epidemiology of cutaneous leishmaniasis in Golestan Province, Iran: A cross-sectional study of 8-years.

BACKGROUND: Leishmaniasis occurs with an incidence of 0.5-1.5 million new cases annually, and is also endemic in 88 countries across the world. AIM: Presently, we aimed to investigate the status of Cutaneous Leishmaniasis (CL) in Golestan Province in North of Iran. METHODS: A retrospective survey was conducted on existed data of 6873 patients with CL who attended to Health Centers in Golestan Province during 2010 to 2017 years. Data were collected using patient sheets and online registry form of CL. Descriptive statistical methods such as mean and standard deviation, and Chi-square test were employed to report and analyze results. p-Value <0.05 was considered significant. RESULTS: CL cases were more common in men 3885 (56.7%) than women 2965 (43.3%) (p = 0.001). The most and least cases was reported in 2017 and 2104 as 18 and 3 CL cases, accordingly. CL was mainly happen in the November (3816 cases), December (2832 cases) months. Presently, CL gradually increases in the last three years from 2014 to 2017 years. CONCLUSION: Decrease of exposurement, improve the nutrition and child's immunity can be more beneficial.

Modifying attitude and intention toward regular physical activity using protection motivation theory: a randomized controlled trial.

We were guided by the Protection Motivation Theory to test the motivational interviewing effects on attitude and intention of obese and overweight women to do regular physical activity. In a randomized controlled trial, we selected using convenience sampling 60 overweight and obese women attending health centres. The women were allocated to 2 groups of 30 receiving a standard weight-control programme or motivational interviewing. All constructs of the theory (perceived susceptibility, severity, self-efficacy and response efficacy) and all anthropometric characteristics (except body mass index) were significantly different between the groups at 3 study times. The strongest predictors of intention to do regular physical exercise were perceived response efficacy and attitude at 2- and 6-months follow-up. We showed that targeting motivational interviewing with an emphasis on Protection Motivation Theory constructs appeared to be beneficial for designing and developing appropriate intervention to improve physical activity status among women with overweight and obesity.

Effect of Motivational Interviewing on Weight Efficacy Lifestyle among Women with Overweight and Obesity: A Randomized Controlled Trial.

Obesity and overweight have become increasingly a major public health problem across the world. This study aimed at exploring the effects of motivational interviewing on weight efficacy lifestyle among women with obesity and overweight. A single-blind randomized clinical trial study was conducted on 100 overweight and obese women who attended a nutrition clinic. The samples were selected based on the clinical records and assigned into two groups, namely motivational interviewing arm (50 samples) and nutrition education arm (50 samples). Data were collected using a standard validated questionnaire entitled "weight efficacy lifestyle". The intervention was designed according to five motivation sessions and four nutrition education programs, such that the participants of the nutrition education arm were also provided with the nutrition pamphlets related to weight control. Data were finally analyzed using the SPSS statistical software by performing the independent t-test, chi-square, LSD and repeated measures ANOVA tests. P<0.05 were considered statistically significant. The mean age of women was 39.9±9.1 and 36.3±8.9 years in the control and motivational interviewing arms, respectively. Compared with the control group, the score of the motivational interviewing group was statistically significant in terms of weight efficacy lifestyle P=0.0001) and all subscales including social pressure (P=0.0001), physical discomfort (P=0.005), food accessibility (P=0.0001), positive and entertainment activities (P=0.0001), as well as negative emotions (P=0.003). Motivational interviewing appeared to be effective in increasing weight efficacy lifestyle among women with overweight and obesity. TRIAL REGISTRATION NUMBER: IRCT2014051817736N1.

Patterns, Beliefs, Norms and Perceived Harms of Hookah Smoking in North Iran

Introduction: Hookah smoking is considered as a public health threat around the globe. The aim of this study was to investigatethe hookah smoking patterns, beliefs, norms and perceived harms in Golestan province of Iran. Methods: A cross-sectional study was conducted on 395 hookah smokers using convenience sampling method in 2015. To collect data, Heinz's hookah patternwas utilized. Ordinal regression models were used to exploring of covariates related to the odds of life time, last-30-day, and current hookah use. Results: In general, 357 (90.4%) subjects were male smokers. Most of subjects smoked hookah in café (62.2%) and with friends (75.6%). The majority of them (71.1%) did not consider themselves as a hooked person. Cigarette smoking (OR =.65, 95 % CI .42-.98), low perceived addictiveness of hookah than cigarettes (OR =2.33, 95 % CI 1.45-3.73), Social context of hookah smoking with friends in café (OR =1.14, 95 % CI 1.08-1.2), and number of close friends who smoked hookah (OR =1.38, 95 % CI 1.18-1.61) were effective variables affected the past month use of hookah. Conclusion:Development, implementation and assessment of interventions particularly adapted to hookah smoking regarding increase of perceived harm of hookah than cigarette and its probable addiction focusing on close friends appeared to be beneficial.

Effect of Motivational Interviewing on a Weight Loss Program Based on the Protection Motivation Theory.

BACKGROUND: The prevalence of overweight and obesity is on the increase the world over, which imposes an ever-increasing burden on societies and health care systems. OBJECTIVES: This study sought to investigate the effect of motivational interviewing (MI) on a weight-loss program based on the protection motivation theory (PMT). PATIENTS AND METHODS: This randomized clinical trial study, comprising pretest-posttest with a control group, was conducted on 150 overweight and obese women attending a private nutrition clinic for the first time. Samples were randomly selected using the clinic's records and then allocated to three groups (50 women in each group) receiving: 1) a standard weight-control program; 2) motivational interviewing; and 3) MI plus intention intervention. Data were collected using a researcher-made questionnaire through in-person interviews and were analyzed using SPSS (version 11) and statistical tests, including the Kruskal-Wallis test, one-way analysis of variance, paired t-test, and linear regression model. RESULTS: In the two intervention groups, the PMT construct scores, namely susceptibility (P = 0.001), severity (P = 0.001), rewards (P =0.004), self-efficacy (P = 0.001), response efficacy (P = 0.001), and costs (P = 0.014), were significantly increased compared to those in the control group. The anthropometric status was statistically significant in the MI group (P = 0.001) and the MI plus intention-intervention group (P = 0.001) at 2 months' follow-up, while in the control group, weight was meaningfully different after the intervention (P = 0.027). Weight was different between the groups after the intervention, with the Tukey test demonstrating that the differences were statistically significant between the control group and the MI group. CONCLUSIONS: Our results demonstrated that MI, combined with the implementation of intention intervention, increased weight loss and PMT construct scores in our study population.

Depression and Quality of Life in Patients With Type 2 Diabetes.

BACKGROUND: Frequency of mood disorders in patients with chronic diseases, especially diabetes and its effects on life quality are dramatically increasing. OBJECTIVES: This study aimed to investigate the relation between depression and quality of life in patients with diabetes. PATIENTS AND METHODS: This is a cross sectional survey. Subjects were selected from 330 eligible people referred to the only diabetes clinic in Gorgan City during 6 months, using systematic random sampling. Beak Depression questionnaire and the brief questioner with 26 questions recommended by the World Health Organization (WHOQOL-BREF) were used to measure depression and quality of life, respectively. Data were analyzed through descriptive methods, Chi-square, Independent t test and linear regression model using SPSS16; moreover, P value < 0.05 was considered as significant. RESULTS: In total, 330 patients with diabetes (35.5 % male and 64.5% women) were studied. The mean and standard deviation of their age and years involved with diabetes were 50.6 ± 9.0 and 5.4 ± 4.5 years, respectively. Range of age was 25 - 75 years, as well. The prevalence of depression in all patients with diabetes was 58.2% (124 mild, 56 medium, and 12 with severe depression). Hypertension was 13.9% more in diabetic patients with depression (P value < 0.001) and physical activity in 24.7% of the cases was less with a meaningful difference (P value = 0.01). The mean and standard deviation of quality of life in diabetic patients with and without depression was 50.7 ± 14 and 60.5 ± 13.3, respectively that was significant in two groups (P < 0.0001). CONCLUSIONS: The prevalence of depression is high in patients with diabetes and has a considerable impact on the consequences of diabetes and quality of life too.

The impact of education intervention on the Health Belief Model constructs regarding anxiety of nulliparous pregnant women.

BACKGROUND: According to investigations, pregnant women hypothesized that anxiety is a common factor that will improve spontaneously; they are not aware of its side effects on the fetus, baby, and pregnancy outcome, as a whole. Other studies have also not tried to design a theoretical framework based on Health Education Models (HBMs) to overcome this problem. The current study aimed at exploring the effectiveness of education on the anxiety of nulliparous women based on a HBM. MATERIALS AND METHODS: An experimental study on 88 eligible nulliparous women (n = 44 per group), from Doroud city, was performed in 2012. The data was collected using a researcher made questionnaire. Education was conducted in three sessions tailored with HBM constructs with the help of lectures, group discussions, inquiries, Power Point presentations, and booklets. Evaluation performed using a posttest four and eight weeks after last session. The collected data were analyzed using statistical tests, including Chi-square, independent t-test, and repeated measure Analysis of Variance (ANOVA) by the significance level of 0.05. RESULTS: The mean score of knowledge, perceived sensitivity, perceived severity, perceived benefits and barriers, cues to action, self efficacy, and behavior, four weeks after intervention (P < 0.001) and eight weeks after intervention (P < 0.001) were significantly more in the case group Than the control group. ANOVA with repeated measures showed a significant increase in the case group in knowledge (from 32.1 to 89.1), perceived sensitivity (from 34.8 to 91.5), perceived severity (from 31.82 to 88.48), perceived benefits (from 39.28 to 92.41), perceived barriers (from 26.93 to 88.61), cues to action (from24.65 to 92.03), self efficacy (from 29.71 to 88.75), and behavior (from 28.83 to 94.63). Changes were not significant in the control group. CONCLUSION: The effect of HBM and education on increasing knowledge and changing people's beliefs and behavior, in terms of anxiety based pregnancy, should make health planners and authorities pay more attention to these issues. Moreover, it will help in the betterment of the health of mothers and babies.

Determinants of childhood obesity in representative sample of children in north East of iran.

Childhood obesity has become, a global public health problem, and epidemiological studies are important to identify its determinants in different populations. This study aimed to investigate factors associated with obesity in a representative sample of children in Neishabour, Iran. This study was conducted among 1500 randomly selected 6-12-year-old students from urban areas of Neishabour, northeast of Iran. Then, through a case-control study, 114 obese (BMI ≥ 95th percentile of Iranian reference) children were selected as the case group and were compared with 102 controls (15th ≤ BMI < 85th percentile). Factors suggested to be associated with weight status were investigated, for example, parental obesity, child physical activity levels, socio-economic status (SES), and so forth. The analysis was conducted using univariate and multivariate logistic regression (MLR) in SPSS version 16. In univariate logistic regression model, birth weight, birth order, family extension, TV watching, sleep duration, physical activity, parents' job, parents' education, parental obesity history, and SES were significantly associated with children's obesity. After MLR analysis, physical activity and parental obesity history remained statistically significant in the model. Our findings showed that physical activity and parental obesity history are the most important determinants for childhood obesity in our population. This finding should be considered in implementation of preventive interventions.

The effects of suburban villages' health volunteer plan on women's health knowledge and attitude.

BACKGROUND: To achieve stable social development, the cooperation of all members of a -community is basically required. Providing and improving the health standard is one of the most fundamental dimensions of human social evolution. This is more essential than the other aspects of development (public cooperation demands) and health volunteers are the forerunners of this cooperation, who have voluntarily set about having the public participate in providing and elevating the level of community health. The present study aimed to determine the effect of implementing "the health communication plan" by health volunteers in suburban villages regarding the health knowledge and attitude of rural women. MATERIALS AND METHODS: In this quasi-experimental study, knowledge and attitude of 121 females (age 15-49 years), who were under the supervision of health centers in four suburban villages (the case group), before and after performing the health volunteer plan, were compared to those of 94 females (age 15-49 years) in another group of four suburban villages (the control group) lacking health volunteers under the care service of two rural health centers. Data gathering instrument was questionnaires and interviews. The obtained data were analyzed by SPSS (ver. 11.5) using statistical paired t-test and Sign test. P≤0.05 was considered to be statistically significant. RESULTS: The study showed that the mean of rural women's health knowledge and attitude had increased and there was a significant difference between before intervention and after intervention values in the two groups (P<0.001). Comparing the averages of the two groups also revealed a significant difference (P<0.001). CONCLUSIONS: According to the findings and the positive effects of performing suburban health volunteer plan on the health knowledge and attitude of rural women, it would therefore be important to suggest that suburban health volunteers are very helpful and effective in improving the knowledge and attitude level of rural women. In brief; as a direct result of their health performance, performing the plan all over rural health centers is recommended.

Smoking behaviors in Iranian male students: An application of transtheoretical model.

OBJECTIVE: To investigate selected constructs of the transtheoretical model (TTM) of behavior change regarding smoking behavior among Iranian male students. MATERIALS AND METHODS: A convenience sample of 578 smokers and ex-smokers from six universities during December 2009 to June 2010 completed three Persian versions of the short form smoking questionnaire based on TTM, developed by Prochaska, Velicer, and Diclemente. Data were analyzed using SPSS 15. Frequency analysis was conducted to demographic variables. Stages' differences were assessed with analysis of variance (ANOVA) followed by post-hoc multiple comparisons with Tukey's honestly significant difference (HSD) test. Alpha levels were set at P<0.05. RESULTS: More than half of the subjects were in contemplation stage. The pros of smoking among subjects in the precontemplation stage were significantly higher than those of subjects in the preparation and maintenance stages. Meanwhile; the pros of smoking ratings were significantly higher for the contemplation and preparation stages than for the maintenance stage. Significant mean differences in cons of smoking behavior emerged across the stages of change. However, pros and cons of smoking in the action stage were not significantly different than other stages of change. In line with self-efficacy/temptation construct, the result showed that positive social efficacy, negative affect efficacy, and habit strength were significantly different between the stages of change. CONCLUSION: The results provide support to the advantages of increased self-efficacy and the role of decisional balance for the intervention program development for smoking cessation.

Exploring practice of Isfahan University of Medical Science students regarding using ecstasy based on health belief model in 2011.

INTRODUCTION: Ecstasy consumption has increased 70% worldwide, and its use is currently outweighed heroin and cocaine. Conducted survey found that students more than other groups used ecstasy pills. Ecstasy usage has recently augmented in students. Therefore, this study aims to determine practice of Isfahan University of Medical Science students about using ecstasy based on health belief model in 2011. MATERIALS AND METHODS: A cross-sectional study was conducted on 267 students of Isfahan University of Medical Science. Data were collected by a validated and reliable questionnaire in 3 parts (demographic information, H.B.M constructs, and practice). To analyze, SPSS software (ver.18) and statistical test including T-Test and Kruskal-Wallis were used. RESULTS: The mean score of age was 20.95 ± 1.61 years, and 39.3% of men and 90.6% of women were single. 2.2% of students have used ecstasy pills. The mean score of H.B.M constructs was perceived susceptibility (72.75 ± 19.68), perceived severity (84.58 ± 16.98), and perceived benefits (80.43 ± 23.49). The finding presented that there was significant differences between the using ecstasy and perceived severity and perceived benefits (P ≤ 0.001), but there was no significant statistical relationship between the using ecstasy and perceived susceptibility and perceived barriers (P = 0.076, P = 0.554). In terms of cues to action, students suggested that radio and TV are most significance cues. CONCLUSION: According to results, to prevent ecstasy usage among Isfahan University of Medical Science students based on health belief model, we should improve perceived susceptibility. Besides, radio and TV rules as the most important cues should not also be denied. Moreover, newly identified susceptibility indicates the need for quantitative research and behavioral trials.