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Original Article
From Rich to Poor: A Decomposition Analysis of Socioeconomic Inequality in Health-related Quality of Life in Iran
Satar Rezaei
J Prev Med Public Health. 2025;58(5):538-547.   Published online August 20, 2025
DOI: https://doi.org/10.3961/jpmph.25.383
  • 3,441 View
  • 216 Download
AbstractAbstract AbstractSummary PDFSupplementary Material
Objectives
Socioeconomic status (SES) is a well-established predictor of health outcomes across an individual’s lifespan. People from lower socioeconomic backgrounds generally have shorter life expectancies and lower levels of health-related quality of life (HRQoL) compared with those from higher-income groups. This study aimed to quantify income-related inequalities in HRQoL among adults in Iran.
Methods
A total of 3518 adults aged 18 years and older were selected using a convenience sampling method across 9 provinces in Iran. HRQoL was assessed with the EuroQoL 5-Dimension 5-Level (EQ-5D-5L) instrument, which evaluates 5 dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. The concentration index (CI) approach was used to measure income-related inequality in worse HRQoL (disutility=1–utility value) and to identify the socioeconomic factors contributing to the observed inequality.
Results
The CI for worse HRQoL was -0.116, while the CI for the EuroQol visual analogue scale (EQ-VAS) score was 0.027. The CIs for reporting any problems in the EQ-5D-5L dimensions were: mobility (-0.122), self-care (-0.070), usual activities (-0.074), pain/discomfort (-0.139), and anxiety/depression (-0.139). Decomposition analysis showed that income (38.00%), educational level (31.53%), age (8.05%), and physical activity (7.30%) were the main factors contributing to socioeconomic inequality in poorer HRQoL in Iran.
Conclusions
This study identified a pro-poor distribution of poorer HRQoL and reported problems across all dimensions of the EQ-5D-5L in Iran. Targeted interventions should focus on reducing disparities in income, education, and physical activity levels.
Summary
Key Message
The study of 3518 adults across 9 Iranian provinces revealed significant pro-poor socioeconomic inequality in health-related quality of life (HRQoL), with worse HRQoL concentrated among lower-income groups (concentration index: -0.116). Income (38%) and education level (31.53%) were the largest contributors to this inequality, followed by age (8.05%) and physical activity (7.30%) based on decomposition analysis. All five EQ-5D-5L health dimensions showed more reported problems in lower socioeconomic groups, emphasizing the need for targeted interventions addressing income, education, and lifestyle factors to reduce HRQoL disparities in Iran.
Brief Report
Drug Prescription Indicators in Outpatient Services in Social Security Organization Facilities in Iran
Afsoon Aeenparast, Ali Asghar Haeri Mehrizi, Farzaneh Maftoon, Faranak Farzadi
J Prev Med Public Health. 2024;57(3):298-303.   Published online April 4, 2024
DOI: https://doi.org/10.3961/jpmph.23.424
  • 5,562 View
  • 304 Download
  • 1 Web of Science
  • 2 Crossref
AbstractAbstract AbstractSummary PDF
Objectives
The aim of this study was to estimate drug prescription indicators in outpatient services provided at Iran Social Security Organization (SSO) healthcare facilities.
Methods
Data on all prescribed drugs for outpatient visits from 2017 to 2018 were extracted from the SSO database. The data were categorized into 4 main subgroups: patient characteristics, provider characteristics, service characteristics, and type of healthcare facility. Logistic regression models were used to detect risk factors for inappropriate drug prescriptions. SPSS and IBM Modeler software were utilized for data analysis.
Results
In 2017, approximately 150 981 752 drug items were issued to outpatients referred to SSO healthcare facilities in Iran. The average number of drug items per outpatient prescription was estimated at 3.33. The proportion of prescriptions that included an injection was 17.5%, and the rate of prescriptions that included an antibiotic was 37.5%. Factors such as patient sex and age, provider specialty, type of facility, and time of outpatient visit were associated with the risk of inappropriate prescriptions.
Conclusions
In this study, all drug prescription criteria exceeded the recommended limits set by the World Health Organization. To improve the current prescription patterns throughout the country, it would be beneficial to provide providers with monthly and annual reports and to consider implementing some prescription policies for physicians.
Summary
Key Message
In present research all drug prescriptions in Iran Social Security outpatient facilities were assessed. In all 45,312,540 studied prescriptions, the average number of drug items per prescriptions was 3.33 items. 17.5% of prescriptions contained injection and 37.5% contained antibiotic. Patient sex and age, provider specialty, type of facility were associated with the risk of inappropriate prescriptions. It seems that correct policy making and proper supervision alongside health education will be core basis for improving drug prescription and use.

Citations

Citations to this article as recorded by  
  • Patterns of drug prescription among hospitalized patients in a tertiary women’s hospital: A retrospective drug utilization study
    Navid Omidifar, Motahareh Mahi-Birjand, Parvin Askari, Paria Abolzadeh Oskuie, Iman Karimzadeh, Mahtabalsadat Mirjalili, Mehdi Hoorang, Payam Peymani
    Journal of International Medical Research.2026;[Epub]     CrossRef
  • A Cross-Sectional Investigation on Drug-Drug Interactions in Prescriptions of Pediatric Outpatient Clinics at a Referral Center in Southern Iran
    Sara Asadi, Omid Moradi, Hossein Amini, MReza Goodarzian, Maryam Babaei, Maral Goodarzian
    Journal of Comprehensive Pediatrics.2024;[Epub]     CrossRef
Original Articles
Patterns of Health-related Quality of Life in Men Who Inject Drugs: A Survey in Southeast Iran
Marzieh Nojomi, Maysam Rezapour, Neda Soleimanvandi Azar, Mehdi Darabi, Mehran Asadi-Aliabadi
J Prev Med Public Health. 2024;57(2):148-156.   Published online February 23, 2024
DOI: https://doi.org/10.3961/jpmph.23.379
  • 4,677 View
  • 285 Download
AbstractAbstract AbstractSummary PDF
Objectives
Understanding patterns of quality of life in people who inject drugs (PWID) can help healthcare providers plan and manage their health problems in a more focused manner. Therefore, the current study aimed to identify patterns of health-related quality of life in PWID in southeast Iran.
Methods
This cross-sectional study was conducted in southeast Iran on men who had injected drugs at least once during the last year. We used convenience sampling in 2 drop-in centers and venue-based sampling at 85 venues. Demographic characteristics, high-risk behaviors, and health-related quality of life were evaluated using the 5-level EQ-5D version (EQ-5D-5L) questionnaire. Latent profile analysis was used to identify patterns of quality of life.
Results
This study enrolled 398 PWID, who had a mean age of 34.1±11.4 years. About 47.9% reported a prison history in the last 10 years, 59.2% had injected drugs in the last month, and 31.6% had a history of sharing syringes. About 46.3% reported having 2 or more sexual partners in the last 6 months, and 14.7% had a history of sex with men. Out of the 5 EQ-5D-5L profiles, the fifth profile had the most people (36.6%). Most variations in quality of life were related to pain and discomfort.
Conclusions
We showed that the pain and discomfort dimension of EQ-5D-5L had more variation in PWID. This finding will be useful for allocating appropriate interventions and resources to promote health-related quality of life in this population.
Summary
Key Message
People who Inject drugs, as an at-risk population in physical and mental disorders, need support to reduce harm. This study found that the health-related quality of life of these people is affected more by the pain and discomfort dimension. This can be caused by their social exclusion and marginalization. Hence, regular planning is necessary to organize the health status of these people. Due to the hard-to-reach nature of this population, special arrangements such as utilizing peer groups may be effective to provide them with services.
Prevalence and Determinants of Catastrophic Healthcare Expenditures in Iran From 2013 to 2019
Abdoreza mousavi, Farhad lotfi, Samira Alipour, Aliakbar Fazaeli, Mohsen Bayati
J Prev Med Public Health. 2024;57(1):65-72.   Published online November 25, 2023
DOI: https://doi.org/10.3961/jpmph.23.291
  • 8,299 View
  • 333 Download
  • 2 Web of Science
  • 3 Crossref
AbstractAbstract AbstractSummary PDF
Objectives
Protecting people against financial hardship caused by illness stands as a fundamental obligation within healthcare systems and constitutes a pivotal component in achieving universal health coverage. The objective of this study was to analyze the prevalence and determinants of catastrophic health expenditures (CHE) in Iran, over the period of 2013 to 2019.
Methods
Data were obtained from 7 annual national surveys conducted between 2013 and 2019 on the income and expenditures of Iranian households. The prevalence of CHE was determined using a threshold of 40% of household capacity to pay for healthcare. A binary logistic regression model was used to identify the determinants influencing CHE.
Results
The prevalence of CHE increased from 3.60% in 2013 to 3.95% in 2019. In all the years analyzed, the extent of CHE occurrence among rural populations exceeded that of urban populations. Living in an urban area, having a higher wealth index, possessing health insurance coverage, and having employed family members, an employed household head, and a literate household head are all associated with a reduced likelihood of CHE (p<0.05). Conversely, the use of dental, outpatient, and inpatient care, and the presence of elderly members in the household, are associated with an increased probability of facing CHE (p<0.05).
Conclusions
Throughout the study period, CHE consistently exceeded the 1% threshold designated in the national development plan. Continuous monitoring of CHE and its determinants at both household and health system levels is essential for the implementation of effective strategies aimed at enhancing financial protection.
Summary
Key Message
• The aim of this study was to analyze the prevalence and determinants of catastrophic health expenditures (CHE) in Iran. • Catastrophic health expenditures (CHE) are used for monitoring financial protection within health systems. • The World Health Organization defines CHE as out-of-pocket payments for healthcare that exceed 40% of a household’s capacity to pay. • In Iran, the prevalence of CHE increased from 3.60% in 2013 to 3.95% in 2019. • Continuous monitoring of CHE and its determinants is essential for implementing effective strategies aimed at enhancing financial protection.

Citations

Citations to this article as recorded by  
  • Determinants of Catastrophic Health Expenditure and Its Impact on Poverty in Deltaic Country: Evidence From Bangladesh
    Md Abdur Rouf Sarkar, Md Jahid Ebn Jalal, Shijun Ding, Ismat Ara Begum, Bo Yang, Mohammad Jahangir Alam
    Sustainable Development.2025; 33(4): 5414.     CrossRef
  • Analysis of national health accounts in Iran (2002–2020)
    Abdoreza Mousavi, Mahdi Mokhtari-Payam, Aliakbar Fazaeli, Mohammad Bakhtiari Aliabad
    Payesh (Health Monitor) Journal.2025; 24(1): 7.     CrossRef
  • An analysis of financial protection and financing incidence of out-of-pocket health expenditures in Kazakhstan from 2018 to 2021
    Askhat Shaltynov, Yulia Semenova, Madina Abenova, Assel Baibussinova, Ulzhan Jamedinova, Ayan Myssayev
    Scientific Reports.2024;[Epub]     CrossRef
Epidemiology of Suicide by Hanging in Fars Province, Iran (2011-2019): A Population-based Cross-sectional Study
Leila Moftakhar, Alireza Mirahmadizadeh, Sanaz Amiri, Fariba Rezaei, Habibollah Azarbakhsh
J Prev Med Public Health. 2023;56(3):264-271.   Published online April 20, 2023
DOI: https://doi.org/10.3961/jpmph.22.519
  • 12,750 View
  • 123 Download
  • 6 Web of Science
  • 4 Crossref
AbstractAbstract PDF
Objectives
Hanging is a common method of attempted suicide. This study investigated the epidemiological profile of attempted and completed suicides by hanging in southern Iran.
Methods
This cross-sectional study was performed on 1167 suicide attempts by hanging between 2011 and 2019. All data related to suicide attempts by hanging were collected from the Fars Suicide Surveillance System. The trends in suicide cases and the mean age of attempted and completed suicides were plotted. The chi-square test was used to identify suicide-related factors. Crude rates of incidence, mortality, and standardized fatality during the study period were calculated. Finally, logistic regression was used to identify the predictors of death in individuals who attempted suicide.
Results
The mean age of those who attempted suicide was 33.21±16.82 years; the majority were male (80.5%). The rate of attempted and completed suicide by hanging were 3.50 and 2.79 per 100 000 people, respectively. The case-fatality rate was calculated as 79.34%. The results of our study indicated an increasing trend in suicide attempts by hanging. The likelihood of death was 2.28 times higher in individuals with a previous history of suicide attempts and 1.85 times higher in those with a psychological disorder.
Conclusions
The findings of this study suggest an increasing trend in attempted and completed suicide by hanging, especially among individuals with a history of suicide attempts and psychological disorders. It is necessary to take action to reduce the rate of suicide attempts and identify the underlying causes of suicide attempts by hanging.
Summary

Citations

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  • Prevalence and analysis of Amussat’s, Martin’s and Simon’s signs in suicide by hanging in socio-demographic context in the Poznan metropolitan area and surrounding provinces in Poland in 2007–2022
    Piotr Adamski, Marta Golik, Piotr Kawalec, Maria Krzemińska, Julia Malinowska, Sandra Przybysz, Jan Radomski, Szymon Rzepczyk, Klaudia Dolińska-Kaczmarek, Paweł Świderski, Czesław Żaba, Bartosz Burchardt
    Legal Medicine.2025; 76: 102656.     CrossRef
  • Epidemiological analysis of self-harm and suicide attempts in Iran: a cross-sectional study in Kurdistan’s emergency hospitals
    Armin Saedi, Bakhtiar Piroozi, Ghobad Moradi, Media Babahajiani, Kourosh akhbari, Leila Azizkhani
    International Journal of Emergency Medicine.2025;[Epub]     CrossRef
  • Assessing the knot in a noose position by thyrohyoid and cervical spine fracture patterns in suicidal hangings using machine learning algorithms: A new insight into old dilemmas
    Aleksa Leković, Arso Vukićević, Slobodan Nikolić
    Forensic Science International.2024; 357: 111973.     CrossRef
  • Trend Analysis of Suicide and Homicide Mortality and Years of Life Lost (YLL) in Children Aged 10-19 Years in the South of Iran, 2004-2019
    Habibollah Azarbakhsh, Fatemeh Jafari, Seyed Parsa Dehghani, Andishe Hamedi, Mohammad Hossein Sharifi, Alireza Mirahmadizadeh
    Journal of Research in Health Sciences.2024; 24(1): e00606.     CrossRef
Adverse Events Following Immunizations in Infants Under 1 Year of Age in Lorestan Province, Western Iran
Anbari khatereh, Ghanadi Koruosh, Toulabipour Alireza, Jamebozuorghi Daryuosh, Baharvand Parastoo
J Prev Med Public Health. 2023;56(2):172-179.   Published online March 14, 2023
DOI: https://doi.org/10.3961/jpmph.22.540
  • 5,452 View
  • 179 Download
  • 1 Crossref
AbstractAbstract PDF
Objectives
Vaccination is an important intervention for preventing disease and reducing disease severity. Universal vaccination programs have significantly reduced the incidence of many dangerous diseases among children worldwide. This study investigated the side effects after immunization in infants under 1 year of age in Lorestan Province, western Iran.
Methods
This descriptive analytical study included data from all children <1 year old in Lorestan Province, Iran who were vaccinated according to the national schedule in 2020 and had an adverse event following immunization (AEFI). Data were extracted from 1084 forms on age, sex, birth weight, type of birth, AEFI type, vaccine type, and time of vaccination. Descriptive statistics (frequency, percentage) were calculated, and the chi-square test and Fisher exact test were used to assess differences in AEFIs according to the abovelisted variables.
Results
The most frequent AEFIs were high fever (n=386, 35.6%), mild local reaction (n=341, 31.5%), and swelling and pain (n=121, 11.2%). The least common AEFIs were encephalitis (n=1, 0.1%), convulsion (n=2, 0.2%), and nodules (n=3, 0.3%). Girls and boys only showed significant differences in mild local reactions (p=0.044) and skin allergies (p=0.002). The incidence of lymphadenitis (p<0.001), severe local reaction (p<0.001), mild local reaction (p=0.007), fainting (p=0.032), swelling and pain (p=0.006), high fever (p=0.005), and nodules (p<0.001) showed significant differences based on age at vaccination.
Conclusions
Immunization is a fundamental public health policy for controlling vaccine-preventable infectious diseases. Although vaccines such as the Bacillus Calmette-Guérin vaccine, oral poliovirus vaccine, and pentavalent vaccine are well-researched and reliable, AEFIs are inevitable.
Summary

Citations

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  • ADVERSE EVENTS FOLLOWING PENTAVALENT VACCINE ADMINISTRATION: A DESCRIPTIVE STUDY IN THE INDIAN CONTEXT
    Roop Sharma, Bhanupriya Sharma, Yashu Saini, Ramesh Bairwa, Munish Kakkar
    Jurnal Berkala Epidemiologi.2025; 13(2): 112.     CrossRef
Adapting the Community Readiness Model and Validating a Community Readiness Tool for Childhood Obesity Prevention Programs in Iran
Mahdieh Niknam, Nasrin Omidvar, Parisa Amiri, Hassan Eini-Zinab, Naser kalantari
J Prev Med Public Health. 2023;56(1):77-87.   Published online January 10, 2023
DOI: https://doi.org/10.3961/jpmph.22.409
  • 6,959 View
  • 145 Download
  • 3 Web of Science
  • 3 Crossref
AbstractAbstract PDFSupplementary Material
Objectives
It is critical to assess community readiness (CR) when implementing childhood obesity prevention programs to ensure their eventual success and sustainability. Multiple tools have been developed based on various conceptions of readiness. One of the most widely used and flexible tools is based on the community readiness model (CRM). This study aimed to adapt the CRM and assess the validity of a community readiness tool (CRT) for childhood obesity prevention programs in Iran.
Methods
A Delphi study that included 26 individuals with expertise in 8 different subject areas was conducted to adapt the CRM into a theoretical framework for developing a CRT. After linguistic validation was conducted for a 35-question CR interview guide, the modified interview guide was evaluated for its content and face validity. The quantitative and qualitative analyses were performed using Stata version 13 and MAXQDA 2010, respectively.
Results
The Delphi panelists confirmed the necessity/appropriateness and adequacy of all 6 CRM dimensions. The Persian version of the interview guide was then modified based on the qualitative results of the Delphi study, and 2 more questions were added to the community climate dimension of the original CRT. All questions in the modified version had acceptable content and face validity. The final CR interview guide included 37 questions across 6 CRM dimensions.
Conclusions
By adapting the CRM and confirming linguistic, content, and face validity, the present study devised a CRT for childhood obesity prevention programs that can be used in relevant studies in Iran.
Summary

Citations

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  • The Community Readiness Instrument: A Quantitative Measurement Using Statistical Best Practices to Assess Systemic Change Readiness
    Natalie M. Ricciutti, Jenny L. Cureton, Sijia Zhang
    Behavioral Sciences.2026; 16(1): 153.     CrossRef
  • Implementation science in higher education: Identifying key determinants in the selection of evidence-based alcohol and substance prevention and treatment
    Ashley C. Helle, Karla T. Washington, Joan Masters, Kenneth J. Sher, Gregory A. Aarons, Kristin M. Hawley
    Journal of Substance Use and Addiction Treatment.2025; 170: 209617.     CrossRef
  • Improving community readiness among Iranian local communities to prevent childhood obesity
    Mahdieh Niknam, Nasrin Omidvar, Hassan Eini-Zinab, Naser Kalantari, Keyvan Olazadeh, Parisa Amiri
    BMC Public Health.2023;[Epub]     CrossRef
Social Contact Patterns Associated With Tuberculosis: A Case-control Study in Southwest Iran
Neda Amoori, Bahman Cheraghian, Payam Amini, Seyed Mohammad Alavi
J Prev Med Public Health. 2022;55(5):485-491.   Published online September 30, 2022
DOI: https://doi.org/10.3961/jpmph.22.335
  • 6,695 View
  • 156 Download
  • 8 Web of Science
  • 7 Crossref
AbstractAbstract PDFSupplementary Material
Objectives
Tuberculosis (TB) is a major public health concern worldwide. Social contact patterns can affect the epidemiology and risk of airborne diseases such as TB. This study was designed to investigate the social contact patterns associated with TB.
Methods
In this case-control study, groups of participants with and without TB were matched by age and sex. Participants reported the nature, location, frequency, and average duration of social contacts over 1 month. The duration and number of social and spatial contacts were compared between groups using the chi-square test and the t-test. Odds ratios (ORs) with 95% confidence intervals (CIs) were used to quantify the relationship between social contact time and TB status. Data were analyzed using Stata version 11 statistical software. A p-value of <0.05 was considered to indicate statistical significance.
Results
In this study, 80 patients with TB and 172 control participants were included, and a total of 3545 social contacts were registered. Social contact with family members (OR, 1.72; 95% CI, 1.10 to 2.40), contact with a person with TB (OR, 1.53; 95% CI, 1.16 to 2.01), and contact at the participant’s home (OR, 1.42; 95% CI, 1.19 to 1.82) were significantly associated with TB status.
Conclusions
The duration of long-term social contact, rather than the number of contacts, may be the main contact-related factor associated with TB transmission in this population. The focus of contact-tracing efforts should be on finding and treating both family members and long-term contacts in non-household settings.
Summary

Citations

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  • Prevalence of Mycobacterium tuberculosis and risk factors among internally and externally displaced populations in northwestern Ethiopia: The case of Dabat and Metema
    Deresse Daka, Belay Tessema, Awelani Mutshembele, Amir Alelign, Wubet Birhan, Baye Gelaw
    IJID Regions.2026; 18: 100836.     CrossRef
  • Geospatial analysis of shared risks for tuberculosis transmission in an urban cohort
    Michael Asare-Baah, Tan M. Luong, Ernest Kwarteng, Charles Domotey, Nellie Arthur, Magalie Zoungrana, Sheila Mireku-Apah, Honesty Ganu, Michael Amo Omari, Adelaide Sackey, Awewura Kwara, Jane Sandra Afriyie-Mensah, Marie Nancy Séraphin
    Scientific Reports.2025;[Epub]     CrossRef
  • Collaboration and involvement of village heads, public health officer, and village midwives in improving adherence of tuberculosis patients
    Nixson Manurung, R. Hamdani Harahap, Fazidah A. Siregar, Lita Sri Andayani
    Clinical Epidemiology and Global Health.2024; 26: 101528.     CrossRef
  • Trends and risk factors for drug-resistant tuberculosis among children in Sichuan, China: A 10-year retrospective analysis, 2013–2022
    Maoying Li, Bin Deng, Yuhong Huang, Qiong Li, Jing Han, Shenjie Tang, Lei Chen
    Medicine.2024; 103(15): e37643.     CrossRef
  • Coping efforts made: Psychological burden of people living with tuberculosis due to social stigma in society. A qualitative phenomenology study
    Abd Nasir, Intan Idiana Hassan, Anwar Ma’ruf, Novianto Edi Suharno, Sianiwati Goenharto, Cucuk Rahmadi Purwanto, Anestasia Pangestu Mei Tyas, I. Marion Sumari-de Boer
    PLOS ONE.2024; 19(7): e0303331.     CrossRef
  • Structured tb risk factors in regions with low and high population density
    Zinaida M. Zagdyn, A. B. Zudin, N. V. Kobesov, T. P. Vasileva, A. S. Galoyan, E. V. Verbitskaya
    Russian Journal of Infection and Immunity.2024; 14(5): 981.     CrossRef
  • Investigating the intensity of social contacts associated with tuberculosis: a weighted networks model
    Neda Amoori, Payam Amini, Bahman Cheraghian, Seyed Mohammad Alavi
    BMC Pulmonary Medicine.2023;[Epub]     CrossRef
The Effect of an Empowerment Program on the Health-promoting Behaviors of Iranian Women Workers: A Randomized Controlled Trial
Fatemeh Noori, Zahra Behboodimoghadam, Shima Haghani, Shahzad Pashaeypoor
J Prev Med Public Health. 2021;54(4):275-283.   Published online June 24, 2021
DOI: https://doi.org/10.3961/jpmph.21.088
  • 7,275 View
  • 158 Download
  • 9 Web of Science
  • 8 Crossref
AbstractAbstract PDF
Objectives
The workplace is an ideal place for encouraging health-promoting behaviors. Therefore, the aim of the present study was to determine the effect of an empowerment program on the health-promoting behaviors of women workers.
Methods
This randomized clinical trial was conducted with 80 women workers employed at a food packaging facility in 2020. The subjects were selected using convenience sampling and were classified into intervention and control groups using block randomization. An empowerment program for women workers was conducted across 6 sessions based on an empowerment model. Data collection tools included a demographic questionnaire and the Health Promoting Lifestyle Profile-II, which participants completed both before the program and 8 weeks after the last session. Data analysis was performed in SPSS version 16 using descriptive analysis and inferential statistics.
Results
There were no significant differences between the 2 groups in various health-promoting behaviors before the program. However, the intervention group’s scores for nutrition (34.92±1.09 vs. 27.87±4.23), physical activity (24.40±2.94 vs. 17.40±5.03), stress management (26.35±2.60 vs. 23.05±4.27), spiritual growth (34.02±3.00 vs. 30.22±5.40), interpersonal relationships (30.82±2.38 vs. 27.60±4.61), and health responsibility (31.60±2.71 vs. 28.22±4.59) were significantly higher than the control group’s 8 weeks after the program had ended. Moreover, there was a significant difference in the total score of health-promoting behaviors for the intervention group compared to the control group (179.00±9.22 vs. 151.42±20.25, p=0.001).
Conclusions
An empowerment program for women workers led to significant improvements in the health-promoting behaviors of the participants. Similar programs can ultimately improve women’s health in the workplace.
Summary

Citations

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  • Effectiveness of Physical Activity-Led Workplace Health Promotion Interventions: A Systematic Review
    Shichao Zhang, Mingjian Nie, Jiale Peng, Hong Ren
    Healthcare.2025; 13(11): 1292.     CrossRef
  • Acceptability of a Colorectal Cancer-Preventive Diet Promoting Red Meat Reduction and Increased Fiber and Micronutrient Intake: A Cross-Sectional Study in Romanian Adults
    Marius-Cătălin Belean, Teodor-Andrei Maghiar, Anca-Maria Căpraru, Andreea-Adriana Neamțu, Dan Iliescu, Valentin-Cristian Iovin, Flaviu-Ionuț Faur, Meda-Ada Bugi, Alina Totorean, Sorina Tăban, Sorin Dema, Cristina-Adriana Dehelean, Bogdan Dan Totolici, Ovi
    Nutrients.2025; 17(14): 2386.     CrossRef
  • The influence of social support and empowerment on physical exercise behavior in university students: A self-determination theory perspective
    Jianglin Huang, Qiaoqiao Lv, Xiaojin Zeng
    Acta Psychologica.2025; 257: 105086.     CrossRef
  • Exercise empowerment: a scoping review of randomized controlled trials and quasi-experimental physical activity interventions
    Aspen E. Streetman, Rachel L. Walden, Colin J. Orr, William J. Heerman
    International Journal of Behavioral Nutrition and Physical Activity.2025;[Epub]     CrossRef
  • Participatory Approaches in the Context of Research Into Workplace Health Promotion to Improve Physical Activity Levels and Reduce Sedentary Behavior Among Office-Based Workers: Scoping Review
    Aidan John Buffey, Christina Kate Langley, Brian P Carson, Alan E Donnelly, Jon Salsberg
    JMIR Public Health and Surveillance.2024; 10: e50195.     CrossRef
  • Perceived lack of behavioral control is a barrier to a healthy lifestyle in post-menopause: a qualitative study
    Khadijeh Khademi, Mohammad Hossein Kaveh, Mahin Nazari, Abdolrahim Asadollahi
    Journal of Health, Population and Nutrition.2024;[Epub]     CrossRef
  • Effectiveness of Multicomponent Interventions and Physical Activity in the Workplace to Reduce Obesity: A Systematic Review and Meta-Analysis
    M. Rocío Jiménez-Mérida, Manuel Vaquero-Abellán, José M. Alcaide-Leyva, Vanesa Cantón-Habas, Elena Raya-Cano, Manuel Romero-Saldaña
    Healthcare.2023; 11(8): 1160.     CrossRef
  • Investigating the Relationship between Attitude towards Aging and Self-Compassion in Middle-Aged People
    Anna Bratt, Cecilia Fagerström
    Journal of Integrative Nursing and Palliative Care.2023; 4(1): 53.     CrossRef
Daytime Napping and Nighttime Sleep During Pregnancy and Preterm Birth in Iran
Farnaz Shaliha, Maryam Mozaffari, Faeze Ramezani, Hamideh Hajnasiri, Farnoosh Moafi
J Prev Med Public Health. 2021;54(3):182-189.   Published online March 31, 2021
DOI: https://doi.org/10.3961/jpmph.20.372
  • 8,882 View
  • 181 Download
  • 4 Web of Science
  • 5 Crossref
AbstractAbstract PDF
Objectives
This study investigated the relationship between sleep quality during pregnancy and preterm birth.
Methods
This longitudinal study was conducted between August 2018 and May 2019. The participants were 150 pregnant women who had been referred to 7 healthcare centers in the city of Qazvin, Iran and met the inclusion criteria. The Petersburg Sleep Quality Index, the Epworth Sleepiness Scale, and 2 questions about daytime sleep status and a demographic questionnaire were administered at 14-18 weeks and 28-32 weeks of gestation. Data were analyzed using the Mann-Whitney test, the Fisher exact test, and univariate and multivariable logistic regression.
Results
In the present study, poor sleep quality affected 84.7% of the participants at 14-18 weeks and 93.3% at 28-32 weeks of gestation. The final model for preterm birth prediction incorporated age and the Petersburg Sleep Quality Index score in the second and third trimesters. Preterm birth increased by 14% with each unit increase in age. With each unit increase in the Petersburg Sleep Quality Index score in the second and third trimesters, preterm birth increased by 42% and 28%, respectively, but the p-values of these factors were not significant.
Conclusions
Although a significant percentage of pregnant women had poor sleep quality, no significant relationship was found between sleep quality during pregnancy and preterm birth.
Summary

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    Ee Yin Kok, Satvinder Kaur, Nurul Husna Mohd Shukri, Nurliyana Abdul Razak, Masaki Takahashi
    BMC Pregnancy and Childbirth.2024;[Epub]     CrossRef
  • Association between sleep quality with maternal and neonatal outcomes during the covid-19 pandemic
    Maryam Akbari, Sara EsmaeilzadehSaeieh, Malihe Farid, Arman Shafiee, Mahmood Bakhtiyari, Touran Bahrami Babaheidari, Mansoureh Yazdkhasti
    BMC Pregnancy and Childbirth.2024;[Epub]     CrossRef
  • Sleep duration, napping behaviors and restless legs syndrome during pregnancy and the trajectories of ultrasonographic measures of fetal growth: Findings from the NICHD Fetal Growth Studies–Singletons
    Muzi Na, Samidha Sudhakar Shetty, Xiaoyue Niu, Stefanie N. Hinkle, Cuilin Zhang, Xiang Gao
    Sleep Health.2024; 10(4): 462.     CrossRef
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    Kunnikar Chaisitsanguan, Puangpaka Kongwattananon, Dawn Hawthrone
    Current Women s Health Reviews.2023;[Epub]     CrossRef
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The Burden of Stroke in Kurdistan Province, Iran From 2011 to 2017
Shahram Moradi, Ghobad Moradi, Bakhtiar Piroozi
J Prev Med Public Health. 2021;54(2):103-109.   Published online February 1, 2021
DOI: https://doi.org/10.3961/jpmph.20.335
  • 6,857 View
  • 155 Download
  • 2 Web of Science
  • 1 Crossref
AbstractAbstract PDF
Objectives
The aim of this study was to calculate the burden of stroke in Kurdistan Province, Iran between 2011 and 2017.
Methods
Incidence data extracted from the hospital information system of Kurdistan Province and death data extracted from the system of registration and classification of causes of death were used in a cross-sectional study. The World Health Organization method was used to calculate disability-adjusted life years (DALYs).
Results
The burden of stroke increased from 2453.44 DALYs in 2011 to 5269.68 in 2017, the years of life lost increased from 2381.57 in 2011 to 5109.68 in 2017, and the years of healthy life lost due to disability increased from 71.87 in 2011 to 159.99 in 2017. The DALYs of ischaemic stroke exceeded those of haemorrhagic stroke. The burden of disease, new cases, and deaths doubled during the study period. The age-standardised incidence rate of ischaemic stroke and haemorrhagic stroke in 2017 was 21.72 and 20.72 per 100 000 population, respectively.
Conclusions
The burden of stroke is increasing in Kurdistan Province. Since health services in Iran are based on treatment, steps are needed to revise the current treatment services for stroke and to improve the quality of services. Policy-makers and managers of the health system need to plan to reduce the known risk factors for stroke in the community. In addition to preventive interventions, efficient and up-to-date interventions are recommended for the rapid diagnosis and treatment of stroke patients in hospitals. Along with therapeutic interventions, preventive interventions can help reduce the stroke burden.
Summary

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  • The incidence, mortality and disease burden of cardiovascular diseases in China: a comparative study with the United States and Japan based on the GBD 2019 time trend analysis
    Menglan Zhu, Wenyu Jin, Wangbiao He, Lulu Zhang
    Frontiers in Cardiovascular Medicine.2024;[Epub]     CrossRef
Household Overcrowding in Iran, a Low-middle-income Country: How Major of a Public Health Concern Is It?
Leila Jansar Hosseini, Ali Hussein Samadi, Abraha Woldemichael, Masoumeh Najaf Gharebelagh, Satar Rezaei, Enayatollah Homaie Rad
J Prev Med Public Health. 2021;54(1):73-80.   Published online January 11, 2021
DOI: https://doi.org/10.3961/jpmph.20.568
  • 10,647 View
  • 138 Download
  • 7 Web of Science
  • 6 Crossref
AbstractAbstract PDFSupplementary Material
Objectives
Household overcrowding (HC) can contribute to both physical and mental disorders among the members of overcrowded households. This study aimed to measure the status of HC and its main determinants across the provinces of Iran.
Methods
Data from 39 864 households from the 2016 Iranian Household Income and Expenditures Survey were used in this study. The Equivalized Crowding Index (ECI) and HC index were applied to measure the overcrowding of households. Regression models were estimated to show the relationships between different variables and the ECI.
Results
The overall, urban, and rural prevalence of HC was 8.2%, 6.3%, and 10.1%, respectively. The highest prevalence of HC was found in Sistan and Baluchestan Province (28.7%), while the lowest was found in Guilan Province (1.8%). The number of men in the household, rural residency, the average age of household members, yearly income, and the household wealth index were identified as the main determinants of the ECI and HC.
Conclusions
The study demonstrated that the ECI and HC were higher in regions near the borders of Iran than in other regions. Therefore, health promotion and empowerment strategies are required to avoid the negative consequences of HC, and screening programs are needed to identify at-risk families.
Summary

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  • Sex, age, and socioeconomic variations in rheumatic heart disease burden in Iran (1990–2021): insights from the Global Burden of Disease 2021 Study
    Farid Farahani Rad, Mohammad-Mahdi Bastan, Amir Hossein Behnoush
    Discover Public Health.2025;[Epub]     CrossRef
  • Future scenarios of palliative care in health system of Iran: a multi-method study
    Salman Barasteh, Akram Parandeh, Maryam Rassouli, Rohallah Zaboli, Amir Vahedian Azimi, Morteza Khaghanizadeh
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    Alireza Jafari, Hadi Tehrani, Fatemehzahra Naddafi, Mahbobeh Nejatian, Mahdi Talebi
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    Urszula Grzybowska, Hanna Dudek, Agnieszka Wojewódzka-Wiewiórska
    Procedia Computer Science.2024; 246: 4441.     CrossRef
  • Social determinants of health and diabetes: Results from a cohort study in Iran
    SeyedJalal Hashemi, Mehrnoosh Jasemzadeh, Nader Saki, Bahman Cheraghian, Sara Sarvandian, Ali Montazeri, Maedeh Raeisizadeh, Marzieh Araban
    Asian Journal of Social Health and Behavior.2023; 6(2): 86.     CrossRef
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    Ju-Yeun Lee, Namhee Kwon, Ga-yeon Goo, Sung-il Cho
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Exploring Reproductive Health Education Needs in Infertile Women in Iran: A Qualitative Study
Zohreh Khakbazan, Raziyeh Maasoumi, Zahra Rakhshaee, Saharnaz Nedjat
J Prev Med Public Health. 2020;53(5):353-361.   Published online July 14, 2020
DOI: https://doi.org/10.3961/jpmph.20.056
  • 8,888 View
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  • 8 Crossref
AbstractAbstract PDF
Objectives
An inadequate understanding of infertility can affect individuals’ self-efficacy and ability to perform self-care; thus, reproductive health education is an important part of infertility treatment. The present qualitative study aimed to explore the experiences and educational needs of infertile women with regard to reproductive health.
Methods
In this qualitative study, we utilized a content analysis approach. Purposive sampling was performed to ensure maximum diversity. In total, 23 individual interviews were conducted with 20 Iranian women with infertility and 3 key informants between July 2018 and February 2019 in northern Iran. Data were collected through in-depth, semi-structured interviews. Data analysis was performed using a conventional content analysis approach.
Results
Reproductive health education needs were identified by analyzing interview data from 4 main categories: familiarity with the fertility process and preparation for pregnancy, recognition of infertility and expectations around seeking treatment, recognition of preventive actions associated with reproductive health, and correction of false beliefs. Recognizing the causes of infertility and understanding the different approaches to infertility treatment are among the most important educational needs of infertile women. The potential for neglect of health-related issues due to concerns about fertility and the maternal experience necessitates education about preventive measures for cervical cancer, breast cancer, and sexually transmitted infections. Correcting misconceptions, including those related to contraceptives and traditional medicine, can also help promote reproductive health.
Conclusions
In infertile women, the educational needs associated with reproductive health are multifaceted. Satisfying these needs can help achieve optimal treatment results and promote reproductive health.
Summary

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  • Needs Assessment in Premarital Education: A Narrative Review of Iranian Studies from 2007 to 2023
    Fardos Ramz, Hossein Ashtarian, Mehdi Moradinazar
    Journal of Health Reports and Technology.2025;[Epub]     CrossRef
  • Needs for Psychosocial Support of Infertile Women
    Fatmanur Sena Karakisla, Ayse Deliktas Demirci, Kamile Kabukcuoglu
    CIN: Computers, Informatics, Nursing.2025;[Epub]     CrossRef
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    Ruoran Murphy Qiu, Renee Muthakana, Wenhui Mao
    Reproductive Health.2025;[Epub]     CrossRef
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    Yue Xie, Yue Ren, Changmin Niu, Ying Zheng, Ping Yu, Lin Li
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    Shereen Assaysh-Öberg, Catrin Borneskog, Elin Ternström
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  • Effect of Teach-back and Douyin platform short video health education in women receiving infertility treatment
    Qin Lin, Haiyan Zhou, Jijun Wu, Pei Chen, Yanping Niu, Weiwei Fang, Ling Li, Ling Peng, Mengxue Fu
    DIGITAL HEALTH.2023;[Epub]     CrossRef
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    Z Rakhshaee, B Kamranpour
    Journal of Health and Hygiene.2023; 14(4): 466.     CrossRef
  • Women’s Attempts Related to Complementary and Alternative Medicine Use in Infertility Causes and Diagnosis: A Narrative Inquiry
    Mohsen Azimi-Nezhad, Malihe Noori Sistani, Mohammad Vahedian-Shahroodi
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Educational Intervention Based on the Health Belief Model to Modify Risk Factors of Cardiovascular Disease in Police Officers in Iran: A Quasi-experimental Study
Mohsen Saffari, Hormoz Sanaeinasab, Hassan Jafarzadeh, Mojtaba Sepandi, Keisha-Gaye N. O'Garo, Harold G. Koenig, Amir H. Pakpour
J Prev Med Public Health. 2020;53(4):275-284.   Published online June 18, 2020
DOI: https://doi.org/10.3961/jpmph.20.095
  • 13,776 View
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  • 19 Crossref
AbstractAbstract PDFSupplementary Material
Objectives
Police officers may be at a greater risk for cardiovascular disease (CVD) than the general population due to their highstress occupation. This study evaluated how an educational program based on the health belief model (HBM) may protect police officers from developing CVD.
Methods
In this single-group experimental study, 58 police officers in Iran participated in a 5-week intervention based on HBM principles. Outcomes included changes in scores on an HBM scale, time spent on moderate to vigorous physical activity (International Physical Activity Questionnaire), body mass index (BMI), blood lipid profile, blood glucose, and blood pressure. The intervention consisted of 5 HBM-based educational sessions. Follow-up was conducted at 3 months post-intervention. The paired t-test was used to examine differences between baseline and follow-up scores.
Results
All aspects of the HBM scale improved between baseline and follow-up (p<0.05), except the cues to action subscale. Self-efficacy and preventive behaviors improved the most. BMI decreased from 26.7±2.9 kg/m2 at baseline to 25.8±2.4 kg/m2 at follow-up. All components of the lipid profile, including triglycerides, cholesterol, high-density lipoprotein, and low-density lipoprotein, showed significant improvements post-intervention. Blood glucose and blood pressure also decreased, but not significantly. Nearly 25% of participants who were not physically active at baseline increased their physical activity above or beyond the healthy threshold.
Conclusions
A relatively brief educational intervention based on HBM principles led to a significant improvement in CVD risk factors among police officers. Further research is needed to corroborate the effectiveness of this intervention.
Summary

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    Zehra Kartoğlu, Nurcan Kolaç
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    Cleise Cristine Ribeiro Borges Oliveira, Bruna Rafaela Carneiro, Isleide Santana Cardoso Santos, Cláudia Silva Marinho, Elieusa Pereira e Silva, Ana Carla Carvalho Coelho, Cláudia Geovana da Silva Pires
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    Cleise Cristine Ribeiro Borges Oliveira, Bruna Rafaela Carneiro, Isleide Santana Cardoso Santos, Cláudia Silva Marinho, Elieusa Pereira e Silva, Ana Carla Carvalho Coelho, Cláudia Geovana da Silva Pires
    Cogitare Enfermagem.2025;[Epub]     CrossRef
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    Cleise Cristine Ribeiro Borges Oliveira, Bruna Rafaela Carneiro, Isleide Santana Cardoso Santos, Cláudia Silva Marinho, Elieusa Pereira e Silva, Ana Carla Carvalho Coelho, Cláudia Geovana da Silva Pires
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    Sri Haryuni, Nurma Afiani, Abdurahman Wahid, Novita Ana Anggraini, Idola Perdana Sulistyoning Suharto, Indah Jayani
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    Leonardo Fabio Fernández Torres, Joel Zapata Salazar, Rafael Armando Samaniego Garay
    Politicas Sociales Sectoriales.2025; 3(2): 441.     CrossRef
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    Vanêssa Piccinin Paz, Adriane Cristina Bernat Kolankiewicz, Luciana de Alcantara Nogueira, Fernanda Moura D’Almeida Miranda, Maria de Fátima Mantovani, Elisiane Lorenzini
    Texto & Contexto - Enfermagem.2025;[Epub]     CrossRef
  • EDUCATIONAL INTERVENTION IN THE POST-OPERATIVE PERIOD OF CARDIAC SURGERY: A MIXED METHODS STUDY GUIDED BY THE HEALTH BELIEF MODEL
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    Texto & Contexto - Enfermagem.2025;[Epub]     CrossRef
  • Role of the Health Belief Model in the Management of Hypertension: A Systematic Review
    Mohammad Tanvir Islam, Shohael Mahmud Arafat, Arna Chowdhury, Keertika Orchi, Shahana Sultana, Tanjela Bushra, Md Redwanul Islam, Khandakar Fatema, Md Maruf Haque Khan, M Atiqul Haque
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    Ayşe Şahin, Ezgi Dirgar, Devrim Çicihan
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    Abeer H. Ahmed, Nashwa I. Basyoni, Maha M. Wahdan, Nanees A. Ismail, Hoda I. Fahim
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    Mohsen Saffari, Hormoz Sanaeinasab, Hojat Rashidi-jahan, Fardin Aghazadeh, Mehdi Raei, Fatemeh Rahmati, Faten Al Zaben, Harold G. Koenig
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    Aparna Padmanabhan, Jayakrishnan Thayyil, G Alan, Siju Kumar
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    Anubrata Karmakar, Aritra Bhattacharyya, Bijit Biswas, Aparajita Dasgupta, Lina Bandyopadhyay, Bobby Paul
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    Fatemeh Mohammadkhah, Abbas Shamsalinia, Fatemeh Rajabi, Pooyan Afzali Hasirini, Ali Khani Jeihooni
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Factors Affecting Breast Self-examination Behavior Among Female Healthcare Workers in Iran: The Role of Social Support Theory
saeed bashirian, Majid Barati, Leila Moaddab Shoar, Younes Mohammadi, Mitra Dogonchi
J Prev Med Public Health. 2019;52(4):224-233.   Published online June 26, 2019
DOI: https://doi.org/10.3961/jpmph.18.277
  • 13,322 View
  • 369 Download
  • 21 Crossref
AbstractAbstract PDFSupplementary Material
Objectives
In women, breast cancer is the most common cancer and the leading cause of cancer death. Screening tests are the basis for early diagnosis. In Iranian women, the mortality rate of breast cancer is high due to insufficient screening examinations and delayed visits for care. Therefore, this study aimed to determine the factors affecting breast self-examinations among Iranian women employed in medical careers.
Methods
This cross-sectional study included 501 women working in the medical professions at Hamadan University of Medical Sciences in western Iran in 2018. The subjects were selected by stratified random sampling. Data were collected using a researcher-developed, self-report questionnaire that contained demographic information and questions based on protection motivation theory and social support theory. Descriptive data analysis was conducted using SPSS version 23 and model fitting with PLS version 2.
Results
The mean age of the participants was 37.1±8.3 years, and most of the women (80.4%) were married. Most women had a bachelor’s degree (67.5%). The findings of this study showed that the coping appraisal construct was a predictor of protection motivation (β=0.380, p<0.05), and protection motivation (β=0.604, p<0.05) was a predictor of breast self-examination behavior. Additionally, social support theory (β=0.202, p<0.05) had a significant positive effect on breast self-examination behavior.
Conclusions
The frequency of practicing self-examinations among women employees in the medical sector was low; considering the influence of social support as a factor promoting screening, it is necessary to pay attention to influential people in women’s lives when designing educational interventions.
Summary

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Measuring and decomposing socioeconomic inequality in catastrophic healthcare expenditures in Iran
Satar Rezaei, Mohammad Hajizadeh
J Prev Med Public Health. 2019;52(4):214-223.   Published online June 14, 2019
DOI: https://doi.org/10.3961/jpmph.19.046
  • 10,721 View
  • 229 Download
  • 22 Crossref
AbstractAbstract PDF
Objectives
Equity in financial protection against healthcare expenditures is one the primary functions of health systems worldwide. This study aimed to quantify socioeconomic inequality in facing catastrophic healthcare expenditures (CHE) and to identify the main factors contributing to socioeconomic inequality in CHE in Iran.
Methods
A total of 37 860 households were drawn from the Households Income and Expenditure Survey, conducted by the Statistical Center of Iran in 2017. The prevalence of CHE was measured using a cut-off of spending at least 40% of the capacity to pay on healthcare services. The concentration curve and concentration index (C) were used to illustrate and measure the extent of socioeconomic inequality in CHE among Iranian households. The C was decomposed to identify the main factors explaining the observed socioeconomic inequality in CHE in Iran.
Results
The prevalence of CHE among Iranian households in 2017 was 5.26% (95% confidence interval [CI], 5.04 to 5.49). The value of C was -0.17 (95% CI, -0.19 to -0.13), suggesting that CHE was mainly concentrated among socioeconomically disadvantaged households in Iran. The decomposition analysis highlighted the household wealth index as explaining 71.7% of the concentration of CHE among the poor in Iran.
Conclusions
This study revealed that CHE is disproportionately concentrated among poor households in Iran. Health policies to reduce socioeconomic inequality in facing CHE in Iran should focus on socioeconomically disadvantaged households.
Summary

Citations

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Validity of Self-reported Hypertension and Factors Related to Discordance Between Self-reported and Objectively Measured Hypertension: Evidence From a Cohort Study in Iran
Farid Najafi, Yahya Pasdar, Ebrahim Shakiba, Behrooz Hamzeh, Mitra Darbandi, Mehdi Moradinazar, Jafar Navabi, Bita Anvari, Mohammad Reza Saidi, Shahrzad Bazargan-Hejazi
J Prev Med Public Health. 2019;52(2):131-139.   Published online March 29, 2019
DOI: https://doi.org/10.3961/jpmph.18.257
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  • 25 Crossref
AbstractAbstract PDF
Objectives
Self-reporting can be used to determine the incidence and prevalence of hypertension (HTN). The present study was conducted to determine the validity of self-reported HTN and to identify factors affecting discordance between self-reported and objectively measured HTN in participants in the Ravansar Non-Communicable Diseases (RaNCD) cohort.
Methods
The RaNCD cohort included permanent residents of Ravansar, Iran aged 35-65 years. Self-reported data were collected before clinical examinations were conducted by well-trained staff members. The gold standard for HTN was anti-hypertensive medication use and blood pressure measurements. The sensitivity, specificity, positive and negative predictive values, and overall accuracy of self-reporting were calculated. Univariate and multivariate logistic regression were used to examine the discordance between self-reported HTN and the gold standard.
Results
Of the 10 065 participants in the RaNCD, 4755 (47.4%) were male. The prevalence of HTN was 16.8% based on self-reporting and 15.7% based on medical history and HTN measurements. Of the participants with HTN, 297 (18.8%) had no knowledge of their disease, and 313 (19.9%) had not properly controlled their HTN despite receiving treatment. The sensitivity, specificity, and kappa for self-reported HTN were 75.5%, 96.4%, and 73.4%, respectively. False positives became more likely with age, body mass index (BMI), low socioeconomic status, and female sex, whereas false negatives became more likely with age, BMI, high socioeconomic status, smoking, and urban residency.
Conclusions
The sensitivity and specificity of self-reported HTN were acceptable, suggesting that this method can be used for public health initiatives in the absence of countrywide HTN control and detection programs.
Summary

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Brief Report
Estimating the Survival of Patients With Lung Cancer: What Is the Best Statistical Model?
Siavosh Abedi, Ghasem Janbabaei, Mahdi Afshari, Mahmood Moosazadeh, Masoumeh Rashidi Alashti, Akbar Hedayatizadeh-Omran, Reza Alizadeh-Navaei, Ehsan Abedini
J Prev Med Public Health. 2019;52(2):140-144.   Published online February 18, 2019
DOI: https://doi.org/10.3961/jpmph.17.090
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  • 8 Crossref
AbstractAbstract PDF
Objectives
Investigating the survival of patients with cancer is vitally necessary for controlling the disease and for assessing treatment methods. This study aimed to compare various statistical models of survival and to determine the survival rate and its related factors among patients suffering from lung cancer.
Methods
In this retrospective cohort, the cumulative survival rate, median survival time, and factors associated with the survival of lung cancer patients were estimated using Cox, Weibull, exponential, and Gompertz regression models. Kaplan-Meier tables and the log-rank test were also used to analyze the survival of patients in different subgroups.
Results
Of 102 patients with lung cancer, 74.5% were male. During the follow-up period, 80.4% died. The incidence rate of death among patients was estimated as 3.9 (95% confidence [CI], 3.1 to 4.8) per 100 person-months. The 5-year survival rate for all patients, males, females, patients with non-small cell lung carcinoma (NSCLC), and patients with small cell lung carcinoma (SCLC) was 17%, 13%, 29%, 21%, and 0%, respectively. The median survival time for all patients, males, females, those with NSCLC, and those with SCLC was 12.7 months, 12.0 months, 16.0 months, 16.0 months, and 6.0 months, respectively. Multivariate analyses indicated that the hazard ratios (95% CIs) for male sex, age, and SCLC were 0.56 (0.33 to 0.93), 1.03 (1.01 to 1.05), and 2.91 (1.71 to 4.95), respectively.
Conclusions
Our results showed that the exponential model was the most precise. This model identified age, sex, and type of cancer as factors that predicted survival in patients with lung cancer.
Summary

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Original Articles
Measuring and Decomposing Socioeconomic Inequalities in Adult Obesity in Western Iran
Farid Najafi, Yahya Pasdar, Behrooz Hamzeh, Satar Rezaei, Mehdi Moradi Nazar, Moslem Soofi
J Prev Med Public Health. 2018;51(6):289-297.   Published online October 29, 2018
DOI: https://doi.org/10.3961/jpmph.18.062
  • 10,103 View
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  • 19 Crossref
AbstractAbstract PDF
Objectives
Obesity is a considerable and growing public health concern worldwide. The present study aimed to quantify socioeconomic inequalities in adult obesity in western Iran.
Methods
A total of 10 086 participants, aged 35-65 years, from the Ravansar Non-communicable Disease Cohort Study (2014-2016) were included in the study to examine socioeconomic inequalities in obesity. We defined obesity as a body mass index ≥30 kg/m2 . The concentration index and concentration curve were used to illustrate and measure wealth-related inequality in obesity. Additionally, we decomposed the concentration index to identify factors that explained wealth-related inequality in obesity.
Results
Overall, the prevalence of obesity in the total sample was 26.7%. The concentration index of obesity was 0.04; indicating that obesity was more concentrated among the rich (p<0.001). Decomposition analysis indicated that wealth, place of residence, and marital status were the main contributors to the observed inequality in obesity.
Conclusions
Socioeconomic-related inequalities in obesity among adults warrant more attention. Policies should be designed to reduce both the prevalence of obesity and inequalities in obesity by focusing on those with higher socioeconomic status, urban residents, and married individuals.
Summary

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What Explains Socioeconomic Inequality in Health-related Quality of Life in Iran? A Blinder-Oaxaca Decomposition
Satar Rezaei, Mohammad Hajizadeh, Yahya Salimi, Ghobad Moradi, Bijan Nouri
J Prev Med Public Health. 2018;51(5):219-226.   Published online August 7, 2018
DOI: https://doi.org/10.3961/jpmph.18.012
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AbstractAbstract PDF
Objectives
This study aimed to explain the health-related quality of life (HRQoL) gap between the poorest and the wealthiest quintiles in the capitals of Kermanshah and Kurdistan Provinces (Kermanshah and Sanandaj), in western Iran.
Methods
This was a cross-sectional study conducted among 1772 adults. Data on socio-demographic characteristics, socioeconomic status (SES), lifestyle factors, body mass index, and HRQoL of participants were collected using a self-administered questionnaire. The slope and relative indices of inequality (SII and RII, respectively) were employed to examine socioeconomic inequality in poor HRQoL. Blinder-Oaxaca (BO) decomposition was used to quantify the contribution of explanatory variables to the gap in the prevalence of poor HRQoL between the wealthiest and the poorest groups.
Results
The overall crude and age-adjusted prevalence of poor HRQoL among adults was 32.0 and 41.8%, respectively. The SII and RII indicated that poor HRQoL was mainly concentrated among individuals with lower SES. The absolute difference (%) in the prevalence of poor HRQoL between the highest and lowest SES groups was 28.4. The BO results indicated that 49.9% of the difference was explained by different distributions of age, smoking behavior, physical inactivity, chronic health conditions, and obesity between the highest and lowest SES groups, while the remaining half of the gap was explained by the response effect.
Conclusions
We observed a pro-rich distribution of poor HRQoL among adults in the capitals of Kermanshah and Kurdistan Provinces. Policies and strategies aimed at preventing and reducing smoking, physical inactivity, chronic health conditions, and obesity among the poor may reduce the gap in poor HRQoL between the highest and lowest SES groups in Iran.
Summary

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Effects of Air Pollution on Public and Private Health Expenditures in Iran: A Time Series Study (1972-2014)
Pouran Raeissi, Touraj Harati-Khalilabad, Aziz Rezapour, Seyed Yaser Hashemi, Abdoreza Mousavi, Saeed Khodabakhshzadeh
J Prev Med Public Health. 2018;51(3):140-147.   Published online May 14, 2018
DOI: https://doi.org/10.3961/jpmph.17.153
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  • 27 Crossref
AbstractAbstract PDF
Objectives
Environmental pollution is a negative consequence of the development process, and many countries are grappling with this phenomenon. As a developing country, Iran is not exempt from this rule, and Iran pays huge expenditures for the consequences of pollution. The aim of this study was to analyze the long- and short-run impact of air pollution, along with other health indicators, on private and public health expenditures.
Methods
This study was an applied and developmental study. Autoregressive distributed lag estimating models were used for the period of 1972 to 2014. In order to determine the co-integration between health expenditures and the infant mortality rate, fertility rate, per capita income, and pollution, we used the Wald test in Microfit version 4.1. We then used Eviews version 8 to evaluate the stationarity of the variables and to estimate the long- and short-run relationships.
Results
Long-run air pollution had a positive and significant effect on health expenditures, so that a 1.00% increase in the index of carbon dioxide led to an increase of 3.32% and 1.16% in public and private health expenditures, respectively. Air pollution also had a greater impact on health expenditures in the long term than in the short term.
Conclusions
The findings of this study indicate that among the factors affecting health expenditures, environmental quality and contaminants played the most important role. Therefore, in order to reduce the financial burden of health expenditures in Iran, it is essential to reduce air pollution by enacting and implementing laws that protect the environment.
Summary

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Barriers to Health Service Utilization Among Iranian Female Sex Workers: A Qualitative Study
Mehran Asadi-Aliabadi, Jamileh Abolghasemi, Shahnaz Rimaz, Reza Majdzadeh, Fereshteh Rostami-Maskopaee, Effat Merghati-Khoei
J Prev Med Public Health. 2018;51(2):64-70.   Published online February 6, 2018
DOI: https://doi.org/10.3961/jpmph.17.174
  • 21,059 View
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  • 16 Crossref
AbstractAbstract PDF
Objectives
In most countries around the world, sex work is an illegal activity. Female sex workers (FSWs) in Iran hide their identities, and they are known to be a hard-to-reach population. Despite free access to HIV testing, fewer than half of FSWs receive HIV testing. The purpose of this study was to characterize the reasons for which FSWs do not seek testing at drop-in centers (DICs) and voluntary counseling and testing (VCT) centers in Iran. Methods: A qualitative study was conducted in 2016. The participants were 24 FSWs who received services at VCT centers and DICs for vulnerable females in the north of Iran and 9 males who were the clients of FSWs. In this study, we made use of purposive sampling and carried out a thematic analysis. Results: We found 4 major and 6 minor themes. The major themes were: fear of being infected (with HIV), stigma, indifference, and knowledge. Conclusions: Despite the significant efforts made by the government of Iran to establish and expand DICs for vulnerable females, the number of FSWs receiving services at these centers has not been very considerable. Consequently, by introducing and implementing training programs for peer groups, it may be possible to take steps toward establishing strategic programs for the control and prevention of HIV/AIDS.
Summary

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Spatial Inequalities in the Incidence of Colorectal Cancer and Associated Factors in the Neighborhoods of Tehran, Iran: Bayesian Spatial Models
Kamyar Mansori, Masoud Solaymani-Dodaran, Alireza Mosavi-Jarrahi, Ali Ganbary Motlagh, Masoud Salehi, Alireza Delavari, Mohsen Asadi-Lari
J Prev Med Public Health. 2018;51(1):33-40.   Published online January 2, 2018
DOI: https://doi.org/10.3961/jpmph.17.167
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AbstractAbstract PDF
Objectives
The aim of this study was to determine the factors associated with the spatial distribution of the incidence of colorectal cancer (CRC) in the neighborhoods of Tehran, Iran using Bayesian spatial models.
Methods
This ecological study was implemented in Tehran on the neighborhood level. Socioeconomic variables, risk factors, and health costs were extracted from the Equity Assessment Study conducted in Tehran. The data on CRC incidence were extracted from the Iranian population-based cancer registry. The Besag-York-Mollié (BYM) model was used to identify factors associated with the spatial distribution of CRC incidence. The software programs OpenBUGS version 3.2.3, ArcGIS 10.3, and GeoDa were used for the analysis.
Results
The Moran index was statistically significant for all the variables studied (p<0.05). The BYM model showed that having a women head of household (median standardized incidence ratio [SIR], 1.63; 95% confidence interval [CI], 1.06 to 2.53), living in a rental house (median SIR, 0.82; 95% CI, 0.71 to 0.96), not consuming milk daily (median SIR, 0.71; 95% CI, 0.55 to 0.94) and having greater household health expenditures (median SIR, 1.34; 95% CI, 1.06 to 1.68) were associated with a statistically significant elevation in the SIR of CRC. The median (interquartile range) and mean (standard deviation) values of the SIR of CRC, with the inclusion of all the variables studied in the model, were 0.57 (1.01) and 1.05 (1.31), respectively.
Conclusions
Inequality was found in the spatial distribution of CRC incidence in Tehran on the neighborhood level. Paying attention to this inequality and the factors associated with it may be useful for resource allocation and developing preventive strategies in atrisk areas.
Summary

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Socioeconomic Inequalities in the Oral Health of People Aged 15-40 Years in Kurdistan, Iran in 2015: A Cross-sectional Study
Ghobad Moradi, Ardavan Moinafshar, Hemen Adabi, Mona Sharafi, Farideh Mostafavi, Amjad Mohamadi Bolbanabad
J Prev Med Public Health. 2017;50(5):303-310.   Published online July 25, 2017
DOI: https://doi.org/10.3961/jpmph.17.035
  • 10,687 View
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AbstractAbstract PDF
Objectives
The aim of this study was to evaluate socioeconomic inequalities in the prevalence of dental caries among an urban population. Methods: This study was conducted among 2000 people 15-40 years of age living in Kurdistan, Iran in 2015. Using a questionnaire, data were collected by 4 trained dental students. The dependent variable was the decayed, missing, and filled teeth (DMF) index. Using principal component analysis, the socioeconomic status (SES) of families was determined based on their household assets. Inequality was measured using the concentration index; in addition, the Oaxaca analytical method was used to determine the contribution of various determinants to the observed inequality. Results: The concentration index for poor scores on the DMF index was -0.32 (95% confidence interval [CI], -0.40 to -0.36); thus, poor DMF indices had a greater concentration in groups with a low SES (p<0.001). Decomposition analysis showed that the mean prevalence of a poor DMF index was 43.7% (95% CI, 40.4 to 46.9%) in the least privileged group and 14.4% (95% CI, 9.5 to 9.2%) in the most privileged group. It was found that 85.8% of the gap observed between these groups was due to differences in sex, parents’ education, and the district of residence. A poor DMF index was less prevalent among people with higher SES than among those with lower SES (odds ratio, 0.31; 95% CI, 0.19 to 0.52). Conclusions: An alarming degree of SES inequality in oral health status was found in the studied community. Hence, it is suggested that inequalities in oral health status be reduced via adopting appropriate policies such as the delivery of oral health services to poorer groups and covering such services in insurance programs.
Summary

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Socioeconomic Inequality in Malnutrition in Under-5 Children in Iran: Evidence From the Multiple Indicator Demographic and Health Survey, 2010
Abdollah Almasian Kia, Aziz Rezapour, Ardeshir Khosravi, Vajiheh Afzali Abarghouei
J Prev Med Public Health. 2017;50(3):201-209.   Published online May 10, 2017
DOI: https://doi.org/10.3961/jpmph.17.028
  • 11,693 View
  • 290 Download
  • 18 Crossref
AbstractAbstract PDF
Objectives
The aim of this study was to assess the socioeconomic inequality in malnutrition in under-5 children in Iran in order to help policymakers reduce such inequality.
Methods
Data on 8443 under-5 children were extracted from the Iran Multiple Indicator Demographic and Health Survey. The wealth index was used as proxy for socioeconomic status. Socioeconomic inequality in stunting, underweight, and wasting was calculated using the concentration index. The concentration index was calculated for the whole sample, as well as for subcategories defined in terms of categories such as area of residence (urban and rural) and the sex of children.
Results
Stunting was observed to be more prevalent than underweight or wasting. The results of the concentration index at the national level, as well as in rural and urban areas and in terms of children’s sex, showed that inequality in stunting and underweight was statistically significant and that children in the lower quintiles were more malnourished. The wasting index was not sensitive to socioeconomic status, and its concentration index value was not statistically significant.
Conclusions
This study showed that it can be misleading to assess the mean levels of malnutrition at the national level without knowledge of the distribution of malnutrition among socioeconomic groups. Significant socioeconomic inequalities in stunting and underweight were observed at the national level and in both urban and rural areas. Regarding the influence of nutrition on the health and economic well-being of preschool-aged children, it is necessary for the government to focus on taking targeted measures to reduce malnutrition and to focus on poorer groups within society who bear a greater burden of malnutrition.
Summary

Citations

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Epidemiology of Animal Bites and Factors Associated With Delays in Initiating Post-exposure Prophylaxis for Rabies Prevention Among Animal Bite Cases: A Population-based Study
Firooz Esmaeilzadeh, Abdolhalim Rajabi, Sajad Vahedi, Mohammad Shamsadiny, Mousa Ghelichi Ghojogh, Nahid Hatam
J Prev Med Public Health. 2017;50(3):210-216.   Published online May 10, 2017
DOI: https://doi.org/10.3961/jpmph.17.027
  • 13,755 View
  • 273 Download
  • 30 Crossref
AbstractAbstract PDF
Objectives
One way to prevent deaths due to rabies is the timely utilization of post-exposure prophylaxis (PEP). Therefore, in addition to an understanding of the epidemiological distribution of animal bites, it is necessary to explore the factors leading to delays in PEP initiation.
Methods
This cross-sectional study was conducted in Iran in 2011, and included 7097 cases of animal bites recorded at the Rabies Treatment Center of the Shiraz University of Medical Sciences using the census method. Logistic regression was used to identify factors associated with delays in PEP.
Results
Among the patients studied, 5387 (75.9%) were males. The prevalence of animal bites in Fars province was 154.4 per 100 000 people. Dogs were the most frequent source of exposure (67.1%), and the most common bitten part of the body was the hands (45.5%). A delay in the initiation of PEP was found among 6.8% of the studied subjects. This delay was more likely in housewives (odds ratio [OR], 4.66; 95% confidence interval [CI], 2.12 to 10.23) and less likely in people with deep wounds (OR, 0.65; 95% CI, 0.43 to 0.97).
Conclusions
Although all animal bite victims received complete PEP, in some cases, there were delays. Further, the type of animal involved, the depth of the bite, and the patient’s occupation were the major factors associated with a delay in the initiation of PEP for rabies prevention.
Summary

Citations

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Avoidable Burden of Risk Factors for Serious Road Traffic Crashes in Iran: A Modeling Study
Fatemeh Khosravi Shadmani, Kamyar Mansori, Manoochehr Karami, Farid Zayeri, Reza Khosravi Shadman, Shiva Mansouri Hanis, Hamid Soori
J Prev Med Public Health. 2017;50(2):83-90.   Published online February 6, 2017
DOI: https://doi.org/10.3961/jpmph.16.085
  • 10,414 View
  • 243 Download
  • 3 Crossref
AbstractAbstract PDF
Objectives
The aim of this study was to model the avoidable burden of the risk factors of road traffic crashes in Iran and to prioritize interventions to reduce that burden.
Methods
The prevalence and the effect size of the risk factors were obtained from data documented by the traffic police of Iran in 2013. The effect size was estimated using an ordinal regression model. The potential impact fraction index was applied to calculate the avoidable burden in order to prioritize interventions. This index was calculated for theoretical, plausible, and feasible minimum risk level scenarios. The joint effects of the risk factors were then estimated for all the scenarios.
Results
The highest avoidable burdens in the theoretical, plausible, and feasible minimum risk level scenarios for the non-use of child restraints on urban roads were 52.25, 28.63, and 46.67, respectively. In contrast, the value of this index for speeding was 76.24, 37.00, and 62.23, respectively, for rural roads.
Conclusions
On the basis of the different scenarios considered in this research, we suggest focusing on future interventions to decrease the prevalence of speeding, the non-use of child restraints, the use of cell phones while driving, and helmet disuse, and the laws related to these items should be considered seriously.
Summary

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JPMPH : Journal of Preventive Medicine and Public Health
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