Predicting physical and verbal aggression perpetration among teenage boys: an application of the theory of planned behavior

Purpose

Aggression has been introduced as one of the serious problems in public health. The purpose of this paper is to evaluate the ability of the extended theory of planned behavior (TPB) to predict the physical and verbal aggression behavior.

Design/methodology/approach

In this research, 462 teenagers were evaluated through the demographic questionnaire along with the main structures of the TPB as a predictor of behavior. After one month of follow-up, physical and verbal aggression was evaluated. Demographic data were analyzed descriptively by SPSS21 and predictability of the structures for intention and behavior of the physical and verbal aggression was analyzed by AMOS.

Findings

Mean and standard deviation of participants’ age were 14.70 and 1.12 years, respectively. In this research, 22.5% of the participants did not show physical aggression over the last one month and 20% of them did not show verbal aggression over the last month. Path analysis revealed that the variables of the TPB predicted 61% and 32% of variance of intention and physical aggression behavior, respectively, while these variables could describe 43% and 22% of the variance of intention and verbal aggression behavior, respectively. All of the concepts could be significant predictors of the behaviors. Subjective norms were the best predictor of the intention for physical and verbal aggression. Intention and perceived behavioral control were good predictors of physical and verbal aggression.

Research limitations/implications

Given the role of subjective norms in intention and also the role of intention and perceived behavioral control of people for aggression, it can be concluded that emphasis on social and psychological education about subjective norms, peer groups and self-control can help reduce this problem.

Originality/value

A few studies have predicted behavior occurrence in the future. Given the lack of focus on the role of constructs that may bring about future behaviors, the current research was conducted to use the structures of the TPB to predict behavioral intention as well as perpetration of physical and verbal aggressive behaviors, independently.

Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-Years for 29 Cancer Groups, 1990 to 2017: A Systematic Analysis for the Global Burden of Disease Study

Importance

Cancer and other noncommunicable diseases (NCDs) are now widely recognized as a threat to global development. The latest United Nations high-level meeting on NCDs reaffirmed this observation and also highlighted the slow progress in meeting the 2011 Political Declaration on the Prevention and Control of Noncommunicable Diseases and the third Sustainable Development Goal. Lack of situational analyses, priority setting, and budgeting have been identified as major obstacles in achieving these goals. All of these have in common that they require information on the local cancer epidemiology. The Global Burden of Disease (GBD) study is uniquely poised to provide these crucial data.

Objective

To describe cancer burden for 29 cancer groups in 195 countries from 1990 through 2017 to provide data needed for cancer control planning.

Evidence Review

We used the GBD study estimation methods to describe cancer incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life-years (DALYs). Results are presented at the national level as well as by Socio-demographic Index (SDI), a composite indicator of income, educational attainment, and total fertility rate. We also analyzed the influence of the epidemiological vs the demographic transition on cancer incidence.

Findings

In 2017, there were 24.5 million incident cancer cases worldwide (16.8 million without nonmelanoma skin cancer [NMSC]) and 9.6 million cancer deaths. The majority of cancer DALYs came from years of life lost (97%), and only 3% came from years lived with disability. The odds of developing cancer were the lowest in the low SDI quintile (1 in 7) and the highest in the high SDI quintile (1 in 2) for both sexes. In 2017, the most common incident cancers in men were NMSC (4.3 million incident cases); tracheal, bronchus, and lung (TBL) cancer (1.5 million incident cases); and prostate cancer (1.3 million incident cases). The most common causes of cancer deaths and DALYs for men were TBL cancer (1.3 million deaths and 28.4 million DALYs), liver cancer (572 000 deaths and 15.2 million DALYs), and stomach cancer (542 000 deaths and 12.2 million DALYs). For women in 2017, the most common incident cancers were NMSC (3.3 million incident cases), breast cancer (1.9 million incident cases), and colorectal cancer (819 000 incident cases). The leading causes of cancer deaths and DALYs for women were breast cancer (601 000 deaths and 17.4 million DALYs), TBL cancer (596 000 deaths and 12.6 million DALYs), and colorectal cancer (414 000 deaths and 8.3 million DALYs).

Conclusions and Relevance

The national epidemiological profiles of cancer burden in the GBD study show large heterogeneities, which are a reflection of different exposures to risk factors, economic settings, lifestyles, and access to care and screening. The GBD study can be used by policy makers and other stakeholders to develop and improve national and local cancer control in order to achieve the global targets and improve equity in cancer care.

Understanding the relapse process: exploring Iranian women's substance use experiences

BACKGROUND

Relapse is one of the main challenges that must be tackled in the drug addiction treatment. Different factors contribute to the relapse process but it remains unclear how relapse occursin women. Describing the relapse phenomenon in women might be of interest to practitioners and academics. The aim of this study was to explore the relapse experiences of Iranian women with a substance use disorder.

METHODS

Qualitative in-depth interviews were conducted with women with a substance use disorder. The interviews contained open-ended questions regarding relapse experiences during previous treatment. Interviews were digitally recorded. Data were analyzed using the content analysis method.

RESULTS

In total, 20 women who use drugs took part in the study. The mean age of the women was 34.57 (age range = 9.6 years), and the minimum age of participants was 23 years. The following five main themes were explored: socioeconomic backgrounds, physical complications of drug withdrawal, psychological burden of drug withdrawal, family atmosphere, and cultural factors. The findings highlighted the different treatment needs in women with a substance use disorder.

CONCLUSIONS

Based on the interviews, it seems necessary to develop female-specific comprehensive treatment programs by putting more emphasis on pain treatment intervention, relapse prevention, the diagnosis and treatment of mental disorders, couples counseling, and financial support. Furthermore, policymakers should be committed to providing a nonjudgmental social environment to remove or reduce stigma of women with drug use problems.

Validation of the Farsi version of the medical outcomes study-social support survey for mammography

BACKGROUND

Social support can provide psychosocial benefits to promote positive health behaviors such as mammography screening. The purpose of this study was to assess the psychometric properties of the Mammography Social Support (MSS) scale among Iranian woman.

METHODS

Participants were selected from women referring to healthcare centers in Sanandaj, Iran. A total of 434 questionnaires were completed (response rate 91%). The study sample for study 1 included 204 participants for the Exploratory Factor Analysis (EFA). Construct validity was determined by confirmatory factor analysis (CFA) using a study sample of 230 women in study 2. The reliability coefficient for each scale was calculated using Cronbach's alpha, corrected item-total correlations and test-retest respectively.

RESULTS

CFA affirmed the three-factor structure of the MSS in measuring the functional dimensions of social support for mammography behavior consisting of 19 items. Initial results of the CFA did not fully support the proposed three-factor model. After the model was modified, the fit indices indicated, x² was 2.3, Comparative Fit Index (CFI) = 0.96, Tucker- Lewis Index (TLI) = 0.95 providing a strong fit to the data. Cronbach's alphas for the subscales ranged from 0.82 and 0.90, whereas the alpha for the overall scale was 0.91. The 2-week test-retest reliability of MSS was 0.95.

CONCLUSION

This study provides evidence for the psychometric properties to support the Farsi version of the MSS when applied to Iranian women. Exploring the three-factor model in relation to related concepts is suggested for future studies.

Predicting vitamin E and C consumption intentions and behaviors among factory workers based on protection motivation theory

BACKGROUND

Study of antioxidant vitamin consumption behavior, especially in high-risk groups with high exposure to toxic metals to reduce metal toxicity, is emphasized. This study aims to examine the structural relationships between knowledge, protection motivation theory constructs, and vitamin E and C consumption behavior among cement factory workers.

METHODS

Protection motivation theory and food frequency questionnaires were completed by 420 factory workers. Data were subjected to structural equation modeling to examine associations between knowledge, protection motivation theory constructs, and vitamin E and C consumption behavior. Efficacy of current recommended models was also explored.

RESULTS

Structural equation modeling showed high explained variance within the constructs of protection motivation theory for vitamin E and C consumption behavior and intention (56-76%). The overall fit of the structural models was acceptable for both vitamin E and C behavior. Knowledge, self-efficacy, response efficacy, and perceived vulnerability predicted intention, which in turn predicted vitamin consumption behavior. Significant relationships between knowledge and self-efficacy, response efficacy, perceived vulnerability, and perceived severity were also found, while self-efficacy and response efficacy showed significant relationships with vitamin E and C consumption behavior.

CONCLUSIONS

Considering that response efficacy, self-efficacy, and intention showed as strong predictors of vitamin E and C consumption behavior, specific attention should be paid to coping appraisals and intention when designing intervention plans. Additionally, establishing the predicting role of knowledge for protection motivation theory constructs and protective behaviors should be integrated into intervention programs.

Environmental interventions based on the Health Belief Model and the Ecological-social model in the continuation of consumption of rice, free from toxic metals

Background and aim

Continuation of healthy nutritional behaviors is one of the important factors in effectiveness of educational intervention programs. The aim of this research is to compare the Health Belief Model and the Ecological-social model in reducing consumption of rice contaminated with toxic metals after completion of environmental intervention and continuation of consumption of healthy rice.

Methods

This research was the implementation of a six-month randomized controlled trial interventional program in two groups’ interventions along with a control group, with 80 people for each group totally, amounting to 240 women, between 18 and 50 years of age in Ilam, Iran in 2014. The questionnaires of the three groups consisted of demographic information, knowledge, the constructs of the models, performance of rice consumption. Friedman test and repeated measures used for data analysis with SPSS (version 20), and confidence interval of 95% were considered.

Results

The results of the Friedman test indicated a significant increase in the number of women consuming healthy rice over six months after intervention in both intervention groups (p<0.001). Women in the ECO group consumed healthy rice 27.5% more than the HBM group (p<0.001). The results of repeated measures analysis of variance suggested greater improvement in the consumption of healthy rice in the ECO group in comparison with the HBM group over six months after intervention (p<0.05).

Conclusions

Both educational environmental intervention methods caused the altered diet of people regarding consumption of healthy rice over six months after the intervention. Increased social support also probably had a more effective role in continuation of healthy diet among the people.

The effect of educational intervention based on an Ecological-social model on consuming fruit and vegetables in women in Ilam

Background

The effect of instructional models on the changing behavior of consuming fruit and vegetables in the prevention of diseases caused by consumption of foods including rice, contaminated with toxic metals, has not been investigated in Iran yet.

Objective

To compare an Ecological-social model (ECO) group and Control group in increasing fruit and vegetable consumption.

Methods

This research involved implementation of a six-month randomized controlled educational interventionist program into a group of Ecological-social framework along with a control group, totally summing up to 160 women between 18 and 50 years of age in Ilam, Iran in 2014. The questionnaire included knowledge, social support construct (immediate family, relatives, friends, colleagues and neighbors.) and fruit and vegetable intake in both groups before and after the intervention was examined. Data were analyzed by SPSS version 16 using the signed ranks test, and repeated measures analysis of variance analysis, and confidence interval of 95% were employed.

Results

The results of the signed ranks test showed a significant increase in social support in the intervention group (p<0.001). This test showed a significant increase in fruit and vegetable consumption and a significant increase in the number of women using healthy rice (p<0.001), and a significant reduction in the number of women consuming unhealthy rice in the intervention group (p<0.001), that determines dietary intake improvement after the intervention compared with before the intervention (p<0.01). However, this improvement was not observed in the control group.

Conclusions

The results showed that ECO plays an effective role in improving fruit and vegetable consumption in women. Therefore, this model was implemented as a health protocol through health-care centers to conduct the prevention of complications resulting from the use of food contaminated with toxic metals.

Effect of Environmental Intervention on the Consumption of Rice without Toxic Metals Based on the Health Belief Model and Ecological-Social Model

INTRODUCTION

The effect of instructional models on the changing behaviour of consuming contaminated rice with toxic metals has not been investigated in Iran yet.

AIM

To compare effect of Health Belief Model (HBM) and Ecological (ECO) social model on decreasing the consumption of rice contaminated with toxic metals.

MATERIALS AND METHODS

The study aimed at implementing a six-month interventionist program among three groups (HBM, ECO and Control). The study population comprised of 240 women, aged 18 to 50. Questionnaires were distributed which consisted of demographic information, knowledge, constructs of the models, performance of rice consumption, and the manner of rice cooking. In HBM group participants were individually provided with instructions based on HBM. However, in ECO group participants received the instruction through social networks consisted of mothers, sisters, family members, and colleagues.

RESULTS

The results of Wilcoxon test indicated improvements in people's diet including a significant increase in the number of women consuming rice without toxic metals, a significant reduction in the number of women consuming rice contaminated with toxic metals in both intervention groups. On the other hand, such an improvement was not observed in the control group. The results of repeated measures' analysis of variance suggested further improvement in healthy diet in ECO group rather than HBM group after the completion of the environmental intervention.

CONCLUSION

Both methods of instructional intervention caused changes in the diet of people regarding the consumption of rice free from toxic metals and changes in the manner of cooking from Kateh (steaming rice) to Pilaw (draining rice). Development of social support had probably a more effective role on the improvement of people's diet.

Psychometric properties of the mammography self-efficacy and fear of breast cancer scales in Iranian women

Background

Research investigating mammography screening has often reported low mammography self-efficacy and breast cancer fear contribute to underutilization of mammography. This study aimed to examine the reliability and validity of Champion’s Mammography Self-efficacy Scale (CMSS) and Champion’s Breast Cancer Fear Scale (CBCFS) in a sample of Iranian women.

Methods

The adapted instruments were administered to a community sample of 482 women aged 40 years or older. They inhibited in Sanandaj, Iran. Cronbach’s α coefficients, item-total, and test-retest correlations were used to assess the reliability of the scales. Confirmatory factor analysis was applied to assess construct validity.

Results

The α coefficients for the Farsi 14-item CMSS and 8-item BCFS were .87 and.95, respectively. In terms of the CMSS confirmatory factor analysis, the proportion of x²/df was 2.4, Comparative Fit Index (CFI) = 0.93, Tucker Lewis Index (TLI) = 0.96 providing a strong fit to the data induced by two-factor model. With regard to CBCFS, x²/df was 86.33, CFI =0.99, and TLI =0.99 supporting one-factor model.

Conclusion

The CMSS and CBCFS exhibited strong initial psychometric properties; therefore, they are recommended to understand women’s breast cancer screening behaviors better.

Predictors of Smoking among the Secondary High School Boy Students Based on the Health Belief Model

BACKGROUND

Smoking is one of the most important risk factors for health and also health problems, such as heart diseases, especially for young people. This study aimed to investigate the effect of factors related to smoking among the secondary high school students in the city of Marivan (Kurdistan-Iran), in 2015, based on the constructs of health belief model (HBM).

METHODS

This cross-sectional study was conducted in 470 secondary high school students in Marivan in 2015. The samples were selected by random cluster sampling. A question with four sections was used to collect data (demographic questions, knowledge section, attitude section, and questions related to e constructs of HBM).

RESULTS

According to the results, the correlation of smoking was stronger with attitude (r = 0.269 and odds ratio = 0.89) but weaker with perceived barriers (r = 0.101). There was not a significant correlation between smoking behavior and knowledge of the harms of smoking (r = -0.005). Moreover, Cues to action was effective predictor of smoking behavior (r = 0.259).

CONCLUSIONS

The findings of this study show that the prevalence of smoking in the studied sample is somewhat lower than other regions of Iran, but it should be noted that if no interventions are done to prevent smoking in this age group. The findings of the study also showed that the structure of attitudes, self-efficacy, and Cues to action are the strongest predictors of smoking among students. Albeit, attitude was strongest predictor of smoking that shows the prevalence of smoking can be reduced by focusing in this part. Considering the mean age of participants (16/2 ± 0.25 years), that shows the riskiest period for smoking is 16 years and authorities can make change in policies of cigarette selling only for over 18 years.

Evaluation of the Relationship Between Family History of Breast Cancer and Risk Perception and Impacts on Repetition of Mammography

Since the mean age of breast cancer in women living in developing countries, compared with those in developed countries, is lower by about 10 years, repetition of mammography can play an important role in reducing morbidity and mortality. Hence, this study aimed to investigate the relationship between family history of breast cancer and risk perception and its impact on repetition of mammography. In this cross-sectional study, 1,507 women aged 50 years and older, referred to the mammography center of Regions 1 and 6 in Tehran, Iran, were enrolled. Data were collected using a self-report questionnaire and analyzed using SPSS and LISREL. According to our findings, knowledge about the time interval of mammography was found to have the highest correlation with repetition of mammography (r =0.4). Among the demographic variables, marital status (β= -0.1) and family history of breast cancer (β=0.1) had the most direct and significant impact on repetition of mammography (P <0.05). Among the other variables studied, knowledge (β=-0.5) had the highest direct and significant impact on repetition of mammography (P <0.05). Family history of breast cancer was one of the predictors of repetition of mammography, but the results did not prove any relationship with risk perception. Further studies are needed to assess the effect of risk perception and knowledge about time interval on the initiation and continuation of mammography.

Relationship Between Perceived Risk and Physician Recommendation and Repeat Mammography in the Female Population in Tehran, Iran

Iranian women are at high risk of low compliance with repeat mammography due to a lack of awareness about breast cancer, negative previous experiences, cultural beliefs, and no regular visits to a physician. Thus research is needed to explore factors associated with repeated mammography participation. Applying the concept of perceived risk as the guiding model, this study aimed to test the fit and strength of the relationship between perceived risk and physician recommendation in explaining repeat mammography. A total of 601 women, aged 50 years and older referred to mammography centers in region 6, were recruited via a convenience sampling method. Using path analysis, family history of breast cancer and other types of cancer were modeled as antecedent perceived risk, and physician recommendation and knowledge were modeled as an antecedent of the number of mammography visits. The model explained 49% of the variance in repeat mammography. The two factors of physician recommendation and breast self-examination had significant direct effects (P < 0.05) on repeat mammography. Perceived risk, knowledge, and family history of breast cancer had significant indirect effects on repeat mammography through physician recommendation. The results of this study provide a background for further research and interventions not only on Iranian women but also on similar cultural groups and immigrants who have been neglected to date in the mammography literature.

Mediators of repeat mammography in two tailored interventions for Iranian women

Background

Many theory-based interventions exist that incorporate theoretical constructs (e.g., self-efficacy, behavioral control) believed to increase the likelihood of mammography. Nonetheless, little work to date has examined if increased screening among women receiving such interventions occurs due to changes in these targeted constructs. The aim of this study is to address this gap in the literature in the context of two interventions for improving regular screening among Iranian women.

Methods

A sample of 176 women over 50 years old in Tehran, Iran were randomly allocated into one of these three conditions: 1) an intervention based on Health Belief Model (HBM); 2) an intervention based on an integration of the HBM and selected constructs from the TPB (TPB); and 3) a control group (CON). Questionnaires were administered before the intervention and after a 6-month follow-up. The Preacher and Hayes method of mediation was used in analytic models.

Results

Changes in susceptibility, self-efficacy, and perceived control appeared to mediate HBM-CON differences in screening. Barriers attenuated the mediating effect of self-efficacy. Changes in barriers and self-efficacy appeared to mediate TPB-CON differences in screening.

Conclusion

This study was successful in identifying which theory-based constructs appear to underlie the effectiveness of HBM- and TPB-based interventions. Specific constructs have been identified that should be targeted in clinical practice to increase mammography practices among Iranian women.

Relapse and Risk-taking among Iranian Methamphetamine Abusers Undergoing Matrix Treatment Model

BACKGROUND

This study investigated the correlation between risk-taking and relapse among methamphetamine (MA) abusers undergoing the Matrix Model of treatment.

METHODS

This cross-sectional study was conducted on male patients who were stimulant drug abusers undergoing the matrix treatment in the National Center for Addiction Research. A sampling was done using the availability method including 92 male patients. Demographic questionnaires and drug abuse related questionnaire were completed for each patient. Then, Bart's balloon risk-taking test was administered to the patients.

FINDINGS

Participants had a mean age ± standard deviation (SD) of 27.59 ± 6.60 years with an age range of 17-29 years. Unemployment, unmarried status, criminal offense, and also addiction family history increased the probability of relapse. In addition, a greater adjusted score of the risk-taking test increased the odds of relapse by more than 97%. The simultaneous abuse of opium and stimulants compared to the abuse of stimulants only, revealed no statistically significant differences for relapse. Patients with higher risk-taking behavior had a more probability of relapse.

CONCLUSION

This finding indirectly implies the usefulness of Bart's risk-taking test in assessing risk-taking behavior in stimulant drug abusers.

The relationship of social support concept and repeat mammography among Iranian women

BACKGROUND

Breast cancer ranks as the first most common cancer among the Iranian women. The regular repeat of mammography with 1-2 year intervals leads to the increased efficiency of early detection of breast cancer. The present study examined the predictors of repeat mammography. It was hypothesized that higher social support is connected with mammography repeat.

METHODS

A cross-sectional study was carried out among 400 women 50 years and older in Sanandaj, Iran. Data was collected by the questionnaire including information on socio demographical variables and measuring social support level. Data was analyzed by SPSS16 software. Multiple logistic regression was used to determine the predictive power of demographic variables and dimensions of social support for repeat mammography.

RESULTS

Women aged 50-55 years had three times odds of repeat mammography compared to women aged 56-60 years) OR, 3.02). Married women had greater odds of repeat mammography compared to single women (P < 0.006). The probability of repeat mammography in women with higher social support was 0.93 times greater than the women with lower social support (OR, 0.93; 95 % CI, 0.91-0.95; P < 0.0001).

CONCLUSIONS

Iranian women are less likely repeat mammography than other Asian women. Identifying the associations between perceived social support and repeat mammography may offer detailed information to allow for future study and guide the development of interventions not only for Iranian women but also for similar cultural that received pay too little attention to date in the breast cancer literature.

Differences in health beliefs across stage of adoption of mammography in Iranian women

BACKGROUND

Despite evidence that screening for breast cancer is effective, adherence with screening recommendations in Iranian women is low.

OBJECTIVES

The aims of this study were to (a) examine the relationships between related beliefs and (b) to determine to what extent women in stages of mammography adoption differ in their agreement of individual perceived health beliefs.

METHODS

A sample of 686 Iranian women completed a questionnaire including selected constructs of the Health Belief Model and stages of mammography adoption.

RESULTS

Proportions of participants who were in the preadoption and adoption stages were 75% and 17.8%, respectively. Precontemplators showed significantly lower positive attitude and greater agreement for most of the barrier items than did those in other adoption stages. In terms of specific items, women in the relapse and maintenance stages endorsed greatest agreement for the barrier items "not knowing how to get a mammogram" and "forget to schedule," respectively. Common barriers for women in preadoption stages were being painful, taking much time, and embarrassing.

CONCLUSION

Iranian women are less likely than other Asian women to be in the maintenance and action stages. Identifying the associations between perceived related beliefs items and stages of mammography adoption may provide detailed information to allow for future research and guide the development of interventions not only for Iranian women but also for similar cultural and immigrant groups that have been neglected to date in the breast cancer literature.

IMPLICATIONS FOR PRACTICE

Examining the interactions between perceived related beliefs items and other beliefs such as perceived control and self-efficacy to having a mammography is warranted.

Facilitator psychological constructs for mammography screening among Iranian women

BACKGROUND

While many researchers often use a theoretical framework for mammogram repeat interventions, it seems they do not apply an identified mediation analysis method. The aim of this study was to determine the mediators of mammogram replication behavior in two tailored interventions for non-adherent Iranian women.

MATERIALS AND METHODS

A sample population of 184 women over 50 years old in Sanandaj, Iran, was selected for an experiment. Participants were randomly allocated into one of the three conditions: 1) an intervention based on the Health Belief Model (HBM) 2) an intervention based on an integration of the HBM and selected constructs from the Theory of Planned Behavior (TPB), and 3) a control group. Constructs were measured before the intervention, and after a 6-month follow-up.

RESULTS

Perceived self-efficacy, behavioral control, and subjective norms were recognized as mediators in the HBM and selected constructs from the TPB intervention. Perceived susceptibility, severity, barriers, self-efficacy and behavioral control met the criteria for mediation in the HBM intervention.

CONCLUSIONS

This study was successful in establishing mediation in a sample of women. Our findings enrich the literature on mammography repeat, indicating key intervention factors, and relegating redundant ones in the Iranian populations. The use of strategies to increase mammography repeat, such HBM and TPB constructs is suggested to be important for maintaining a screening behavior, once the behavior has been adopted.

Longitudinal changes in beliefs by stage of physical activity adoption in Iranian girls

BACKGROUND

The aims of this study were to examine the relationships among physical activity (PA)-related beliefs and to determine to what extent Iranian adolescents in different stages of PA adoption differ in perceived benefits and barriers during a 3-year transition from junior high school to high school.

METHODS

Data were collected from female adolescents in 2010 (N = 558), of whom 412 provided follow-up data in 2013. One-way analysis of variance and logistic regression were conducted for statistical analysis.

RESULTS

Participants in the action and maintenance stages reported the greatest agreement with benefits. Pre-contemplators were about 4 times more likely to cite "not enough time" than preparers (OR = 3.95). Pre-contemplators were over 4 times more likely to cite not liking exercise than those in action and maintenance stages at baseline (OR = 4.32 and 4.85), a finding which was maintained at follow-up (OR = 3.66 and 8.65).

CONCLUSIONS

These findings could help with the creation of interventions tailored to encourage pre-contemplators to progress toward adoption of PA. Providing transportation supports, enhancing time management, and mitigating boredom may be helpful strategies either to prevent relapse in adoption stages or to move females in early stages of change toward action and maintenance.

A Delphi study to curriculum modifying through the application of the course objective and competencies

BACKGROUND

In order to incorporate new knowledge, skills and emerging concepts from dynamic fields of public health into ongoing courses reform of curriculums sounds necessary. Accordingly, this study was performed to modify health education curriculum of public health undergraduate level.

MATERIALS AND METHODS

Using Delphi technique, 18 health education lecturers from Tehran, Tabriz, Yazd, Shiraz, Gonabad, Ghazvin, Avhvaz and Kurdistan Universities Medical of Sciences based on their expertize in health education with PhD degree as scientific members, also 5 heads of departments according to working at health deputy for at least more than 5 years were asked during three rounds through panel experts to suggest and rate topics they deemed most important to graduate public health experts and curricula related to the areas of knowledge and skills in health education course.

RESULTS

The experts suggested that health enhancing behaviors and reduce health risks, advocate health, behavior change theories and developing a framework are key objects in the curriculum. Much more new topical outlines were related to previous course. Skills rated as important included need assessment and health communication. The most evaluators suggested that adding a practicum unit to two theory units will be helpful.

CONCLUSION

The results from our survey suggested that changes in the course definition including new course objectives, topical outlines, and required skills were deemed important by the lecturers and were appropriately integrated into the health education course curriculum. The new curriculum should be evaluated constantly to seek and provide experiences that will best prepare students to meet challenges as a health educator.

Effect of Life Skills Training on Drug Abuse Preventive Behaviors among University Students

BACKGROUND

Drug abuse is now-a-days one of the gravest social harms. Recent years have experienced a drastic rise in drug abuse among school and university students. Thus, the need for special attention to the issue is deemed important. The present study was conducted with the aim of assessing the impact of life skills training on promotion of drug abuse preventive behaviors.

METHODS

This field trial experimental study was conducted on 60 students of Gonabad Medical University selected through quota random sampling and assigned randomly into two Intervention and control groups. Data were collected through a questionnaire, including two sections of demographic information and drug abuse preventive behaviors. The questionnaire was first assessed as to its validity and reliability and then administered both before and after educational intervention and also as a follow-up 4 years after intervention - Data were then analyzed using t-tests and Chi-square.

RESULTS

Comparison of post-test mean scores of drug abuse preventive behaviors of both groups showed a significant difference (P < 0.01) which remained stable 4 years after intervention. There was a significant relationship between father's educational level and drug abuse preventive behaviors (P < 0.01).

CONCLUSIONS

Life skills' training is effective in the promotion of drug abuse preventive behaviors of university students.

Development and psychometric testing of the Adolescent Healthy Lifestyle Questionnaire

BACKGROUND

Lifestyle choices and individuals' behaviors have the potential to influence health and improve the quality of life.

OBJECTIVES

The purpose of this study was to develop and psychometrically test an instrument for measuring healthy lifestyle in Iranian adolescents.

MATERIALS AND METHODS

A comprehensive literature review related to health-promoting lifestyles was used to identify potential scale items. Data were collected from 797 school students. Construct validity was analyzed using exploratory factor analysis. Confirmatory factor analysis (CFA) was used to cross-validate.

RESULTS

Nine factors emerged that explained 59.8% of the variance in the 43 items. Cronbach's α coefficient Healthy Lifestyle Questionnaire was r=0.82. After the model was modified, the fit indices indicated that the data were an adequate-to-good fit to the proposed models.

CONCLUSIONS

The current study provides some support to the internal and external validity of the healthy lifestyles questionnaire for Iranian adolescents.

Predicting mammography stage of adoption among Iranian women

OBJECTIVE

Despite evidence that screening for breast cancer is effective, adherence with screening recommendations in Iranian women is low. The purposes of this study were to (1) identify the associations between individual characteristics, related health beliefs, and stages of mammography behavior and (2) examine the socio-demographic factors and the health beliefs that predicate stages of mammography behavior.

DESIGN

All health care centers were considered as clusters and 30 women were randomly selected from each of them. A sample of 689 Iranian women completed a questionnaire.

MATERIALS AND METHODS

The questionnaire used was based on Champion's revised Health Belief Model Scale (CHBMS). One-way analysis of covariance (ANCOVA) was used to assess differences in the outcome variables (perceived severity, susceptibility, benefits, and barriers) across the stages. Multinomial logistic regression was conducted to test multivariate relationships.

RESULTS

THE PERCENTAGE OF PARTICIPANTS IN EACH STAGE WAS: 40.1% in pre-contemplation, 34.7 in contemplation, 7.5% in relapse, 12% in action, and 5.7% in maintenance stage of mammography adoption. Older women were most likely to be in the pre-contemplation stage and action stage, and the youngest women were most likely to be in the relapse stage. Differences across stages of change were found for related beliefs for all participants except those in the relapse stage.

CONCLUSION

Iranian women are less likely to be in maintenance and action stages than ot er Asian women and this study identifies constructs that may be targeted in interventions.

Application of a social cognitive model in explaining physical activity in Iranian female adolescents

Adolescent Iranian girls are at high risk for physical inactivity due to cultural barriers such as restrictions regarding exercising in public and research is needed to explore ethnic and gender-related factors associated with physical activity (PA) participation. Using social cognitive theory as the guiding model, the purpose of this study was to test the fit and strength of barriers self-efficacy, outcome expectations, self-regulation and social support in explaining PA in female Iranian adolescents (n = 558). Using path analysis, social support was modeled as an antecedent of self-efficacy and outcome expectations, while self-efficacy was modeled as an antecedent of outcome expectations, self-regulatory planning and PA. Outcome expectations and self-regulatory planning were subsequently modeled as additional antecedents of PA. The model explained 52% of the variance in PA. The two significant (P < 0.05) direct effects were from self-efficacy and outcome expectations. Social support from mothers, fathers and friends had significant indirect effects on PA through self-efficacy. These results will allow for future research and interventions not only for female Iranian adolescents but also for similar cultural and immigrant groups that have been neglected to date in the PA literature.

Evaluation of the Health Promotion Model to Predict Physical Activity in Iranian Adolescent Boys

Promoting sustainable physical activity (PA) behavior change is challenging, and a number of theoretical models have been developed and applied to this problem. Pender’s health promotion model (HPM) is a relatively new model that is based on Bandura’s social cognitive theory but includes the additional construct of competing demands, which are viewed as alternative behaviors (e.g., watching television) that have powerful reinforcing properties. This study evaluates the HPM as a means to predict PA in a sample of Iranian adolescent boys. Participants were 515 boys from 100 junior high and high schools in Sanandaj, Iran. Participants’ mean age was 14.33 years ( SD = 1.6, range = 12-17). Participants completed questions assessing social cognitive variables, and structural equation modeling was used to fit the data to the HPM. The HPM accounted for 37% of the variance in PA but did not represent a good data fit (χ2 = 913.85, df = 473, p < .001). There were significant pathways between PA and self-efficacy (β = .25, p < .001), enjoyment (β = .22, p < .01), and PA modeling (β = —.13, p < .05). A revised model that included the indirect effects of competing demands explained 34% of the variance in PA and represented a good data fit (χ 2 = 9.12, df = 4, p = .058). In the revised model, self-efficacy, commitment to planning, and enjoyment were associated with PA. According to the HPM, competing demands influence PA. In the study sample, competing demands were not related to PA but were inversely associated with commitment to planning.

Application of the health promotion model to predict stages of exercise behaviour in Iranian adolescents

A cluster random sample of 1073 students in the Islamic Republic of Iran (mean age 14.37 years) completed a self-report questionnaire consisting of an exercise measure, selected constructs of Pender's health promotion model and an assessment of stages of behaviour change in exercise. In multivariate discriminant analysis, exercise self-efficacy, perceived barriers to exercise, perceived benefits of exercise and exercise behaviour were significant predictors of the stage of exercise behaviour change for both female and male adolescents. The findings support the importance of self-efficacy for engaging in physical activity for both sexes of Iranian adolescents. The barriers faced by Iranian girls should be considered in interventions to increase physical activity rates.

A school-based randomized controlled trial to improve physical activity among Iranian high school girls

BACKGROUND

Physical activity (PA) rates decline precipitously during the high school years and are consistently lower among adolescent girls than adolescent boys. Due to cultural barriers, this problem might be exacerbated in female Iranian adolescents. However, little intervention research has been conducted to try to increase PA participation rates with this population. Because PA interventions in schools have the potential to reach many children and adolescents, this study reports on PA intervention research conducted in all-female Iranian high schools.

METHODS

A randomized controlled trial was conducted to examine the effects of two six-month tailored interventions on potential determinants of PA and PA behavior. Students (N = 161) were randomly allocated to one of three conditions: an intervention based on Pender's Health Promotion model (HP), an intervention based on an integration of the health promotion model and selected constructs from the Transtheoretical model (THP), and a control group (CON). Measures were administered prior to the intervention, at post-intervention and at a six-month follow-up.

RESULTS

Repeated measure ANOVAs showed a significant interaction between group and time for perceived benefits, self efficacy, interpersonal norms, social support, behavioral processes, and PA behavior, indicating that both intervention groups significantly improved across the 24-week intervention, whereas the control group did not. Participants in the THP group showed greater use of counter conditioning and stimulus control at post-intervention and at follow-up. While there were no significant differences in PA between the HP and CON groups at follow-up, a significant difference was still found between the THP and the CON group.

CONCLUSION

This study provides the first evidence of the effectiveness of a PA intervention based on Pender's HP model combined with selected aspects of the TTM on potential determinants to increase PA among Iranian high school girls.