Health concerns of Iranian adolescents: Protocol for a mixed methods study

Background: Adolescents have particular health and developmental needs that suggest they should neither be treated as older children nor younger adults. Objectives: The aim of this paper is to report the protocol for a mixed methods study that set out to investigate the health concerns of Iranian adolescents and their sources of health information with the goal of identifying suitable strategies to address their health concerns. Materials and Methods: This mixed methods study consists of an explanatory sequential design to be conducted in two phases. The first phase was a population-based cross-sectional survey of 915, 14-18 year old adolescents who were selected by stratified cluster random sampling method from the 22 main municipal sectors of Tehran, Iran. They completed a series of self-administered questionnaires which were analyzed using quantitative approaches. The second phase was a qualitative study in which adolescents were selected using purposeful sampling for individual in-depth semi-structured interviews on the basis of the quantitative findings from the first phase. These data, together with a literature review and data obtained through nominal group technique, would then be used to in the development of strategies to reduce adolescents' health concerns. Results: The findings of this mixed methods sequential explanatory study are expected to provide unique information about the health concerns of Iranian adolescents and their sources of information, which to date have received little attention. Conclusions: These data will provide a rich source of information that can be used by intervention programs, health professionals and policy makers in addressing the health concerns of adolescents, with the goal of facilitating a successful passage to adult life. © 2014, Iranian Red Crescent Medical Journal

Prevalence of Home Smoking Bans and its Determinants in Families with Infants

Background Exposure to cigarette smoke has numerous health risks for infants and children. Home smoking ban is a simple way to reduce the detrimental impacts of cigarette smoke. This study aimed to determine the prevalence of cigarette smoking bans in homes as well as associated factors in families with infants in Tehran, Iran. Materials and Methods This study was a population-based cross-sectional survey on 1,112 families with infants, selected through stratified-cluster sampling. In this study, a researcher made questionnaire including four parts: sociodemographic characteristics, smoking status, smoking restrictions, and parental awareness and belief, was completed. The multivariable logistic regression was used to investigate the relationship between smoking bans in homes and associated factors. Results Complete smoking ban in homes was 37.3%. In the multivariable logistic regression, cigarette smoking ban in homes was significantly higher for employed mothers (odds ratio [OR] = 3.03, 95% confidence interval [CI]: 1.2-7.2, P<0.001), for those who did not have any smoker friends or relatives (OR = 2.3, 95% CI: 1.3-4.4, P<0.001), for those smoking a smaller number of cigarettes (OR = 2.7, 95% CI: 1.4-5.3, P=0.003), and for parents who concurred with the impacts of thirdhand cigarette smoke on infant health (OR = 4.7, 95% CI: 1.4-14.9, P<0.001). Conclusion This study indicates that complete smoking ban is not established in many households with infants in Iran. Furthermore, it is necessary to perform health interventions for reducing infant exposure to cigarette smoke, while considering the factors associated with smoking ban. Keyword

Smoking in the home after childbirth: prevalence and determinants in an English cohort

Objectives Children's exposure to secondhand smoke (SHS) is causally linked to childhood morbidity and mortality. Over 38% of English children (aged 4–15) whose parents are smokers are exposed to SHS in the home. Little is known about the prevalence of SHS exposure in the homes of young infants (≤3 months). This study aimed to estimate maternal self-reported prevalence of SHS exposure among infants of women who smoked just before or during pregnancy, and identify factors associated with exposure. Setting Primary Care, Nottingham, England. Participants Current and recent ex-smoking pregnant women (n=850) were recruited in Nottingham, England. Women completed questionnaires at 8–26 weeks gestation and 3 months after childbirth. Data on smoking in the home 3 months after childbirth was available for 471 households.Primary and secondary outcome measures Maternal-reported smoking in the home 3 months after childbirth. Results The prevalence of smoking in the home 3 months after childbirth was 16.3% (95% CI 13.2% to 19.8%) and after multiple imputation controlling for non-response 18.2% (95% CI 14.0% to 22.5%). 59% of mothers were current smokers; of these, 24% reported that smoking occurred in their home compared to 4.7% of non-smokers. In multivariable logistic regression, mothers smoking ≥11 cigarettes per day were 8.2 times (95% CI 3.4 to 19.6) more likely to report smoking in the home. Younger age, being of non-white ethnicity, increased deprivation and less negative attitudes towards SHS were also associated with smoking in the home. Conclusions This survey of smoking in the home 3 months after childbirth found a lower prevalence than has been reported in older children. Interventions to support smoking mothers to quit, or to help them restrict smoking in the home, should target attitudinal change and address inequality relating to social disadvantage, younger age and non-white ethnic groups

Complex osteoclastogenic inductive effects of nicotine over hydroxyapatite

Cigarette smoke is associated to pathological weakening of bone tissue, being considered an important playmaker in conditions such as osteoporosis and periodontal bone loss. In addition, it is also associated with an increased risk of failure in bone regeneration strategies. The present work aimed to characterize the effects of nicotine on human osteoclastogenesis over a hydroxyapatite substrate. Osteoclast precursors were maintained in the absence or presence of the osteoclastogenesis enhancers M-CSF and RANKL, and were further treated with nicotine levels representative of the concentrations observed in the plasma and saliva of smokers. It was observed that nicotine at low concentrations elicit an increase in osteoclast differentiation, but only in the presence of M-CSF and RANKL it was also able to significantly increase the resorbing ability of osteoclasts. A slight downregulation of NFkB pathway and an increase in the production of TNF-α and, particularly PGE2, were involved in the observed effects of nicotine. At high concentrations, nicotine revealed cytotoxic effects, causing a decrease in cell density. In conclusion, nicotine at levels found in the plasma of the smokers, has the ability to act directly on osteoclast precursors, inducing its osteoclastogenic differentiation. The stimulatory behavior appears to be dependent on the stage of osteoclastic differentiation of the precursor cells, which means, in the absence of M-CSF and RANKL, it only favors the initial stages of osteoclast differentiation, while in the presence of the growth factors, a significant increase in their resorbing ability is also achieved.info:eu-repo/semantics/publishedVersio

The association of psychiatric symptomatology with patterns of alcohol, tobacco, and marijuana use among Brazilian high school students

Background and Objectives: Studies have highlighted psychosocial factors associated with drug use among adolescents. Association of specific psychiatric comorbidity with substance use has not been properly established in Brazil. This study aimed to investigate alcohol, tobacco, and marijuana use by 15–18-year-old high school Brazilian students and to estimate associations with psychiatric symptoms. Methods: A cross-sectional survey of 4,034 students from 128 public and private schools in São Paulo State was carried out using a two-step probability sample. Data were collected through self-report standardized questionnaires including questions on substance use patterns and the Strengths and Difficulties Questionnaire (SDQ). Key outcome variables were past-month use and past-month frequent use of alcohol, tobacco and marijuana. Questionnaires with missing information were excluded, resulting in a final sample of 2,532 adolescents. Weighted data was analyzed through logistic regressions, adjusted by gender and by socio-economic status (SES). Results: Regarding SDQ total score, 43.6% of students had no psychiatric symptoms, 7.9% had subclinical symptoms and 48.5% presented clinically significant symptoms. Respondents with a clinically significant SDQ score were more likely to be past month alcohol (aOR = 1.51; 95%CI 1.22–1.88), tobacco (aOR = 1.82; 95%CI 1.25–2.66), and marijuana (aOR = 1.79; 95%CI 1.21–2.64) users as compared to those with no symptomatology. Discussion and Conclusions: Psychopathological symptoms were associated with alcohol, tobacco and marijuana use by 15–18-year-old adolescents. These associations should also be considered when planning public policies of mental health promotion. Scientific Significance: This study discusses the importance of the association between psychopathological symptoms and substance use in a middle-income country, with high level of social inequalities, in a state representative sample

Health-promoting behaviors and social support of women of reproductive age, and strategies for advancing their health: Protocol for a mixed methods study

<p>Abstract</p> <p>Background</p> <p>Determining the health-promoting behaviors of women during the important period of reproduction provides valuable information for designing appropriate intervention programs for advancing women's health. There is no study on the health-promoting behaviors of women of reproductive age in Iran. Thus, the aim of this study is to explore these health-promoting behaviors for the purpose of developing comprehensive and culturally sensitive health advancement strategies for Iranian women.</p> <p>Methods/Design</p> <p>This study has a sequential explanatory mixed methods design. The follow-up explanation model is used to elaborate the quantitative results by collecting qualitative data from participants who could best assist in elucidating the results. The study is conducted in two sequential phases. The first phase is a population-based cross-sectional survey in which 1350 Iranian women of reproductive age are selected by proportional random multistage cluster sampling of the 22 main municipal sectors of Tehran, Iran. Questionnaires are completed through a face-to-face interview. The second phase is a qualitative study in which participants are selected using purposive sampling in the form of extreme case sampling on the basis of health-promoting behavior scores. The qualitative phase is based on data collected from focus group discussions or individual in-depth interviews. A conventional qualitative content analysis approach is used, and the data are managed with a computer-assisted program. Women's health-promoting strategies are developed using the qualitative and quantitative results, a review of the related literature, and the nominal group technique among experts.</p> <p>Discussion</p> <p>The findings of this mixed methods sequential explanatory study, obtained using a culturally sensitive approach, provide insights into the health behavioral factors that need to be considered if preventive strategies and intervention programs are to be designed to promote women's health in the community.</p

Bone mineral density, body mass index and cigarette smoking among Iranian women: implications for prevention

BACKGROUND: While risk factors of osteoporosis in Western populations have been extensively documented, such a profile has not been well studied in Caucasians of non-European origin. This study was designed to estimate the modifiable distribution and determinants of bone mineral density (BMD) among Iranian women in Australia. METHODS: Ninety women aged 35 years and older completed a questionnaire on socio-demographic and lifestyle factors. BMD was measured at the lumbar spine (LS) and femoral neck (FN) using DXA (GE Lunar, WI, USA), and was expressed in g/cm(2 )as well as T-score. RESULTS: In multiple regression analysis, advancing age, lower body mass index (BMI), and smoking were independently associated with LS and FN BMD, with the 3 factors collectively accounting for 30% and 38% variance of LS and FN BMD, respectively. LS and FN BMD in smokers was 8% lower than that in non-smokers. Further analysis of interaction between BMI and smoking revealed that the effect of smoking was only observed in the obese group (p = 0.029 for LSBMD and p = 0.007 for FNBMD), but not in the overweight and normal groups. Using T-scores from two bone sites the prevalence of osteoporosis (T-scores ≤ -2.5) was 3.8% and 26.3% in pre-and post-menopausal women, respectively. Among current smokers, the prevalence was higher (31.3%) than that among ex-smokers (28.6%) and non-smokers (7.5%). CONCLUSION: These data, for the first time, indicate that apart from advancing age and lower body mass index, cigarette smoking is an important modifiable determinant of bone mineral density in these Caucasians of non-European origin

Predictors of children's secondhand smoke exposure at home: a systematic review and narrative synthesis of the evidence

BACKGROUND: Children's exposure to secondhand smoke (SHS) has been causally linked to a number of childhood morbidities and mortalities. Over 50% of UK children whose parents are smokers are regularly exposed to SHS at home. No previous review has identified the factors associated with children's SHS exposure in the home. AIM: To identify by systematic review, the factors which are associated with children's SHS exposure in the home, determined by parent or child reports and/or biochemically validated measures including cotinine, carbon monoxide or home air particulate matter. METHODS: Electronic searches of MEDLINE, EMBASE, PsychINFO, CINAHL and Web of Knowledge to July 2014, and hand searches of reference lists from publications included in the review were conducted. FINDINGS: Forty one studies were included in the review. Parental smoking, low socioeconomic status and being less educated were all frequently and consistently found to be independently associated with children's SHS exposure in the home. Children whose parents held more negative attitudes towards SHS were less likely to be exposed. Associations were strongest for parental cigarette smoking status; compared to children of non-smokers, those whose mothers or both parents smoked were between two and 13 times more likely to be exposed to SHS. CONCLUSION: Multiple factors are associated with child SHS exposure in the home; the best way to reduce child SHS exposure in the home is for smoking parents to quit. If parents are unable or unwilling to stop smoking, they should instigate smoke-free homes. Interventions targeted towards the socially disadvantaged parents aiming to change attitudes to smoking in the presence of children and providing practical support to help parents smoke outside the home may be beneficial