Journal of School of Public Health and

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Background and Aim: The prevalence of congenital hypothyroidism (CH), one of the main causes of preventable mental handicap in neonates, is much higher in Iran than the global average.
The objective of this study was to identify risk factors for congenital hypothyroidism (CH) by using the screening program in Fars Province, Iran, during the period 2003-2006.

Methods and Materials: A case-control study was carried out, the samples being 126 cases and 401 controls. The neonates were those born between 2003 and 2006, under coverage of the National Congenital Hypothyroidism Program. The data were analyzed using the univariate and multivariate analysis tests.

Results: An increased risk for CH was detected in infants with consanguine parents, by a multivariate analysis test (odds ratio (OR) = 2.9, 95% confidence interval (CI):1.8-4.8). The test also confirmed previously reported statistically significant associations with additional birth defects OR = 2.2 (1-4.6), birth defects in first-degree relatives OR = 4.7 (1.6-4.8), female gender OR = 1.9 (1.1-3), and twin births. Although not significant, an increased risk for CH was observed among infants with gestational age<30 weeks (preterm delivery) (OR = 1.7(0.9-1.3)).

Conclusion: This study identified risk factors contributing to the etiology of CH. In particular, our results suggest a multifactorial origin of CH, in which both genetic and environmental factors play a role.

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Background and Aim: In the raw furniture preparation workshops, in which the workers usually have an undesirable postures when at work, ergonomic assessment and the work environment improvement seem essential. Developing checklists and calculating ergonomic indices would be useful in this assessment. This study was conducted with the objectives of assessing musculoskeletal disorders (MSDs) risk factors and determining types of corrective measures in raw furniture preparation workshops.

Materials and methods: After conducting task analysis, 268 workers were assessed using an ergonomic checklist developed for the purpose and ergonomic indices were calculated. The Nordic musculoskeletal disorders questionnaire was used to determine the prevalence rate of MSDs among the workers. Data were analyzed using the t-test and the test of proportions.

Results: The highest prevalence was in the lower back (38.4%) and the knees 36.2%). Statistical analysis revealed that there were significant associations between MSDs and calculated ergonomic indices (p<0.001). In addition, calculation of OR revealed that ergonomic conditions were associated with MSDs in different body parts (OR=2.90-9.49, p<0.001). On the whole, the working conditions of 32.46% of the workers studied were poor from an ergonomic point of view.

Conclusion: The checklist developed was found to be an appropriate and low-cost tool for ergonomic assessment. The most important problems in the workshops were due to inappropriate general working conditions, inappropriate organization, and unsuitable work stations.

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Background and Aim: Bioaerosols are one of the most important agents that cause post operating infections in hospitals. Surgical masks are recommended for prevention of bioaerosols transmition in operating rooms. This study aimed at evaluation of submicron particle filtration efficiency of domestic and imported surgical masks.
Materials and Methods: In this cross sectional study, 5 types of surgical masks that have the most utilization in operating rooms of country’s hospitals including domestic and imported surgical masks were tested. To evaluate all samples, the submicron particle filtration measurements were carried out based on ISIRI 6138 and American DOP standards. Filtration efficiency calculations and pressure drop measurements were performed and the results were analyzed using statistical tests.
Results: Results showed that particle filtration efficiency of domestic and imported masks were 56.130% (±10.7) and 31.906% (±7.062) respectively. Also, filtration efficiency in domestic masks were more than imported masks (P> 0.001). Among all samples, Arman mask had the most filtration efficiency (66.5475 % ±6.14951), where the least (27.8275 % ±4.44152) filtration efficiency (P> 0.001) belongs to Blosom. The maximum mean of pressure drop in Arman mask (35 ±2. 58 Pa) and the least mean of pressure drop in Zist filter mask (11 ±1.82 Pa) were observed. According to the effect of filtration efficiency and pressure drop on general quality of mask, the quality factor of masks were also evaluated. Results showed that Zist filter mask had the most quality factor (0.068) while Blosom had the least quality factor (0.016).
Conclusion: This research showed that domestic surgical masks have a better quality toward imported surgical masks but can not obtained quality confirmed by standards, yet. To reduce respective infections and prevalence of diseases, it is recommended using filters with suitable physical characteristics and also carrying out test of surgical masks before supplying.

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Background and Aim: Job satisfaction is one of the most important factors in maintenance of a professional person and the job success, increasing the personal efficiency and the quality of services. On the other hand, it is a tool in the hands of managers in order to maintain the staff in their jobs. The aim of this descriptive study was to investigate the satisfaction of physicians and midwives participating in the family physician scheme with the plan.
Materials and Methods: The study population was made up of 221 physicians and 144 midwifes. The tool was an author made questionnaire certified by experts as a standard, valid and reliable scale via content validity measurements through a pilot study.
Results: The average satisfaction of physicians and midwives was 44.34% while the highest satisfaction was 65% with the location of services and the lowest was 30.6% with the financial issues. In relation to the financial affairs, physicians were more dissatisfied than midwives, so satisfactions were increased by the increase in the amount of salaries.
Conclusion: Over 4 years of implementation of family physician plan, the physicians and midwives satisfaction was shown to be still low. It is necessary to consider re-programming in the scheme in order to increase the amount of payments and create more motivational factors for physicians as well as to reduce working hours for midwives and establish appropriate levels of payments for them.

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  Scientific Journal of School of Public Health and Institute of Public Health Research /85

  Vol. 11, No. 2, Summer 2013

  

  Forecasting ambient air pollutants by time series models in Kerman, Iran

  

  Mansouri, F., MS.c. Student, Dept of Environmental Health Engineering, Faculty of Public Health, Kerman Medical University, Kerman, Iran

  Khanjani, N., Ph.D. Assistant Professor, Department of Epidemiology and Department of Environmental Health, Faculty of Public Health, Kerman Medical University, Kerman, Iran - Corresponding author: n_khanjani@kmu.ac.ir

  Rananadeh Kalankesh, L., MS.c. Student, Department of Environmental Health Engineering, Faculty of Public Health, Kerman Medical University, Kerman, Iran

  Pourmousa, R., MS.c. Lecturer, Department of Statistics, School of Mathematics and Statistics, Shahid Bahonar University, Kerman, Iran

 

  

  Received: Apr 3, 2012 Accepted: Feb 14, 2013

 

  ABSTRACT

 

  Background and Aim: Air pollution is one of the most important problems of big cities in developing countries and can have several negative health effects on humans. Therefore studying these pollutants can help in developing programs for air pollution control. The aim of this study was to estimate and predict the changes of air pollutants in Kerman, Iran.

  Materials and Methods: In this ecological study, data about seven important air pollutants in Kerman including NO, CO, NO₂, NO_x, PM₁₀, SO₂ and O₃ from March 2006 until September 2010 was inquired from the Kerman Province Environmental Protection Agency. Then the data was calculated as averages per month and by incorporating time series models, predictions were done for each pollutant.

  Results: All of the pollutants were steady in Kerman, except CO which is significantly decreasing and PM₁₀ which is increasing. All of the pollutants had a seasonal pattern. Time series models with a 12, 3, 8, 12, 12, 12 and 6 month seasonal pattern were fit for O₃ , SO₂ , PM₁₀ , NO_x , NO₂ , CO and NO consecutively.

  Conclusion: The production of ambient CO is decreasing in Kerman and one reason is probably replacing and retiring old automobiles. However PM₁₀ is increasing in Kerman and in most seasons it is above standard and therefore control initiatives should be implemented.

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  Background and Aim: Measuring the hand's grip strength and comparing it with its normative data is a valid method for detecting intensity of the numerous damages of hand. In addition, co mparing grip strength of people in different regions can reveal hidden facts resulting from genetic and environmental factors . Therefore , the present study was carried out with the aim of comparing grip strengths and three types of pinch (tip, key and palmar) strengths of healthy people living in five Iranian cities and determining normative data of grip strengths of citizens of these cities.

  Materials and Methods: This was an applied cross-sectional study. The study population included 1008 healthy adults (526 males and 482 females) from the Fars (Persian) ethnic populations in five cities of Iran ( Mashhad, Isfahan, Shiraz , Kerman and Yazd ). The American Society of Hand Therapists (ASHT) recommendations were followed to establish normative data of grip and pinch strengths . Jamar dynamometer and Seahan pinch gauge were used to measure grip and pinch strengths. In addition, the effect of body mass index (BMI) and other anthropometric variables (hand length, height and weight) on grip strengths was assesed.

  Results: In the present study, no significant differences were found between grip and pinch strengths of adults in the five cities. From among the parameters studied , height and hand length had the most influence on the grip strengths .

  Conclusion: The findings of this study show that populations of any particlular ethnic group have similar grip strength despite living in different geographical areas. The normative data of grip strength obtained in this study are important for ergonomists helping them to optimize work programs and designing tools, as well as for therapists helping them to reach the goals of treatment, assessing the body response to medical treatment, and detecting good function of the upper extremities .

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Background and Aim: MS is a chronic and destructive inflammatory disease with a not contradiction continuing of life but can influenced the quality of life of patients. The purpose of this study is to determine the quality of life in MS and its related factors. Materials and Methods: This cross-sectional study was performed on 172 patients admitted to the MS Society of Iran (Tehran) and convenience samplings were obtained for 10 months. Tools for data collection were MSQOL-54 and MS patients were also interviewed. Data using descriptive and Analytical tests such as multiple regression were analyzed. Results: The mean age of patients was 34/8 ± 9/6 years. Analysis of 14 sub-domains of quality of life questionnaire showed that the highest average score in the domain of quality of life was social functioning (71/7 ± 21) and the least was role limitations due to physical problems (44/2 ± 39/4). Results of multivariate regression models shown that between age has an significant inverse relationship to domain of physical combined and only variable significant on the combined domain of psychological – psychiatric, Area residential Variable was (p.value 0/001). Conclusions: The study shows that demographic variables medical and economic factors influence the quality of life of patients with multiple sclerosis. Identify the factors related to the quality of life of these patients can be helpful in predicting quality of life. The variables influence on the quality of life for MS patients must be targeted in designing effective intervention programs to improve their quality of life.

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  Background and Aim: Chlorophenols are acidic Organic compounds and priority Pollutants. One of the best ways to removal chlorophenols was using different absorbents . In this study, removal efficiency of ortho- chlorophenol as one of the most common organic contaminants in aquatic environments was investigated with absorption method using activated Fly Ash.

  Materials and methods: In this experimental study, Fly ash of collected from Zarand Power plant was activated by sulfuric acid. Factors affecting in sorbent activation process including temperature, time, amount and concentration of the acid and also factors influencing in the adsorption process were adjusted for optimum conditions. Experiments was followed on real wastewater samples from coal washing plant of zarand . Data was analyzed by SPSS software.

  Results : The sorbent activation was performed in optimized condition acid concentration 1.8 mM, time 5h, temperature 29±2˚C and acid/fly ash ratio 7. Removal efficiency of zarand coal washing plant Effluent at the optimal conditions (pH: 2, adsorbent doze: 1g, time: 3h) was 84.4%.

  Conclusion: In addition to the high efficiency of ortho-chlorophenol absorption because of sorbent activation does not require complex and expensive technology, the adsorbents can be used to remove these contaminants from industry effluent.

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  Background and Aim: Suicide by burning is one of the main health problems very common among women living in the west part of Iran. The objective of this study was to explore its causes and preventive strategies from the viewpoint of healthcare providers .

  Materials and Methods: This was a qualitative study, using semi-structured interviews, carried out in Kermanshah. The participants were the health care personnel working in Imam Khomeini Hospital, a teaching hospital and referral center in the west part of Iran. Sampling was purposeful and continued until data saturation. Data analysis was conducted through thematic analysis.

  Results: Four themes were extracted for the causes of self-immolation including cultural context, mental health problems, self-immolation as a way to highlight the outcry, and economic problems. As regards prevention strategies, two main themes, namely, cultural changes and mental education and services, emerged.

  Conclusion: Self-immolation is a multi-dimensional phenomenon. Different factors interact, resulting in self-immolation by women in stressful situations. Comprehensive preventive strategies such as education, as well as cultural changes, can help to reduce the burden of self-immolation.

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  Background and Aim: Investigation of seasonal suicide might help in learning about the etiology of suicide committers’ behavior. Literature search indicates that a large number of preliminary studies have been carried out on this subject, in many of which seasonal and climatological aspects of suicide have been investigated. In the present study, the seasonal and time pattern of suicide incidence in Iran was determined based a systematic review.

  Materials and Methods : Search was performed in the national databases, namely, SID, Iranmedex, Magiran and Medlib, as well as international databases such as PubMed, Scopus and Google scholar, using such keywords as Iran/Iranian, seasonality and suicide. The technical quality of papers was assessed using checklists. Data of each of the preliminary studies were extracted in terms of general variables and such specific variables as season, month, hour, weekdays and climatic conditions.

  Results: Of a total number of 49,522 documents obtained from a primary electronic search, eventually 32 papers were included in this study. The highest numbers of suicides committed were 7 and 8 in summer and spring, respectively. Similarly, among the primary studies that had reported only the monthly occurrence of suicide, the highest rate in 7 cases was spring and 7 in summer. In most of the studies (8 cases) the highest number of suicides had taken place between 1:00 and 6:00 PM.

  Conclusion: These findings indicate that suicide occurrence in Iran has a seasonal pattern, most cases committed being in spring and summer.

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Background and Aim: Malaria is still one of the major health problems in comparison with any other parasitic disease in Iran with considerable economic and mortality consequences. Sistan-and-Baluchestan, Hormozgan and Kerman are the most affected provinces in the country approximately 96% of the cases are reported from these three provinces. The aim of this study was to determine the frequency, distribution and rate of parasitaemia of human Plasmodium (P.) species in patients infected with malaria parasites in Kerman province.

Materials and Methods: A total of 92,798 peripheral blood smears were collected from suspected malaria patients during the period 2009-10. Thin and thick blood smears were prepared according to the World Health Organization (WHO) standard procedure. Percentage of parasitaemia was determined based on the number of parasites in the positive slides. The Chi-square test was used for data analysis.

Results: A total of 571 samples were found to contain human Plasmodium species, including 523, 44, and 4 cases of P. vivax, P. falciparum and mixed infection, respectively. The results also showed that, as compared with the previous year, the total number of P. vivax cases

decreased in 2010 by 33.96%. The highest level of parasitaemia was observed in one of the patients infected with P. falciparum, with 77240 parasites/µl of blood, and the lowest in a patient infected with P. vivax, with 48 parasites/µl of blood. There were no differences between the positive and negative cases as regards parameters such as nationality, habitat or gender (Chi-square, p<0.05).  Furthermore, based on the Mann-Whitney test, there was no significant difference between the mean counts of P. falciparum and P. vivax (p-value = 0.464).

Conclusion: Considering that Iran is in the elimination stage of malaria, patient finding and rapid, timely diagnosis of the disease are very important, particularly cases coming from Pakistan and Afghanistan, helping sustainability of the elimination program.

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Background and Aim: Considering the importance of cutaneous leishmaniasis in Iran, this study was conducted to present the epidemiological characteristics of patients with cutaneous leishmaniasis, the time trend and the mapping of the disease in the cities under the supervision of Shiraz University of Medical Sciences.

Materials and Methods: Data was collected from the Heath deputy of Shiraz University of Medical Sciences and Health Centers of cities from 2005 to 2014; and was analyzed using Excel and SPSS19 software. Chi square test and Poisson regression were used for analysis.

Results: The incidence of the disease increased from 109 cases per 100,000 in 2005 to 218 in 2008 and decreased to 110 in 2014. The 0-9 age group was the most vulnerable and housewives were the most involved occupational group. Most people had a wet wound. The hands were the most affected. The highest incidence of disease was in the autumn. Zoonotic Cutaneous Leishmaniasis (ZCL) was the dominant type. Cutaneous leishmaniasis was more in northern than southern regions of the province in the recent years.

Conclusion: In the last years of the study, unlike in the early years, the incidence of disease in the northern region of the province was more than the southern regions. This finding could be a warning signal that the disease could be relocating and spreading in areas where the disease was not endemic before.

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Background and Aim: Condom use in extramarital sexual relations is a major tool, protecting the two partners against venereal diseases. Therefore, it is essential to investigate this matter. This study aimed to determine the reasons for using and not using the condom by the Iranian youth
in their extramarital sexual relations and the related cultural issues.
Materials and Methods: This was a national cross-sectional survey using multistage sampling in 13 provinces in Iran, including 3246 participants 19-29 years old, conducted in 2014, using a questionnaire to collect data.
Results: The proportion of males in the sample was 51% and that of females 49%. On the whole, 19.5% of the participants (31.7% of the males and 6.9% of the females) had had extramarital sex relations. The proportions of the participants with a history of extramarital sex using the condom at every intercourse, almost at every intercourse, sometimes and never were 21.7%, 15.4%, 35.3% and 27.6%, respectively. The reasons for not using the condom regularly were unavailability of the condom, not liking it, its high price, it not being necessary and using other tools.
Conclusion: The major reasons for not using the condom had cultural roots or were related to personal and cultural preferences. Encouraging condom use widely would require appropriate cultural policy-making

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Background and Aim: Along with the expansion of health systems, the importance of primary health care as the basis of an efficient health system is more evident and the quality of the provided services at this level becomes more important. In this way, the present study attempts to collect patterns used to improve the quality of primary health care.
Materials and Methods: The present study is a systematic review. The advanced search was done in the Web of Science, Scopus, Embase, PubMed, Cochrane, SID, MagIran, IranDoc, and Google Scholar databases in title, abstracts and keywords fields. Inclusion criteria include a comprehensive attitude, focus on primary health services, English or Persian language, published between 2006 and 2018. Exclusion criteria include studies that focus outside of primary health care. The quality of the studies was evaluated using the JBI checklist. Two independent researchers conducted the task of selecting studies, extracting data and evaluating the quality of studies, and disagreement cases were resolved by the third researcher.
Results: After screening and reviewing the criteria for the entry of 10095 studies, 11 studies were finally included. The quality of the four studies was evaluated average and the rest of the quality was high. Two studies have provided patterns for improving the quality of primary health care, three evaluated the effectiveness of quality improvement tools, and five presented conceptual frameworks.
Conclusion: A total of eight types of systems extracted to assess and improve the quality of primary health services. Studies on primary health care have been used at various levels of personal, professional, practical and national policy, and have developed models, tools and frameworks that each of them can be used separately or combined for different situations with regard to the limitations and facilities mentioned and improve health outcomes.

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Background and Aim:  The health, safety and environment (HSE) system is an integrated system that tries to create a healthy, pleasant and lively environment with no accidents, damages and injuries by converging and synergizing human resources, facilities and equipment. The purpose of the present study was to investigate the validation of the revised scale of HSE performance.
Materials and Methods: This was a descriptive and analytical research conducted using the psychometric method. The statistical population included all workers of the steel companies in Kerman Province, Iran in 1400. Using the cluster sampling method based on psychometric criteria a sample of 100 was selected for the convergent validity and a sample of 578 for the construct validity section. Data were collected through two scales of HSE performance and job stress (Cohen et al., 1983). Content validity, convergent validity and factor analysis methods were used to check the validity of the scale. The reliability of the scale was checked using the internal homogeneity and classification reliability (dividing in 2 haves).  The SPSS version 22 software was used for data analysis.
Results: Confirmatory factor analysis confirmed the six-factor model. The questionnaire was used along with the 35-item occupational stress questionnaire of Cohen et al. (1983) which had good reliability and validity. The alpha coefficient obtained for the whole scale was 0.79, and for the subscales as follows: resilience 0.93, demand 0.90, role 0.93, control 0.85, support 0.72 and relationships 79.0. In addition, the reliability coefficient of the scale was also calculated using the classification method. The classification coefficient for the first and second halves of the data was 0.87 and 0.62, respectively, the correlation between the two halves being 0.248. These findings indicated a favorable internal consistency coefficient for the HSE performance scale (P<0.001).
Conclusion: According to the findings obtained based on the HSE validation, which showed that the fit of the model is high and also that the evaluation of HSE performance has a great role in the health of employees, more attention should be paid to the establishment and implementation of HSE management in Kerman steel companies.
 

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Background and Aim: Performance evaluation is a useful way to obtain information for decision-making and management of healthcare organizations. The purpose of this study was to assess the performance of health houses in rural areas in Kerman City, Iran during the outbreak of Covid-19.
Materials and Methods: This cross-sectional study was conducted in 2021-22 using descriptive and analytical methods. The research population included all the health houses in Kerman City (n=57), Iran. The tool for data collection was the Health House Performance Evaluation Checklist of the Ministry of Health and Medical Education developed to supervise the performance of health houses during the outbreak of Covid-19. Data analysis was done using SPSS 26 software, the statistical tests being descriptive statistics (mean and standard deviation) and analytical statistics including independent t-test, one-way analysis of variance and Pearson and Spearman correlations.
Results: The average performance score of the health houses (n =55) in managing Covid-19 was 96.37 out of 136. Installation of the village map on the wall of the health house  (92.3%), screening and following up the positive-test individuals and informing the health care team to track and isolate individuals in close contact (84.6%) were found to have the highest, and injecting the third dose (78.8%) and the second dose (75%) of the Covid vaccine the lowest,  scores. From among the characteristics investigated the variable of native Behvarzes (the personnel of health houses) had a statistically significant positive relationship with the performance score (p=0.01). In addition, the health houses with more than one Behvarz were found to perform better than those with only one Behvarz (p=0.05).
Conclusion: Assessing the performance of health care units at times of crisis, including communicable diseases epidemics, will make it possible to identify the bottlenecks that need improvement for better preparedness in the future. Based on the findings of this  research, the expansion of the coverage of the covid-19 vaccination, updating the disease incidence, the performance of health care teams at home visits, and the progress of the operational plan were the variables that needed improvement most.
 

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Background and Aim:  One of the most significant predictors of substance use disorders is the level of resilience in individuals. This study aimed to determine the association between resilience and substance (alcohol, tobacco, and other drugs =ATOD) use disorders among young people aged 18 to 29 in Kerman city, Iran in 2022.
Materials and Methods: This was a cross-sectional study using a multi-stage sampling method including 407 young individuals aged 18 to 29 years in Kerman city, Iran from spring to winter 2022. The sample was selected from among individuals referring to five women's and five men's hair salons and four methadone maintenance treatment centers in each district of Kerman Municipality. The date on resilience, as well as demographic information, were collected using the short-form RS-14 Resilience Scale, the ACE-8 Childhood Experiences Scale and the Substance Use Disorder questionnaires through face-to-face interviews.
Results: The likelihood of substance abuse and referral to methadone maintenance treatment centers was found to increase with age, male gender, a history of domestic violence, and lower education levels. Conversely, higher resilience was associated with decreased likelihood of substance abuse and referral to treatment centers (p ≤ 0.05).
Conclusion: The findings of this study highlight the importance of developing effective programs to enhance resilience among youth, which will result in reduced risk of substance abuse. The results of this study can be used for appropriate planning and development of strategies to support youth health.
 

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Background and Aim: Stomach cancer is of great importance in Iran due to its high incidence and mortality rates. This study aimed to evaluate the status of behavioral risk factors for stomach cancer among adults visiting healthcare centers in Kerman city in the year 2023.
Materials and Methods: This cross-sectional study was conducted on 410 adults visiting comprehensive health centers in Kerman city using a quota sampling method. A questionnaire containing demographic information and a Gastric Cancer Behavioural Risk Assessment Inventory (GC-BRAI) was provided to the participants. Independent t-tests, one-way ANOVA, and Pearson correlation tests were used for analysis. A significance level of less than 0.05 was considered.
Results: The total score for behavioral risk factors for stomach cancer was 49.54. The mean total score decreased with increasing age (p=0.007) and increased with a higher body mass index (p=0.006). Men had a significantly higher mean score than women (p<0.001). The mean total score significantly differed based on occupation (p<0.001).
Conclusion: These findings emphasize the importance of addressing modifiable risk factors for stomach cancer, particularly in individuals identified as being at higher risk according to this study.