Journal of School of Public Health and

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Background and Aim: Becoming to an adult who is sexually healthy is one of the key developmental activities for adolescents. sexual health is included of sexual development and reproductive health and also the ability to create and maintain good interpersonal relationships, are valued for their body, Respectful engagement with both sexes in correct method and expressed a desire, love and intimacy based on personal and stable social values.
Materials and Methods: In this study, using key words adolescence, sexual behavior, sexual risk behavior and sexual health and peers, related studies from 1370 to 1390 in IranMedex, Irandoc, Medlib, SID and Google scholar were investigated.
Results: Factors and challenges are associated with adolescent sexual health can be categorized into the following 4 themes (12 sub themes): Religious beliefs and spirituality (abstinence) lack of sexual education (false beliefs and knowledge about sexual function adolescents' attitudes toward risky behavior and sexual relations information sources of adolescents skills for "say no") community and youth issues(gender differences relationships with peers monitoring and control by the family communication challenges between teen and parents socioeconomical factors Centers for reproductive health services to adolescents) adolescents sexual relationship outcomes (catching sexually transmitted diseases probability).
Conclusion: In some areas, including relationships between parents with children, gender differences, attitudes and sexual behavior and the influence of peers, Studies conducted in our country is well. But in areas such as spirituality and religious beliefs, self-control, prevalence of sexually transmitted diseases and AIDS, life skills in adolescents and intervention strategies to promote sexual health of adolescents there are a great gap.

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Background and aim: Oral and dental diseases limit an individual&aposs activities at the school, work place and home, leading to a loss of millions of work and school hours all over the world. The period of adolescence is critical as regards shaping of healthy behaviors related to oral and dental diseases. The purpose of this study was to explore and describe school pupils&apos viewpoints on factors influencing development of dental caries.  

Materials and Methods: A qualitative study with a content analysis approach was conducted to collect the perspectives of 18 Iranian students in 8 guidance schools selected by purposive sampling. Structured and semi-structured interviews were held to collect data. An informed consent was obtained and the interviews were recorded and transcribed. The data was analyzed through an inductive approach of content analysis. In order to support the validity and rigor of the data, different criteria such as acceptability, confirmability and transferability were utilized.

Results: Data analysis could identify four major factors influencing dental caries development: "family interactions in dental health", "role of school in caring for teeth", "role of dentists in caring for teeth" and "effect of education in caring for teeth". The factors influencing caring for teeth and mouth had a greater significance.

Conclusion: The students&apos experiences, as observed in this study, can help in developing mutual trust between students and dentists, delivering better services in schools by relevant organizations, and designing more effective oral health interventions, with due consideration of vital role of the parents.

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 Background and Aim: Definition of World Health Organization 1948 for Health includes social domain which two other domains of health, physical and mental, have counter effects on it. Quantity and quality of an individual relation to community in order to improve population welfare is a definition for social health. Social capital and security improvement and reduction of impoverishment and inequity is the impact of this relation and it's opposite side is increasing social problems. In this article, by reviewing social health situation of Iranian community and analysis of it's determinants, improvement strategies have been provided and role of Ministry of Health and Medical Education(MOHME) proposed.

 Materials and Methods : This is a descriptive and analytic study A conceptual framework were described based on a nationally committed definition of social health and used for description and analysis. Secondary data of reviewing existing research and documents were utilized for situational analysis Focus group discussion of steering/stakeholder committee members and review of the best evidences and international experiences made analysis and proposed interventions.

  Results: The evidences show that average increasing rate of social problems during recent years is 15% annually. Albeit, it is not possible to draw the increasing or decreasing trend of social health indices precisely since past 2 decades due to the lake of surveillance system. Several social problem reduction and social health improvement interventions are running by organization but, inadequate sensitivity of responsible persons, not to evaluate the current interventions, inadequate utilization and coverage of population from primary level preventive services, inappropriate selection of essential interventions, allocation of most available resources to tertiary level of prevention(after harm services), weakness of activity implementation system and intersectoral collaboration for executing interventions, disintegration of social health related financial resources and inadequate sensitivity and competencies of people in combating to social problems and risks are obstacle to effective interventions in improving social health indices. Economical, political, international and technological big changes should be added to these reasons.

  Conclusion: Social health progress will not be achieved without intersecotral collaboration Improvement of existing situation is not under duties and responsibilities of MOHME, so proposed direction including vision, strategic objectives and interventions, for social health should be implemented partially by MOHME Remaining parts required advocacy to be done by other sectors. It is essential that the proposed program be approved in health policy council of MOHME for implementation of this direction and achieving to it's objectives and then be approved by health and food security high council and social council of country after that the intersectoral collaboration agreements of social health improvement should be supervised deeply.

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  Background and Aim: Current traditional research methods for solving social problems were challenged due to limited participation of community . The health companion project was carried out with the aim of determining effective model of community participation for solving health problems in Boyerahmad and Dena township. .

  Materials and Methods : This study is a community based participatory research performed in Kohgiloyeh and Boyerahmad province 2005-2009.The study population was the entire rural and urban households of Boyerahmad and Dena county.The strategic committee of project including academic researchers, managers of health and health related sectors was formed and this committee selected six regions for research activities. In each region local directing group "health companion " was established with participation of stakeholders: academic researchers, local leaders, health providers and public representatives to guide all aspects of project. The members of the group empowered and enabled by attending training workshops for need assessment, priority setting, research methodology that through these activities the health problem priorities of the regions were recognized, the research area determined and intervention programs were designed and implemented according to these research area.

  Results: The most important achievement of this project is the methods of activities to reaching goals. Implementation of six participatory interventional proposal for solving health problems and needs are the other achievement. The frequency and means of health problems and their risk factors significantly reduced after the completion of intervention program in each region.

  Conclusion: Establishing and activities of health companion groups followed model of Planned Approach to Community Health (PATCH) that help community to form health promotion team, collecting and organizing of data, choosing health priorities, developing a comprehensive intervention plan and evaluation .

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 Background and Aim: Global growth in the elderly population for both health care providers and families and also the community is an important challenge . Elders are the largest and fast factor for increasing hospital admissions in Society . Increasing costs of aging is the most concern to elders and their families. This study aimed to investigate the health team s approach about cost–effective alternatives for aging health services.

  This study is a qualitative research which was done through content analysis.

  18 people consisting of five faculty members , 6doctors , 3 nurses and 4health public health expert were participated. Samples were selected based on purposive sampling . Data were collected through interviews .

  Results: Four core themes derived from this study which included: 1- Emphasis on training for aging care ( including training doctors, nurses , health professionals , public health experts, elder sand their family caregivers). 2- Emphasis on proper implementation of primary health care for the elderly. 3- Emphasis on home care for elderly.4-attntion to mental health of elderly.

  Conclusion: It seems effectiveness of tree alternatives emphasis to training, home care and mental health for elderly are obvious and evident, so implementing and applying these suggestions would be helpful.

  But the second alternative emphasis on proper implementation of primary health care for the elderly must be performed based on a comprehensive needs assessment in elders population. Finally it is stressed that calculating and comparing actual costs of each alternative in elders caring must be measured through quantitative researches.

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  Background and Aim: After conducting a comprehensive study on shift work systems in petrochemical companies and recommending appropriate shift schedules, some companies changed shift patterns. After a year, the present study was carried out at a petrochemical company which changed its shift pattern from 4-4-4 to 3-3-3. The objective of the study was evaluation of effectiveness of shift schedule change on shift workers’ health problems.

  Materials and Methods: In this study, samples consisted of 195 shift workers of the present study and 44 shift workers from the previous study. Data were collected by an anonymous questionnaire, in which questions on demographic characteristics, health problems and workers’ opinions about shift pattern change were included. Data were statistically analyzed using SPSS 11.5.

  Results: The results showed that prevalence of gastrointestinal, cardiovascular, and musculoskeletal problems were not statistically different between the two groups (p>0.05), but prevalence of some psychological disorders were lower in the present study subjects as compared to the individuals of the previous study (p<0.01). The results revealed that from the viewpoint of shift workers new shift pattern improved quality and quantity of sleep. The findings showed that 76.8% of the subjects evaluated the new shift schedule to be better than the previous one.

Conclusion: Based on the findings, changing the shift pattern from 4-4-4 to 3-3-3 resulted in reduction of prevalence of psychological problems. Therefore, the change implemented in the shift pattern was useful.

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  Background and A im : sexual health in children is difficult subject, does not deal with it formal method. Importance of Sex education of children is accepted in the world. The aim of this paper is describing the concept of sexual health from the viewpoint of children's famil y and identification norms of child sex education and determining sex education priorities of the parent's viewpoint.

  Materials and Methods: This is qualitative study. Samples were selected by targeted method of student's parents of five regional educated o f Tehran. Data were collected by focus group interview and discussion and were analyses by subject and content analysis.

 
Results: The findings were classified in three main areas: 1) Family management 2) the role of school 3) framework of the religion an d traditions.

 

  C ONCLUSION onclusion : Most participants believed sexual health behavior in children is not health indicators. They implemented their family policies in management of Sexual behavior o f their children. In Family control was meant: restriction of sexual behavior in child as a norm. Culture of silence and connivance in management of children's behavior has become norm, because child's sexual behavior is inconsistent with traditional values of family. In identifying priorities of sexual education of children, progression interaction between home and school was known as the most deficits. They are acting their internal values in educational system of children because their conflict of values, norms and tastes difference has not been challenge. It is important and priority of parents to being prepared for the management of their children's sexual behavior .

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Background and Aim: Intersectoral Collaboration and Community Participation are two main strategies for sustaining equity in health. Based on the 4th 5years country development plan, Health and Food Security High Council(HC) as a strategy for developing intersectoral collaboration. Reviewing members' opinions of HC may show the clear way of improving intersectoral collaboration for health promotion of the population to senior officials of Ministry of Health and Medical Education. Materials and Methods: This was a descriptive and qualitative study. Information were gathered by structured interview to HC members and content analysis of the documents and gray materials related to initiation and performance of the HC since it's opening. Content analysis and adding up the interviews were done by hand after defining the main domains. Results: Most of HC members believed that the HC effectiveness is very low or low. For the 1st step, defining health priorities and then responsibilities and expectations of each organization were proposed. Organizations necessity to introduce a sustained representative, creating taskforces for deep working on the issues, regular meeting in secretariat, concurrent information sharing to the members, strengthening similar structure in provinces and giving more authority to them and connecting the council to the scientific committees of health elites are main improvement approaches. Conclusion: There is gap between the performance of the HC and the law makers' expectations. Implementing secretariat of HC including expertise and special working system of intersectoral collaboration will mostly cover the weakness. Defining periodical roles and expectations of organizations and capacity building of health collaborators of the ministries and organizations, and incentivizing organization which have effective contribution, will strengthen and continue the collaboration more.

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  Background and Aim: In recent years great emphasis has been put on the importance of a healthy lifestyle. This study aimed to assess the lifestyle of high school and pre-university students in Bandar-Abbas, Iran.

  Materials and Methods: Using a multistage sampling method a total of 410 high school and pre-university students in Bandar-Abbas, Iran were selected. To assess the lifestyle of the students the Adolescent Health Promotion Scale was used. This 40-item scale assesses six health-promoting behaviors, including those related to nutrition, social support, personal responsibility, health valuation, physical activity, and stress management.

  Results: The mean age of the students (49.8% males and 50.2% females) was

  16.5 (SD=1.34) years. The data showed the mean score of the total scale to be 64.89 out of 100. The mean scores (out of 100) of the subscales of nutrition, social support, personal responsibility, health valuation, physical activity and stress management were 71.06, 63.00, 63.12, 82.11, 41.49, and 68.58, respectively.

  Conclusions: The findings of this study reveal that the health-promoting behaviors of high school students living in Bandar-Abbas are not, on the whole, desirable. The regular physical activity subscale had the least score, which shows that a sedentary lifestyle is a common, serious problem among thestudents.

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Background and Aim: women’s barriers and beliefs are important in the care of teeth and oral health in family and it influence on family’s goals, values and health behavior. Depend on the role of women in shaping health behaviors in family and explain their experiences in the field of oral and dental diseases, the aim of this study was to apply grounded theory approach to develop a process about dental caries in women. Materials and Methods: A grounded theory design was used for data gathering and analysis. 23 participants including 18 women, 3 dentists and 2 spouses were chosen through purposive and theoretical sampling methods. Face to face and semi-structured interviews and two focus groups were held to gather data. Interviews were recorded, taped and analyzed via the grounded theory method developed by Strauss and Corbin. In order to support the validity and rigor of the data, different criteria such as acceptability, confirmability and transferability were utilized. Results: During the data analysis, the core category of “Promoting acknowledge for preservation of teeth” and five main themes of “destructive factors of teeth”, “maintaining dental”, “social and environmental factors”, “Effective believes in dental health”and“Trying to rebuild teeth” were developed. Conclusion: To prevent of oral and dental disease, promoting women’s awareness is not only individual factor but also family, dentist, social and religious believers and policies and executive systems are important. The findings of this study can be effective in designing educational appropriate models in women’s oral and dental health and also may be useful for developing educational context in dentists and policymakers.

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Background and Aim: Since health is a multidimensional issue and several factors affected on it, forming a structure which can manage these factors at provincial level is difficult but possible. Analysis of Stewardship function of Iranian Health system showed that an effective platform for operationalizing the national policies has not been provided in provinces yet So, study the current situation of policy making and planning process and designing a model for provinces was necessary. Materials and Methods: This is a descriptive and analytic study which used system designation mathod. Information were gathered by reviewing scientific literatures of policy making systems, critical review of documents related the policy making and planning structures in universities of medical sciences(UMS) in the country and written survey of the chancellors. Synthesized information presented to steering committee, that had been selected after stakeholder analysis, and the principles and requirement of designation were agreed by them. Based on the principles, Components of the proposed system as "Provincial Health Policy Secretarite(PHPS)" including mission and goals, system process, procedures and standards, management style and financial, human and information resources prepared and finalized by running several focus group discussion sessions, presenting selected health experts and steering committee. Results: Scattering of policy and decision making centers in UMSs, weakness of monitoring and evaluation of provincial health policies and programs, weakness of coordination of education, research and health services policies, weakness of evidence based policy making system in 3 levels of UMS, board of trustees and health and food security technical taskforce of the province, weakness of presence of key stakeholders in preparing policies in UMS are the most important improving opportunities of provincial health policy and planning system. Considering existing gaps, PHPS could operationalize brokering, supervising and surveillance roles of the chancellor (Vice Minister of Health at Province) and ensure the attainment of the three streams: following the standards of academic and community engagement, evidence based policies and plans and monitoring progress of provincial health indices improvement policies and plans among executive organizations. Conclusion: Several units effective on policy and planning in province should be coordinated. PHPS not only prevent the parallel structure but can improve the other structures functions as well. Formal implementation of PHPS in top chart of UMSs and training experts of the unit will help integrated policy and planning and facilitate to achieve the best health indices in the province and the country.

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  Background and Aim: In this paper, contribution rate of health capital in economic growth is computated.

  Materials and Methods: In order to this, fuzzy neural network method is applied on statistical data from Middle East and North Africa countries in the period of fifteen years (1996-2010).

  Results: The obtained results present that contribution rate of health capital in economic growth these countries has averagely been 44/79 percentages in this priod.

  Conclusion: Investment in the field of health and education form the political suggestion of this research.

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  Background and Aim: Economic factors, including life insurance in financial sector may have a significant effect on health sector and consequently on the life expectancy of the society. The life insurance effects on health index indirectly through economic growth and directly through bringing mental relaxation and social welfare for the person applying for life insurance. The main purpose of this study was to investigate how life insurance demand and other economic factors effect on life expectancy index of the society.

  Materials and Methods: In this study, the relevant data with respect to life expectancy as dependant variable and economic factors including life insurance demand have been collected from Organization of Islamic Conference ( OIC) countries for the years 2011 to 1998 using panel data analysis .

  Results: The results of the study indicate a significant and statistically positive effect of life insurance demand on life expectancy index of the selected OIC countries. On the other hand, the variables such as financial development and per capita income also have significant positive effect, while the variables such as unemployment and inflation have significant negative effect on life expectancy index of health.

  Conclusion: The results suggest that economic conditions improvement through lowering rate of unemployment, lowering rate of inflation, increase in per capita income and the financial market development could probably improve the condition of life expectancy in a society. Therefore, that is recommended for the planners to take into account the fundamental economic indicators specially life insurance consumption while planning for health and welfare betterment of the society.

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  Background and Aim: Health-risk behaviors are socially constructed and influenced by the given culture. Therefore, the health-risk behaviors are prioritized differently in diverse cultures. In this study, we aimed to explore the priority of health risk behaviors among high school students in Tehran.

  Materials and Methods : In this qualitative study using rapid assessment approach, we interviewed 130 individuals who voluntarily participated in the focus group discussions (FGDs, n=17). They were students (n=9 FGDs), the parents (n=5 FGDs), and the teachers (n=3 FGDs). Four of the principals were individually interviewed. Interviews focused on (1) perceptions about and description of healthy or unhealthy behaviors (2) priority of health risk behaviors in adolescents (3) perceptions and beliefs about the formation of the risk behaviors among adolescents. All sessions were embarked on the public schools located in the area five in West Tehran. After obtaining a written consent form from the participants, primary investigators and three of the trained facilitators (male and female) conducted the sessions. We employed content analysis to extract the major themes and sub-themes. The rigor of the data was obtained.

  Results : Addiction, risky sexual behavior, and social misconduct ion (aggression) were identified as the main concerns for the boys. Risky sexual behavior, early marriage, eating unhealthy habits, physical motionless, and fear of the future (job, education, marriage) were identified as the main health-risk behaviors for the girls.

  Conclusion : According to our findings, health risk behaviors are classified differently for boys and girls. However, sexual risk behaviors are common findings for both groups. The adolescents' risky behaviors are formed throughout their socialization and seriously influenced by the given culture. Understanding of gender schema was identified as an important factor in the way participants do priority health-risk behaviors of young people. Comprehensive and holistic health education and promotion programs targeting adolescents as well as training programs for parents are suggested.

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  In this article 40 years of Iranian experience in primary health care in west Azarbaijan and behvarzs is presented. In this regard quantitative development of PHC during this period will be discussed, moreover challenges and opportunities of this program will be analysed. Finally family physician program should be considered as an appropriate tool to achieve universal coverago of PHC in iran.

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  Background and Aim: Addiction behaviors have been established among high risk behaviors among different age groups in Iran. This study aimed to investigate the effects of a designed educational program on high risk behaviors of a sample of addicts in Qom, Iran.

  Materials and Methods: Totally, 128 men with addiction history in self help groups referred to health centers in Qom were studied. The instruments used to collect data were a self administered demographic questionnaire and the designed scale high risk behavior based on Health Belief Model (HBM).

  Results: The mean age of participants was 32.4 years. There were no significant difference between two groups at baseline in terms of all demographic data and all HBM constructs. The mean scores of HBM constructs, improved significantly in comparison with baseline. (p < 0.05).

  Conclusions: This study indicated that designed educational program could improve all HBM constructs after intervention. Additionally, behavior intention might be changed after intervention significantly.

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  Background and Aim: The community assessment is the basis of strategic policies for health professionals and managers. The aim of community assessment is collection of the data that relating to public health problems, data analysis and concludes about necessary capacities for providing the necessary resources to resolve problems.

  Materials and Methods: In this study the databases of Scientific Information Database, MagIran, MEDLINE, Google Scholar, and IranMedex were searched up to April 2014 (farvardin1393). All papers of community assessment in the country according to our standard community assessment model were included in this study.

  Results: Overall 11 studies were evaluated and the common feature of all research is to identify problems of society and local problems. The drug addiction was classified in 3 of the studies as a main problem and in 7 of studies was classified in the ten major problems. Poverty and unemployment are allocated to the next priority, the second priority in 2 studies, the third priority in 3 studies and the fourth priority in 3 studies. Environmental health problems and socio-cultural problems were the next priorities.

  Conclusion: The proposed model can be used to suggest new health services with due consideration of community problems, as well as develop suitable, effective intervention strategies. This type of community study should not be conducted only once. Rather, it should be repeated periodically in any community, results compared and used for policy-making.

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  Background an Aim: Community-based health promotion program encompasses actions aiming at enabling individuals, organizations and communities for enhancing behaviors and creating a healthier environment. Considerable experiences regarding community health promotion and community-based health promotion exists in Iran, but they have not been documented adequately.

  Materials and Methods: This paper reports some of the findings of a situation assessment project of community-based health promotion programs in Iran, including typology of community-based health promotion programs and critical analysis of challenges and threats, discussing potential opportunities to improve community-based health interventions. All the available reports, official documents, information and published papers related to community-based health promotion programs implemented in Iran were examined.

  Results: The majority of health-related interventions excluding three national programs, namely, the volunteers, community health workers (Behvarzes) and polio eradication programs, were categorized in three large groups ─ community-based initiatives, community-based participatory research, and community-based addiction prevention. Many of these programs were not community-based in the true sense of the word.

  Conclusion: The findings indicate that in Iran, unlike many other countries, the majority of the interventions are initiated and implemented at the national level with good organizational support. Although implementation of such programs is generally considered feasible in Iran, it seems that the available opportunities have not been adequately exploited for their implementation.

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  Background and Aim : Equitable improvement of the national health situation in Iran requires a sufficient and logical balance between preventive and curative needs. Considering the profound changes that have occurred in disease patterns and the population over the last three decades, it is essential to review the ongoing preventive services with due consideration of the current and future needs of the population in an attempt to provide more effective and appropriate services. The provincial health deputies (PHDs, vice-chancellors of the universities of medical sciences), who are responsible for establishing and adjusting new preventive health services, are confronted with many challenges in this matter. A thorough knowledge of these challenges will help greatly in developing strategies aiming at improving the national preventive health services.

  Materials and Methods : The participants in this study were the PHDs throughout the country. Data were collected through interviews and focus-group discussions. The main question was "What are the challenges and procedures in the area of preventive health services in the Iranian universities of medical sciences in the stewardship/supervision, resources and services domains?".

  Results : Results of the study reveal that PHDs have various challenges that have increased over time because of their persistency and the additional burden of the family physician program and referral system, and the effects are quite apparent in both the staff domain and in the universities where the family physician program is being executed. Although the challenges in all the three domains of stewardship, resources and service provision are not equally distributed, service and resource provision domains suffer most. However, solutions to the problem proposed by the participants emphasize on improvement of stewardship in the domain of public health. The universities consider the Ministry of Health and Medical Education to be the main culprit for these problems.

  Conclusion : The existing challenges will prevent establishment of legal articles of the 5^th ational Development Plan in the health sector. In order to promote the health situation in Iran on an equitable basis (achievement of better health indices), at least ten actions to be taken in the universities of medical sciences at the national level are required: activation of the High Council of Health and Food Security and encouraging social accountability of all the governmental, private, and nongovernmental sectors developing a ten-year plan for preventive health and intersectoral collaboration specifying general and specific annual expectations from preventive health departments of medical universities in the form of memoranda of understanding (MoUs) and creating health oriented competition among provinces and cities adopting a model for provision of health services in cities and suburban areas in coordination with the family health program and the referral system evaluating and integrating the existing preventive health programs elimination of overlapping units in the organizational chart at the central level increasing funds for the national preventive health services programs and not letting use of these funds for other programs measuring general satisfaction of the preventive health managers and employees and maintaining and promoting human resources of the health sector expansion of preventive health services coverage down to the district level and, finally, better management of the facilities, equipment and standards of health centers.

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  Background and Aim : Empowering women means enabling them to decide independently on the basic issues of life. The great challenge of fertility and reproductive health of women is indicative of their inability to make decisions . The third objective of the Millennium Development Goals is empowerment of women and the effect of social determinants of health in this regard has been recognized. This study was conducted to assess the relationship between structural social determinants of health and women's empowerment in reproductive health.

  Materials and Methods: This was a descriptive-correlation study including 400 women consulting the Shahid-Beheshti University of Medical Sciences health centers in Tehran, Iran. In the first stage, the health centers were selected by the simple random method, followed by quota sampling the f inal sampling was done by the convenience sampling method. The tools for data collection were demographic and socio-economic questionnaires, as well as a questionnaire to obtain data on women's empowerment in reproductive health . Data were analyzed using SPSS-17.

  

  Results: That data showed that the women’s empowerment in reproductive health was at an intermediate level. Structural social determinants of health were correlated with women’s empowerment in reproductive health the highest correlation was found to be with women’s education level (r= 0.44, P< 0.001).

  Conclusions: Women's general empowerment, as well as their empowerment and in family planning needs special attention. Structural social determinants of health are correlated with women's empowerment in reproductive health . Thus, policies should be adopted and plans executed aiming at strengthening the role of women in the family and the society .