Journal of School of Public Health and

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Background and Aim: Sleep disorders and insomnia are problems which create many problems for the elderly and imperil their physical and mental health. The present study aimed to investigate the effect of multi-component cognitive-behavioral therapy on insomnia symptoms and sleep parameters in elderly people.
Materials and Methods: The statistical population includes all the elderly people residing in Kahrizak nursing home, Tehran. The sample consisted of 30 elderly people with insomnia selected by purposive sampling and randomly assigned to experimental and control groups.They completed the Athens Insomnia Scale and Sleep Log. The experimental group received the Edinger’s insomnia disorder multi-component cognitive-behavioral therapy in six 90-min sessions; the control group received no intervention.
Results: Based on  MANCOVA, ANCOVA and Benferoni post hoc, group comparison in the pre-test and follow-up showed that the average scores of insomnia and sleep-onset latency were statistically significantly reduced in the experimental group as compared to the control group, and the total length of sleep was significantly increased (P≤ 0/001). Follow-up did not reveal any significant differences between the experimental and control groups as regards the total time of staying in bed.
Conclusion: Based on the findings of this study, it is recommended that psychologists and nurses working in area of elderly use the multi-component cognitive-behavior therapy to improve the sleep quality of the elderly.

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Background and Aim: The objective of this study was to design and examine the effectiveness of a parent-child relationship improvement program in reducing the externalized problems in children with Down's syndrome. A parent-child relationship improvement program was designed, followed by assessing its effectiveness in a random sample of pupils using a quasi-experimental research design with a pre-test, post-test and follow-up.
Materials and Methods: The study population was all the pupils with Down’s syndrome in the schools for exceptional student in Tehran and their parents in the academic year 2016-2017. The parents and their children were divided into two experimental and control groups.
Thirty-six out of 56 mothers were screened based on a diagnostic interview and inclusion and exclusion criteria and completed the CBCL and parent-child relationship questionnaires in the pre-test, post-test, and follow-up stages. Data analysis was performed using the multivariate covariance analysis with repeated measurements.
Results: The results showed that the mean post-test scores were statistically significantly different between the control and experimental groups, the mean scores of the experimental group being lower than those of the control group, which indicates a positive effect of the family-centered intervention.
Conclusion: Based on the findings, it is concluded that the parent-child relationship improvement program can reduce the subscales of conflict and dependence and increase the subscale of intimacy in the parent-child relationships. Moreover, it can also reduce behavioral problems in children with Down’s syndrome.

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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: The present study aimed to determine the stages of changes and cognitive and behavioral processes (Transtheorical model) in the use of nutrients in overweight middle-aged women.
Materials and Methods: The present study was a descriptive-analytic. The research sample consisted of 281 middle-aged women with overweight referring to comprehensive health centers in Isfahan. Personal characteristics, stage of change and behavior and cognitive behavioral processes, and FFQ questionnaire (168-item) were completed by Questioning, and then the information entered the N4 and SPSS 18 software, and information was analyzed using descriptive and analytical tests.
Results: 57.7% of the people were inactive (pre-thinking, thinking, preparation) and 42.3% of them were in active phase. There was a significant difference between the different stages of change and the use of behavior change processes (p=0.001) And Benfrown's test shows the increasing use of cognitive and behavioral processes during the stage of change in use of nutrients (p<0.001).
Conclusion: The difference in the mean of changes processes during the stage of change show the impact of these processes on the nutritional individual's behavior, which is recommended to use stage of change and behavioral change processes for education nutrition behavioral.

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Background and Aim: In recent years bullying behaviors among school adolescent have risen and have raised concerns for psychologists, teachers and their families around the world. The use of bullying control methods in schools is important. Therefore, the purpose of this study was to evaluate the effectiveness of bullying control training program on health promotion behaviors in bullying adolescents in Tehran.
Materials and Methods: The statistical population consisted of students aged 12 to 17 years old in public schools in Tehran. A total of 40 subjects (20 controls and 20 experimental groups) were randomly assigned into two groups of experimental and control groups. Using a pilot, pre-test, post-test and one month follow up with the control group, Hartler's bullying questionnaire and health promotion behaviors were implemented on both groups. Then, experimental testing of bullying control training was performed in 8 sessions on the experimental group and after the completion of the sessions the post-test was presented to both groups. After that, a month's follow-up was carried out. For data analysis, multivariate analysis of repeated measurements was performed using SPSSV22 software.
Results: The results showed that the cognitive-behavioral bullying control training program on health promotion behaviors between the two groups was significantly different in three stages (p<0.05).
Conclusion: According to the results of this study, bullying control education can be effective on health promotion behaviors of adolescents aged 12 to 17 years and can be used to improve their health. Parents, teachers, managers and other professionals can learn from these trainings.

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Background and Aim: Since many of the healthy behaviors are adopted and develop during adolescence, proper choice of such behaviors is very important in this period of life. In addition, paying attention to the health of girls is crucial because they will transfer such behaviors to the next generation. Therefore, this study aimed to identify the role of health literacy and demographic variables in determining health-promoting behaviors among second-grade high school girl students in the City of Tehran, Iran.
Materials and Methods: This descriptive-analytic cross-sectional study was conducted on 370 female students using cluster sampling method in 2018. Data were collected using demographic, Health Literacy Measure for Adolescents (HELMA) and Health-Promoting Lifestyle Profile II (HPLPII) questionnaires and analyzed using SPSS₂₅.
Results: The results of multivariate regression analysis revealed that there were statistically significant direct associations between health-promoting behaviors and the following variables: one’s health literacy (β= 0.39, p<0.001), interest in health topics (β= 1.35, p<0.001), reading of journals and newspapers (β=0.76, p= 0.007), father's education (p= 0.002), body mass index (p= 0.022), field of study (p<0.001), the first source of health information (p<0.001) and place of residence (p = 0.023). Further analysis of the data showed an indirect association between health-promoting behaviors and age (β= -1.69, p<0.001) and health assessment (β=-1.67, p<0.01).
Conclusion: Based on the findings it is concluded that the subjects’ health literacy and health-promoting behavior scores were “not sufficient” and “intermediate”, respectively. It is recommended to design and implement appropriate training/intervention programs aiming at increasing the heath literacy and promoting health behaviors of female students.

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Background and Aim: Human resources are of paramount importance in the success of any organization. In the health care system, nurses play a great role in the delivery of high-quality care. In this regard, in the process of providing high-quality and efficient healthcare delivery, justice perception of performance appraisal system and organizational citizenship behavior (JPPAS & OCB) are strong tools for performance management. The aim of this study was to determine the association between JPPAS & OCB among nurses in Tehran University of Medical Sciences hospitals in Tehran, Iran.
Materials and Methods: This was a cross-sectional study with a sample size of 346 nurses working in Tehran University of Medical Sciences hospitals. Data were collected using two questionnaires, namely, the JPPAS & OCB and a general demographic questionnaire. SPSS 24.0 for windows was used for statistical analysis of the data.
Results: Analysis of the data showed that justice perception of performance appraisal system (2.70) and organizational citizenship behavior (2.66) are at a moderate level. Based on the correlation analysis, a significant positive association was found between performance appraisal and organizational citizenship behavior. In the final analysis it was shown that performance appraisal could predict organizational citizenship behavior (30.9% of the variance).
Conclusion: Justice perception of performance appraisal system can positively influence loyalty, job satisfaction and employees’ commitment, as well as create organizational confidence, enhance productivity and improve participation.

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Background and aim: Health literacy can be one of the most important effective factors in the adoption of preventive behaviors of osteoporosis by raising awareness and understanding the benefits of diagnostic and preventive behaviors. The objective of this study was to determine the health literacy skills effective in predicting adoption of osteoporosis preventive behaviors in high school female students.
Materials and methods: This was a descriptive cross-sectional study including 375 high school girls in Qazvin, Iran, selected by multi-stage sampling. Data were collected using the standard Health Literacy Measure for Adolescents (HELMA) and the Preventive Behavior of Osteoporosis Measurement questionnaires. The data were analyzed using the statistical software SPSS-23, the tests being descriptive statistics, Spearman correlation coefficient and multiple regression analysis.
Results: Two of the eight components of health literacy, namely, understanding and communication, and two, namely usage of health information and calculation, were found to receive the highest and the lowest mean scores, respectively. The total scores of health literacy and the adoption of preventive behaviors of osteoporosis were 70.84±12.58 (out 100) and 22.43±5.60 (out of 36), respectively. Multiple regression analysis showed that the components of health literacy could predict 38.4% of the changes in the adoption of preventive behaviors of osteoporosis (R² = 0.384). The only other predictor of adoption of behavior was the usage of health information (P=0.001، β=0.044). 
Conclusion: Based on the findings of this study, it is recommended to pay special attention, when developing educational programs for the prevention of osteoporosis in adolescents, to health literacy as a whole, especially the usage of health information component. 

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Background and Aim: Childhood and adolescent externalizing behavior is a serious public health issue, and the family, as an underlying factor, may play an important role in preventing or reducing behavioral problems in childhood and adolescence. The aim of this study was to investigate the effective of parental autonomy support training on school students' externalizing behavior.
Materials and Methods: Thirty school students who had got high scores in the Child Behavior Checklist (CBCL) were selected and randomly assigned to an experimental (N=15) or control (N=15) group. Mothers of the pupils in the experimental group participated in seven 90-minute sessions receiving parental autonomy intervention training; the control group did not received any training. The CBCLs were completed before and after the intervention and compared. The data were analyzed using the multivariate covariance analysis (MANCOVA).
Results: Multivariate covariance analysis showed a statistically significant difference between the scores of the experimental and control groups (p <0.01, F = 21.123, Wilk's Lambda = 0.266). However, no significant difference was found between the two groups as regards aggression, breaking the law and externalized behavior. Further analysis of the data revealed that parental autonomy support skills training favorably influenced the school students' aggression, law-breaking and externalized behavior.
Conclusion: Based on the findings it can be concluded that parental autonomy support training can be effective in decreasing externalized behavior in school students.  Hence, it is recommended to develop and implement training programs for parents and school teachers in areas of meaningful rationales, use of non-controlling language and offering meaningful choices aiming to reduce and prevent externalized behavior in school students.

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Background and Aim: This study aimed to improve the symptoms of children with obsessive-compulsive disorder (OCD), relationships between parents and children, and marital satisfaction using the family-based cognitive-behavioral therapy (CBT).
 Materials and Methods: This was a quasi-experimental pretest-posttest research. The statistical population was all of the 9- to 12-year-old school students suffering from OCD who had consulted the Psychological and Consultation Services Center during academic year 2015-2016 in the city of Tehran. A sample of 28 students selected randomly were assigned to an experimental and a control group. The following questionnaires were completed initially (pre-test) and finally (post-test): 1. Questionnaires completed by the mothers of the children: the Spence Anxiety Scale-Parent Form, the Parent-Child Relationship Questionnaire and the Afrooz Marital Satisfaction Questionnaire (short form); 2. The questionnaires completed by the children: the Spence Children's Anxiety Scale. The intervention program was designed based on CBT and included 22 sessions, eight group sessions for mothers, eight individual play therapy sessions for children, and two specific sessions for each family.

Results: Data analysis using multivariate analysis of covariance showed that family-based cognitive-behavioral therapy was effective in improving marital satisfaction and parent-child interaction as well as reducing child anxiety (p <0.01).

Conclusion: Based on the findings, it can be concluded that family-based cognitive-behavioral therapy intervention may lead to improved relationship between parents and children with obsessive-compulsive disorder and marital satisfaction, as well as reduced anxiety of these children and their parents. 

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Background and Aim: Patients with diabetes need continous support for sustainable self-care behaviors. The use of supportive forces to improve the level of self-management of diabetes is felt. The aim of this study was to compare the effectiveness of direct and indirect virtual educational interventions on the promotion of self-management behaviors and diabetes control in women with type 2 diabetes. The study was conducted in 2019.
Materials and Methods: This clinical trial study included 100 females with type 2 diabetes under the coverage of three health centers affiliated to Tehran University of Medical Sciences, randomly divided into two groups of direct and indirect education (50 subjects in either group). A questionnaire was used as the standard tool of diabetes self-management. The education imparted to the subjects was based on the latest version of Diabetes Self-Management Education (DSME), and the educational sessions were based on the Stanford University's self-management model, including six 90-minute sessions during three weeks. Data were analyzed using SPSS-16 statistical software, the statistical tests being covariance analysis, etc.        
Results: There were no statistically significant differences between the direct and indirect educational groups as regards the self-management scores and HbA1c levels in the first and second pre-tests (p<0.05). However, both the self-management scores and HbA1c levels of the two groups, determined at 3- and 6-month follow-ups, were found to be statistically significantly different (p<0.05).               
Conclusion: The findings of this study indicate the feasibility of using volunteers, after empowering them properly, to implement diabetes self-management educational interventions.              

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Background and Aim: Internet addiction means excessive and unnecessary use of the Internet. The aim of this study was to investigate the role of brain-behavioral systems in Internet addiction among university students.
Materials and Methods: This was a descriptive and correlational research. The statistical population was all the students of Islamic Azad University, Karaj Branch in the academic year 1397-98. A sample of 162 students were selected, based on the Tabachnick & Fidell formula, using the multi-phase cluster sampling technic. The tools used to collect data were the harmful Internet use and the brain and behavioral system questionnaires.
Results: Based on the multivariate regression analysis, 66.7% of Internet addiction among the students could be explained by brain-behavioral systems.  Active avoidance and approach, as components of the behavioral activation system, could predict Internet addiction negatively, while passive avoidance and extinction, as components of the behavioral inhibition system, and fight and flight from the components of the fight/flight system, could predict Internet addiction positively.
Conclusion: Purposeful communication and information search (pleasant unconditional stimuli), tedium and constant logic dominating the internet environment (unpleasant unconditional stimuli) have their own conditional cues on the Internet that indicate the degree of susceptibility of brain-behavioral systems to internet addiction.

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Background and Aim: According to the definition proposed by WHO, social health is a health dimension that impacts, or is affected by, the two physical and mental dimensions. Based on the definition given by the Academy of Medical Sciences of Islamic Republic of Iran, social health includes reciprocal qualitative and quantitative behaviors by individuals towards welfare of the society. Pro-social behaviors and an encouraging environment are considered as the two main components of social health promotion. The purpose of this study was to identify pro-social behaviors in the Iranian society.
Materials and Methods: This was a qualitative study. Data were collected using 1). Literature review based on sources related to Iranian culture and religious advice, as well as published international experiences, and 2). Expert opinions based on focus group discussions on eight specialized disciplines. The data obtained were content analyzed.
Results: Analysis of the data of this study showed twenty pro-social behaviors (possible to be categorized into three domains/areas of social thinking, speech and expression, and behavior):
acceptance of diversity and altruism, understanding human rights, not telling lies, cooperation, humbleness, donation/free contribution, being critical, patience and forgiveness, lack of distrust/suspicion, speaking competence, proper balance/equilibrium, sense of responsibility, brotherhood, personal discipline/order, fidelity, trustworthiness, consultation, cultural exchange, self-identity and, finally, respecting the environment.
Conclusion: Behavior change requires applying evidence-based models, e.g., social marketing. It is, thus, suggested that after investigating and surveying pro-social behaviors in the Iranian society, barriers to pro-social behaviors should be investigated and social marketing programs be developed and implemented aiming to help improve these behaviors.

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correlation coefficient, and multiple regression analysis were performed using SPSS 27.
Results: The results of multiple regression analysis showed the effect of nutritional knowledge variables on nutritional behavior (p <0.001, β = 0.159) and physical activity knowledge on nutritional behavior (p = 0.008, β = 0.120) if the Physical activity knowledge variable was not effective on physical activity behavior and also nutritional knowledge variable had no effect on physical activity behavior.
Conclusion: Increasing knowledge of nutrition and physical activity improves students' nutritional behavior, but this increase in knowledge does not affect physical activity behavior. The sedentary lifestyle and the presence of the Covid-19 pandemic appear to have significantly reduced physical activity. By increasing knowledge, nutritional behavior and physical activity can be improved to some extent
 

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Background and Aim: The pandemic of coronavirus can be considered as one of the most important issues in the world in the last two years. Undoubtedly, reducing the outbreak of coronavirus requires preventive behaviors. The purpose of this study was to investigate the status of preventive behaviors of people and its relationship with demographic and socio-economic variables.
Materials and Methods: A total of 385 residents aged 18 to 65 years in Shiraz City were surveyed using the cluster sampling method and a structured questionnaire. The SPSS.20 software was used to analyse the data.
Results: The findings showed that with increasing age and level of education preventive behaviors increased, while increasing income led to a decrease in such behaviors. Preventive behaviors were more common among women than men, and less common among employed people and housewives than students.
Conclusion: Preventive behaviors in connection the coronavirus are relatively acceptable but far from ideal. Men, young people and people with lower literacy levels should be given more attention in health-related teaching programs.
 

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Background and Aim: Self-care behaviors are the most common behavioral response in attempts to prevent corona stress in patients with diabetes. Therefore, this study aimed to compare the effectiveness of positive thinking skills training and behavioral activation therapy on self-care and corona stress in patients with diabetes mellitus.
Materials and Methods: This was a semi-experimental study using a pretest-posttest and follow-up design with experimental and control groups. The statistical population included all the diabetic patients referring to the Vanoshe Diabetes Clinic in Qaemshahr city, Iran in 2020-2021, from among whom 45 patients were selected by accessible sampling technic based on the inclusion and exclusion criteria and randomly divided into three 15-member groups, namely,  positive thinking skills training, behavioral activation therapy and a control group. The first and second experimental groups received positive thinking skills training in six 60-minute virtual sessions and behavioral activation therapy training in eight 70-minute virtual sessions, respectively, and the control group was in the waiting list. Data were collected using the Corona Stress Scale "CSS-18" and the Summery of Diabetes Self-Care Activities "SDSCA" and analyzed using the repeated measures of variance analysis and the Bonferroni post hoc test with SPSS-22.
Results: The findings revealed that there was a significant difference between the two experimental groups and the control group. Both the positive thinking skills training and behavioral activation therapy interventions reduced corona stress (F= 15.73) and increased self-care (F= 16.17) in the patients, and the effects of the interventions in the follow-up phase were found to be continuing (p <0.05). In addition, the results of Bonferroni post hoc test showed that positive thinking skills raining was more effective than behavioral activation therapy on corona stress reduction (IJ= 9.02), while as regards self-care the behavioral activation therapy (IJ= 12.93) was more effective (p <0.05).
Conclusion: Based on the findings it can be concluded that positive thinking skills training and behavioral activation therapy interventions can be effective in improving self-care and corona stress reduction among diabetic patients. It is recommended that therapists and counselors use, in addition to other treatment methods, these therapies to improve the self-care and corona stress reduction in diabetic patients.
 

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Background and Aim: Organizational citizenship behavior (OCB) of employees in an organization as an optional and voluntary behavior may help to improve organizational productivity. It is important to know that encouraging employees to perform voluntary behaviors needs pre-employment education training in the format of organizational socialization. Therefore, this study was conducted to find the association between organizational socialization and OCB among Tehran University of Medical Sciences Senate staff members, Tehran, Iran 
Materials and Methods: This research was a cross-sectional descriptive-analytical study conducted in 2021-2022. The research population was a group of 1419 staff members in the Tehran University of Medical Sciences Senate, Tehran, Iran, from among whom an available sample of 243 was selected according to Krejcie and Morgan Table based on a response rate of 86%.  Data were collected using the Katz’s Organizational Socialization and the Organ & Konovsky’s OCB Questionnaires, the face and content validity of which had been determined by experts, and based on the Cronbach's alpha test the reliability of the questionnaires was found to be 0.83 and 0.81 for the organizational socialization and OCB questionnaires, respectively.  Data analysis for descriptive and analytical statistics was done using the SPSS software.
Results: The means of the employees’ organizational socialization and OCB scores were 3.8 and 3.35 (relatively high), respectively.  A statistically significant correlation was observed between the organizational socialization and OCB and their subthemes.
Conclusion: Explaining and encouraging voluntary behaviors of organizational citizenship among the employees through implementation of pre-employment and on-the-job training and empowerment courses may help to promote organizational productivity.
 

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Background and Aim: Tobacco use, narcotics, drug abuse, consumption of alcohol, having unsafe sexual relations and other such behaviours are risky behaviors that tend to cause great concerns in families. Parents try to cope with high-risk behaviors through care strategies. The purpose of this research was to determine the typology of strategies for taking care of risky behaviors based on to the family socioeconomic status (SES).
Materials and Methods: This was a quantitative descriptive-correlational research including all the urban families of Tabriz, Iran, from among whom a sample of 384 families was selected by the multi-stage cluster method. Two measurement tools (checklist for high-risk behavior care strategies and a family SES questionnaire) were used to gather data, the one-way analysis of variance (F) test and linear regression being used to determine the relationships between the variables.
Results: The means of strategies for taking care of risky behaviors were significantly different based on the SES of the family, the upper classes adopting a more appropriate (procedural) strategy to take care of children against risky behaviors than the lower classes. Conclusion: Families with a medium and low SES use ineffective care strategies (inefficient and momentary) to cope with risky behaviors. In order to improve the public's health, it is necessary to adopt prevention-based cultural-educational policies to transform ineffective care strategies to procedural strategies.                        
 

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Background and Aim: The purpose of this study was to determine the effectiveness of cognitive behavioral therapy on cognitive flexibility and executive functioning in epilepsy patients.
Materials and Methods: This research was a semi-experimental study with a pre-test and post-test format with a control group. The statistical population was all girls aged 7 to 14 years with epilepsy in Mazandaran province, Iran. The statistical sample included 40 girls (20 in the experimental group and 20 in the control group) selected by the available sampling method and randomly assigned in the two groups. The data collection tools were Dennis et al.'s Cognitive Flexibility (2010) and Coolidge's (2002) Executive Function questionnaires. Data analysis was done using SPSS software version 26.
Results: Multivariate analysis of covariance (MANCOVA) showed that the cognitive behavioral training program had a direct effect on cognitive flexibility and executive functioning of the girls with epilepsy. The effect on cognitive flexibility (F=5.44 (35,1)) and executive functioning (F=2.73 (1,35)) was significantly different at the 0.001 level (P>0.01).
Conclusion: It is concluded that cognitive behavioral therapy has an effect on the cognitive flexibility and executive functioning of epilepsy patients, and the patients affected by cognitive behavioral therapy improve their cognitive flexibility and executive functions.
 

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Background and Aim: Adolescence is a critical period for educational investment, which can enhance individual quality of life and reduce the future burden of disease and healthcare costs. This study aimed to compare the effectiveness of direct education and peer education on health-promoting behaviors among first-grade middle school students in Shush, Khuzestan, in 2024.
Materials and Methods: This quasi-experimental study with pre-test, post-test, and three-month follow-up was conducted on 448 female first-grade middle school students in Shush using multistage cluster sampling. In the peer education group, selected students served as peer educators after receiving training and passing written and practical evaluations. Data were collected using the Walker Health-Promoting Lifestyle Profile (HPLP-II). The intervention was delivered in eight 60–90-minute sessions. Data was analyzed using descriptive and inferential statistics in SPSS software version 27, with a significance level of 0.05.
Results: Both direct and peer education significantly improved health-promoting behaviors (p< 0.05). Direct education had greater effects on overall scores and the dimensions of health responsibility, physical activity, and stress management, which persisted up to three months. Peer education had the strongest impact on interpersonal relationships and spiritual growth.
Conclusion: Both direct and peer education are effective in promoting health behaviors; however, direct education provides more durable effects on core health dimensions, while peer education primarily enhances interpersonal and motivational aspects. A combination of these methods may yield better outcomes in promoting student health.