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Prevalence and Correlates of Health Risk Behaviors among High School Adolescents in Iran: With focus on Water-pipe Smoking, Suicide Ideation, Physical Activity and Nutrition
Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.ORCID iD: 0000-0001-9780-4192
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Adolescence is a transitional stage from childhood into adulthood and many habits, with long-term implications for health, from this period of life can continue into adulthood. Identifying risk factors related to health risk behaviors is therefore an important part of health promotion. The main aim of this thesis was to analyze the prevalence and correlates of health risk behaviors among 15-17 year old high school adolescents in Iran. The risk behaviors explored in Papers I–IV include waterpipe smoking, suicide ideation, physical inactivity and sedentary behavior, and nutritional habits.

Methods: Two-stage cluster sampling was used to select representative high schools and classes in the Iranian city of Tabriz. At the first stage, high schools were selected with a probability proportional to the enrollment size. At the second stage, classes were randomly selected, and all students in these selected classes were eligible to participate in the study. Overall, thirty high schools, including sixteen girls’ and fourteen boys’ high schools, ninety classes (grades 9 to 11) and 1,517 students, including 727 boys (47.9%) and 790 (52.1 %) girls participated in the study. The participants’ (students’) response rate was 84.27 %. A reliable, valid and anonymous self-administered Persian Version of the Global School-Based Student Health Survey (GSHS) questionnaire was used for data collection. Statistical methods used were Chi- square test, Fisher exact and multivariate logistic regression analyses.

Results:

Water pipe smoking: Overall, 21.6 % of students were classified as ever WP smokers and 9.7% as current smokers. Ten percent of students had started WP smoking when younger than 12. Ninety-one percent of current WP smokers smoked one session per day, 49% smoked at a café (Ghahvekhaneh). Ninety- five percent of students reported that their age did not prevent them from being served a WP. Ninety-one students out of 147 reported that they did not notice any health warning on the WP tobacco packages. Seven percent of students out of 1,517 participants reported that they would accept a WP if offered by their friends. Being in the third grade of high school, having experienced cigarette smoking, even one or two puffs, and accepting a WP offered by close friends showed significant odds ratios for ‘ever WP smokers’. Accepting a WP offered by close friends and gender (female) showed significant odds ratios for current WP smokers.

Suicide ideation: Four percent of students had seriously considered attempting suicide in the past 12 months. Thirteen point two percent of students reported that they wanted to use alcohol or other drugs when they were worried. The results also revealed that 8.8% of students had been sexually abused. Also, 20.6% declared that they had been bullied in the past 30 days.

Being worried, being a current cigarette smoker, consuming alcohol or other drugs and being sexually abused were significantly associated with suicide ideation.

Physical activity/inactivity and sedentary behavior: The prevalence of physical inactivity (<5 days/Weeks) was 72.2% and sedentary behavior (sitting ≥3 h or more) 71.4%. Being female, having a higher BMI (being overweight or obese), walking/cycling to or from school on 1-4 days, sedentary behavior, low vegetable intake, being the victim of bullying, lack of parental support, peer support, and parental connectivity (protective factors) were directly associated with physical inactivity. Walking/cycling to or from school on 5-7 days was negatively associated with physical inactivity.

Walking/cycling to or from school on 1-4 days, being physically inactive, inadequate fruit intake, and being bullied were positively associated with sedentary behavior.

Fruit and vegetable intake: The prevalence of fruit intake was 76.1% (≥ 2 times/daily) and vegetable intake 23% (≥ 3 times /d). Low fruit consumption was associated with being an 11th grade student, sedentary behavior (sitting ≥3h/d), low intake of vegetables (intake < 3 daily), low or lack of parental support, low or lack of peer support, and the lack of enough food (hunger) at home. Low vegetable consumption was associated with higher BMI (overweight or obese), low consumption of fruit (< 2 daily), lack of peer support, and physical inactivity.

Conclusion: Identified correlated factors (risk factors) should be taken into consideration by public health authorities in the development and implementation of interventions aimed at promoting health among students in the related areas.

Place, publisher, year, edition, pages
Sundsvall: Mid Sweden University , 2018. , p. 87
Series
Mid Sweden University doctoral thesis, ISSN 1652-893X ; 292
Keywords [en]
Global Youth Tobacco Survey, High school students, Iran, Waterpipe/hookah smoking, Student health, Suicide ideation, Global School- Based Student Health Survey, Physical activity, Physical inactivity, Sedentary behavior, Fruit intake, Vegetable intake.
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:miun:diva-34914ISBN: 978-91-88527-83-7 (print)OAI: oai:DiVA.org:miun-34914DiVA, id: diva2:1264308
Public defence
2018-12-20, C326, Holmgatan 10, Sundsvall, 10:00 (English)
Supervisors
Projects
Global School Based Student Health Survey
Note

Vid tidpunkten för disputationen var följande delarbeten opublicerade: delarbete 3 (accepterat), delarbete 4 (manuskript).

At the time of the doctoral defence the following papers were unpublished: paper 3 (accepted), paper 4 (manuscript).

Available from: 2018-12-03 Created: 2018-11-19 Last updated: 2018-12-03Bibliographically approved
List of papers
1. The Prevalence, Attitudes, and Correlates of Waterpipe Smoking Among High School Students in Iran: a Cross-Sectional Study
Open this publication in new window or tab >>The Prevalence, Attitudes, and Correlates of Waterpipe Smoking Among High School Students in Iran: a Cross-Sectional Study
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2016 (English)In: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 23, no 6, p. 686-696Article in journal (Refereed) Published
Abstract [en]

Purpose

The purpose of the present study was to determine the correlates of waterpipe (WP) smoking among 15–17-year-old high school students in Iran.

Method

Data were collected using the Global Youth Tobacco Survey (GYTS), a self-administrated questionnaire distributed to a representative sample of high school students aged 15–17 in the city of Tabriz. Current WP smoking was defined as past 30-day use, and ever WP smoking was defined as at least one or two lifetime puffs. Differences in WP use, knowledge, and attitudes were analyzed using chi-square and Fisher exact tests. Binary logistic regression estimated the association between relevant independent variables (e.g., age) and the dependent variables (current/ever WP smoking).

Results

Of 1517 students, 21.6 % (95 % confidence interval [CI] = 19.5, 23.8) were ever WP smokers, and 9.7 % (95 % CI = 8.2, 11.2) were current WP smokers. Of current WP smokers, 40.3 % have stated that they want to stop smoking now. Moreover, 14.1 % of non-WP smokers reported that they might enjoy smoking WP. Of current WP smokers, 49.0 % have smoked at cafés. Additionally, 95.3 % of current WP smokers reported that their age did not prevent them from being served a WP. Studying in high school third grade (adjusted odds ratios (AORs) = 1.70; 95 % CI [1.10, 2.63]), experience of cigarette smoking (AORs = 1.57; 95 % CI [1.12, 2.20]), and being prepared to accept a WP offered by close friends (AORs = 3.31; 95 % CI [2.17, 5.04]) were independently associated with ever WP smoking, and accepting a WP offered by close friends (AORs = 4.36; 95 % CI [2.69, 7.07]) and gender (female) (AORs = 0.45; 95 % CI [0.30, 0.70] were independently associated with current WP smoking.

Conclusion

Prevalence of current and ever WP smoking is high in Tabriz. There is an urgent need to design interventions in order to increase students’ and their parents’ awareness regarding the harmfulness of WP, and to establish legal measures to restrict adolescents’ access to WPs and tobacco in society.

Keywords
GlobalYouth Tobacco Survey, High school students, Iran, Prevalence of waterpipe/hookah smoking, Student health, Waterpipe/hookah smoking
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:miun:diva-27202 (URN)10.1007/s12529-016-9555-x (DOI)000388938600005 ()26940816 (PubMedID)2-s2.0-84960114373 (Scopus ID)
Projects
GSHS
Note

First online: 03 March 2016

Erratum to: The Prevalence, Attitudes, and Correlates of Waterpipe Smoking Among High School Students in Iran: a Cross-Sectional Study

Ziaei, R., Mohammadi, R., Dastgiri, S. et al. Int.J. Behav. Med. (2017) 24: 480. doi:10.1007/s12529-017-9631-x

WOS: 000400775600008

Scopus: 2-s2.0-85009895029

Available from: 2016-03-04 Created: 2016-03-04 Last updated: 2018-12-03Bibliographically approved
2. Suicidal ideation and its correlates among high school students in Iran: A cross-sectional study
Open this publication in new window or tab >>Suicidal ideation and its correlates among high school students in Iran: A cross-sectional study
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2017 (English)In: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 17, no 1, article id 147Article in journal (Refereed) Published
Abstract [en]

Background

Globally, the second leading cause of death among adolescents is suicide and in middle-income countries adolescents’ suicidal ideation is a neglected public health area. The present study was conducted to determine the prevalence and correlates of suicidal ideation among 15–17-year-old high school students in Iran.

Methods

Self-administered, Global School-based Student Health Survey (GSHS) questionnaires were distributed to a representative sample (N =1517) of high-school students aged 15–17 in the city of Tabriz. Multivariate logistic regression was used to assess the association between relevant independent variables (e.g. gender) and the dependent outcome variable (suicidal ideation in the past 12 months).

Results

Overall, 62 (4.1%, 95% CI= 3.1, 5.2) of 1,517 students had thoughts of suicide. Three hundred and thirteen (20.6%, 95% CI= 18.6, 22.7) students reported being bullied in the previous 30 days. In addition, 134 (8.8%, 95% CI= 7.5, 10.3) students reported having been sexually abused. Being worried that they could not eat or did not feel hungry (Adjusted Odds Ratio (AOR) = 4.15; 95% Cl [1.71, 10.07]; current cigarette smoking (AOR = 3.00; 95% CI [1.69, 5.30]; thinking about using alcohol or other drugs (AOR = 4.28; 95% CI [2.41, 7.59]; and being sexually abused (AOR = 2.63; 95% CI [1.32, 5.24]) were all factors positively associated with suicidal ideation.

Conclusion

The prevalence of suicidal ideation was lower in our school students than in earlier studies. Interventions that address the issue of current cigarette smoking, worries, thinking about using alcohol or other drugs and sexual abuse should be given more priority by the public health authorities.

Keywords
Suicidal ideation Suicide Adolescents High school students Global School-Based Student Health Survey Iran
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:miun:diva-30531 (URN)10.1186/s12888-017-1298-y (DOI)000405441500003 ()28427369 (PubMedID)2-s2.0-85018524249 (Scopus ID)
Projects
Global School Based Student Health Survey
Available from: 2017-03-30 Created: 2017-03-30 Last updated: 2018-12-03Bibliographically approved
3. Prevalence and Correlates of Physical Activity/Inactivity and Sedentary Behavior among High-School Adolescents in Iran: A Cross-Sectional Study
Open this publication in new window or tab >>Prevalence and Correlates of Physical Activity/Inactivity and Sedentary Behavior among High-School Adolescents in Iran: A Cross-Sectional Study
Show others...
(English)In: Iranian Journal of Public Health, ISSN 2251-6085Article in journal (Refereed) Accepted
Abstract [en]

Background

Physical inactivity and sedentary behavior are the main risk factors for non-communicable diseases. However, there is a lack of reliable data regarding the recommended level of physical activity and sedentary behavior and its correlates among school students in Iran. The aim of the present study was to report the prevalence and correlates of physical activity/ inactivity and sedentary behavior among Iranian high school adolescents.

Methods

The Global School-based Student Health Survey (GSHS) was used for data collection. Related data comprising socio-demographics, health risk behavior, and protective factors were obtained from 1,517 high school students. Multivariate logistic regression was used to assess the association between relevant independent variables and the dependent outcome variable (physical inactivity/sedentary behavior).

Results

The prevalence of physical activity was 27.8 %, physical inactivity 72.2 % and sedentary behavior 71.4 %. Being female (Adjusted Odds Ratio (AOR) = 1.48; 95 % Cl [1.08, 2.03]; being overweight or obese (AOR = 2.22; 95% CI [1.23, 2.92]; walking/cycling to or from school on 1-4 days (AOR = 1.57; 95% CI [1.09, 2.25];  sitting 3 or more hours/day (sedentary behavior) (AOR = 1.85; 95% CI [1.39, 2.46]; insufficient vegetable intake (AOR = 1.44; 95% CI [1.06, 1.97]; being bullied (AOR = 1.56; 95% CI [1.08, 2.25];, and lack of parental support (AOR = 1.54; 95% CI [1.14, 2.07]; peer support (AOR = 1.36; 95% CI [1.04, 1.78];  and parental connectivity (protective factors) (AOR = 1.44; 95% CI [1.10, 1.90];  were positively associated with physical inactivity. On the other hand, walking/cycling to or from school on 5-7 days (AOR = 0.44; 95% CI [0.32, 0.60]; was negatively associated with physical inactivity. Walking/cycling to or from school on 1-4 days (AOR = 1.40; 95% CI [1.05, 1.88]; being physically inactive (AOR = 1.53; 95% CI [1.19, 1.97]; inadequate fruit intake (AOR = 1.79; 95% CI [1.33, 2.41]; and being bullied (AOR = 1.70; 95% CI [1.23, 2.33]; were positively associated with sedentary behavior.

Conclusion

The prevalence of physical inactivity and sedentary behavior was high in our studied sample. Interventions that address the issue of active school transport (making safe paths for walking or bicycling), sedentary behavior (lowering screen-based activities), fruit and vegetable intake (availability and accessibility of fruits and vegetables at home), family and peer support and bullying (decreasing victimization by increasing students’ awareness) should be given more priority by the public health authorities.

Keywords
Physical activity, physical inactivity, sedentary behavior, Students, Global School-based Student Health Survey, Iran.
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:miun:diva-33296 (URN)
Available from: 2018-03-18 Created: 2018-03-18 Last updated: 2018-12-03
4. Fruit and vegetable intake and its correlates among high-school students in Iran
Open this publication in new window or tab >>Fruit and vegetable intake and its correlates among high-school students in Iran
(English)Manuscript (preprint) (Other academic)
National Category
Health Sciences
Identifiers
urn:nbn:se:miun:diva-35002 (URN)
Available from: 2018-12-03 Created: 2018-12-03 Last updated: 2018-12-03Bibliographically approved

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1231 of 3
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