Farideh Khalajabadi Farahani

REPRODUCTIVE KNOWLEDGE, ATTITUDES AND BEHAVIOR AMONG ADOLESCENT MALES IN TEHRAN, IRAN

CONTEXT Irans culture and religion prohibit sexual contact prior to marriage. Due to the sensitivity of the topic, little is known about the sexual activity of unmarried adolescent males or about their knowledge of, and attitudes toward, sexuality and reproductive health. METHODS A population-based study of 1,385 males aged 15-18 in Tehran was conducted using a self-administered questionnaire. Participants were questioned about their beliefs and knowledge regarding reproductive health, and asked whether they had engaged in sexual activity. Bivariate and multivariate analyses were performed to identify factors associated with sexual knowledge, attitudes and behavior. RESULTS Twenty-eight percent of the sample reported having engaged in sexual activity. Sexual experience was associated with older age, access to satellite television, alcohol consumption and permissive attitudes toward sex. Substantial proportions of respondents held misconceptions regarding condoms, STIs and reproductive physiology. Attitudes toward premarital sex were more permissive among respondents who were older, were not in school, had work experience, had access to the Internet or satellite television, lived separately from their parents, or reported having used alcohol, cigarettes or drugs. CONCLUSION The relatively high prevalence of sexual activity and the lack of knowledge regarding STIs and contraceptives pose a significant threat to the sexual and reproductive health of adolescent males in Iran. Programs are needed to provide adolescents with the information and skills to make safe sexual decisions.

Associations Between Family Factors and Premarital Heterosexual Relationships Among Female College Students in Tehran

CONTEXT Although premarital heterosexual relationships, especially those involving sexual contact, are discouraged in Iran, particularly for females, a considerable minority of young people are involved in such relationships. However, the determinants of such relationships have not been identified, especially those pertaining to family. METHODS In 2005-2006, a random sample of 1,378 unmarried female college students from four universities in Tehran completed anonymous, self-administered surveys that asked whether the respondent had ever had a premarital heterosexual relationship. Bivariate and multivariate regression analyses were conducted to examine associations between such relationships and family factors, including socioeconomic measures, parent-child communication and closeness, family values and atmosphere, and parental control. RESULTS Having had a boyfriend was positively associated with paternal income (odds ratio, 1.3), maternal educational attainment (1.3) and more liberal family values (1.3), and negatively associated with parent-child closeness (0.6). Very strict and very relaxed parental control during adolescence were both associated with having had a boyfriend, but only the former was associated with having had premarital sex. In addition, respondents were more likely to have had premarital intercourse if they did not live with both parents (2.0) or if their family had more liberal values (1.3); they had reduced odds of having had sex if they had a closer relationship with their parents (0.7). CONCLUSION Good family relationships may reduce the likelihood that youth will engage in premarital sex, possibly by fostering parent-child closeness. Moderate parental control may discourage premarital relationships more effectively than lesser or greater degrees of control.

Fertility in Islamic Republic of Iran: Levels, Trends and Differentials during Three Decades (1967-1996)

This study focuses on the fertility levels and trends of Iranian women aged 10- 49 years during three decades, 1967-1996. Information was collected by interviewing a systematic cluster sample of 13,253 households. The basic date of concern was the date of each live born child for a sample of women in reproductive age and whether the live born was alive at the time of the study. The detailed nature of these data collected for each birth enabled fertility rates to be calculated for exact periods before the survey, for exact calendar years. Higher fertility rates were found for the period 10-15 and 15-20 years preceding the survey. These high fertility levels are probably due to some socio-economic changes in favor of higher level of fertility immediately after the 1979 revolution. However the results of the present survey show during 1967-1996, the TFR1 had dropped from 6.38 to 2.88 (an expected TFR based on fertility behavior during 1992-96). This decline was probably due to delay in marriage and policy changes in favor of population control particularly since 1987. Despite this potential fertility decline in recent years, Iran is expected to face a baby boom as the offspring who were born during the 1976-86 reach to the reproductive age in the coming decades.

Factors Influencing Fast-Food Consumption Among Adolescents in Tehran: A Qualitative Study.

Background: The consumption of different types of fast food is increasingly growing in all parts of the world, both in developed and developing countries. Because of the changes and transitions in the lifestyle and dietary habits of people, an increasing number of people from different age groups, particularly adolescents and young adults, are inclined toward consuming fast food. Objectives: The objective of this study was to investigate the factors influencing fast-food consumption among adolescents in Tehran, Iran. Patients and Methods: The present qualitative study was conducted in 2012 - 2013 in Tehran, the capital of Iran. To achieve the objective of this study, 42 adolescents were enrolled in this study through a purposive sampling method, and the required data was collected via individual semi-structured in-depth interviews. Data collection and analysis were carried out simultaneously, and the collected data was analyzed via a thematic content analysis and using MAXQDA 10 software. Results: In this study after coding the transcribed interviews, the findings were categorized into three main themes as follows: personal views, social factors, and family factors. Each theme included several categories and subcategories, and the coded sentences and phrases were placed under each category and subcategory. Conclusions: The results of this study showed that the number of factors promoting fast-food consumption appeared to be more than the inhibiting factors and that the diverse factors at the individual and social level influenced fast-food consumption among adolescents.

EXPLORING BARRIERS OF THE HEALTH SYSTEM TO REHABILITATION SERVICES FOR PEOPLE WITH DISABILITIES IN IRAN: A QUALITATIVE STUDY

Introduction The United Nations (UN) identified health as a basic human right, but, unfortunately, the evidence shows that people with disabilities (PWD) often have lower levels of health than the general population. This can be associated with problems in access to the services and programs. The aim of this study was to explore barriers of the health system to rehabilitation services for PWD in Iran. Methods This was a qualitative study conducted on 21 participants using semi-structured, in-depth interviews and content analysis from June 2014 to July 2015. Data analysis was performed by MAXQDA version 10. Results “Barriers” were the most prominent challenge of people with disabilities that needed access to rehabilitation services. These barriers were categorized into eight concepts of deficiency in the system that provides rehabilitation services, defect of education, deficiency in detecting and screening of people with disability, defect of stewardship in rehabilitation, ignoring socio-cultural factors, accessibility hardships, lack of identification, and financial hardships in rehabilitation. Conclusions An efficient rehabilitation plan requires a common understanding, considering the long-term complications involved in addressing the barriers. Understanding the barriers of the health system to rehabilitation services requires comprehensive management that first should be familiar with all of PWD, providers, policy makers, and other beneficiaries. It also is necessary for policy makers to consider rehabilitation services as a main part of the health plan; especially, they must change their oversight of rehabilitation services and programs. Thus, policy makers should have need comprehensive management and recommended further research.

HIV/STI RISK-TAKING SEXUAL BEHAVIOURS AND RISK PERCEPTION AMONG MALE UNIVERSITY STUDENTS IN TEHRAN: IMPLICATIONS FOR HIV PREVENTION AMONG YOUTH

Recent evidence indicates a rising trend in premarital sexual activity among young people in Iran. However, little is known about the extent to which young peoples sexual behaviours expose them to HIV and STI risks. This study aimed to assess HIV/STI-related sexual risk-taking behaviours (correlates and determinants) and HIV/STI risk perception among male university students in Tehran. A representative sample of male university students (N=1322) studying in government and private Tehran universities completed an anonymous questionnaire survey in 2013-14. Respondents were selected using two-stage stratified cluster sampling. About 35% of respondents had ever had premarital sex (n=462). The majority (about 85%) of the sexually experienced students reported having multiple sexual partners in their lifetime. More than half (54%) reported inconsistent condom use over the previous month. Despite this exposure to HIV/STI risk, the respondents had a very low level of HIV/STI risk perception. Only 6.5% were highly concerned about contracting HIV over the previous year, and an even lower percentage (3.4%) were concerned about contracting STIs in the near future. Early sexual debut (<18 years), studying in a private university, ever watching pornography and work experience were found to be significant predictors of having multiple sexual partners. Younger age at sexual debut, having one lifetime sexual partner and poor HIV knowledge were significant predictors of inconsistent condom use over the preceding month. HIV prevention programmes among Iranian youth need to focus on the postponement of first sex and enhancement of HIV/STI knowledge in the light of increasing access of young people to pornography.

Development and Psychometric Properties of The Delayed Childbearing Questionnaire (DCBQ-55)

The comprehensive assessment of delayed childbearing needs a valid and reliable instrument. Therefore, the aim of the present study was to develop an instrument to evaluate factors influencing delayed childbearing among women and to assess its psychometric properties. The current methodological study was performed in two phases of (i) qualitative instrument development, and (ii) quantitative psychometric assessment of the developed instrument. Face and content validity of the instrument was assessed by eligible women and a panel of experts. Construct validity was assessed using the exploratory factor analysis (EFA). For reliability, internal consistency reliability and intra-rater reliability analysis were used. The initial instrument developed from the qualitative phase consisted of 60 items, which were reduced to 55 items after the face and content validity processes. EFA (n = 300) using the Kaiser criteria (Eigenvalues > 1) and the scree plot led to a six-factor solution accounting for 61.24% of the observed variance. The Cronbach’s alpha coefficient, Spearman’s correlation, test–retest and intra-class correlation coefficients for the whole instrument were reported as 0.83, 0.86 and 0.81, respectively. The final instrument entitled the delayed childbearing questionnaire (DCBQ-55) included 50 items with six domains of ‘readiness for childbearing’, ‘stability in the partner relationship’, ‘awareness about the adverse outcomes of pregnancy in advanced maternal age’, ‘attitude toward delayed childbearing’, ‘family support’, and ‘social support’ on a five-point Likert scale. The DCBQ-55 as a simple, valid and reliable instrument can assess factors influencing delayed childbearing. It can be used by reproductive healthcare providers and policy makers to understand factors influencing delayed childbearing and devise appropriate strategies.

Psychometric Analysis of the HIV Behaviors Questionnaire for Female Adolescents(HBQFA) in Iran

Background: In the absence of a valid instrument for measuring theory-based HIV/AIDS behaviors in highschool adolescent girls in Iranian. This study was aimed to develop and evaluate the psychometric properties of a questionnaire to assess HIV/AIDS related behaviors among female adolescents. Materials and methods: In this cross-sectional study 578 female adolescent participants were enrolled. Multistage cluster randomization sampling techniques was used to select study participants. The data on demographic and components of the TPB (theory of planed behavior) model were collected through self-maid using structure questionnaire. Content, face, and construct validity analysis of the questionnaire were assessed. Results: Results showed that the data was fit to the model (χ2=39222.95, P<0.001). Exploratory Factor Analysis (EFA) (KMO=0.73) with varimax rotation was used to construct validity. For optimal reduced solution 18 items and 6 factors were used. These factors jointly accounted for 63% of the observed variance of outcome variable. The confirmatory factor analysis indicated good fit to the data (RMSE= 0.045 95% CI 0.038 - 0.052). In addition, Cronbach’s alpha coefficient was showed an excellent internal consistency (alpha=0.94). Conclusion: This study finding verified that, the factor structure of the expanded TPB scale of HIV of adolescent’s. Providing and applying valid and reliable questionnaires are necessary to assess HIV behaviors that need intended intervention.

Effect of theory-based intervention to promote physical activity among adolescent girls: a randomized control trial

Background Physical activity (PA) rates decline among most high school female students, and due to cultural restrictions, the reduction of physical activity might be exacerbated in female Iranian adolescents. Objective To determine the effects of the physical activity education theory-based intervention to promote activity among adolescent girls. Methods This randomized clinical trial was conducted at public high schools in Tehran, Iran, from September 2015 to July 2016 on 578 girls. The subjects were assigned randomly to two groups of experiment and control (n=289 per group). All participants in the experimental group received an educational program based on a modified TPB. Measures were assessed before and 6 months after the experiment. The data were analyzed using SPSS version 23. We used descriptive statistics, multilevel analysis, Likelihood Ratio (LR) test, P-value less than 0.05 were considered statistically significant. Results Five hundred and seventy-eight participants with a mean age of 14.26±0.96 years were studied in two groups of experiment (n=289) and control (n=289). Moreover, adjusted for the baseline values, the mean of the scores of the knowledge (84.1±13.6), attitude (31.2±13.6), subjective norm (40.4±11.1), behavioral intention (34.3±14.7), perceived behavioral control (38.4±11.6), perceived parental control (42.9±14.2), behavioral (42.6±17.1) was significantly higher in the experiment group compared with the control group (p<0.001). Conclusions The results of this study implicate that theory based educational intervention is considered to be more effective in improving physical activity in adolescents. This result can be used to increase adolescent’s health promotion. Trial registration The trial was registered at the Iranian Registry of Clinical Trials (IRST) with the identification number: IRCT2015070623089N2. Funding The authors received no financial support for the research from Kermanshah University of Medical Sciences.