Health Education and Health Promotion

Abstract Aims: Given that the skin is the body’s largest organ, it is not surprising that skin cancer is considered the most prevalent type of cancer among humans. This study aimed to investigate the behavior of students at Khomein University of Medical Sciences regarding the use of sunscreen to prevent skin cancer based on the health belief model.
Instrument & Methods: This cross-sectional study was conducted with students of Khomein University of Medical Sciences in Markazi Province in central Iran from February to January 2024. Given the small student population, a census sampling method was used, resulting in the participation of 353 students. The research tool comprised a demographic information questionnaire, along with a researcher-made questionnaire on the use of sunscreen in skin cancer prevention based on the health belief model. Data analysis was performed using STATA 17 software, employing descriptive statistics and simple and multiple linear regression analyses, with a significance level set at α=0.05.
Findings: A one-unit increase in the scores of perceived benefits, perceived barriers, cues to action, and perceived self-efficacy led to increases of 0.13 (95% CI=0.05, 0.26; p=0.041), 0.10 (95% CI=0.02, 0.17; p=0.007), 0.14 (95% CI=0.07, 0.22; p≤0.001), and 0.18 (95% CI=0.07, 0.29; p=0.001) in the mean behavioral score.
Conclusion: Gender, socioeconomic status, parental occupation, and level of education are associated with the adoption of sunscreen use behavior and perceived benefits, cues to action, and self-efficacy are strong predictors of sunscreen use.

Abstract Aims: This study aimed to investigate the role of health literacy and the health action process approach in predicting the adoption of breast cancer screening behaviors among Iranian women.
Instrument & Methods: This cross-sectional (descriptive-analytical) study was conducted on 350 women aged 30 to 69 years who were served by comprehensive health centers in the city of Alborz, Qazvin Province, Iran, selected by multi-stage cluster sampling. The data collection tools included a demographic information form, questionnaires related to the constructs of the health action process approach, and a short version of the Health Literacy Measurement Scale for Iranian Adults. Data analysis was performed by SPSS version 25 software using the Kolmogorov-Smirnov test for assessing data normality, descriptive statistics (mean and standard deviation), and multiple regression analysis to predict screening behavior.
Findings: The mean age of the participating women was 44.73±10.22 years. The average health literacy score was 29.54, indicating a low level of health literacy. Additionally, a significant relationship was found between health literacy and the performance of breast screening tests, such that women with higher education levels, spouses with higher education, a history of mammography and breast self-examination, better financial status, employment, and health insurance coverage had higher health literacy. The constructs of perceived risk, perceived barriers, and coping planning explained 24% of the variance in screening behavior.
Conclusion: The health action process approach enhances women’s participation in breast cancer screening.

Abstract Aims: The rate of seat belt use among adolescents as a passenger age group is lower than that of adults. There is limited research on seat belt usage among adolescents. The present study aimed to compare the predictability of seat belt-wearing behavior among adolescents using the theory of planned behavior and its extension.
Instrument & Methods: This cross-sectional study was conducted among 952 adolescent students as car occupants. A researcher-developed questionnaire was used for data collection. In the extended theory of planned behavior, constructs related to threat appraisal were added to the theory of planned behavior. These constructs included perceived severity, perceived rewards, and perceived sensitivity. Structural equation modeling was used to determine which theory better predicts seat belt use behavior.
Findings: The mean score for seat belt use among adolescent students was unfavorable. Structural equation modeling confirmed the validity of both the theory of planned behavior and its extension in predicting seat belt use behavior among adolescents. However, in the extended theory of planned behavior, the additional constructs of threat assessment—such as perceived rewards, perceived severity, and perceived sensitivity—showed no statistically significant relationship with behavioral intention. Consequently, the inclusion of threat assessment dimensions did not enhance the prediction of seat belt-wearing behavior.
Conclusion: The rate of seat belt use among adolescent students is unfavorable, and the theory of planned behavior is an appropriate framework for predicting seat belt use among this demographic.

Abstract Aims: This study aimed to assess the effectiveness of community-based educational interventions in preventing stunting, with a focus on their planning, execution, and effects on growth outcomes and associated behaviors in low- and middle-income countries.
Information & Methods: This systematic review was conducted following PRISMA 2020 criteria, by a comprehensive search of PubMed, MEDLINE, Embase, Scopus, and other relevant databases until December 2024. Studies that focused on community-based education for stunting prevention were considered experimental, including randomized controlled trials and quasi-experimental research. Changes in height-for-age z-scores were the primary outcome measured, while improvements in maternal and child nutrition knowledge, attitudes, and practices served as secondary objectives. The ROBINS-I and RoB 2 tools were utilized to assess the risk of bias.
Findings: A total of 17 studies from various low- and middle-income countries (Indonesia, Kenya, Bangladesh, Afghanistan, China, and Peru) were included. These studies employed a range of educational strategies, such as home visits, group workshops, mobile health applications, and digital platforms. The duration of interventions varied from two weeks to two years, with many incorporating behavior change communication techniques, practical demonstrations, and culturally tailored content. Significant improvements were observed in height-for-age z-scores, dietary diversity, exclusive breastfeeding, and complementary feeding practices. Programs that were culturally adapted, sustained over longer periods, and integrated multiple delivery methods proved to be the most effective. However, shorter interventions demonstrated limited long-term impact.
Conclusion: Community-based educational interventions effectively reduce stunting and improve nutrition-related behaviors in low- and middle-income countries.

Abstract Aims: Waste separation behavior is beneficial for implementing waste management, recycling, and financial savings. The present study aimed to identify the predictors of waste separation behavior and behavioral intention based on the integrated behavioral model among housewives in Tehran.
Instrument & Methods: This descriptive cross-sectional study was conducted on 326 housewives in an institutional district located in the northern part of Tehran in 2023. Data collection was carried out using a developed questionnaire based on the integrated behavioral model.
Findings: The mean age of the study participants was 38.96 years. Waste separation behavior, environmental factors, and normative beliefs significantly influenced the behavioral intention score for waste separation (p<0.0001). The levels of increase for the aforementioned factors were reported as 0.655, 0.101, and 0.204, respectively (R²=0.569). Additionally, the history of waste separation training (p<0.0001) and the spouses’ educational level (p=0.003) were found to significantly affect the behavioral intention score for waste separation, with levels of increase reported as 0.786 and 0.275, respectively (R²=0.203).
Conclusion: The housewives’ behavior and their behavioral intention regarding waste separation largely depend on the history of waste separation training at the source and on environmental factors.

Abstract Aims: Osteoporosis is one of the most common diseases among women, and dietary patterns, especially during adolescence, significantly impact its occurrence and prevention. The present study examined the determinants of osteoporosis in female students at the first secondary school level in Ilam City based on the health belief model.
Instrument & Methods: This cross-sectional study involved 819 participants selected by a two-stage cluster random sampling approach. Data were collected using a 52-item researcher-developed questionnaire based on the health belief model and analyzed using descriptive tests, Pearson’s correlation, multiple linear regression, one-way analysis of variance, and Chi-square test by SPSS 22 software.
Findings: The average age of participants was 13.72±0.97 years, with an age range of 12 to 16 years. Also, 22.2% of participants had a family history of osteoporosis. Additionally, 29.2% and 22.6% of the participants reported a history of calcium and vitamin D supplement intake in the last month, respectively. The health belief model constructs accounted for a total of 18.9% of the variance in behavior. Perceived barriers and perceived self-efficacy were identified as the most important predictors of behavior, while other constructs were not significant predictors despite showing significant correlations with behavior.
Conclusion: The constructs of self-efficacy and perceived barriers directly affected nutritional behavior preventing osteoporosis among teenage girls in Ilam City, while another construct had an indirect effect.

Abstract Aims: Modernization and globalization have rendered teenagers susceptible to environmental influences, including risky sexual behaviors. Comic media, serving as a graphic medium, functions as a tool for simplifying complex topics, instilling value, captivating interest and attention, aiding in data interpretation, and condensing information. This research aimed to assess the effectiveness of health education utilizing digital comic media in promoting healthy reproductive behavior among adolescents.
Materials and Methods: This quasi-experimental research with a one-group pre-test-post-test design was done on 100 students. Statistical analysis was done using SPSS 16 by the Wilcoxon test.
Findings: There was an improvement of 3.2 in the behavior mean score from the pre-test to the post-test. The results of bivariate analysis using the Wilcoxon test on pre-test and post-test respondents revealed a p-value of 0.0001, which was less than 0.05. Therefore, there was a significant difference in knowledge and behavior between the pre-training and post-training stages using digital comics.
Conclusion: Health education delivered through digital comic media has a substantial impact on students’ knowledge and behavior, thereby contributing to the enhancement of healthy reproductive practices among teenagers at SMA N 01 Muaro Jambi.

Abstract Aims: Obesity in adolescent is associated with several negative outcomes. This study aimed to determine factors associated with obesity among female students during the COVID-19 pandemic.
Instrument & Methods: In this descriptive correlational study, a convenience sample of female adolescent students of high schools in Tabriz, Iran (322 students who were classified as obese or overweight) was selected between January and May 2021. An online self-administered questionnaire was distributed through the Shad platform. The survey package included socio-demographic questions, health literacy measures for adolescents, an inventory of determinants of obesity-related behaviors in adolescents, and mother's nutritional literacy. Multiple regression analysis examined associated factors with obesity using SPSS 133. The study adhered to the STROBE guidelines for reporting.
Findings: The mean score of obesity-related behaviors was moderate (124.18±22.35). Participants' mean scores in the domains of lack of support, unhealthy nutrition, physical inactivity, and perceived inability were more than average. Adolescents' health literacy mean score was moderate (167.43±20.06). Mother’s occupation (β=15.73; 95% CI: 7.54 to 23.92; p<0.001) and mother's nutritional literacy (β=-0.88; 95% CI: -1.50 to -0.27; p=0.005) were statistically significant predictors of the obesity-related behavior.
Conclusion: Mothers' nutritional literacy plays a pivotal role in shaping adolescents' behaviors related to obesity; thus, empowering mothers with appropriate knowledge and skills in the field of healthier lifestyles and improving the overall well-being of adolescents is essential.

Abstract Aims: Determining the effective factors in the use of e-learning among students can be useful in providing appropriate and practical solutions to increase the use of e-learning. Therefore, this study aimed to determine the factors related to the behavior of using e-learning among medical university students using the technology acceptance model (TAM) as a conceptual framework.
Instrument & Methods: This cross-sectional study was conducted among 425 students of Hamadan University of Medical Sciences who were selected by stratified random sampling. The data collection tools included a questionnaire, including demographic data and TAM constructs. The data were analyzed in SPSS 23 software using one-way analysis of variance, independent t-test, Pearson correlation coefficient, and linear regression analysis.
Findings: The age range of participants was between 18 and 54 years with an average age of 24.2±3.96 years. The history of participating in e-learning classes was significantly related to all the constructs of the TAM (p<0.05). Also, undergraduate and graduate students had a significantly more positive attitude, higher perceived usefulness, and more usage intention and behavior concerning e-learning than professional doctorate students (p<0.05). Attitude (β=0.394), perceived usefulness (β=0.313), and external variables (β=0.196) were respectively the strongest predictors of intention to use e-learning (p<0.05). The intention of e-learning usage directly and significantly predicted the behavior of using it (β=0.483, p<0.05).
Conclusion: The TAM constructs predict the behavior of using e-learning among students.

Abstract Aims: This study aimed to analyze the effect of knowledge on the application of clean and healthy living behavior through perceived susceptibility in the prevention of AIDS.
Participants & Methods: Using quantitative research, we examined the possible causality between certain factors possibly causing the studied symptoms. The statistical population was 290 people living in Wakatobi Regency, of whom 166 people were considered as samples using the Lemeshow formula. Descriptive and inferential analyses were performed using path analysis, t-test, and normality tests.
Findings: Based on the results of the path analysis, the path coefficient value of the knowledge to perceived susceptibility was 0.177 with a t-value of 7.762 > 1.974 and a p-value of < 0.005. Thus, it can be concluded that knowledge has a positive and significant effect on clean and healthy living behavior in the community.
Conclusion: The results showed that knowledge about the dangers of smoking had a significant effect on fostering clean and healthy behavior (PHBS) through perceived susceptibility.

Abstract Aims: Sexual satisfaction is one of the aspects of sexual health that is vital in maintaining the couple's relationship and their quality of life. The present study aimed to investigate the factors predicting sexual satisfaction based on the IMB model among Iranian men.
Instrument & Methods: This was a cross-sectional descriptive-analytical study. A number of 362 men living in Sanandaj, Iran, with a marriage age of fewer than 5 years were systematically included in the study. Data collection tools were Larson sexual satisfaction questionnaire, sexual health questionnaire based on information-motivation-behavioral skills model constructs, and men's sexual function questionnaire. Data analysis was performed at a significant level of 0.05 and with SPSS 20 software.
Findings: The results indicate that 1.4% of participants have no sexual satisfaction at all, 43.1% have poor sexual satisfaction, 53.9% have moderate sexual satisfaction and 1.7% have high sexual satisfaction. The regression model showed that the level of education, information, and motivation of the IMB model were predictors of sexual satisfaction with a 13% variance (F=19.48, p=0.001, r=0.13, R²=0.37).
Conclusion: The findings of this study showed that sexual dissatisfaction is related to the level of education, information, and motivation of men about sexual issues.

Abstract Aims: This study aimed to design and psychometric a tool for measuring the knowledge, beliefs, and behavior of teachers regarding COVID-19 preventive behaviors.
Instrument & Methods: The goal was to create a tool that may be used to create an educational intervention that promotes preventive behaviors. A 60-item scale regarding COVID-19 preventive behaviors was developed upon literature review. Then, face and content validity were evaluated using quantitative and qualitative methods, through the involvement of the participants and expert panel. The internal consistency and reliability were assessed and approved using Cronbach's alpha index and test-retest.
Findings: The face and content validity of the primarily developed scale was confirmed by item impacts of 1.5, 0.49 CVR, and 0.79 CVI, and the number of items dropped to 60. The reliability of the instrument was approved by Cronbach's alpha of 0.67 to 0.95 and a correlation coefficient of 0.65 to 0.93.
Conclusion: Based on the results, the scale that was developed using the constructs of the HBM for COVID-19 preventive behaviors among teachers had appropriate validity and reliability.

Abstract Aims: Adolescents are among one of the most vulnerable populations, and the COVID-19 pandemic has led to rapid and unprecedented changes in the lives of millions of adolescents around the world. The present study aimed to evaluate the health-promoting behaviors among female Iranian adolescents during the COVID-19 pandemic.
Instrument & Methods: In this descriptive-analytical study, 529 female students from Saveh, Iran high schools were selected by multi-stage sampling and participated in the study. Data were collected using the Demographic Information and Health Promoting Lifestyle Profile (HPLPII). Data were analyzed using ANOVA and independent t-tests in SPSS 21.
Findings: The results showed that the mean and standard deviation of the health-promoting behavior score was moderate (89.3±11.2). Among the dimensions of HPLPII, the highest scores were related to health responsibility, nutrition, physical activity, and stress management. There were significant differences in mean scores across numerous health-promoting behavior domains and father’s occupation status, mother’s education level, hobby type, and participants' academic status.
Conclusion: Moderate overall mean score of health-promoting behaviors and low mean scores across stress management and physical activity domains suggest that female youth require resources to improve health behaviors, particularly during the ongoing pandemic.

Abstract Aims: Social media has increasingly been used as a tool to deliver health education. This study examined the effect of a Telegram delivered oral health education program on self-efficacy, perceived benefits and barriers, gingival index, motivational beliefs, and dental cleaning behavior among students with gingivitis.
Materials & Methods: This randomized controlled trial was conducted in Sanandaj city, Iran, from January to December 2019. A total of 160 students were recruited from 8 schools and randomized into intervention and control groups. An oral health education program aimed at increasing dental cleaning behavior was developed based on the trans-theoretical model. The program consisted of 9 sessions delivered via a social media app called Telegram for 24 weeks. Outcomes included dental cleaning behavior, perceived self-efficacy, benefits, barriers, motivational beliefs, and gingival index, measured at baseline and 24 weeks after the intervention.
Findings: There were significant differences between the intervention and the control groups in the mean scores of perceived self-efficacy (p=0.01), perceived benefits (p=0.01), motivational beliefs (p=0.01), and gingival index (p=0.01) after the intervention. Further, 71.3% (n=57) of students in the intervention group (versus 10.1% (n=10) in the control group) performed the dental cleaning behavior after intervention (p<0.01).
Conclusion: The findings showed that an oral health education program delivered via social media apps could improve students' oral health. Social media apps could reach a broad range of users, thus could improve access to oral health education programs.

Abstract Aims: Pregnancy is associated with changes in the woman's nutritional needs. The mother's nutritional status affects her own health, that of the fetus, and the outcome of the pregnancy. This study aimed to determine the knowledge, attitude, and practice of pregnant women towards proper nutrition.
Instrument & Methods: This cross-sectional study was carried out on 445 pregnant women who were referred to urban health centers in Jiroft, Kiar, Fasa, Borkhar, and Ilam cities in 2020. Participants were selected by multi-stage random sampling. The instrument to collect data was multi-section research made questionnaire including demographic information, knowledge, attitude, and practice towards proper nutrition. Data was analyzed using SPSS 18 by Chi-square, t-test, ANOVA, and correlation coefficient.
Findings: The mean age of participants was 29.58±9.81 years and the mean month of pregnancy was 5.58±2.30 in all cities. Of them 59.10% had a good level of knowledge. In general, 81.10% had a positive attitude, but in Kiar city, 86.70% of pregnant women had a moderately desirable level of attitude and 63.8% were in a good level of behavior. There was a significant relationship between the history of receiving education and knowledge level in Jiroft and Kiar cities (p<0.05).
Conclusion: Due to the low levels of knowledge, attitude and practice of pregnant women towards proper nutrition, it is recommended to provide nutrition counseling for pregnant women in health centers. As a result of women's awareness of the principles of proper nutrition during pregnancy, the consequences of pregnancy will improve.

Abstract Aims: Appropriate complementary feeding is one of the main ways to prevent malnutrition in infants, which is a serious health problem in developing countries including Iran. This study aimed to investigate the effectiveness of a theory-based educational intervention on timely complementary feeding initiation in primiparous mothers.
Materials & Methods: In this randomized controlled trial, 68 primiparous mothers (34 in each intervention and control group) of infants aged 2 to 3 months participated in the study using a Multi-stage random sampling method in Kashan, Iran, 2019. The educational intervention was designed based on the theory of planned behavior. The data collection tool included a demographic information questionnaire and a researcher-made questionnaire designed based on the theory of planned behavior. SPSS 22 software was used for data analysis, using Chi-square test, independent and paired t-test. Statistical significance was set at p<0.05.
Findings: After the intervention, there were significant increases in the mean scores of knowledge (p=0.004) and attitude (p=0.02) in the intervention group compared to the control group, but the mean scores of intentions to initiate complementary feeding timely, showed no significant differences between the control group and the intervention group. A significant increase was seen in the mean score of perceived behavioral control in the intervention group (p=0.002). Only perceived behavioral control significantly increased the chances of timely initiation of complementary feeding (OR=1.36, p=0.002).
Conclusion: The educational programs based on the theory of planned behavior has small effects on improving timely complementary feeding.

Abstract Aims: Preventive behaviors play an important role in reducing mortality caused by this disease. This study aimed to determine the application of the extended theory of planned behavior to predicting preventive behaviors against COVID-19.
Instrument & Methods: In this descriptive-analytical cross-sectional study, 416 university students were selected and examined through virtual networks through convenience and snowball sampling methods. The data collection tool was developed by the researcher-made questionnaire based on the extended theory of planned behavior. Data were analyzed using descriptive statistics and correlation test and linear regression by SPSS 18 software.
Findings: A positive and significant correlation was observed between the mean of all the studied theoretical constructs with preventive behaviors against COVID-19 (p<0.01). Attitudes, subjective norms, perceived behavioral control, and perception of others' behavior predicted 43% of behavioral intention variance. Moreover, behavioral intention perceived behavioral control and perception of others’ behavior predicted 56% of preventive behaviors variance against COVID-19. Behavioral intention, attitude, perception of others' behavior, subjective norms, and perceived behavioral control had the greatest impact on COVID-19 preventive behaviors.
Conclusion: The extended theory of planned behavior can be used as an appropriate framework in designing educational interventions to promote preventive behaviors against COVID-19.

Abstract Aims: As a basic factor in a healthy lifestyle, physical activity is less than necessary in health system workers such as health workers. Explaining Physical activity by successful perceptual frameworks such as the developed theory of planned behavior identifies the factors influencing this complex behavior to design effective educational interventions. This study aimed to assess path analysis of the Physical activity of health workers based on the developed theory of planned behavior with planning.
Instrument & Methods: This analytical cross-sectional study was performed on 210 female health workers at Babol University of Medical Sciences in 2019. Data were collected by a valid and reliable theory of planned behavior-based questionnaire. Data were analyzed by SPSS 21 and Lisrel 8.8 software using the maximum likelihood method and correlation matrix at a significance level of less than 5%.
Findings: A total of 210 female health workers with a mean age of 39.35±8.64 participated. The developed theory of planned behavior model explained 62, 56, 37, and 58% of the variances of behavioral intention, action planning, coping planning, and Physical activity behavior, respectively. The intention was predicted by perceived behavioral control. Behavior was explained by intention, perceived behavioral control, and action planning, respectively. Fit indices showed that the developed model was fitted to the data (Relative Chi-square=1.58, RMSEA: 0.05, Comparative Fit Index: 1, Goodness of Fit Index: 0.98).
Conclusion: Intention, perceived behavioral control, and action planning, based on the developed theory of planned behavior, were the constructs influencing physical activity behavior. It is necessary to consider these structures and their relationships in designing educational interventions to promote physical activity in health workers as a key element in promoting community health.

Abstract Aims: Considering that behaviors can be explained based on different theories, one of the most important theories in choosing health behaviors is the Health belief model. Therefore, this study was conducted to determine the preventive behaviors regarding corona disease and its related factors based on the health belief model.
Instrument & Methods: The study utilized a cross-sectional study (descriptive-analytical). Web-based sampling methods were used in this study. The sample size was estimated at 2240 samples. Data collection tools included a researcher-made questionnaire. Data were analyzed by Mann-Whitney, Kruskal-Wallis, and Spearman correlation coefficient tests using SPSS 23. Moreover, the coefficient at a significance level less than 0.05.
Findings: There was a significant correlation between age with all constructs of the health belief model in terms of preventive behaviors from COVID-19, gender with all constructs except perceived benefits, education with all constructs except the perceived barriers and performance, and occupation with all constructs except perceived sensitivity (p<0.05). There was a statistically significant negative correlation between perceived benefits and perceived barriers and between perceived barriers and performance. There was a positive and significant correlation between performance score with knowledge (p<0.001, r=0.102) and perceived benefits (p<0.001, r=0.066).
Conclusion: The results showed that the most source of information for people is social networks and the most trusted source of information is a television program. Variables of age group, education, and occupation had the greatest effect on the constructs of the health belief model, and it is suggested that more attention be paid to the elderly, low-educated people, and non-employed occupational groups.

Abstract Aims: Health-promoting behaviors have a major role in healthcare. The present study was conducted to assess health-promoting behaviors and its related factors in Iranian female household heads based on Pender's model.
Materials & Methods: The present cross-sectional study recruited 106 female household heads selected according to census sampling from Gonabad Health Centers, eastern Iran, from January to August in 2015. Data were collected using the Health-Promoting Lifestyle Profile-II (HPLP-II) and a researcher-made cognitive and emotional factors questionnaire based on Pender's model. Data were analyzed by SPSS 16, using descriptive and analytical tests, including ANOVA and independent student t-test.
Findings: Participants' statistical mean age was 40.16±7.21 years, and most of them (61 women, 57.5%) were widowed and the rest were divorced. The statistical mean score of health-promoting behaviors was 123.16±20.42, in moderate level, and showed significant relationships with cognitive and emotional factors of self-efficacy, barriers, and interpersonal relationships (p<0.05). Among health-promoting behaviors, spiritual growth had the highest Statistical mean score (24.91±5.3), and physical activity (12.83±3.5) and stress management (17.83±3.9) the lowest mean score.
Conclusion: Health-promoting behaviors in Iranian female household heads need improvement. The results can be used by these women and the healthcare system to identify related factors and develop interventions for modifying health-promoting lifestyles.

Abstract Aims: Pre-adolescence is an essential time for the formation and stability of behaviors. The aim of this study was to determine the correlated factors with nutritional behaviors in elementary school students.
Instrument and Methods: In descriptive-analytic study, 300 fifth-grade elementary schools students of Talesh and Fouman cities of Guilan Province, Iran were selected using the random cluster method, in 2017. Data were collected by researcher-made questionnaire. The one way analysis of variance, two independent samples t-test, Spearman correlation coefficient, and SPSS 21 software were used.
Findings: There was no significant relationship between demographic characteristics and nutritional behaviors (p>0.05) but father's education level had a significant reverse correlation with barriers (r=-0.147; p<0.05). The most important barriers of having breakfast during the week in school were lack of appetite and adequate time, and on vacation, was to be alone. Barriers were disliked milk, embarrassment of taking bread and cheese as a snack, and the lack of fruits and vegetables at home (p<0.05). The important cues to action were mothers (76.5%), fathers (44.5%) and then health workers and teachers, respectively.
Conclusions: Barriers play an important role in nutritional behaviors. The most important barriers of having breakfast during the week in school are lack of appetite and adequate time, and on vacation, being alone.

Abstract Aim: Oral hygiene must start at a young age. Childhood is the perfect time to start the conversion of knowledge into creative thinking and subsequent health care activity. This study aimed to measure the constructs of the Health Belief Model (HBM) in relation to the oral health practice of female students in Tehran.
Methods: A cross-sectional descriptive study was conducted on 416 grade five female students of elementary schools in the school year of 2016-2017 in Tehran, Iran. Data were collected using an author-designed questionnaire based on the constructs of the HBM. The validity of the questionnaire was confirmed using face validity while its reliability was approved using Cronbach’s alpha statistics. Data were analyzed using Pearson's correlation and regression analysis at 0.05 level of significance.
Findings: According to the findings, the mean age of the participants was 10.88±0.628 years. Pearson's correlation showed that four the HBM constructs of Self-efficacy, Cues to action, Perceived benefits, Perceived barriers were significant predictors for oral health practices (P < 0.05). In addition, the variables of knowledge and socio– economic conditions (mother's educational level, father's educational level, mother's job, father's job and family income) had significant relationship with performance (P < 0.05).
Conclusion: Our study shows that for improving the beliefs related with oral health behaviors, designing educational programs with emphasis on increasing self-efficacy and perceived benefits, and overcoming the barriers to promote oral health behaviors is essential.

Abstract Aim: Recently, prevention of osteoporosis has become the goal of many health professionals. Behavior change is one of the most powerful strategies for osteoporosis prevention. This study aimed to determine calcium intake in order to identify osteoporosis preventive behavior in women aged 30-50 years in Khorramabad city, Iran. Methods: This descriptive cross-sectional study included 269 women aged 30-50 years who were selected from all the health centers of Khorramabad city according to the inclusion criteria of the study and by cluster and systematic sampling. The tools for data collection were valid and reliable questionnaires of demographic information, stages of change, decisional balance, self-efficacy, and calcium intake. Chi-square test and logistic regression were applied to analyze the data. Findings: The mean age of the subjects was 38.72±7.003, and the mean total calcium weekly intake was 3191.03±3869.24. The results also showed that self-efficacy among the constructs of the Trans-theoretical Model (TTM) was a significant predictive of dietary calcium intake for the behavior. Conclusion: The results showed that the weekly intake calcium in women was low. Self-efficacy among the constructs of the TTM was the only significant predictive for osteoporosis prevention behavior. Therefore, the findings of this study can be considered when designing educational interventions for prevention of osteoporosis by health authorities.

Abstract Aim: Injury from needle is one of the main ways of transmitting blood diseases in the medical staff. Prevention and reduction of such diseases' side effects have been emphasized by the Health Ministry. This study aimed to investigate factors influencing the behavior of the Elam city medical staff when working with sharps instruments. Methods: In a cross-sectional study, using a census method, all healthcare staff working in the health centers of Abdanan Dehloran city (total n=66) after providing written informed consent were enrolled. Data were gathered by a questionnaire. After verifying the validity and reliability, the data were collected, and analyzed using SPSS19 and descriptive statistics, Chi-square and t-test. Findings: 59% of the participants were male; 80% were married; 62% had academic educations, and 47% worked in the nursing and injection sections. The mean scores of knowledge and attitude of the participants were 3.1±1.38 and 1.7±4.1, respectively, and just 13.4% of the subjects had not reported control tests and injury events. Conclusion: Knowledge, attitudes and practices of the medical staff of injuries from sharp objects are not desirable. it seems that empowering the staff through theoretical and practical training is proper solution in this regard.