Health Education and Health Promotion

Abstract Objektive: This study evaluated the effectiveness of the JUMINTEN TABAH model in improving anemia prevention knowledge, compliance with IFA consumption, and hemoglobin levels among adolescent girls.
Methods: A quantitative quasi-experimental study with a nonequivalent control group pretest–posttest design was conducted from January to August 2025 in several public senior high schools in Muaro Jambi District, Jambi Province, Indonesia. A total of 100 adolescent girls aged 15–18 years were recruited and allocated into intervention and control groups. The intervention group received the JUMINTEN TABAH model, which consisted of scheduled weekly consumption of IFA tablets every Friday, health education using a pocket book, a Friday calendar as a reminder tool, and peer mentoring and monitoring by Youth Red Cross (PMR) cadres, supported by complementary activities. The control group received routine school health education and IFA distribution. Data were collected using structured questionnaires and hemoglobin measurements. Statistical analyses included paired and independent tests as well as effect size estimation.
Results: The intervention group showed a significant increase in knowledge and compliance behavior after the intervention (p < 0.001), while changes in the control group were not statistically significant. Improvements in knowledge and compliance were significantly higher in the intervention group compared to the control group (p < 0.001), with large effect sizes, indicating a strong impact of the intervention.
Conclusion: The JUMINTEN TABAH model is effective in improving knowledge and compliance with IFA tablet consumption among adolescent girls and has the potential to support anemia prevention programs in school settings.
 

Abstract Aims: Depression is the most common mental disorder worldwide, affecting a range of age groups, including adolescents and youth. This study aimed to provide a national model for a depression information system in Iranian adolescents and youth.
Materials & Methods: This applied study was conducted in three stages. In the first stage, depression information systems in different countries were examined through a literature review, and Denmark, the United States of America, China, Indonesia, and India were selected as the countries for conducting a comparative study. In the second stage, after reviewing information sources and conducting a comparative study in the selected countries, and considering the geographical and social conditions of Iran, a proposed model for the national depression information system in Iran was presented. In the third stage, the proposed model was validated using expert opinion obtained from specialists in psychiatry, psychology, and health information management, and was finally approved after incorporating their feedback.
Findings: Two parts, the structural components and the key processes of the information system, were identified as the main components of the proposed model for the information system on depression in adolescents and youth in Iran.
Conclusion: By implementing a national information system on depression in adolescents and youth, systematic access to accurate data and statistics related to depression in this population group will be provided. The model in the present study can provide an appropriate information infrastructure for the implementation of a national information system on depression in adolescents and youth in Iran.

Abstract Aims: This study explored the diverse impacts of family structure on rural Chinese adolescents’ non-cognitive skills using longitudinal data from the China Education Panel Survey.
Instrument & Methods: This observational analytical study with a longitudinal cohort design was conducted in China from 2013 to 2015, utilizing two waves of the China Education Panel Survey and comprising 5,111 rural adolescents. Family structure was classified into four categories: dual-parent, mother-only, father-only, and grandparent-headed (skip-generation) households. Non-cognitive skills were quantified using culturally adapted Big Five dimensions, with principal-component scores standardized on a 0-1 scale. Departing from resource-deterministic models, we incorporated psychosocial covariates (sibling interactions, intergenerational role modelling, and emotional reciprocity) and applied multilevel linear regressions, alongside subgroup analyses for only-child status and grandparental cohabitation, to disentangle structural and emotional pathways. Stata software was used to analyse the data.
Findings: Compared with dual-parent households, mother-only, father-only, and non-parent (skip-generation) families showed 1.99%, 2.15%, and 2.52% lower non-cognitive scores (p<0.01), particularly in emotional stability and cooperation. Maternal care exerted stronger protection than paternal care, and grandparental co-residence only partially offset maternal absence.
Conclusion: Dual-parent residency yields the highest non-cognitive outcomes, and parental absence significantly undermines adolescents’ emotional stability and cooperative skills.

Abstract Aims: This study aimed to explore the perceptions of adolescent e-cigarette users and non-users toward various types of message appeals in e-cigarette prevention campaigns.
Participants & Methods: This qualitative study employed the focus group discussion technique with 51 high school adolescents, including those who used e-cigarettes (vape group) and those who did not (non-vape group). Participants were selected by the school for this study. Data analysis was conducted using thematic analysis.
Findings: Emotional appeals had a strong influence on both groups, particularly messages featuring testimonials from former users. Rational appeals were considered less appealing despite presenting important data; however, combining them with emotional appeals was regarded as more ideal. Although not all participants liked humorous appeals, both groups agreed that they enjoyed the humor appeal of Dr. Tirta, a doctor who has become an influencer on social media. Fear appeals were considered more effective for early adolescents who have never tried e-cigarettes, as they tend to be underestimated by those who have already experienced addiction. Customizing e-cigarette prevention messages based on adolescents’ experiences could enhance message effectiveness. Emotionally resonant messages that present facts with credible delivery offer a promising strategy for adolescent-focused public health campaigns.
Conclusion: A combination of fact-based, emotionally resonant messages delivered by credible individuals is a promising alternative strategy for adolescent-focused public health campaigns.

Abstract Aims: This study aimed to analyze the role of community-based education in enhancing the effectiveness of the Juminten Tabah model in anemia prevention behavior among adolescent girls.
Materials & Methods: This experimental study employed a two-group pre-test-post-test approach, including a control group, involving 100 participants divided equally into intervention and control groups. The intervention consisted of administering iron supplementation tablets every Friday, supported by community-based educational sessions conducted in schools. Data collection included pre- and post-test assessments using structured questionnaires and hemoglobin level measurements. Statistical analysis was performed using paired t-tests to evaluate within-group differences and independent t-tests to compare outcomes between the intervention and control groups.
Findings: The intervention group demonstrated a significant improvement in hemoglobin levels and anemia prevention behaviors compared to the control group (p<0.05). The proportion of adolescents with normal hemoglobin levels increased from 10% to 20% in the intervention group, whereas the control group exhibited a more modest increase from 8% to 12%. Additionally, the mean score for anemia prevention behaviors in the intervention group increased substantially from 48.40 to 67.20.
Conclusion: Community-based education through the Juminten Tabah model significantly improves anemia prevention behaviors and hemoglobin levels among adolescent girls.

Abstract Aims: Diabetes mellitus is one of the most prevalent chronic diseases among pediatric patients. Current research indicates that efforts to prevent diabetes in children and teenagers have not been successful. The aim of this study was to evaluate the risk factors associated with diabetes among children and adolescents.
Information & Methods: This systematic review was conducted through literature searches in PubMed, ScienceDirect, Cochrane Library, and Medline databases. The search filter incorporated terms such as diabetes mellitus, T1DM, T2DM, child, and adolescent.
Findings: The initial database search retrieved 9,949 articles. Ultimately, only 15 studies met the criteria and proceeded to the next stage for extraction and analysis. Based on the analysis of the eligible studies, various risk factors for the incidence of diabetes in children and adolescents were identified and categorized into non-modifiable and modifiable risk factors. Non-modifiable factors included family history of diabetes, ethnicity, gender, and age. Additionally, maternal pregnancy and unmarried parents were found to contribute to the incidence of diabetes in children. Modifiable risk factors included obesity, sedentary behavior, physical activity, smoking history, and diet.
Conclusion: Family history of diabetes mellitus and obesity are the main risk factors for diabetes. There is a significant relationship between modifiable and non-modifiable risk factors.

Abstract Aims: Cyber victimization can generate a series of negative effects on the mental, physical, and social health of those affected, triggering anxiety, depression, and other emotional problems. The aim of the study was to determine the relationship between cyber victimization and depression in high school students in the province of Tumbes, located in northern Peru.
Instrument & Methods: The sample of this non-experimental, cross-sectional, and quantitative study consisted of 372 high school students between 11 and 18 years of age. The Cyber Victimization Questionnaire (CBV) was used as an instrument, obtaining a Cronbach's Alpha reliability of 0.902 in a pilot test. The Beck Depression Inventory-II was also used, with a Cronbach's Alpha reliability of 0.921.
Findings: Using Spearman's Rho correlation method, there was a significant and positive relationship between cyber victimization and depression (two-sided p-value=0.0001). Likewise, the linear regression model showed that cyber victimization was a significant predictor of depression to a degree of 32.2% (R²=0.322; p-value =0.0001).
Conclusion: Cyber victimization is significantly related to and predictive of depression.

Abstract Aims: This study aimed to assess the knowledge and attitudes of teenagers towards certain health risk factors to determine the need for more comprehensive health education among this group.
Materials & Methods: In February 2023, a survey was conducted using a direct group approach among 71 children aged 11-13, at two primary schools in the municipality of Pleven, Bulgaria. The children were interviewed after obtaining written informed consent from their parents. An originally developed questionnaire, containing 29 questions adapted to the children's ages, was utilized. Survey data were processed with IBM SPSS Statistics 25 and Excel for Windows statistical software packages. The results are presented through graphs and numerical indicators such as structure, frequency, averages, correlation coefficients, etc. Both the χ² and Fisher's exact test were applied for statistical analysis.
Findings: The results of this study highlight a significant concern that the 11-13 age group is particularly vulnerable to behavioral health risk factors.
Conclusion: Given the findings regarding the risky behaviors of Bulgarian adolescents and their level of health awareness, as derived from the literature review and this study, the urgent introduction of mandatory health and educational measures for adolescents in Bulgaria is recommended.

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: Approximately 49% of pregnancies in adolescents aged 15-19 years are mistimed. Significantly in Jambi City, this trend has increased. It reflects adolescents lack of understanding about healthy living, the risks of sexual relations, and the rejection of unwanted relationships. This study aimed to determine the effect of counseling using videos and leaflets on adolescents' knowledge about the impact of mistimed pregnancy.
Materials & Methods: This quasi-experimental study, with a pre-test and post-test with a control group design, was conducted from January to June 2021 in the work area of the Penyengat Olak Public Health Center, Jambi City, Indonesia. Ninety-six adolescents participated in the study and were divided into groups with video intervention and leaflet education, totaling 48 adolescents each. Research data were analyzed using the analysis of covariance test.
Findings: A significant increase was observed in student's knowledge after education using videoeo media, with a different mean score of 36 (p=0.001). Also, there was a significant increase in student's knowledge after receiving an education using leaflet media, with a different mean score of 24 (p=0.001).
Conclusion: Education using video media is more effective than leaflet media in increasing adolescents' knowledge about mistimed pregnancy.

Abstract Aims: Substance abuse in adolescents is caused by many factors, including family conflicts, negative parenting models, and family estrangement. The aim of this study was to determine the relationship between resilience and family functioning with drug use risk behavior among adolescents in Limo District, Depok city, Indonesia.
Instruments & Methods: This descriptive correlational study with a cross-sectional approach was conducted on adolescents aged 10-15 years who lived in Limo District, Depok, Indonesia. 315 adolescents were selected by simple random sampling method. Walsh Family Resilience Questionnaire was used to measure family resilience, and Family Assessment Device was used to measure family functioning. Data analysis was performed using chi-square test and logistic regression analysis.
Findings: Family resilience (p=0.011) and family functioning (p=0.001) were significantly related to drug use risk behavior. Adolescents whose families have poor resilience are 1.694 times more likely to engage in risky drug behaviors than adolescents whose families have good resilience. Also, adolescents who have poor-functioning families are 2.054 times more at risk of risky drug behaviors than adolescents whose families function well.
Conclusion: Adolescents whose families have low resilience and whose families have poor functioning are 60.7% more likely to exhibit drug use risk behavior.

Abstract Aims: The problem of drugs is still urgent and complex, especially in Indonesia, and even in the last decade, it has become increasingly widespread. This situation can be seen in the significant increase in drug abusers or addicts, drug crime cases with various patterns, and the massive syndicate network. This study aimed to examine the effectiveness of educational media, animated videos, and e-books on adolescents' knowledge in managing drug abuse.
Materials & Methods: This quasi-experimental study with a two-group pre-test and post-test design was conducted in SMPN 5 Kendari City in 2021. Forty eight samples were selected among 8th-grade students using proportional random sampling method and divided into the video animation group (n=24) and the e-book group (n=24). Students' knowledge about drug abuse was assessed before and after the intervention turough a questionare. Collected data were analyzed using ANCOVA.
Findings: The mean score of knowledge, before and after education with animated video media and e-books increased. The mean difference of knowledge score before and after the education with animated video media was 1.3 (p=0.001), and before and after education with e-book media was 1.25 (p=0.0001).
Conclusion: Education with animated video media and e-books effectively increases adolescent knowledge in managing drug abuse.

Abstract Aims: Health deviant behavior of many of today's youth is a serious problem for modern society. The present study aimed to examine the causes and consequences of health deviant behavior and identify the main strategies to overcome this problem.
Participants & Methods: This study is mixed research (qualitative and quantitative) conducted on 21 May 2021 in a group of students aged 16 to 18 years with health deviant behaviors. So, the purposive sampling method was used to select subjects (N=142). A researcher-made questionnaire was used, and students were asked to answer the questionnaire anonymously, enabling more honest responses. The collected data in the quantitative part of the research were analyzed using the SPSS 22 software using the Pearson correlation test.
Findings: There was a significant positive correlation between health deviant behavior and vulnerability to the negative peer influence (r=0.69; p<0.01). Relatively weak and negative correlations were found between self-esteem and health deviant behavior (r=-0.13; p<0.001) and between vulnerability to the negative peer influence and self-esteem (r=-0.16; p<0.001).
Conclusion: The main reasons for health deviant behavior appear to be biological, psychological, and social. Psychological reasons lie in temperament and accentuations and the interaction of the teenager with society, family, and school. Thus, the reasons for health deviant behavior can be reduced to the characteristics of the individual, the conditions of the social environment, education, upbringing, and social activity.

Abstract Aims: Adolescents who have been deprived of family support for various reasons are more likely to be in vulnerable groups in society, resulting in more risky behaviors. This study aimed to determine the effectiveness of psycho-drama in reducing high-risk behaviors in unsupervised adolescent boys.
Materials & Methods: This study was a quasi-experimental pretest-posttest design with a control group. The statistical population consisted of unsupervised teenage boys between the ages of 12-13, who were studying in the sixth grade in Zanjan in the 2018-2019 academic year. 40 students were selected by purposive sampling and substituted in two equal groups as experimental and control groups. The main tool was the Youth Risk Behavior Surveillance System (2013). Psychodrama intervention was performed for 9 sessions (each session 90 minutes) for the experimental group, but the control group received no intervention. At the final session, both experimental and control groups received a posttest. Data were analyzed using analysis of covariance by SPSS23.
Findings: Results showed a significant difference between the two groups in the posttest phase (p<0.05). Psychodrama decreased high-risk behaviors in the experimental group. The percentage of these changes based on the Eta-square was 41.3%. Also, according to the results, Eta-square of components was 37% for the smoking, 32% for the alcohol; 17.9% for the psychotropic; 36.3% for aggressive behaviors,35.3% for thinking and committing suicide, 30.5% for escape component, and 35.5% for relationship the opposite sex (p<0.05).
Conclusion: According to the findings, it can be concluded that psychodrama is an effective adjunctive therapy to reduce the symptoms of high-risk behaviors of unsupervised adolescent boys, and it is recommended to counselors in preventing psychological damage in schools.

Abstract Aims: The prevalence of Diabetes type 2 has been increased significantly during recent years. So, prevention is necessary from adolescence. This study aimed to investigate the effect of Health Belief Model-based education on preventive behaviors of Diabetes type 2 in male adolescences.
Materials & Methods: This semi-experimental study was conducted on 208 secondary school students of Hamadan city (104 students in an experimental group and 104 students in a control group) in 2018, who were selected using the stratified-proportional sampling method. Data were collected using a researcher-developed questionnaire including demographic, awareness, model constructions, and preventive behavior. Afterward, an educational intervention was implemented in the experimental group based on Health Belief Model in four 45-60 minute sessions. After one month, the data were recollected from the two groups and analyzed using Chi-square, t-test, and linear regression by SPSS 16 software.
Findings: Comparing the scores of awareness, Health Belief Model constructs, and student’s preventive practices revealed no statistically significant differences between the two groups at the beginning of the study (p>0.05). However, after the intervention, significant differences were observed between the two groups regarding awareness, the Health Belief Model constructs, and student’s preventive practices (p<0.05). Linear regression analysis indicated that self-efficacy was the most important independent predictor of type-2 diabetes-preventative behavior (p<0.05).
Conclusion: Health Belief Model-based education is effective in promoting type-2 diabetes prevention behaviors in students.

Abstract Aims: As adolescents constitute around 20% of the total population and near 90% of them are living in developing countries, they need much attention. Moreover, they need to meet their raised nutritional needs because of physiological and sexual growth otherwise, they will susceptible to poor nutritional status. The ultimate goal of the present study was evaluating health literacy and eating habits of adolescent girls before and after a nutrition education program.
Materials & Methods: The intervention study was implemented on 64 adolescent girls aged between 13-15 years from two governmental girls' high school in Mashhad, Iran. Questionnaires included food frequency, health belief model (HBM), and health literacy (HL) implemented in three stages, before intervention as a pretest, immediately after intervention and two months later for reassessment.
Findings: Nutrition education intervention has considerably improved HL and eating habits of adolescent girls. After intervention HL of girls improved from 1.75±1.07 to 4.96±0.96 and their healthy nutritional behavior improved from 1.65±4.92 to 20.62±1.33. After educational interventions, all HBM constructs and awareness of girls increased significantly.
Conclusion: The results of the present study indicated that education based on health belief model positively affected students’ health literacy and nutritional behaviors.

Abstract Aims: Oral and dental problems are among the most common diseases in the world. The aim of this research was to determine the effect of an education program designed based on the health belief model on improving the behaviors preventing oral and dental problems in the 7th-grade students.
Materials & Methods: This semi-experimental study was conducted on 7th-grade female students in Qom in 2016. The samples were selected via multistage sampling method. Using the list of students, a total of 100 students were selected of each school. The participants were divided into two groups include the intervention and control groups, there were 50 people in each groups. Before the intervention, a standardized questionnaire based on the health belief model was distributed in both groups. Then the educational content which had been already prepared was presented to cases in five sessions via different methods. Data were analyzed using independent t-test, chi-square, paired t-test and SPSS 20 software.
Findings: After the intervention, the constructs of Knowledge (p<0.001), perceived susceptibility (p=0.001), perceived severity (p=0.01), perceived barriers (p=0.02), and perceived self-efficacy (p<0.001) had significantly changed in the intervention group, as compared with the time before the intervention.
Conclusion: Health belief model has an impact on student's knowledge and perception of oral health and it can be used to increase students' Knowledge and understanding in order to promote their oral and dental health.

Abstract Aims: Adolescence is a golden chance for preventing the harms caused by unhealthy behaviors and it is the time for choosing a permanent healthy lifestyle. The aim of study was to evaluate the impact of educational program on parental nutritional social support among parents' female adolescents.
Materials & Methods: The present field trial was conducted from January to May, 2016. Sixty-three female adolescents (33 persons in intervention group and 30 persons in control group) with the age range of 12 to 15 years at schools of Isfahan, Iran, were selected by multistage random sampling method as the samples of the study. Samples were randomly allocated to two groups. Adolescents’ perceived and received social support from their parents was measured, using a researcher-made questionnaire, of which the validity and reliability were approved. The intervention included 3 educational sessions (each session took 2 hours) within a one-week interval for adolescents’ parents. One month after performing the educational intervention for parents, adolescents’ received and perceived social support for having a healthy diet was measured. The data were analyzed, using SPSS 19 and independent t test, paired t test, Chi square, and Mann-Whitney test.
Findings: There was no significant difference between two groups regarding the demographic characteristics of the two groups. Also, no significant difference was observed between the two groups after the intervention regarding the mean level of their perceived and received nutritional social support.
Conclusion: Educational intervention on parents does not increase perceived and received social support in early adolescents for receiving healthy nutrients.

Abstract Aim: One of the most significant outcomes of health education is health literacy (HL) so that it must be widely applied for achieving health promotion. The aim of this study was assessing HL and its relationship with using cell phone in adolescents in Mashhad City.
Methods: In this analytic-descriptive research, 445 high school adolescents selected with cluster sampling were assessed. For assessing HL, the Newest Vital Sign (NVS) was used. Cell phone use assessment tool was used for assessing the use of using cell phone. Data were analyzed by SPSS version 16.
Findings: Based on the obtained results, 82.1% and 86.2% of the female and male adolescents had not adequate HL, respectively. There was a negative correlation between the adolescents’ HL and using cell phone (p<0.0001).
Conclusion: Most of the adolescents had limited HL, and the adolescents with higher rate of using cell phone had worse HL score. In fact, adequate HL has a significant role for promoting health in the society. Therefore, policy makers are suggested to design useful educational programs for adolescents, especially in non-medical settings such as schools, was most of the day, adolescents spend their time over there.

Abstract Aim: Evidence indicates that demographic factors such as age, gender, and mother's literacy are important predictors of fruit and vegetable consumption among adolescents. So, this study was conducted in order to survey the relation between socio-demographic factors and fruit and vegetable consumption among Tehranian adolescents in 2013. Methods: This cross-sectional study (descriptive-analytic) was carried out for surveying Tehranian adolescents, socio-demographic factors and fruit and vegetable consumption. The total of 500 adolescents (11-14 years old) was included in the study using multistage random sampling method. Being at the age of 11-14 years, giving informed consent, and voluntary participation were criteria for students' selection. Data were gathered using questionnaire encompass socio-demographic characteristics (11 items) and Frequent Fruit and Vegetable Questionnaire (FFQ). Data were analyzed using statistical software SPSS 18 (descriptive statistics, and tests of independent t and one way ANOVA). Findings: There was no relationship between age, gender, family size, parent’s job, and fruit and vegetable consumption. Based on one way ANOVA test, there was a significant relation between vegetable consumption and mother’s and father’s literacy, as well as between home size and fruit and vegetable consumption. Conclusion: The finding that economic factors and parent’s education level have a strong association with the adolescents’ intake of fruits and vegetables in this sample concurs with other research findings regarding the importance of family environment to promote healthy eating behaviors among adolescents.