Volume 33, Issue 3

Background Socioeconomic and environmental factors can affect the health of the people living in slums in the suburbs. In these areas, the youth and adolescents are the main age groups susceptible to a multitude of harms such as addiction, AIDS, delinquency, aggressive behavior, and prostitution. The present study was conducted to investigate the state of social harms and social class in Iranian youth and adolescents living in slums in the suburbs. Methods In the present systematic review, the researchers searched for observational and qualitative papers published in Persian or English languages during 2010–2020 timespan in the following databases: Embase, PubMed, Scopus, Web of Science, Irandoc databases, Google Scholar, SID, and Magiran. Based on MESH, the keywords of “social class”, “social harm”, “youth”, “adolescent”, and “slum” were chosen. Papers were assessed according to the inclusion criteria, and the quality of the papers was evaluated using the Newcastle–Ottawa scale for quantitative articles and the COREQ scale for qualitative ones. Results Of 491 articles assessed, 11 (eight cross-sectional and three qualitative papers) were deemed suitable. According to the results, social harms reported were: drug abuse (two studies), female sex workers (two studies), poverty (two studies), AIDS (two studies), social insecurity (two studies), psychedelic substances (one study), alcohol (one study), delinquency (one study), divorce (one study), physical problems (one study), prostitution because of poverty (one study), unemployment (one study), and adolescents’ forced labor due to destitution (one study). Moreover, the assessed papers used education (three studies), economic status (three studies), occupation (two studies), income (two studies), place of residence (two studies), social status (two studies), and cultural status (one study) as indicators of the social class in the individual and their parents, and categorized them in three groups of high (one study), middle (three studies), and low classes (seven studies). Conclusion The present systematic review investigated, for the first time in Iran, social harms and social class in the youth and adolescents living in slums in the suburbs. The results showed that social harm is high among the youth and adolescents in outskirt slums of Iranian cities. Therefore, any attempt to empower the youth and adolescents living in these parts will have direct effects on the health of the residents of these areas.

Objectives To assess whether Health Literacy (HL) acts as a determinant of obesity in adults and children by synthesizing the results of recent scientific evidence. Content This is a systematic qualitative review following the MOOSE guidelines. A systematic, computer-assisted literature search via PubMed scientific database, between January 1st, 2000, and September 30th 2020, was conducted. Only cross-sectional epidemiologic research studies that were published in the English language, investigating HL’s possible role as a determinant of childhood and adult obesity, were included. Summary After screening 725 citations from the PubMed database, 39 (n=39) studies in total were included in this literature review; Four (n=4) studies were conducted in the children population, seven (n=7) studies were performed in children-parent/caregiver dyads, and 28 studies (n=28) enrolled adults. There is significant evidence that HL knowledge and skills determine the consequent management of obesity and BMI rates in children and adult populations. Outlook Despite policies and action plans put in place by countries globally, overweight and obesity continue to be a pressing public health issue and one of the critical drivers of non-communicable diseases, constituting a health, social and economic burden worldwide. Health Literacy as an essential health policy and promotion agenda item and a critical empowerment strategy could increase children’s and adults’ control over their overall health and awareness to overcome obesity issues. Initiatives to improve HL levels could be useful tools in managing the obesity epidemic, starting from integrating HL in the school curriculum and further in family and community action plans.

Objectives Tuberculosis (TB) is a leading infectious cause of death globally. Of the estimated 10 million people who developed active TB in 2019, 1.8 million (18%) were adolescents and young adults aged 15–24 years. Adolescents have poorer rates of TB screening, treatment initiation and completion compared to adults. Unfortunately, there is relatively less programme, research and policy focus on TB for adolescents aged 10–19 years. This article reviews the scope of health services and the relevant policy landscape for TB case notification and care/treatment, TB/HIV management, and latent TB infection for adolescents in Nigeria. Additionally, it discusses considerations for TB vaccines in this population. Content All Nigeria Federal Ministry of Health policy documents relevant to adolescent health services and TB, and published between 2000 and 2020 underwent narrative review. Findings were reported according to the service areas outlined in the Objectives. Summary and Outlook Nine policy documents were identified and reviewed. While multiple policies acknowledge the needs of adolescents in public health and specifically in TB programming, these needs are often not addressed in policy, nor in program integration and implementation. The lack of age-specific epidemiologic and clinical outcomes data for adolescents contributes to these policy gaps. Poor outcomes are driven by factors such as HIV co-infection, lack of youth-friendly health services, and stigma and discrimination. Policy guidelines and innovations should include adaptations tailored to adolescent needs. However, these adaptations cannot be developed without robust epidemiological data on adolescents at risk of, and living with TB. Gaps in TB care integration into primary reproductive, maternal-child health and nutrition services should be addressed across multiple policies, and mechanisms for supervision, and monitoring and evaluation of integration be developed to guide comprehensive implementation. Youth-friendly TB services are recommended to improve access to quality care delivered in a patient-centered approach.

This review analyzed the studies that evaluated cardiovascular health indicators (blood pressure, waist circumference, heart rate, glucose index and lipid blood) in recreational soccer players during adolescence, and identify possible associated factors. The search was performed in the electronic databases (PubMED, SciELO, LILACS, Scopus, SPORTDiscus and Web of Science). Inclusion criteria were: population composed of children and/or adolescents (10–19 years or average age up to 19 years); studies adolescents engaged in recreational soccer regularly and observational studies with cross-sectional or longitudinal design. The process of analysis of studies involved reading titles, abstracts and full texts. After these phases, seven articles were eligible. Regarding the design, all studies were cross-sectional. Of the total studies included, five presented moderate methodological quality values and two presented low methodological quality values, according to National Heart, Lung, and Blood Institute instrument. The most cardiovascular health indicators used in recreational soccer players during adolescence was waist circumference; three studies analyzed heart rate, two evaluated blood pressure, one analyzed insulin resistance and none of the included studies analyzed lipid profile. Factors associated were analyzed in four studies, being that sedentary time and body mass index (BMI) present association with at least one indicator of cardiovascular health.

Objectives This systematic and meta-analysis review was conducted to determine the status of Iranian children and adolescents’ physical activity. Content All the related articles which were published in the major databases, including Pubmed, Scopus, Web of Science, Embase, Magiran, SID from the beginning of 2010 to the end of 2019, were reviewed by researchers. The Newcastle-Ottawa scale was also used to evaluate the quality of articles. Moreover, I 2 index and chi-square were used to assess the heterogeneity between the results. Summary 490 articles were found as a result of the search in the selected international and local databases, where finally, 10 articles were included into the meta-analysis after the elimination of the duplicated articles and applying inclusion and exclusion criteria. The results indicated that 29.5% of the girls were considered active according to WHO criteria (16.1–42.8: 95% CI) and also 20.5% of the boys (7.3–33.7: 95% CI). Outlook Overall, this study’s findings showed that a large percentage of Iranian children and adolescents do not achieve the level of physical activity recommended by the World Health Organization. This can lead to undesirable consequences for this group of population that is considered as the human capital of any country; consequently, it seems necessary to take basic measures at the micro and macro levels in order to reduce such problems in the society.

Objectives Child marriage is one of the most important challenges of the current era that threatens women’s health and violates human rights. The present study aimed to systematically review studies evaluating the challenges and strategies to overcome child marriage. Content Medical databases (CINAHL, EMBASE, MEDLINE, EMBASE, PsycINFO, SCOPUS, Web of Science, ProQuest Nursing and Allied Health Source, and Social Science Research Network, as databases for English studies and IranMedex, Google Scholar, SID, Magiran, and Iran Doc as databases for Persian studies) were systematically searched from January 2010 to February 2020. To better identify appropriate studies, reference lists of relevant studies were searched. All potentially relevant abstracts and full-text were screened by two independent reviewers. Disagreements between two reviewers that could not be resolved were resolved via arbitration or consultation of a third author. Summary and Outlook From 225 articles included in this review, 16 research articles met our inclusion criteria. Most of the articles were dedicated to negative health outcomes related to child marriage. Ten studies addressed the program of overcoming the Child marriage and six studies reported challenges of it. Although, many studies have shown the efficacy of strategies to decline Child marriage. On the basis of the available evidence, it seems there are a number of obstacles to end Child marriage. To delineate the most effective strategy to end Child marriage is required further research.

Objectives Paediatricians increasingly need to take care of adolescents, a life stage with specific needs, however many of them admit a limitation in their medical education regarding Adolescent Medicine. The objective of this paperwork is to evaluate the formative model adopted in the Department of Paediatrics, Hospital de Santa Maria, and assess the impact of the training in Adolescent Medicine. Methods We surveyed the current Paediatric Residents and those who graduated as Paediatricians from the Department in the past five years, in order to get feedback on the one-month compulsory training at the Adolescent Medicine Division during their Residency. Results Both groups considered it as a very interesting/useful training. Paediatricians considered that the training had an insufficient duration, with statistical difference comparing to the current Residents’ opinion. Conversely, Residents considered more often that the acquired competencies would be useful in their future clinical practice, when compared to Paediatricians. Conclusions In order to potentiate learning and training during such a short period of time, a few changes were identified as beneficial to be implemented.

Objectives Traffic accidents in pedestrians is one of the most important causes of death. Understanding the status quo and identification of effective factors are necessary for the management and planning of efficient training interventions in the prevention of traffic accidents for pedestrians. Hence, the present study aimed to determine the predictors of safe road-crossing behavior among female high school students of Shahr-e Kord. Methods The present research was a descriptive-analytical study which was conducted on 347 female high school students of Shahr-e Kord in the academic year 2016–2017. The participants were selected using random sampling method and the required data were collected through a standard questionnaire based on the theory of planned behavior. The obtained data were statistically analyzed using Pearson correlation test and regression analysis. Results The mean score of participants on the adoption of safe road-crossing behavior was equal to 57.06 ± 14.74. Among the independent variables of this study, the lowest and the highest scores were related to behavioral intention and outcome expectancy, respectively. The results of multiple regression test showed that behavioral beliefs, outcome expectancy, compliance motivation and behavioral intention are predictors of the adoption of safe road-crossing behavior. In total, these constructs were able to predict 25.8% of behavioral changes. Conclusions Based on the study findings, the theory of planned behavior can be considered an appropriate framework for designing training interventions in order to improve students’ road-crossing behavior.

Background In June 2013, the fear of adverse events compelled the government to withdraw its recommendation of the Human papillomavirus (HPV) vaccine. Since then, the rate of vaccination among Japanese girls has dropped dramatically. Objective This study aims to assess how the Japanese government's policy change against HPV vaccination influenced the degree to which parents in remote areas in Japan accepted the vaccine for their daughters, and to analyze related factors. Methods A self-administered questionnaire was distributed to parents with daughters attending secondary schools or high schools in two remote areas of the country. Results Out of 700 eligible parents, 246 (35%) responded. The percentage of parents in the “accept group” (those whose daughters had already been vaccinated or those who intended to have their daughters vaccinated) dropped from 54% before the government withdrew its HPV vaccine recommendation to only 4.5% after the withdrawal (1.5% of whom intended to vaccinate and 3% of whom had already had their daughters vaccinated). Vaccine acceptance was higher in parents who were employed as healthcare workers, had been educated through to the completion of high school, had good levels of knowledge about cervical cancer and the HPV vaccine, had low perceived barriers against the HPV vaccine, and received high levels of social support. Conclusion The acceptance of HPV vaccination among parents was low overall. Higher acceptance may be possible if the government restores its recommendation and healthcare providers disseminate appropriate information about the HPV vaccination and cervical cancer.

Background Anemia is the most prevalent disease in teenage girls and like other chronic diseases not only affects different aspects of their quality of life (QOl) but also quality of life of their parents. Objective The aim of present study is investigating the effectiveness of family centered empowerment model (FCEM) on adolescent girls with anemia and their mother’s quality of life. Methods Semi-experimental practical research is performed by choosing 60 girls with anemia and their mothers classified in two case and control groups based on random allocation in Tehran city. The eight sessions of educational program based on educational needs of girls & mothers in case group done for two months. The post test was carried out 1/5 month after the end of intervention through QOl questionnaire in case and control groups. Data analysis was performed using statistical methods including t-test, paired t-test. Results There was no significant difference in the QOl in adolescent girls and their mothers between the two case and control groups before intervention (P=0/473 & P=0/94 respectively). While, after the intervention independent t-test showed a significant difference between the two case and control groups (P>0/001). Conclusions Findings showed that the FCEM promote the QOl in adolescent girls with anemia and their mothers. It is recommended that extensive studies be performed on the effectiveness of this model for other chronic diseases in different age groups.

Introduction It is important to recognize the various dimensions of puberty and planning for the education of adolescents and their parents who are on the verge of this course. The present study aimed to investigate predictors of puberty health behavior in adolescent girls. Materials & Methods This correlational study was carried out on 280 female students from the eighth and ninth grades of high school who were selected by multi-stage random sampling method. The data gathering tool was a researcher-made questionnaire whose validity was assessed using the face and content validity method (Panel view of the experts) and its reliability was tested by test-retest and internal consistency. The collected data were analyzed by SPSS 16 using descriptive statistics, Pearson correlation coefficient and multiple regression at a significant level less than 0.05. Results Regression results with stepwise analysis showed that demographic variables other than the age of students (p = 0.031) had no effect on the adoption of puberty health behaviors, but their students’ knowledge and their attitude were good predictors of behaviors Health is puberty. Among the underlying and psychological variables, was the strongest prediction (Beta = 0.48). Attitude with knowledge and age was 34.9% of variance for explaining puberty health behaviors in adolescents. Conclusion Considering the power of predictors such as knowledge and attitude, it is possible to develop puberty health behaviors by increasing knowledge of students and providing correct and appropriate information to them and improving attitudes.

Objective To explore the perception on PCOS and its prevalence among adolescent and young women. Methods The study was conducted over 2 year period in a tertiary care teaching hospital from Eastern India. A pre-formed, validated questionnaire was used to record the details. Descriptive statistics was used to report the findings. Results Of 965 young patients with mean (SD) age 20.64 (2.1) years, 27 (2.79 %) were aware of an entity called PCOS. Awareness among adolescents with PCOS was 25.9 % (7/27). All aware patients belonged to the urban sector with professionals constituting around 48%, of which 11% were students. The major source of information among aware patients was from doctors (40.7%), and friends and Internet (25.9%); rest being from books, newspapers, and teachers. Majority (70%) were aware that diet restriction and exercise were the primary modalities of treatment, whereas, only 3.7% knew about the role of contraceptive pills in PCOS. Conclusions Awareness regarding PCOS among the young women is very low mainly in the rural set up. Doctors and health staffs should play a major role in spreading awareness of the entity to prevent long term complications.

Aim Primary spontaneous pneumothorax (PSP) is a rare pulmonary pathology that occurs in the absence of known lung disease. A retrospective study was performed to evaluate the results and outcome of PSP treatment in adolescents. Methods The cases with PSP from January 2004 to December 2017 were evaluated for age, sex, family and smoking history, clinical and radiological findings and results of treatment. Results Ten cases with PSP were included. The mean age of the patients was 15 years (10–17 years) and the male to female ratio was 9:1. Two of the patients (20%) had family history of PSP and four cases (40%) had smoking history. The initial complaints were chest pain (n=8), acute onset of cough (n=1) and breathing difficulty (n=1). Tube thoracostomy was performed in nine cases in which three of them were bilateral. Chest computed tomography (CT) demonstrated bullae (n=4; 40%) and subpleural blebs (n=2; 20%). Pleurodesis with talc was performed in four patients with pneumothorax for longer than a week in follow-up (n=4; 40%). Five cases had recurrent PSP within one year (n=5; 50%) and underwent pleurodesis with talc (n=4), autologous-blood (n=1) and bleomycin (n=1). Bleb excision was performed in two cases with persistent pneumothorax despite pleurodesis. Conclusion Tube thoracostomy and oxygen supplementation, are considered as initial and adequate treatment of PSP in most of the adolescents. Prolonged air leaks require pleurosdesis as the first line treatment and surgical excision of blebs should be reversed for the patients who are unresponsive to other treatment options.

Objectives Parents are challenged to provide the required information about reproductive issues for their adolescents. The study aims to explain women’s perception of the necessity of education about adolescent girls, reproductive health to mothers. Methods This research is a qualitative content analysis. Sampling was performed using purposeful sampling to saturation of data. The study sample included 26 mothers and 14 key informants. To collect data, semi-structured interviewing was used. Data trustworthiness was verified based on Lincoln and Guba’s criteria and the data was analyzed using conventional content analysis with MAXQDA10 software. Results Four themes and 13 main categories each with some subcategories were extracted in this research. The themes and categories included: “risky social-environmental factors (existence of inappropriate educational resources, a challenge between tradition and modernity in the society, social harms, and educational barriers)”, weakness in awareness, attitude, and family relationships (mother's limited awareness, mother's negative attitude, improper interaction between the parents and the adolescent in the family, and lack of discussion about sexual and reproductive matters in the family), problems associated with sexual and reproductive health of adolescent girls (puberty changes, insufficient perception, and understanding of the process of puberty and harms arising from early education), and high-risk behaviors of adolescents and their consequences (the adolescent's maladaptive behaviors and their outcomes). Conclusion The results of this research necessitate education of adolescent girls' reproductive health to mothers.

Objectives Desirable nutrition and breakfast intake have a major contribution to nutritional needs of students. Empirical evidence has shown that breakfast removal has an unpleasant effect on cognitive and perceptual performance of individuals. The aim of this study was to determine the Iranian students’ attitudes about breakfast consumption and its related factors. Methods In this descriptive & analytical (cross sectional) study 320 female high school students of Ardal district in 2018 were enrolled in a multistage sampling method. Data were collected using a questionnaire consist of behavioral beliefs and evaluation of the outcome. Face validity test was carried out with the view of 15 adolescents and content validity with seven expert opinions. Internal consistency and test-retest method were used for instrument reliability. Independent–samples T -Test, One–Way ANOVA and Post Hoc Multiple Comparisons were used for data analysis by SPSS ver.16. Results There was a significant relationship between the attitude of adolescents and father’s education (P = 0.047), sleep time (P < 0.001) and who ate breakfast (P = 0.003). But there was a significant relationship between attitudes with other variables not observed (P > 0.05). There was a significant relationship between behavioral beliefs of students with family size variable (P = 0.003), sleep time (0.001), who ate breakfast (P < 0.001) and father’s education, evaluation of behavioral outcomes with sleep time variable (P = 0.01) There was a significant relationship. According to the classification, the attitudes of most students (%51/6) regarding breakfast consumption was good and most of them have acceptable beliefs on positive outcomes of breakfast consumption except (example; better learning lessons and having physical health) but in the outcome of more activity in school and energy and vitality, student had unacceptable beliefs. Conclusion In designing interventions, we must work to maintain a positive attitudes toward breakfast consumption through promoting behavioral beliefs and evaluation of behavioral outcomes.

Objectives Most of the adult mental health disorder occurs either during childhood or adolescent stage. Assessment of positive mental health among adolescents will help in predicting the future physical and mental health outcome. Hence, this study was done to determine the prevalence and factors associated with positive mental health among adolescents in rural Puducherry. Methods A cross-sectional study was conducted among adolescents (10–19 years) during April and May 2018. Mental Health Continuum-Short Form (MHC-SF), a validated questionnaire was used for the assessment of positive mental health. Prevalence of positive mental health was expressed as proportion with 95% confidence interval. Results Of the total 245 adolescents interviewed, almost half of them belonged to the age group of mid-adolescence (14–16 years). Majority (66.5%) were boys and more than one third were studying in secondary class. Prevalence of positive mental health was 51.8% (95% CI: 45.6–58.1). Mother’s education between primary and secondary (aPR-0.77 95% CI: 0.60–0.98), upper middle (aPR-1.74 95% CI: 1.03–2.94) and middle socioeconomic status (aPR-1.80 95% CI: 1.11–2.87) were significantly associated with positive mental health. Conclusion Current study found that more than half of the rural adolescents had positive mental health. Maternal education and upper socioeconomic status were found to be significant predictors of positive mental health. Our findings on the burden and risk factors as well as protective factors of mental health can contribute to the mental health strategy in public health action.

Objective The present study aimed to assess whether six months intervention program with parents' implication in primary schools is able to decrease morning snack consumption among children aged 6–12 years. Methods We carried out a quasi-experimental study with two groups of schoolchildren in the region of Sousse (Tunisia) from 2015 to 2016. One primary school in each group was selected. In each school, we randomly selected a sample size of schoolchildren and their parents. The intervention was based on healthy eating habits promotion. Results The consumption of morning snacks the day before data collection, reported by children, decreased significantly in post-intervention in both intervention and control groups . The decrease of consumption of morning snacks was significantly higher in intervention group (p=0.009). According to parents, the proportion of children who had the habit of eating morning snack decreased significantly from pre to post-intervention in intervention group (p<0.001). Conclusion A healthy environment should be created through effective school policies to prevent obesity.

Introduction and Objectives Adolescence is a transition stage when girls start developing positive and negative images regarding their body shape and appearance. It is a period where there is a constant urge among females to get a skinny and slim body shape. These distinguished unreal body shapes are influenced by the mass media and other common cultural idols. As it is important to know the factors affecting their perception, we aimed to determine the proportion of college girls who overestimate/underestimate their body image and also the influence of media, peers and parents in their perception of body image. Methods Total 510 students were selected between 18 and 21years. Standardized self -administered questionnaire such as the Figure Rating Scale (FRS) was used to determine the perception of body image among college girls. The FRS consists of schematic silhouette image of nine female from outmost slender to outmost overweight. Data regarding Sociodemographic, Anthropometry and effect of various factors influencing them were also collected. Results The present study showed that almost 60.2% of the college girls were having correct perception of their body shape. 21.2% of the college girls overestimated their body shape and 18.6% of college girls underestimated their body shape. The perception was significantly influenced by media, parents and peers. Conclusion The study concluded that almost two in five girls have a misconception of their body shape and it is more influenced by media and family, so encouraging adequate support from their parents and following healthy eating behavior is the need of the hour.

Purpose The purpose of this study was to explore the differences between youths with a sibling affected by a chronic condition or a disability (SCCD) and their peers with healthy siblings. Method Using data from the second wave of GenerationFRee study, we compared adolescents from each gender with healthy siblings to adolescents with SCDD on demographical, familial, internalizing and externalizing behavior variables. Subsequently we repeated the analysis excluding from each group adolescents who suffered from a chronic condition or disability themselves. Results At the bivariate and multivariate level, among those with SCDD, healthy females reported more somatic symptoms, healthy males more violent behaviors, and both genders lived more often in non-intact families. When considering both healthy and unhealthy adolescents, at bivariate analysis female adolescents with SCDD were more likely to have a poorer relationship to their mother, to be unhealthy, to smoke, to be at risk for disordered eating and to report somatic symptoms. At multivariate level, only the association with SCDD and smoking remained. Male adolescents with SCDD, at both bivariate and multivariate analyses, were more likely to be unhealthy and to live in larger and non-intact families. Conclusion Healthy adolescents with an SCDD are more at risk of somatic symptoms and violent behaviors than their peers with healthy siblings. Health professionals in contact with adolescents should always consider them with a systemic approach. Parents should be informed about the potential effect on the siblings of a CDD child, but also reassured, as adolescents with SCDD are not different from their peers with healthy siblings.

Objectives To compare self-perceived global self-esteem (GSE) and physical self-esteem (PSE) among children and adolescents aged 11 and 14 years in Southeastern Sweden, investigated in 2000 and 2017. Methods The present study consists of two independent cross-sectional study-cohorts from Southeastern Sweden, investigated in 2000 and 2017. The same protocol, procedures, and instruments were used in 2000 and 2017. In October 2000, data for self-perceived GSE and PSE, and anthropometry were collected from 11-years old children (Grade 5) (n=74) and 14-years old adolescents (Grade 8) (n=84). In October 2017, children (n=186) and adolescents (n=140) from the same grade-levels, schools and classrooms provided data for the same variables as in 2000. GSE and PSE were assessed with the Children and Youth Physical Self-Perception Profile (CY-PSPP). Results Self-perceived GSE was higher in 2017 as compared to 2000 among both 11-years old boys (p<0.001) and girls (p<0.001) and 14-years old boys (p=0.008) and girls (p<0.001). Similarly, self-perceived PSE was higher in 2017 as compared to 2000 among both 11-years old boys (p<0.001) and girls (p=0.023) and 14-years old boys (p=0.025) and girls (p=0.002). Conclusions Self-perceived GSE and PSE among children and adolescents aged 11 and 14 years in Southeastern Sweden were higher in 2017 as compared to 2000. These results are not in agreement with the increased psychological ill-health as being reported among children and adolescents during the last decade in Sweden.

Background According to the fact that women make up half the population of each community and are considered as a family health center, exploring the factors promoting their quality of life and health must be prioritized. Objective This study aimed to understand the meaning of social support in young women's life. Methods Participants were 40 Iranian youth women who were selected by purposive sampling from the capital of Iran, Tehran. Interviews were carefully recorded and concurrent with data collection, analysis was done using conventional content analysis method. After securing the data saturation, interviews were finished and data were categorized by eight stages of zhang technique. Results From the interviews three main themes were identified: (i) financial support; (ii) informational support, and (iii) service-based social support. Discussion Awareness about aspects of social support in women' life could help health care providers and politicians in Iran to provide more effective programs to promote QOL and as a result total health of women.

Background Aesthetic alterations in the face can be self-perceived and can affect quality of life in young adults. Objective To assess the impact of malocclusion on self- perceived oro-facial behaviour among young adults. Methods A Cross sectional study was conducted among 638 young adults (aged 18–21 years) of Hyderabad city. One college from each of the five zones of the Hyderabad city (five colleges) were selected by simple random sampling procedure. A 21-item Oro-facial investment scale (OFIS) questionnaire assessing self-perceived oral health knowledge, attitude, practice and Dental Aesthetic Index (DAI) assessing the severity of malocclusion was used. Data were analysed with standard statistical software (SPSS, Statistical package for the social sciences, version 20.0). p < 0.05 was considered statistically significant. Results Males had higher mean scores for knowledge (2.90 ± 0.49) than females (2.73 ± 0.82) and was statistically significant (p = 0.002 * ). No statistically significant gender differences were found in relation to attitude and practice. Analysis of variance (ANOVA) showed that there was a significant difference in all the three scores (knowledge, attitude, practice) with respect to age, with significantly high score for knowledge and practice among 18 year old subjects (p = 0.0001 * ; p = 0.0003 * respectively) and attitude among 21 year old subjects (p = 0.0049 * ). No statistically significant age, gender differences were found in relation to DAI scores. Upon correlation, DAI significantly and positively correlated with knowledge (p = 0.03 * ) and attitude (p = 0.0001 * ). Conclusion This study has shown significant impact of malocclusion on the self-perceived oro-facial behaviour.

Objectives To determine the prevalence of Second Hand Smoking (SHS) and assess the factors related to exposure, knowledge and response to SHS among adolescents in rural Puducherry, South India. Methods A community based cross-sectional study was conducted among adolescents during March and April 2018. Two out of four villages were selected randomly and all the adolescents were contacted through household visit and questionnaire was administered. Semi structured questionnaire contained three sections: sociodemographic details, environmental assessment and third section contained knowledge about SHS, COTPA and response towards being exposed to SHS, as well as exposure history. Continuous variables like age were summarized as mean (SD). Categorical variables such as awareness, attitude and practise towards SHS were summarized as proportions with 95% confidence interval. Results Total number of adolescents interviewed was 789. The mean age of the study participants were 14.1 (2.4) years and majority, 440 (55.8%) were boys and 684 (86.7%) belonged to nuclear family. More than one fourth, 210 (26.6%) belonged to middle class of socio-economic status. Environmental assessment of household showed more than half, 456 (57.8%) were staying in pucca house and majority 642 (81.4%) had adequate cross ventilation. It was found that about 70.1% had adequate knowledge about SHS and its harmful effects. Prevalence of exposure to SHS was 49%. Majority (40.5%) told that they will scold or advice the family member to stop smoking if they are exposed to SHS in the living place. However, almost 80% of adolescents mentioned that they will no’t react if they see someone smoking in a public place. Conclusions Current study found that almost half of the adolescents were exposed to SHS. Even though, almost three fourth had adequate knowledge, attitude towards preventing SHS in public place was found to be poor. Hence, adolescents need to be motivated enough to address the problem in the public place through motivational counselling in adolescent clinics by health care workers.

Objectives University students with pain face unique physical, psychological, social and academic challenges, but research on this is limited. The main aim of this study was to examine how pain, disability and perceived social support relate to psychological and academic outcomes in students with pain. It also compared students with pain and students without pain on measures of depression, anxiety and perceived social support. Methods Three hundred and eleven students enrolled in Chinese universities took part in the study, 198 with pain (102 reported acute pain and 96 chronic pain) and 113 without pain. They completed measures of perceived social support, depression, anxiety, pain (intensity, frequency, duration), disability and pain interference with academic functioning. Results Students with chronic pain reported higher levels of anxiety and depression and lower levels of perceived social support than students without pain. There were no significant differences between students with acute and chronic pain, and between students with acute pain and those without pain. In the pain sample (containing both acute and chronic pain group), greater interference with academic functioning was predicted by higher levels of pain and disability, and disability also predicted higher levels of depression. After controlling for effects of pain and disability, lower levels of perceived social support predicted higher levels of both anxiety and depression. Conclusions These results highlight the role of pain and disability in academic functioning and the role of perceived social support in psychological functioning of students with pain.

Objectives The aim is to determine the differences in nutritional status and level of physical activity (PA) of ten year old menstruating and non-menstruating girls. Methods On the sample of 208 girls, fourth graders of elementary schools in Croatia, the indicators of nutritional status were measured: body mass index(BMI), body fat % and waist to hip ratio(WHR), while the PA was assessed using PAQ-C questionnaire. Welch´s t-test was applied to establish the differences and multivariate regression analysis was applied to establish the relationships. Results Menstruating girls have significantly higher body mass (43.42 kg±8.31 vs. 38.64 kg±8.33), waist circumference (68.10 cm ± 9.86 vs. 62.22 cm ± 7.16), hip circumference (80.81 cm ± 7.24 vs. 76.63 cm ± 7.7), BMI (19.70 ± 3.42 vs. 17.74 ± 3.10), body fat % (28.05 ± 7.54 vs. 21.98 ± 7.67) and WHR (0.84 ± 0.06 vs. 0.81 ± 0.05) in comparison to non-menstruating girls, while non-menstruating girls have significantly higher PA level (2.93 ± 0.57 vs. 2.68 ± 0.57). The regression analysis have shown a significant relationship between body fat % and the onset of menarche ( β =−0.23, SEβ=0.07, p<0.01). Conclusions Results show differences in the indicators of nutritional status of girls with regard to the status of maturity. Increased nutritional status and body fat % may be indicators of the accelerated developmental tempo and a determinant for the earlier onset of menarche.

Astract Objectives The objective of this study was to compare the characteristics of adolescents and young adults (AYA) who perceive themselves as popular with AYAs who perceive themselves as unpopular vis-á-vis peers from same-sex, opposite-sex, or both. Methods Among a representative sample of in-school 15–24 year-olds students (n=5,179) who completed a self-administrated questionnaire, we measured self-perception of popularity, socio-demographic data, ease to make same/opposite-sex friends, emotional well-being, school variables, substance use, sensation seeking, self-perception of pubertal timing, and aggressive/violent behavior. Results Overall, our findings put forth that popularity was associated to easiness of making same/opposite-sex friends, emotional well-being, socio-economical background, sensation seeking behaviors, and alcohol misuse. Differences appeared between males or females. Conclusion Findings indicate that popularity remains a very important issue among this age group and should be a red flag in clinical assessment. Future research should explore whether feeling of unpopularity can be used as a marker of adolescent well-being and hence help identify those youths who might need help.

Objectives Risk-taking reasons in adolescents are divided into four cognitive, emotional, socio-environmental, and family factors. Structure, composition, and size of family as well as parenting styles effect on the development of creative abilities, transmitting cultural and social values, and the amount of adolescent risk-taking. The present study aimed to evaluate the tendency toward high-risk behaviors based on ways of interacting with children in only-child families. Methods This research is a descriptive analytical study. The research population was only-child adolescents and one of their parents who referred to health centers in Qazvin city to receive healthcare. The sampling has been conducted in census method. The data collection tools were adolescents’ risk-taking questionnaires and Baumrind Parenting style Inventory which were completed by adolescents and one parent, respectively. The questionnaires were completed in health centers of Qazvin City, and the sampling was conducted since February to September 2018. The SPSS version 24 was used to analyze the data. Results One hundred and seventeen adolescents aged between 13 and 19 years together with one of their parents participated in this study. The majority of the mothers were housewives (62.9%) and fathers were either employees or self-employed (76.9%). Authoritative parenting style was the most dominant parenting style amongst parents (93%), and the majority of the samples (78%) had the least amount of risk. The average risk-taking score of adolescents was 23.3 ± 61.29 and the highest risk-taking behavior was dangerous driving (12.83). Risk-taking amount was negatively correlated with authoritative parenting style ( r  = −0.20, p = 0.28), while having direct and meaningful correlation with the permissive style ( r  = 0.20, p = 0.02). Conclusion The authoritative parenting style in only-child families has been a dominant trend that justifies the intimate parent-children relationships and decreases the risk-taking amount of adolescents. Therefore, parents are suggested to focus on increasing their relationship with their adolescents, rather than reducing their family size.

Objectives Smartphone use, now a ubiquitous habit among the youth and psychological stress are interestingly juxtaposed. Sense of coherence (SOC) is the ability to comprehend a stressful situation and tackle it positively. This study measured the pattern of smartphone use, perceived stress, SOC and the inter-relationship between them among undergraduate medical students. Methods Perceived Stress Scale (PSS-10) and SOC-13 scales were used to measure perceived stress and SOC, respectively in 163 medical college students. ‘App Usage’, a mobile application was used to objectively record smartphone usage. Results Nearly two-thirds (64.4%) were female students. The mean (SD) SOC score was 48.7 (11.1) and the mean (SD) PSS score was 20.7 (6.2). SOC was inversely correlated (r=−0.662, p<0.001) with PSS. The median (IQR) duration of smartphone use was 3.4(1.8, 4.8) hours per day which was not significantly correlated with perceived stress (rho=0.12, p=0.26). Linear regression showed that male students used smartphones for a longer duration than females (p=0.0008), after controlling for confounders. Conclusions Medical college students use smartphones for an average of 3 to 4 h a day. Students with a better sense of coherence perceive less stress. Initiatives to improve the sense of coherence will help increase their resilience and reduce susceptibility to problematic use of smartphones.

Objectives The study aimed to report on the prevalence and socio-psychological correlates of non-fatal injury among school-going adolescents in Timor-Leste. Methods Cross-sectional data from the 2015 Timor-Leste “Global School-based Health Survey (GSHS)” included 3,704 school children (median age 16 years, interquartile range 3) that were representative of all students in secondary school, excluding grade 12. Results The proportion of participants with one or multiple serious injuries in the past year was 70.0% (40.6% once, 17.2% two-three times and 12.2% 4–12 times). The most frequent cause of the reported injury were “I fell” (33.8%) and motor vehicle (10.2%) and the most common type of injury was “a broken bone or dislocated joint” (7.8%) and “cut, puncture or stab wound” (6.7%). In adjusted multinomial logistic regression analysis, suicide attempt was associated with one injury, and truancy was associated with both one and multiple injury. Current tobacco use, lifetime cannabis use, soft drink consumption, and loneliness were associated with multiple injuries. Conclusions Several variables were identified that could be targeted in injury prevention programmes in this school population.

Objectives This investigation aimed to study associations between multiple health risk behaviour and psychological distress among in-school adolescents in five association of Southeast Asian Nations (ASEAN) countries. Methods Cross-sectional data from the 2015 “Global School-based Health Survey (GSHS)” included 33,184 students (mean age 14.3 years, standard deviation (SD) = 1.6 years) that were representative of all students in middle school students in Indonesia, Laos, Philippines, Thailand and Timor-Leste. Results The mean prevalence of health risk behaviours was 3.1 (SD = 1.2) (range 0–8), and the prevalence of single psychological distress was 14.6% and multiple psychological distress 8.6%. In adjusted multinomial logistic regression analysis, engaging in a greater number of health risk behaviours, being female, older age, food insecurity (experience of hunger) were positively and parental or guardian support and school attendance were negatively associated with both single and multiple psychological distress. Conclusions This study confirms that the co-occurrence of multiple health risk behaviours is associated with psychological distress among adolescents, which should be considered when designing intervention programmes in this population.