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Hajebi A, Nasserinejad M, Rezaei N, Azadnajafabad S, Rashidi MM, Ahmadi N, Ghasemi E, Farzi Y, Yoosefi M, Djalalinia S, Fattahi N, Rezaei S, Foroutan Mehr E, Kazemi A, Haghshenas R, Rezaee K, Momen Nia Rankohi A, Afsari M, Mahdavihezaveh A, Jamshidi H, Farzadfar F. Alcohol consumption among Iranian population based on the findings of STEPS survey 2021. Sci Rep 2024; 14:16819. [PMID: 39039151 PMCID: PMC11263364 DOI: 10.1038/s41598-024-66257-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 07/01/2024] [Indexed: 07/24/2024] Open
Abstract
Alcohol production and consumption have been prohibited in Iran for over four decades, leading to a typical underestimation of its consumption. This study aimed to assess the prevalence of alcohol consumption, its associated factors, and estimate per capita alcohol consumption among Iran's adult population. In this population-based survey, 27,874 adults from across Iran were selected using systematic proportional-to-size cluster sampling. Alcohol consumption was evaluated through a modified Persian version of the STEPS questionnaires from previous studies, applied over different timespans. Per capita consumption was calculated using the quantity-frequency method, expressed in liters of pure alcohol. Adjusted odds ratios were reported for associates of alcohol consumption concerning metabolic risk factors, sociodemographic elements, and lifestyle variables. The prevalence of lifetime alcohol consumption was 6.9% (95% CI 6.5-7.2) in the adult population, with a notable sex difference (males: 13.7% [95% CI 13-14.4]; females: 1.4% [95% CI 1.1-1.6]). The 12 month prevalence was 3.8% (95% CI 3.6-4.1). For individuals aged 18 and older, the per capita alcohol consumption in Iran was 0.12 L. Factors such as being a lifetime smoker, younger, wealthier, and having 7-12 years of education were significantly linked to higher alcohol consumption. Significant associations were also observed between alcohol consumption and having a history of heart attacks (OR = 2.04, 95% CI 1.44-2.89), and physical injuries (OR = 1.88, 95% CI 1.34-2.64). The estimated lifetime and 12-month prevalence of alcohol use in our study were higher among some of the subpopulations. The findings also revealed a complex relationship between alcohol consumption, behavioral risk factors, and metabolic profiles. Consequently, immediate preventive measures tailored to each factor's association with alcohol use are recommended.
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Affiliation(s)
- Amirali Hajebi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Nasserinejad
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Center for Life Course Health Research, Faculty of Medicine, , University of Oulu, Oulu, Finland
| | - Negar Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sina Azadnajafabad
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad-Mahdi Rashidi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Naser Ahmadi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Erfan Ghasemi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Yosef Farzi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Moein Yoosefi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shirin Djalalinia
- Development of Research and Technology Center, Deputy of Research and Technology Ministry of Health and Medical Education, Tehran, Iran
| | - Nima Fattahi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahabeddin Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Human Nutrition Program, Department of Human Sciences, The Ohio State University, Columbus, OH, USA
| | - Elmira Foroutan Mehr
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ameneh Kazemi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Rosa Haghshenas
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Kamyar Rezaee
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Azadeh Momen Nia Rankohi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Massomeh Afsari
- NCD Management Office, Ministry of Health and Medical Education, Tehran, Iran
| | | | - Hamidreza Jamshidi
- Department of Pharmacology, School of Medicine, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
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Noroozi A, Danesh A. Prevalence of alcohol consumption among clients of opioid agonist treatment (OAT) centers in Golestan province, Iran. Front Psychiatry 2023; 14:1134683. [PMID: 37304429 PMCID: PMC10248063 DOI: 10.3389/fpsyt.2023.1134683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 05/04/2023] [Indexed: 06/13/2023] Open
Abstract
Introduction Opioid agonist treatments (OATs) with methadone and buprenorphine are known to be effective treatments for people with opioid use disorder (OUD). However, concomitant use of other substances such as alcohol can negatively affect OAT outcomes. This study aimed to determine the prevalence of alcohol use among clients of OAT centers in the Golestan province in the northern part of Iran. Materials and methods This is a secondary analysis of a sample of 706 clients who were receiving OATs from certified OAT centers in Golestan province in 2015. They had been on OATs for at least 1 month and were randomly selected for the study. Data were collected via interviews with selected OAT clients. The main indicators studied in the present study were lifetime history of alcohol consumption, alcohol consumption during last month, lifetime history of excessive alcohol use on one occasion, and years of regular alcohol consumption. Results The prevalence of lifetime history of alcohol consumption was estimated at 39.2%. Prevalence of alcohol consumption during last month and lifetime history of excessive alcohol use on one occasion was 6.9 and 18.8%, respectively. Conclusion Despite a total ban on alcohol consumption in Iran, a sub-sample of participants admitted past-month alcohol use concurrent with their OATs. The estimated past-month prevalence of alcohol use was lower than the reported prevalence in countries where the production, distribution, and consumption of alcohol are legal.
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Affiliation(s)
- Alireza Noroozi
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Ahmad Danesh
- Health Management and Social Development Research Center, School of Medicine, Golestan University of Medical Sciences, Gorgan, Golestan, Iran
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Moradzadeh M, Karamouzian M, Najafizadeh S, Yazdi-Feyzabadi V, Haghdoost AA. International Journal of Health Policy and Management (IJHPM): A Decade of Advancing Knowledge and Influencing Global Health Policy (2013-2023). Int J Health Policy Manag 2023; 12:8124. [PMID: 37579384 PMCID: PMC10425691 DOI: 10.34172/ijhpm.2023.8124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 05/23/2023] [Indexed: 08/16/2023] Open
Affiliation(s)
- Mina Moradzadeh
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Karamouzian
- Centre On Drug Policy Evaluation, St. Michael’s Hospital, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV, Kerman University of Medical Sciences, Kerman, Iran
| | - Sahar Najafizadeh
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Vahid Yazdi-Feyzabadi
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali-Akbar Haghdoost
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Olfati L, Safari-Faramani R, Najafi F, Nazar MM, Shakiba E. Population size estimation of female sex workers using network scale-up method in Kermanshah city. BMC Public Health 2023; 23:268. [PMID: 36750800 PMCID: PMC9906867 DOI: 10.1186/s12889-023-15141-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/25/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Appropriate estimate of size of the female sex workers as well as the other hard-to-reach-populations plays a crucial role in reaching them with effective preventive measures. This study aimed to estimate the population size of female sex workers in Kermanshah City using the network scale-up method. METHOD In this cross-sectional study, of the 1000 pedestrians aged between 18 and 65 years, selected from the population of Kermanshah City via a multistage sampling, were recruited in the study. Face-to-face interview using a questionnaire including the number of FSWs in the social network of the respondent was used to collect the data. RESULTS The overall estimated number of female sex workers in the general population was 4848(UI 95%: 4597, 5074). Accordingly, the prevalence of FSWs among women 18 years and older in Kermanshah in 2018 was about 11.92 (UI 95%: 11.30, 12.47) in one thousand. More than half of the female sex workers in the respondent's social network were unmarried and were in the age range of 18 to 29, and had a high school or university degree. Among high-risk behaviors, a history of alcohol consumption accounted for the highest percentage. CONCLUSION The number of female sex workers estimated in this study is considerable, which highlights the importance of planning harm reduction interventions in order to alleviate the burden of HIV infection in the population.
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Affiliation(s)
- Lida Olfati
- grid.412112.50000 0001 2012 5829Student Research Committee, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Roya Safari-Faramani
- Department of Epidemiology, School of Health Research Centre for Environmental Determinants of Health Research Institute for Health, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Farid Najafi
- grid.412112.50000 0001 2012 5829Department of Epidemiology, School of Health Research Centre for Environmental Determinants of Health Research Institute for Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mehdi Moradi Nazar
- grid.412112.50000 0001 2012 5829Department of Epidemiology, School of Health Research Centre for Environmental Determinants of Health Research Institute for Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ebrahim Shakiba
- grid.412112.50000 0001 2012 5829Department of Biochemistry, School of Medicine Social Development and Health Promotion Research Centre Research Institute for Health Kermanshah, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Rezaei N, Ahmadi N, Shams Beyranvand M, Hasan M, Gohari K, Yoosefi M, Djalalinia S, Saeedi Moghaddam S, Modirian M, Pazhuheian F, Mahdavihezaveh A, Moradi G, Delavari F, Larijani B, Farzadfar F. Alcohol consumption and related disorders in Iran: Results from the National Surveillance of Non-Communicable Diseases' Survey (STEPs) 2016. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000107. [PMID: 36962484 PMCID: PMC10021244 DOI: 10.1371/journal.pgph.0000107] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 06/28/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND Alcohol consumption is a public health concern which is illegal in Iran. Moreover, due to cultural and religious beliefs, the available population-based research findings on alcohol consumption are inadequate. We aimed to provide an estimate on alcohol consumption using a large-scale population-based survey in Iran. MATERIALS AND METHODS The National Surveillance of Non-Communicable Risk Factors in Iran was a population-based survey conducted in 2016. The epidemiologic distribution of alcohol consumption and its related disorders were assessed using weighted survey methods and multiple logistic regression models. Age standardized rates were calculated using Iran's national population census in 2016. RESULTS At the national level, the prevalence rates of lifetime and current alcohol consumption were 8.00% (95% CI: 7.67-8.32) and 4.04% (95% CI: 3.81-4.27), respectively. The highest prevalence was reported among 25 to 34 year-olds. Individuals of higher socioeconomic status consumed significantly greater levels of alcohol. At provincial level, the highest and lowest percentages of the current alcohol drinking rates in Iran's provinces were, 23.92% (95% CI: 17.56-30.28) and 0.4% (95% CI: 0-1.18) in males, 1.58% (95% CI: 0.22-2.94) and 0% in females, respectively. In urban regions, the highest alcohol consumption rate was more than 22 times greater than the lowest alcohol consumption rate. Current alcohol drinkers were 2 times more prone to injury as compared to nondrinkers (ORadj: 2.0, 95%CI: 1.7, 2.3). CONCLUSION In Iran, the prevalence of alcohol consumption is low, although there is a considerable variation of alcohol consumption at provincial level as well as in different gender groups. Therefore, preventive WHO-recommended measures should be adopted more seriously by vulnerable groups.
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Affiliation(s)
- Negar Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Naser Ahmadi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehran Shams Beyranvand
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Milad Hasan
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Kimiya Gohari
- Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Moein Yoosefi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shirin Djalalinia
- Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
| | - Sahar Saeedi Moghaddam
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mitra Modirian
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Forough Pazhuheian
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Ghobad Moradi
- Social Determinants of Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Farnaz Delavari
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Roshanfekr P, Ali D, Noroozi M, Bahrami G, Vameghi M. Lifetime alcohol-use prevalence and correlated factors among street children in Iran. Brain Behav 2022; 12:e2781. [PMID: 36227702 PMCID: PMC9660407 DOI: 10.1002/brb3.2781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/29/2022] [Accepted: 09/15/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Several studies on street children in Iran reported a high prevalence of alcohol consumption among this group. This study assessed the prevalence of lifetime alcohol use and correlated factors among street children in Iran. METHODS We conducted a cross-sectional survey among 856 street children from six provinces of Iran. Behavioral data were collected by trained interviewers using a structured questionnaire. Our target outcome was lifetime alcohol use. We examined associations between individual variables and lifetime alcohol use using the chi-square. A multiple logistic regression model included variables with a p-value < .2. Lastly, we reported the adjusted odds ratio (an OR) point estimate and 95% confidence interval (95% CI) as the effect measure. RESULTS Mean age and standard deviation (SD) of alcohol drinkers were 14.94 ± 2.16. Overall, 16.6% (CI95%: 14.38%, 19.55%) of participants reported lifetime alcohol use, and almost 60% of children reported alcohol use over three past months. In the final model, factors that were independently associated with alcohol use included the 15-18 age range (AOR 2.35, 95% CI 1.48-3.73), Iranian nationality (AOR 3.36, 95% CI 2.07-5.45), working longer than 5 years in the streets (AOR 2.90, 95% CI 1.72-4.88), father's drug use (AOR 1.93, 95% CI 1.22-3.01), and illiteracy (AOR 1.65, 95% CI 1.03-2.66). CONCLUSIONS The results of the present study demonstrated that preventive plans for alcohol use among street children must be addressed using the services provided by governmental and nongovernmental organizations.
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Affiliation(s)
- Payam Roshanfekr
- Social Welfare Management Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Delaram Ali
- Social Welfare Management Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mehdi Noroozi
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Giti Bahrami
- Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Meroe Vameghi
- Social Welfare Management Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Rastegari A, Baneshi MR, Hajebi A, Noroozi A, Karamouzian M, Shokoohi M, Mirzazadeh A, Khojasteh Bojnourdi T, Nasiri N, Haji Maghsoudi S, Haghdoost AA, Sharifi H. Population Size Estimation of People Who Use Illicit Drugs and Alcohol in Iran (2015-2016). Int J Health Policy Manag 2022; 12:6578. [PMID: 36243944 PMCID: PMC10125066 DOI: 10.34172/ijhpm.2022.6578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/09/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Estimating the number of people using illicit drugs and alcohol is necessary for informing health policy and programming. However, it is often challenging to reliably estimate the size of these marginalized populations through direct methods. In this study, we estimated the population size of these groups using the indirect Network Scale-Up (NSU) method in Iran from 2015 to 2016. METHODS Using a self-administered questionnaire, we asked 15 124 individuals (54% men) about the number of people they know who used different types of drugs at least once in the past 12 months. Prevalence estimates were reported per 100 000 population. The uncertainty level (UL) was calculated using the bootstrap method. RESULTS The average age of the respondents was 33 years old, and 35.1% of them were unmarried. The most common drugs and their prevalence were as follows: opium (2534 [95% UL: 2467-2598]), hashish (849 [95% UL: 811-886]), stimulants (methamphetamine, ecstasy pills, cocaine, and Ritalin) (842 [95% UL: 802-879]), heroin/crack (578 [95% UL: 550-607]), and drug injection (459 [95% UL: 438-484]). Additionally, we estimated the prevalence of alcohol use as 2797 (95% UL: 2731-2861). On average, substance use was 5.23 times more prevalent among men than women. Opium use was more prevalent among individuals aged >50 years old. Moreover, alcohol use was more prevalent among participants between 18 and 30 years old (5164 per 100 000 population). CONCLUSION Although opium continues to be the most prevalent illicit drug in Iran, the patterns of illicit drug use are heterogeneous among different age groups, genders, and provinces. Age-gender specific and culturally appropriate interventions are warranted to meet the needs of people in different subgroups.
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Affiliation(s)
- Azam Rastegari
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Reza Baneshi
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Center for Longitudinal and Life Course Research, School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Ahmad Hajebi
- Research Center for Addiction & Risky Behaviors (ReCARB), Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
- Department of Psychiatry, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Noroozi
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Karamouzian
- Centre On Drug Policy Evaluation, St. Michael’s Hospital, Toronto, ON, Canada
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV, Kerman University of Medical Sciences, Kerman, Iran
| | - Mostafa Shokoohi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Mirzazadeh
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV, Kerman University of Medical Sciences, Kerman, Iran
- Institute for Health Policy Studies, University of California, San Francisco, CA, USA
| | | | - Naser Nasiri
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV, Kerman University of Medical Sciences, Kerman, Iran
| | - Saiedeh Haji Maghsoudi
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Akbar Haghdoost
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV, Kerman University of Medical Sciences, Kerman, Iran
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV, Kerman University of Medical Sciences, Kerman, Iran
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Clay-Warner J, Kawashima T, Edgemon TG. Measure of Personal Network Size Using the Known Population Method: A Methodological Guide. Am J Public Health 2022; 112:747-753. [PMID: 35298281 PMCID: PMC9010921 DOI: 10.2105/ajph.2022.306731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2022] [Indexed: 11/04/2022]
Abstract
The network scale-up method (NSUM) has shown promise in measuring the prevalence of hidden public health problems and at-risk populations. The technique involves asking survey respondents how many people they know with the health problem or characteristic of interest and extrapolating this information to the population level. An important component of the NSUM estimate is the size of each respondent's network, which is determined by asking respondents about the number of people they know who belong to populations of known size. There is little systematic discussion, however, to guide selection of these questions. Furthermore, many of the most commonly used known population questions are appropriate only in countries with a robust data infrastructure. Here, we draw from the NSUM literature to present a set of best practices in the selection of NSUM known population questions. Throughout, we address the unique situations that many researchers face in collecting prevalence data in the developing world, where innovative prevalence estimation techniques, such as NSUM, are most needed. (Am J Public Health. 2022;112(5):747-753. https://doi.org/10.2105/AJPH.2022.306731).
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Affiliation(s)
- Jody Clay-Warner
- Jody Clay-Warner and Tenshi Kawashima are with the Department of Sociology, University of Georgia, Athens. Timothy G. Edgemon is with the Department of Sociology, Anthropology, and Social Work, Auburn University, Auburn, AL
| | - Tenshi Kawashima
- Jody Clay-Warner and Tenshi Kawashima are with the Department of Sociology, University of Georgia, Athens. Timothy G. Edgemon is with the Department of Sociology, Anthropology, and Social Work, Auburn University, Auburn, AL
| | - Timothy G Edgemon
- Jody Clay-Warner and Tenshi Kawashima are with the Department of Sociology, University of Georgia, Athens. Timothy G. Edgemon is with the Department of Sociology, Anthropology, and Social Work, Auburn University, Auburn, AL
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Hosseinkhani Z, Mohammadkhanloo M, Zamanian M, Moradzadeh R, Ramezani M, Cheraghi Z, Bagheri H, Jafari E, Osooli M. Prevalence of alcohol consumption in most at-risk groups in Iran: a systematic review and meta-analysis. JOURNAL OF SUBSTANCE USE 2021. [DOI: 10.1080/14659891.2021.2018728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Zahra Hosseinkhani
- Metabolic Diseases Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Marzieh Mohammadkhanloo
- Metabolic Diseases Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Maryam Zamanian
- Department of Epidemiology, School of Health, Arak University of Medical Sciences, Arak, Iran
| | - Rahmatolla Moradzadeh
- Department of Epidemiology, School of Health, Arak University of Medical Sciences, Arak, Iran
| | - Mohammad Ramezani
- Department of Medical Sciences and Technologies, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Zahra Cheraghi
- Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Hadi Bagheri
- Children Growth Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Elahe Jafari
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Mehdi Osooli
- Division of Occupational and Environmental Medicine, Institution of Laboratory Medicine, Lund University, Lund, Sweden
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Homaie Rad E, Hajizadeh M, Yazdi-Feyzabadi V, Delavari S, Mohtasham-Amiri Z. How Much Money Should be Paid for a Patient to Isolate During the COVID-19 Outbreak? A Discrete Choice Experiment in Iran. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2021; 19:709-719. [PMID: 34312818 PMCID: PMC8313371 DOI: 10.1007/s40258-021-00671-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/20/2021] [Indexed: 05/07/2023]
Abstract
INTRODUCTION Isolation of COVID-19 patients is a vital strategy for preventing the spread of the virus. Isolation without any incentive or compensation for the patients cannot be effective. We sought to find the monetary value of the willingness to accept (WTA) being isolated for COVID-19 in Iran. METHODS In this discrete choice experiment, scenarios were designed by reviewing the literature and semi-structural interviews. Fourteen choice sets with two scenarios were included in an internet-based questionnaire that was sent to the Telegram Social Network. A total of 617 individuals completed the questionnaire. A random-effects logistic regression model was used for the main analysis. RESULTS The average monetary value of a WTA 7 days of isolation was US$51.71 (95% confidence interval [CI] 43.09-60.33). The WTA for one day of isolation was US$1.48 (95% CI 1.11-1.85) for unemployed groups, US$1.49 (95% CI 1.18-1.79) for office employees and US$1.36 (95% CI 0.73-2.01) for manual workers. The WTA was 0.44 (95% CI 0.35-0.53) US$ for low-income groups, US$0.68 (95% CI 0.52-0.84) for middle-income groups and US$0.77 (95% CI 0.35-1.18) for high-income groups. CONCLUSIONS Our findings suggested that financial preferences for being isolated vary widely across individuals within different socioeconomic groups. Policymakers should consider these differences when designing effective intervention to increase compliance with the isolation protocols during infectious disease outbreaks.
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Affiliation(s)
- Enayatollah Homaie Rad
- Social Determinants of Health Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | | | - Vahid Yazdi-Feyzabadi
- Health Services Management Research Center, Institute for Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
- Department of Health Management, Policy and Economics, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran.
| | - Sajad Delavari
- Health Human Resources Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Mohtasham-Amiri
- Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran
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Estimating the Size of Hidden Groups. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021. [PMID: 34339010 DOI: 10.1007/978-3-030-75464-8_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register]
Abstract
NSU studies have been applied in different countries. For example, this technique has been used in the United States to estimate the number of women who had been raped in the last year.
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12
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Ocagli H, Azzolina D, Lorenzoni G, Gallipoli S, Martinato M, Acar AS, Berchialla P, Gregori D. Using Social Networks to Estimate the Number of COVID-19 Cases: The Incident (Hidden COVID-19 Cases Network Estimation) Study Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115713. [PMID: 34073448 PMCID: PMC8198250 DOI: 10.3390/ijerph18115713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/14/2021] [Accepted: 05/19/2021] [Indexed: 11/16/2022]
Abstract
Recent literature has reported a high percentage of asymptomatic or paucisymptomatic cases in subjects with COVID-19 infection. This proportion can be difficult to quantify; therefore, it constitutes a hidden population. This study aims to develop a proof-of-concept method for estimating the number of undocumented infections of COVID-19. This is the protocol for the INCIDENT (Hidden COVID-19 Cases Network Estimation) study, an online, cross-sectional survey with snowball sampling based on the network scale-up method (NSUM). The original personal network size estimation method was based on a fixed-effects maximum likelihood estimator. We propose an extension of previous Bayesian estimation methods to estimate the unknown network size using the Markov chain Monte Carlo algorithm. On 6 May 2020, 1963 questionnaires were collected, 1703 were completed except for the random questions, and 1652 were completed in all three sections. The algorithm was initialized at the first iteration and applied to the whole dataset. Knowing the number of asymptomatic COVID-19 cases is extremely important for reducing the spread of the virus. Our approach reduces the number of questions posed. This allows us to speed up the completion of the questionnaire with a subsequent reduction in the nonresponse rate.
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Affiliation(s)
- Honoria Ocagli
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Via Loredan, 18, 35121 Padova, Italy; (H.O.); (D.A.); (G.L.); (M.M.)
| | - Danila Azzolina
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Via Loredan, 18, 35121 Padova, Italy; (H.O.); (D.A.); (G.L.); (M.M.)
- Research Support Unit, Department of Translational Medicine, University of Eastern Piedmont, Via Solaroli, 17, 28100 Novara, Italy
| | - Giulia Lorenzoni
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Via Loredan, 18, 35121 Padova, Italy; (H.O.); (D.A.); (G.L.); (M.M.)
| | | | - Matteo Martinato
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Via Loredan, 18, 35121 Padova, Italy; (H.O.); (D.A.); (G.L.); (M.M.)
| | - Aslihan S. Acar
- Department of Actuarial Sciences, Hacettepe University, 06800 Ankara, Turkey;
| | - Paola Berchialla
- Department of Clinical and Biological Sciences, University of Torino, Regione Gonzole 10, 10043 Orbassano, Italy;
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Via Loredan, 18, 35121 Padova, Italy; (H.O.); (D.A.); (G.L.); (M.M.)
- Correspondence: ; Tel.: +39-049-827-5384
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13
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Damari B, Sarami H, Alikhani S, Mirzaei H. A National survey on substance use among Iranian industrial workers. Med J Islam Repub Iran 2020; 34:20. [PMID: 32551309 PMCID: PMC7293805 DOI: 10.34171/mjiri.34.20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Indexed: 11/06/2022] Open
Abstract
Background: Recent evidence shows that the prevalence of substance abuse is 2.1% in Iranians aged 15-64 years, while reported rates are higher in studies that target industrial workplaces. Our study intends to provide a national picture of substance use among industrial workers in Iran.
Methods: This survey was designed to collect data through interviews and dipstick urine tests. Using a multi-stage sampling approach, we recruited our study subjects from a representative sample of industrial workers from all provinces in 2015. Data were weighted to estimate the prevalence rate of substance use. Odds ratios were calculated through adapting logistic regression to test the strength of association between substance use (based on self-report and urine test) and sociodemographic factors including sex, age group, education level, marital status and worker’s professional training status. All statistical analyses were conducted using SPSS Version 22. P <0.05 was considered significant.
Results: We analyzed the data collected from 13,128 participants; both self-reported use and urine test results. Majority of the respondents were male (n=12077, 92%), aged 21-40 years old (n=9491, 72.3%), had finished middle/secondary school (n=8353, 63.6%) and were married (n=11012, 83.9%). Opium was the most popular abused substance (n=352, 2.7%) followed by alcohol (304, 2.3%), based on self-reports. Urine tests showed that 23.8% (n=3105) of the participants had a positive result for the use of opiates/opioids, crystal meth and/or cannabis. The highest rate of substance use reported from a province was 60.50%; the lowest provincial rate was 9.0%.
Conclusion: Nearly a one-fourth of Iranian industrial employees are engaged in use of substances with significant geographical distribution. Urine test is the recommended method to assess the prevalence of drug use among industrial workers in Iran.
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Affiliation(s)
- Behzad Damari
- Department of Governance and Health, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Sarami
- Cultural planning and management Edalat University, Tehran, Iran
| | | | - Hossein Mirzaei
- Department of Biostatistics and Epidemiology, School of Health, Kerman University of Medical Sciences, Kerman, Iran
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14
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Moradinazar M, Najafi F, Jalilian F, Pasdar Y, Hamzeh B, Shakiba E, Hajizadeh M, Haghdoost AA, Malekzadeh R, Poustchi H, Nasiri M, Okati-Aliabad H, Saeedi M, Mansour-Ghanaei F, Farhang S, Safarpour AR, Maharlouei N, Farjam M, Amini S, Amini M, Mohammadi A, Mirzaei-Alavijeh M. Prevalence of drug use, alcohol consumption, cigarette smoking and measure of socioeconomic-related inequalities of drug use among Iranian people: findings from a national survey. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2020; 15:39. [PMID: 32503660 PMCID: PMC7275311 DOI: 10.1186/s13011-020-00279-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 05/28/2020] [Indexed: 02/06/2023]
Abstract
Background Drug use can lead to several psychological, medical and social complications. The current study aimed to measure and decomposes socioeconomic-related inequalities in drug use among adults in Iran. Methods This was a cross-sectional study The PERSIAN Cohort is the largest and most important cohort among 18 distinct areas of Iran. This study was conducted on 130,570 adults 35 years and older. A structured questionnaire was applied to collect data. The concentration index (C) was used to quantify and decompose socioeconomic inequalities in drug use. Results The prevalence experience of drug use was 11.9%. The estimated C for drug use was − 0.021. The corresponding value of the C for women and men were − 0.171 and − 0.134, respectively. The negative values of the C suggest that drug use is more concentrated among the population with low socioeconomic status in Iran (p < 0.001). For women, socioeconomic status (SES) (26.37%), province residence (− 22.38%) and age (9.76%) had the most significant contribution to socioeconomic inequality in drug use, respectively. For men, SES (80.04%), smoking (32.04%) and alcohol consumption (− 12.37%) were the main contributors to socioeconomic inequality in drug use. Conclusions Our study indicated that drug use prevention programs in Iran should focus on socioeconomically disadvantaged population. Our finding could be useful for health policy maker to design and implement effective preventative programs to protect Iranian population against the drug use.
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Affiliation(s)
- Mehdi Moradinazar
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Farid Najafi
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Farzad Jalilian
- Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Yahya Pasdar
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Behrooz Hamzeh
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ebraim Shakiba
- Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammad Hajizadeh
- School of Health Administration, Faculty of Health, Dalhousie University, Halifax, Canada
| | - Ali Akbar Haghdoost
- Modeling in Health Research Center, Institute for Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Reza Malekzadeh
- Digestive Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Poustchi
- Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Marzeyeh Nasiri
- Modelling in health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Hassan Okati-Aliabad
- Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Majid Saeedi
- Department of Pharmaceutics, School of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Fariborz Mansour-Ghanaei
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Sara Farhang
- Liver and gastrointestinal Diseases Research center, Tabriz University of Medical sciences, Tabriz, Iran
| | - Ali Reza Safarpour
- Gastroenterohe Pathology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Najmeh Maharlouei
- Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mojtaba Farjam
- Non-communicable diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | - Saeed Amini
- Health Services Management, Arak University of Medical Sciences, Arak, Iran
| | - Mahin Amini
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ali Mohammadi
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mehdi Mirzaei-Alavijeh
- Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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15
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Pakzad R, Nedjat S, Yaseri M, Salehiniya H, Mansournia N, Nazemipour M, Mansournia MA. Effect of Smoking on Breast Cancer by Adjusting for Smoking Misclassification Bias and Confounders Using a Probabilistic Bias Analysis Method. Clin Epidemiol 2020; 12:557-568. [PMID: 32547245 PMCID: PMC7266328 DOI: 10.2147/clep.s252025] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose The aim of this study was to determine the association between smoking and breast cancer after adjusting for smoking misclassification bias and confounders. Methods In this case–control study, 1000 women with breast cancer and 1000 healthy controls were selected. Using a probabilistic bias analysis method, the association between smoking and breast cancer was adjusted for the bias resulting from misclassification of smoking secondary to self-reporting as well as a minimally sufficient adjustment set of confounders derived from a causal directed acyclic graph (cDAG). Population attributable fraction (PAF) for smoking was calculated using Miettinen’s formula. Results While the odds ratio (OR) from the conventional logistic regression model between smoking and breast cancer was 0.64 (95% CI: 0.36–1.13), the adjusted ORs from the probabilistic bias analysis were in the ranges of 2.63–2.69 and 1.73–2.83 for non-differential and differential misclassification, respectively. PAF ranges obtained were 1.36–1.72% and 0.62–2.01% using the non-differential bias analysis and differential bias analysis, respectively. Conclusion After misclassification correction for smoking, the non-significant negative-adjusted association between smoking and breast cancer changed to a significant positive-adjusted association.
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Affiliation(s)
- Reza Pakzad
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Saharnaz Nedjat
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Yaseri
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Salehiniya
- School of Public Health, Birjand University of Medical Sciences, Birjand, South Khorasan, Iran
| | - Nasrin Mansournia
- Department of Endocrinology, AJA University of Medical Sciences, Tehran, Iran
| | - Maryam Nazemipour
- Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Chegeni M, Kamel Khodabandeh A, Karamouzian M, Shokoohi M, Abedi L, Khalili M, Rajaei L, Ardalan G, Sharifi H. Alcohol consumption in Iran: A systematic review and meta-analysis of the literature. Drug Alcohol Rev 2020; 39:525-538. [PMID: 32441436 DOI: 10.1111/dar.13093] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 04/10/2020] [Accepted: 04/15/2020] [Indexed: 12/13/2022]
Abstract
ISSUES Alcohol production, marketing and consumption are illegal in Iran. This systematic review examines the lifetime and last 12-month prevalence of alcohol consumption among the general and young population in Iran. APPROACH We searched Web of Science, PubMed, Embase, Scopus and Iranian scientific databases (i.e. Scientific Information Database and Magiran) for relevant publications in English and Persian from inception to 12 May 2019. Following a random-effects meta-analysis, we estimated the pooled prevalence of alcohol consumption among the general population and young people (<30 years old). Meta-regression was used to identify potential sources of heterogeneity. KEY FINDINGS Of the 2400 identified records, 62 met the inclusion criteria. The overall pooled prevalence of lifetime alcohol consumption among the general population and young people was 13.0% [95% confidence intervals (CI) 10.0, 16.0]. The overall pooled prevalence of last 12-month alcohol consumption was 12.0% (95% CI 7.0, 18.0) for the general population and 15.0% (95% CI 9.0, 22.0) for young people. The prevalence of alcohol consumption varied from 0.03% to 68.0% in different regions, 0.3% to 66.6% among males and 0.2% to 21.0% among females. IMPLICATIONS Our findings highlight the need for public health surveillance of alcohol use in Iran. CONCLUSION These estimates show that, on average, one in eight people in the general population have ever consumed alcohol in Iran, indicating that alcohol consumption is not an uncommon practice in the country.
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Affiliation(s)
- Maryam Chegeni
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Atiyeh Kamel Khodabandeh
- Department of Biostatistics and Epidemiology, School of Public Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Karamouzian
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.,School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada.,British Columbia Centre on Substance Use, Vancouver, Canada
| | - Mostafa Shokoohi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.,Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Canada.,Division of Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Leili Abedi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Malahat Khalili
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Leila Rajaei
- Adolescent and Youth Health Office, Ministry of Health and Medical Education, Tehran, Iran
| | - Gelayol Ardalan
- Adolescent and Youth Health Office, Ministry of Health and Medical Education, Tehran, Iran
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Al-Ansari B, Noroozi A, Thow AM, Day CA, Mirzaie M, Conigrave KM. Alcohol treatment systems in Muslim majority countries: Case study of alcohol treatment policy in Iran. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 80:102753. [PMID: 32387885 DOI: 10.1016/j.drugpo.2020.102753] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 04/01/2020] [Accepted: 04/02/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Alcohol is a leading risk factor for death and disability globally. Due to the Islamic prohibition of alcohol consumption, alcohol policy is an under-studied and sensitive topic in Muslim majority countries (MMCs). In addition, drinkers in these countries may face barriers to treatment access due to stigma or the legal status of alcohol. Using Iran as a case study this paper explores how alcohol treatment is planned and delivered in the complex environment of an MMC. METHOD We searched academic and grey literature, clinical manuals, guidelines and policy documents for information on the development and implementation of alcohol treatment policy in Iran. The search was conducted in English, Persian and Arabic. We conducted 6 consultations to verify information obtained. We analysed information based on the Walt & Gilson health policy analysis triangle, which identifies context, process, actors and content as key factors for understanding policy. RESULTS Iran initiated an alcohol-specific national strategy in 2011-2012 that aims to prevent, reduce and treat alcohol use disorders. This strategy has been designed to be implemented on a multi-sectoral level. Screening and prevention are mainly initiated in primary health care and cases are referred accordingly. Alcohol treatment is provided in specialised outpatient and inpatient settings. Due to contextual factors such as stigma, feasibility and affordability, alcohol outpatient units are planned to be integrated into existing public/ private drug addiction treatment facilities. However, the Ministry of Health has faced many challenges in implementing this pilot project. To date only small numbers of outpatient and inpatient units have formally commenced offering alcohol treatment. CONCLUSION Implementing alcohol treatment has been challenging for Iran. Approval of new treatment programs may not be seen as a priority because of the low prevalence of alcohol use disorders in the country. Also, policy makers are implementing treatment services with caution due to the existing alcohol prohibition for the country's Muslim majority population. Barriers to treatment seeking need to be addressed at the micro and macro levels. Support from international agencies such as the WHO could assist MMCs to develop appropriate services that are feasible for their unique alcohol policy environment.
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Affiliation(s)
- Basma Al-Ansari
- Addiction Medicine, Sydney School of Medicine (Central Clinical School), University of Sydney, NSW, Australia.
| | - Alireza Noroozi
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences (TUMS), Tehran, Iran; Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine (SATiM), TUMS, Tehran, Iran
| | - Anne-Marie Thow
- Menzies Centre for Health Policy, Sydney Medical School, University of Sydney, NSW, Australia
| | - Carolyn A Day
- Addiction Medicine, Sydney School of Medicine (Central Clinical School), University of Sydney, NSW, Australia
| | - Masoud Mirzaie
- Research Center of Prevention and Epidemiology of Non-Communicable Disease, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Katherine M Conigrave
- Addiction Medicine, Sydney School of Medicine (Central Clinical School), University of Sydney, NSW, Australia; Drug Health Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
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18
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Pourmohammadi B, Jalilvand MA. Prevalence of alcohol consumption and related factors among students of higher education centers in one of the northeastern cities of Iran. AIMS Public Health 2020; 6:523-533. [PMID: 31909072 PMCID: PMC6940569 DOI: 10.3934/publichealth.2019.4.523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 11/14/2019] [Indexed: 11/30/2022] Open
Abstract
Introduction Knowing the prevalence and the factors associated with alcohol abuse among students can be an important step in initiating preventive measures. The purpose of this study was to determine the prevalence of alcohol consumption and its related factors in students of higher education centers in one of the northeastern cities of Iran in 2017. Methods This descriptive-analytical study was performed on 668 students from 7 higher education centers. The samples were selected by stratified random sampling. The valid researcher-made questionnaires were issued to the subjects, and were collected immediately after being filled out. The obtained data were analyzed using appropriate statistical tests. Results Ninety-two (13.77%) students had history of alcohol consumption, with 55.6% continued to drink alcohol. The mean age of the consumers was 23.92 years, of whom 77.41% were male, 75% were single, 55.43% were non-indigenous, and 74.46% had history of smoking. 81.52% of the subjects were undergraduates, while 36.95% studied mathematics and engineering. There was a significant relationship between alcohol consumption and age, gender, GPA, being non-indigenous, personal residence, smoking, history of alcohol consumption in family and friends, satisfaction with academic major and city in which they study (p < 0.05). Conclusion The findings showed that alcohol consumption was relatively high in students of higher education centers and many variables (ten out of fifteen studied variables) were involved in this process. Therefore, careful planning and serious measures are needed to prevent this problem.
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Affiliation(s)
- Behrad Pourmohammadi
- Research Center for Health Sciences and Technologies, Semnan University of Medical Sciences, Semnan, Iran
| | - Moahammad Ali Jalilvand
- Student Research Committee, School of Management and Medical Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
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Narouee S, Shati M, Nasehi M, Dadgar F. The size estimation of injection drug users (IDUs) using the network scale-up method (NSUM) in Iranshahr, Iran. Med J Islam Repub Iran 2019; 33:158. [PMID: 32280664 PMCID: PMC7137874 DOI: 10.34171/mjiri.33.158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Indexed: 11/05/2022] Open
Abstract
Background: The size estimation of key populations is a necessary part of surveillance systems to access global human immunodeficiency virus (HIV) infection. In this study, the NSU method was used to estimate injection drug users (IDUs). Methods: NSU method was performed on 1000 individuals in Iranshahr province with street-based sampling from 2016 to 2017. A questionnaire comprising items on demographic information and items measuring the network size of participants about IDUs was administered. The estimated size was adjusted for transmission error and barrier effect with PF and VF factors. The relationship between knowing IDUs and demographic variables was assessed using logistic regression. All analyses were performed in SPSS 19 and Microsoft Excel. Results: In this study, 500 men and 500 women were included. The average age (standard deviation) of the participants was 29.6 (7.8) years. IDUs were estimated at 1263 per 100 000 population of Iranshahr in Sistan and Baluchestan province, Iran. The estimated size was 7.5 times more in men than in women (2766 vs 364). Moreover, the highest estimated size belonged to the population of 18- 30-year-olds (1187). Sex and education level had significant relationships with knowing IDUs (p<0.001). Conclusion: To improve preventive programs, the number of outreach teams must be increased to have access to IDUs, educate them, and upgrade the coverage of harm-reduction services. According to cultural considerations and the illegal nature of injection drug use, social mobilization is essential to reduce the stigma.
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Affiliation(s)
- Sakineh Narouee
- Department of Health, Iranshahr University of Medical Sciences, Sistan and Baluchestan, Iran
| | - Mohsen Shati
- Mental Health Research Center, School of Behavioral Sciences and Mental Health, Tehran Institute of Psychiatry, Iran University of Medical Sciences, Tehran, Iran
| | - Mahshid Nasehi
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Farhad Dadgar
- Iranshahr University of Medical Sciences, Sistan and Baluchestan, Iran
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Methodological considerations in using the Network Scale Up (NSU) for the estimation of risky behaviors of particular age-gender groups: An example in the case of intentional abortion. PLoS One 2019; 14:e0217481. [PMID: 31185067 PMCID: PMC6559635 DOI: 10.1371/journal.pone.0217481] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 05/13/2019] [Indexed: 12/05/2022] Open
Abstract
Background Network Scale Up (NSU) is a promising tool for size estimation of sensitive issues. In this study we investigated the important methodological considerations to employ this method for estimating behaviors, such as abortion, which happens in a particular age-gender group. Methods We recruited 1250 males and 1250 females aged 18 to 50. Abortion rate was calculated through direct question and NSU methodology. The NSU was applied on three sub-samples (male, female and aggregate). Integrating replies to 25 reference groups, we estimated the network size (C) of respondents and its age-gender structure. To calculate the part of network that is subject to abortion, we compared two approaches: proportional and data based. The Visibility Factor (VF) was calculated through 222 females who had abortion. Direct estimate was considered as gold standard. Results Using C’s derived from proportional method, the Relative Bias (RB) in the male and female samples was 33% and 84%. Applying the data-based C’s, the RB in the gender-specific and aggregate samples was 5% and 2%. Conclusion The proportional method overestimates the prevalence. The data-based method to calculate the C is superior. The determination of the age-sex distribution of the network and the specific VF is essential.
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A public health approach to alcohol use and its related harms in Iran. LANCET PUBLIC HEALTH 2019; 4:e175-e176. [DOI: 10.1016/s2468-2667(19)30038-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 02/26/2019] [Indexed: 11/23/2022]
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22
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Mehrabi M, Hajebi A, Mohebbi E, Baneshi MR, Khodadost M, Haghdoost AA, Sharifi H, Noroozi A. Prevalence and Correlates of Lifetime Alcohol Use among Adult Urban Populations in Iran: A Knowledge, Attitude, and Practice Study. J Psychoactive Drugs 2019; 51:290-297. [PMID: 30798779 DOI: 10.1080/02791072.2019.1578909] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Globally, alcohol use is one of the leading contributors to the burden of disease. The aim of this study was to provide data on prevalence and correlates of lifetime alcohol use among Iranian adults living in urban areas. This cross-sectional study investigated knowledge, attitude, and practice (KAP) of Iranian adults towards drug and alcohol use. Participants were recruited from the capital cities of five provinces-Tehran, West Azerbaijan, Markazi, Kerman, and Khorasan Razavi-in 2015. We used multivariate logistic regression models to conduct data analysis. Completing the questionnaire were 2,065 participants (44.06% female). Prevalence of lifetime alcohol use was 28% (95% CI: 25-29%). Lifetime alcohol use was significantly associated with male gender (Odds Ratio (OR) = 1.74, 95% Confidence Interval (CI): 1.26- 2.39), positive attitude towards alcohol (OR = 2.15, CI: 1.60-4.34), lifetime stimulants use (OR = 5.73, CI: 3.56- 9.23), and lifetime opioids use (OR = 4.47, CI: 3.12- 6.39). Estimated lifetime prevalence of alcohol use in our study was higher than the regional average. Primary alcohol prevention programs need to target sub- populations who are at risk for alcohol use and provide services that impede the development of positive attitudes towards alcohol.
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Affiliation(s)
- Maryam Mehrabi
- a Department of Mental Health, Social Health and Addiction, Ministry of Health , Tehran , Iran.,b Health sociology researcher, Health and Medical Sociology Group of Iran Sociology Association , Tehran , Iran
| | - Ahmad Hajebi
- c Research Center for Addiction and Risky Behavior (ReCARB), Psychiatric Department, Iran University of Medical Sciences (IUMS) , Tehran , Iran
| | - Elham Mohebbi
- d Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences (KUMS) , Kerman , Iran
| | - Mohammad Reza Baneshi
- d Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences (KUMS) , Kerman , Iran
| | - Mahmoud Khodadost
- e Department of Epidemiology, Faculty of Health, Shahid Beheshti University of Medical Sciences , Tehran , Iran.,f Department of Epidemiology, Faculty of Health, IUMS , Tehran , Iran
| | - Ali Akbar Haghdoost
- d Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences (KUMS) , Kerman , Iran.,g HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies Health, Kerman University of Medical Sciences , Kerman , Iran
| | - Hamid Sharifi
- g HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies Health, Kerman University of Medical Sciences , Kerman , Iran
| | - Alireza Noroozi
- h Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences (TUMS) , Tehran , Iran.,i Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine (SATiM), TUMS , Tehran , Iran
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23
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Mohseni F, Rafaiee R. Results of Activity of Anonymous Alcoholic Association in Iran. ADDICTION & HEALTH 2019; 10:11-16. [PMID: 30627380 PMCID: PMC6312557 DOI: 10.22122/ahj.v10i1.554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Alcoholics Anonymous (AA) is the largest non-governmental organization (NGO) for alcoholics in the world. During the recent decades, Iran has suffered from alcohol abuse and its consequences. Alcoholism is a taboo subject in Iran and there are few studies in this area. This is the first study in Iran to investigate the results of the activity of anonymous alcoholics. Methods Data were collected from the improved members of the AA in Iran (n = 6197). Findings The obtained results included members’ demographic characteristics, age of sobriety, average attendance in weekly meetings, status of the sponsor, status of relapse, and the way of entering each member into AA groups. Conclusion The activity of the AA in Iran is facing limitations and obstacles. The number of individuals with sobriety age above 20 years is not available because of the short-age activity of the AA in Iran. The number of men using this program is higher compared to women. Most members are individuals aging 31 to 40 years who are considered active members of the society.
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Affiliation(s)
- Fahimeh Mohseni
- PhD Student, Addiction Research Center AND Department of Addiction Studies, School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Raheleh Rafaiee
- PhD Student, Addiction Research Center AND Department of Addiction Studies, School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran
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24
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Ebrahimi Kalan M, Naseh M, Dastoorpoor M. Harmful Effects of Alcohol Use in Iran: Acting Now is Crucial. Subst Use Misuse 2019; 54:2064-2065. [PMID: 31179804 DOI: 10.1080/10826084.2019.1625401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Mohammad Ebrahimi Kalan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University , Miami , FL , USA
| | - Mitra Naseh
- School of Social Work, Robert Stempel College of Public Health and Social Work, Florida International University , Miami , FL , USA
| | - Maryam Dastoorpoor
- Social Determinants of Health Research Center, Ahvaz Jundishapur University of Medical Sciences , Ahvaz , Iran.,Department of Epidemiology and Biostatistics, School of Public Health, Ahvaz Jundishapur University of Medical Sciences , Ahvaz , Iran
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25
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Haghdoost A, Ahmadi Gohari M, Mirzazadeh A, Zolala F, Baneshi MR. A review of methods to estimate the visibility factor for bias correction in network scale-up studies. Epidemiol Health 2018; 40:e2018041. [PMID: 30121969 PMCID: PMC6280069 DOI: 10.4178/epih.e2018041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 08/16/2018] [Indexed: 11/09/2022] Open
Abstract
Network scale-up is an indirect size estimation method, in which participants are questioned on sensitive behaviors of their social network members. Therefore, the visibility of the behavior affects the replies and estimates. Many attempts to estimate visibility have been made. The aims of this study were to review the main methods used to address visibility and to provide a summary of reported visibility factors (VFs) across populations. We systematically searched relevant databases and Google. In total, 15 studies and reports that calculated VFs were found. VF calculation studies have been applied in 9 countries, mostly in East Asia and Eastern Europe. The methods applied were expert opinion, comparison of NSU with another method, the game of contacts, social respect, and the coming-out rate. The VF has been calculated for heavy drug users, people who inject drugs (PWID), female sex workers (FSWs) and their clients, male who have sex with male (MSM), alcohol and methamphetamine users, and those who have experienced extra-/pre-marital sex and abortion. The VF varied from 1.4% in Japan to 52.0% in China for MSM; from 34.0% in Ukraine to 111.0% in China for FSWs; and from 12.0% among Iranian students to 57.0% in Ukraine for PWID. Our review revealed that VF estimates were heterogeneous, and were not available for most settings, in particular the Middle East and North Africa region, except Iran. More concrete methodologies to estimate the VF are required.
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Affiliation(s)
- Aliakbar Haghdoost
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Milad Ahmadi Gohari
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Mirzazadeh
- HIV/STI Surveillance Research Center, WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.,Department of Epidemiology and Biostatistics and Institute for Global Health Sciences, University of California, San Francisco, CA, USA
| | - Farzaneh Zolala
- Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Reza Baneshi
- Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Noorbakhsh S, Shams J, Faghihimohamadi M, Zahiroddin H, Hallgren M, Kallmen H. Psychometric properties of the Alcohol Use Disorders Identification Test (AUDIT) and prevalence of alcohol use among Iranian psychiatric outpatients. Subst Abuse Treat Prev Policy 2018; 13:5. [PMID: 29382376 PMCID: PMC5791308 DOI: 10.1186/s13011-018-0141-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 01/12/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Iran is a developing and Islamic country where the consumption of alcoholic beverages is banned. However, psychiatric disorders and alcohol use disorders are often co-occurring. We used the Alcohol Use Disorders Identification Test (AUDIT) to estimate the prevalence of alcohol use and examined the psychometric properties of the test among psychiatric outpatients in Teheran, Iran. METHODS AUDIT was completed by 846 consecutive (sequential) patients. Descriptive statistics, internal consistency (Cronbach alpha), confirmatory and exploratory factor analyses were used to analyze the prevalence of alcohol use, reliability and construct validity. RESULTS 12% of men and 1% of women were hazardous alcohol consumers. Internal reliability of the Iranian version of AUDIT was excellent. Confirmatory factor analyses showed that the construct validity and the fit of previous factor structures (1, 2 and 3 factors) to data were not good and seemingly contradicted results from the explorative principal axis factoring, which showed that a 1-factor solution explained 77% of the co-variances. CONCLUSIONS We could not reproduce the suggested factor structure of AUDIT, probably due to the skewed distribution of alcohol consumption. Only 19% of men and 3% of women scored above 0 on AUDIT. This could be explained by the fact that alcohol is illegal in Iran. In conclusion the AUDIT exhibited good internal reliability when used as a single scale. The prevalence estimates according to AUDIT were somewhat higher among psychiatric patients compared to what was reported by WHO regarding the general population.
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Affiliation(s)
- Simasadat Noorbakhsh
- Behavioral Sciences Research Center of Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Jamal Shams
- Behavioral Sciences Research Center of Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Hanieh Zahiroddin
- Behavioral Sciences Research Center of Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mats Hallgren
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Hakan Kallmen
- Department of Clinical Neuroscience, STAD, Centre for Psychiatry Research, Karolinska Institutet & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
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