Social Determinants of Health

growing numbers of people living to older ages, age-related diseases have become an increasing challenge for societies everywhere. Many age-related diseases however, should rather be considered lifestyle-related diseases since lifestyle plays an important role in the etiology and the treatment of cardiovascular disease, obesity, type 2I diabetes and many forms of cancer. This has led to a large body of literature investigating the possibility to change people’s lifestyle. Interventions with, for example, physiotherapists that engage in daily physical activity with older people have shown substantial benefits, even reversing type 2 diabetes and some characteristics of the ageing process (1,2). Most lifestyle interventions, however, struggle to achieve sustained, long-term behavioural change (3,4). Few individuals can maintain the effort to adopt a new diet or exercise regime themselves, without intensive coaching by professionals. These interventions are therefore expensive and this hinders the widespread and continued delivery to the growing number of older people with unhealthy lifestyle and (risk for) age-related disease. Therefore, it is important to explore novel sustainable and cost-effective methods for lifestyle interventions to combat the burden of agerelated disease in ageing societies. One often overlooked influence on the health behaviour of older people is the effect of the social environment. We believe that peer coaching, in which older people coach each other in achieving lifestyle changes, is such a promising method to deliver health benefits in a sustainable, scalable way. Although there is substantial documentation of the effect of peers on adolescents and children, the influence of peers has been overlooked in older people. In peer coaching, the social environment is applied as a method to deliver an intervention. Peer coaching is a face-to-face intervention in which a group is led by a peer, a non-professional, who shares a common background with the participants. A peer coach uses experiential knowledge to understand the wishes, motivations, possibilities and limitations of the participants. In the secondary prevention of alcohol abuse, peer coaching is already applied very successfully through Alcoholics Anonymous, which delivers health benefits through peer coaching to over two million members spread over 150 countries (5,6). Since increasing physical activity is able to ameliorate so many characteristics of the ageing process, we have studied a proof-of-principle in which peer coaching is applied to establish a sustainable and cost-effective increase in physical activity of a group of older adults in The Netherlands

Background: Occupational stress is a kind of stress that a person undergoes doing certain jobs, and it is caused by the interaction between working conditions and demographic characteristics of the employee. Given the role of the health professionals in preventive care services in our health system, decision was made to determine the occupational stress among the staffs of the health centers in Yazd. Methods: In the present cross-sectional descriptive study, staffs of the health centers in Yazd were studied following census method and making use of standard Occupational Stress Questionnaire of Health and Safety Executive (HSE). A total of 237 questionnaires were collected and the obtained data was analyzed using SPSS software 16 (SPSS Inc., Chicago, IL, USA). Results: The mean score of occupational stress in individuals was calculated as 91.5±13.51. Findings of the study indicated that 54.1% of the participants were very undesirable and undesirable in terms of occupational stress. There was no statistically significant relationship between the occupational stress and age (P=0.7), gender (P=0.24), marital status (P=0.08), and educational level (P=0.19). On the other hand, the rate of occupational stress was significantly associated with work experience (P=0.04). A greater percentage was observed in unfavourable category regarding communication and change sub-scale. Conclusion: According to the results of the current study, it seems that health care workers have a high level of occupational stress. Therefore, the reformation ideas such as stress reduction techniques, supervisor support, staff training on working conditions, and how to manage tasks and participate in decision-making are among the necessities of making an environment enabling so that managers can use the potential capabilities of the staffs in providing services to the community.

Background: Testicular Cancer (TC) is the most common cancer among men between 20 and 40 years old. Treatment for TC is highly effective when detected before the metastatic stage. Although screening of TC through self-examination is recommended, it seems that many men do not do self-examination routinely, so the current study aimed to evaluate the Theory of Planned Behavior (TPB) as a framework for considering Testicular Self-Examination (TSE) intention among a sample of 20- to 34-year-old men.

  Methods: A cross-sectional study was designed and 50 young men were randomly selected. A questionnaire was administered to young men, referring to one of the hospitals in Tehran in 2016. The data were analyzed using SPSS software 16 (SPSS Inc., Chicago, IL, USA), running descriptive tests, chi-square, Pearson correlation, and linear regression analysis.

  Results: Mean (SD) age of participants was 30 (3.77) years old. The majority were married (29), followed by single (19), divorced (2).  The correlation tests showed a statistically significant relationship between self-efficacy with intention (P<0.001, r=0.585) and PBC (P=0.006, r=0.359). In a linear regression analysis, TPB components could predict 36.4% of the variance in TSE intention and self-efficacy was found to be the independent predictor of TSE intention (P<0.001, β=0.55).

  Conclusion: The structures of TPB might be useful for increasing TSE. So, educational interventions based on TPB could be effective for the primary prevention of testicular cancer.

  Background: Divorce is a complex, multidimensional concept and its direct and indirect impacts affects thousands of people in Iran each year. However, the concept of post-divorce adjustment in Iranian women has not been studied in detail. The aim of the present qualitative study was to determine the factors contributing to post-divorce adjustment in divorced women.

  Methods: A qualitative research was carried out using grounded theory approach, followed by three phases of open coding, axial coding, and selective coding. The participants consisted of 21 divorced women who were selected using purposive sampling method. Semi-structured interviews were conducted and then interviews were recorded and transcribed for further analysis.  

  Results: A total of 21 divorced women participated in the current study. The majority of the participants were between 20-30 years old; they were between 17 to 30 years when they married. Also, most of the participants had bachelor’s degree (11) and most of them had a job (16). In the primary data coding, 35 open concepts were extracted. These concepts were then reduced into 32 secondary concepts. At the final stage, 6 main categories contributing to post-divorce adjustment were extracted including: (a) demographics, (b) interpersonal, (c) attitudinal, (d) relational, (e) supportive, and (f) coping strategies.

  Conclusion: The present study emphasizes the value of lived experiences of divorced women. Based on the findings of our study, it is important to develop a solid support network and provide interventions targeting the quality of life in divorced women.

  Background: There are different techniques for anesthesia in Cesarean Section (C/S), which can be affected by different factors including mothers and health care providers' preferences. The objective of the present study was to evaluate social determinants of anesthesia choice for Cesarean Section in mothers attending selected primary health care centers of Tehran.

  Methods: The current descriptive cross-sectional study was conducted in mothers who had a history of C/S and settled in catchment area of selected Primary Health Care centers known as Defined Population (DP). The DP is linked to Social Determinants of Health Research center affiliated to Shahid Beheshti University of Medical Sciences, Tehran.  

  Results: Totally, 1408 mothers participated in the study. The mean±SD age of mothers was 27.6±4.42, more than 50% of the participants had university education, and about 25% of mothers were unemployed. The previous history of C/S was reported by 29.9% of mothers and 91.9% of these mothers had experienced general anesthesia. Anesthesia choice of the study participants was as follows: 562 (39.9%) general anesthesia, 566 (40.2%) local anesthesia, 231 (16.4) had no idea about the anesthesia method, and 46 (3.5%) did not want to have C/S. The most frequent person with whom mothers discussed the method of anesthesia prior to their admission was their gynecologist (44%). The final decisions for choosing anesthesia method were made by the patient in about 40% of the participants.

  Conclusion: Informing mothers appropriately about anesthesia procedure and possible complications of each technique in the prenatal period can help mothers for choosing the best method of anesthesia and may increase mothers' tendency to have local anesthesia.

Background: Adverse birth outcomes are serious health problems that increase morbidity and mortality in neonates. Socioeconomic inequities are linked with Low Birth Weight (LBW) and High Birth Weight (HBW); however, the associations of these factors differ in various groups. The present survey aimed to estimate the prevalence of LBW and HBW and also to determine the associated demographic and socioeconomic factors.
Methods: A population-based, cross-sectional survey was conducted on 6495 children, aged 0-2 years, selected through cluster and multistage sampling methods in 30 cities of Fars province, Iran, from December 2012 to January 2013. Determinants were assessed using a questionnaires including demographic, health parameters, and socioeconomic variables. Also, birth weights were recorded from health report cards. We examined the association between probable factors related to LBW and HBW, and analyzed the data using multinomial regression model.
Results: Among the study population, 636 (9.7%) were LBW and the rate of HBW was estimated to be 152 (2.3%). In multinomial regression, the odds ratio of LBW was significantly higher in girls (OR=1.38, 95%CI=1.17-1.63), and the first (OR=1.7, 95%CI=1.25-2.31) and the second born child (OR=1.4, 95%CI=1.06-2.02); this ratio was lower in families with the father as the head of the family (OR=0.31, 95%CI=0.13-0.68) or mother (OR=0.43, 95%CI=0.11-1.64), and children from low populated families (OR=0.54, 95%CI=0.42-0.68). Moreover, the lower maternal education (OR=2.52, 95%CI=1.36-4.70) was significantly associated with increased HBW; however, girls (OR=0.56, 95%CI=0.39-0.79), low populated families (OR=0.60, 95%CI=0.37-0.96), and fathers as family head (OR=0.19, 95%CI=0.05-0.71) lowered the odds of HBW.
Conclusion: LBW was identified at a relatively high level. The prevention of adverse birth outcomes may be applicable by targeting demographic and social determinants like gender, birth order, family size, mother’s education, and family head as predictors of birth weight in public health interventions.

Background: Alexithymia is a personality construct described as an asymptomatic clinical disability to identify and describe individual feelings. Individuals with alexithymia have difficulties regarding distress tolerance. The present research aimed at studying alexithymia among people with low distress tolerance in comparison to non-clinical sample.

Methods: The study population consisted of all male employees working for General Education Office of Kermanshah Province, Iran. A total of 300 individuals from among these employees were selected based on Morgan table using multistep clustering method. Demographic data questionnaire, Toronto alexithymia scale, and distress tolerance questionnaire were used for data collection.

Results: Mean (SD) score for tolerance, attracting, Assessment and Regulation were 7.3 (2.74), 8.4 (3.20), 16.8 (4.99), and 6.7 (2.63), respectively, in the normal group and 22.54 (6.07), 17 (4.28), 30.67 (6.65), and 30.50 (74.6) in the group with low distress tolerance. independent t-test showed that low distress tolerance group had significantly higher score regarding tolerance, absorption, evaluation, and regulation in comparison with the normal group (P<0.001).

Conclusion: Findings of the present study can help psychologists and counsellors to pay more attention in alexithymia among people with Low Distress Tolerance to help them for better adaptability and confrontation ability against life difficulties such as distress, and ultimately for better health.