Journal of Education and Health Promotion

Abstract BACKGROUND: Chronic liver disease (CLD) is one of the most common chronic diseases in the
world that threatens the health of children due to its many complications such as malnutrition and
problems related to growth and development. Paying attention to nutrition and lifestyle modification
in these children is of special importance. Therefore, the aim of this study was to determine the effect
of nutritional education program on micronutrient intake in children with CLD.
MATERIALS AND METHODS: The present study is a two‑group randomized clinical trial that was
performed by available sampling and referred to Ghaem Children’s Hospital in Mashhad in 2016. In
this study, 77 children with CLD who met the inclusion criteria (45 children in the intervention group and
32 children in the control group) were studied. The intervention included six workshops and training on
proper diet, post‑workshop phone calls, and regular face‑to‑face counseling sessions (first 4 weeks
once a week and second 4 weeks once every 2 weeks) on adherence to the above diet. Patients
in the control group received routine care. The collection tools in the study included demographic
information questionnaires, body composition device, and diet plan form in the form of 24‑h recall
forms. Data analysis was performed using descriptive statistical tests and Mann–Whitney and
Wilcoxon statistical tests using SPSS software version 16.
RESULTS: Based on the results of the study, the mean age of the research units was 7.8 ± 3.6 years.
The mean duration of CLD was 4.6 ± 1.8 years in the intervention group and 5.1 ± 1.9 years in the
control group. The mean crude intake of most minerals after the intervention was significantly higher
than before the intervention, except for the crude intake of retinol, thiamine, riboflavin, folate, Vitamin
C, iodine, and Vitamin B12. Furthermore, in relation to the modified intake of micronutrients, the
mean modified intake of most micronutrients after the intervention showed a significant increase
compared to before, except for retinol, Vitamin D, niacin, B12, and iodine.
CONCLUSION: Considering the effect of providing a nutritional education program to improve
micronutrient intake in children with CLD and emphasizing the importance of adequate micronutrient
intake in improving the health of children, special nutrition programs should be provided to these
children with special attention. In this regard, nurses can play an important role in improving the
quality of nutrition of children by providing nutrition programs with appropriate follow‑up.

Abstract BACKGROUND: A large proportion of noncommunicable diseases (NCDs) can be prevented by
reducing unhealthy nutrition, inadequate physical activity, smoking, and alcohol consumption. The high
burden of NCDs underlines the need for a greater understanding of the causes of these risk factors.
This paper aims to identify factors affecting smoking, alcohol consumption, unhealthy nutrition, and
inadequate physical activity in current and future times.
MATERIALS AND METHODS: A scoping review was conducted in Iran University of Medical
Sciences, Tehran, Iran, in 2020 to identify factors affecting smoking, alcohol consumption, unhealthy
nutrition, and inadequate physical activity. The review was guided by the five‑step Arksey and O’Malley
model. A deductive qualitative content analysis was employed to identify the factors synthesized
through descriptive and narrative synthesis. The search was conducted in English without date
restrictions up to January 2020.
RESULTS: We identified 1437 studies through database search and other sources and finally included
72 studies in the review. The content analysis of the data led to the identification of 27 factors affecting
smoking, alcohol consumption, nutrition, and physical activity. The factors categorized into social,
technological, environmental, economic, political, and values factors.
CONCLUSION: Political and economic factors have a significant effect on all risk factors, and it is
necessary to take comprehensive measures to improve these factors. Technological factors have a
greater impact on healthy nutrition. Physical activity is more affected by environmental factors than
other risk factors. However, smoking and alcohol consumption are more influenced by social factors
and individual attitudes.

Abstract BACKGROUND: Chronic liver disease is associated with decreased quality of life. The quality of life
of children with chronic liver disease is related to their quality of life. Malnutrition is associated with
death from cirrhosis, development of complications, and health‑related quality of life in people with
liver disease. Therefore, this study was conducted to determine the effect of nutritional adjustment
program on quality of life in children with chronic liver disease.
MATERIALS AND METHODS: This clinical trial study was performed on children with chronic liver
disease referred to the nutrition clinic of Ghaem Educational‑Research Center in Mashhad in 2015.
In this study, 77 children with chronic liver disease were randomly divided into two groups. Before
and after the intervention, patients’ quality of life was assessed with the PedsQL™ 4.0 generic core
scale questionnaire. Data analysis was performed using SPSS16 software.
RESULTS: In the postintervention stage, the mean total score of quality of life in the experimental
group was 1965.0 ± 270.9 and in the control group was 1522.5 ± 321.3 (P < 0.001). The difference
in quality of life score of physical, social, and school performance in the two groups was significant.
CONCLUSION: According to the results of this study, it seems that interventions that can improve
the quality of life of children with chronic liver disease can be an important step in advancing these
people toward a healthy and quality life. As a result, it is possible to take steps to improve the quality
of life of patients by encouraging children with liver disease and providing information about diet.

Abstract BACKGROUND: Osteoporosis is one of the major problems associated with aging and is more
common among women than men. This study was designed to modify osteoporosis‑related behaviors
in female students based on the transtheoretical model (TTM).
MATERIALS AND METHODS: This quasi‑experimental study was conducted on female
secondary school students. The sample size was determined 100 by using Altman’s nomogram,
including 50 cases and 50 controls. Participants were completed the Demographic Information and
Osteoporosis‑Related Behavior Questionnaire based on TTM. Evaluation of the data showed that
each participant was at what stage of change in physical activity and preventive dietary behavior
of osteoporosis. The content of the training package was designed, and for the intervention group,
2‑h training sessions were held weekly by the instructor in accordance with the stage of change
for 2 months, and the booklet was provided with the appropriate contents of the stage of change.
Three months after the completion of training, the questionnaires were completed by intervention
and control groups. Statistical analysis was performed using SPSS 23 software.
RESULTS: Concerning the stages of change in physical activity and nutrition, a significant difference
was before and after the intervention in the intervention group (P < 0.001), while no significant
difference was observed in the control group. After the intervention, there was a significant difference
in the self‑efficacy and some subconstruct of processes of change, but there wasnot a significant
difference in the decisional balance.
CONCLUSION: Educational intervention based on TTM has been successful in achieving the goal of
modifying osteoporosis‑related behaviors in female students. The results of this study can be used
by health planners to plan and implement health promotion interventions that will undoubtedly help
reduce the burden of disease.

Abstract INTRODUCTION: Adolescence is characterized by a rapid phase of growth and development
during which the requirement of nutrition and micronutrients is relatively high. Although there is a
decreasing trend in the prevalence of undernutrition among adolescents, the current prevalence
of undernutrition is still very high (41.9%). Adolescents with good nutrition knowledge are more
likely to follow healthy eating habits. In the light of this, the current study was planned to assess the
baseline nutrition‑related knowledge of adolescent girls and the effectiveness of nutrition education
material (flipchart) in increasing their nutrition‑related knowledge.
MATERIALS AND METHODS: A school‑based interventional study was conducted among adolescent
girls of class 9th of a school in an urban slum of Delhi. A structured pretested Knowledge Assessment
Questionnaire consisting of 10 multiple‑choice questions in Hindi with a maximum score of 10 was
used. The intervention was a nutrition education session conducted by doctors of Community Health
department using specially designed flipcharts covering important aspects of nutrition relevant for
adolescent girls. A demonstration of food items and charts and flex material was also given. The
total sample size was 265 adolescent girls.
RESULTS: Baseline knowledge as assessed by mean pretest score was poor (3.698 ± 1.81).
The students’ baseline knowledge was significantly associated with mother’s educational
status (P = 0.024). There was a significant increase (mean difference was 1.7890 ± 0.1434) in the
nutrition‑related knowledge of the participants after the intervention (P < 0.001). The proportion of
students who improved, i.e., 147 (55.47%) was more than proportion who deteriorated (25 [9.43%])
after the educational session. This difference was found to be statistically significant (P ≤ 0.001).
CONCLUSION: Nutrition knowledge was found poor among school‑going adolescent girls, which
significantly improved after the nutrition education session.

Abstract BACKGROUND: Premenstrual syndrome (PMS) is the emergence of periodic one or more
symptoms of symptoms before menstruation and in the first few days of menstruation. Lifestyle is
one of the series of factors that affect the health of people. Activity, smoking, and food intake are
factors associated with lifestyle, and evidence suggests that women and girls with PMS do not have
an adequate life span. The aim of this study was to determine the factors associated with PMS in
female high school students.
METHODS: This cross‑sectional correlation study was conducted in 200 female high school students
in Sabzevar city using multistage random sampling in the academic year of 2016–2017. Data
gathering tools include the temporary diagnostic questionnaire of the PMS, and Beck Depression
questionnaire; the nonresonant tape was accurate to 0.1 cm and the digital scale was accurate to
0.1 kg. We analyzed the data using SPSS software and Mann–Whitney U‑test.
RESULTS: The results of this study showed that there is a significant relationship between PMS and
fried foods (P = 0.017), sweet drink (P = 0.018), fast food (P = 0.048), fruit (P = 0.012), no habitual
exercise (P = 0.006), family history of PMS (P = 0.002), hip circumference (P = 0.04), and body
mass index (P = 0.04).
CONCLUSION: There is a relationship between PMS and some anthropometric indices and nutritional/
metabolic factors. Therefore, having a proper lifestyle is effective in reducing PMS.

Abstract BACKGROUND: The content of the mass media is a suitable tool for making changes to the society.
One of the most read news in the mass media is nutritional information. The goal of this study is to
assess the scientific authenticity of such information published in Iranian popular magazines.
MATERIALS AND METHODS: This study is a qualitative study (content analysis) and uses
bibliographic approach. A researcher‑designed checklist is used as data gathering tool, and the
statistical population included the messages obtained from the printed material in 173 volumes
of 8 Iranian popular magazines. 10 most frequent messages were identified, and their scientific
authenticity was investigated using Pubmed and IranMedex databases. The SPSS Software
version 24 (IBM Corporation, Armonk, New York, USA) was applied in the analysis of this work.
RESULTS: The findings indicated that preventive trends had the highest (86.8%) and the treatments
had the lowest (4.2%) frequency. Concerning the type of cancer, more than half (51.2%) of the
conclusions were about cancer. Regarding authorship, 68% of articles were author signed, but the
profession of 66.4% of the authors was not clear. Regarding references, only 25.4% of the articles
had validated references.
CONCLUSION: It is revealed that 70% of the “nutrition information” related to cancer which was
published in the popular magazines during 2012, considered to be acceptable according to scientific
medical information sources. Although in some cases, the amount of evidence is not sufficient.
Finally, it could be deduced that the nutrition information published in the Iranian popular magazines
are still credible.

Abstract INTRODUCTION: Nowadays websites are among the most important information sources used by
most people. With the spread of websites, especially those related to health issues, the number of
their visitors also increases, more than half of which are about nutritional information. Therefore,
quality analysis of nutrition and diet therapy websites is of outmost importance. This study aims to
evaluate the quality of Persian nutrition and diet therapy websites.
METHODS: The current work is a survey study and uses an applied study method. The statistical
population consists of 51 Persian websites about nutrition and diet therapy and census method was
used in order to study them. Data gathering was done using a checklist and with direct visit to each
website. Descriptive and analytical statistics were used to analyse the gathered data with the help
of SPSS 21 software.
RESULTS: Findings showed that content (66.7%), organization (82.4%), user friendly
interfaces (52.9%) and total quality (70.6%) of most websites had a mediocre score while the design
score for most of the websites (70.6%) was acceptable also organizational websites had better design,
organization and quality compared to private websites. The three websites with the highest general
quality score were the websites of “Novel Diet Therapy,” “Behsite” and “Dr. BehdadiPour” (jointly)
and “Dr. Kermani” respectively. Also in the dimension of content the factors of goal, relevance and
credibility, in the dimension of design the factors of color, text and sound, pictures and videos, in the
dimension of organization the factors of stability and indexing and in the dimension of user friendliness
the factors of confidentiality, credibility and personalization had the highest scores.
CONCLUSION: The results showed that the design score was higher than other scores. Also the
general quality score of the websites was mediocre and was not desirable. Also websites didn’t have
suitable scores in every factor. Since most people search the internet for nutritional and diet therapy
information, the creators of these websites should endeavor to fix the shortcomings of their websites
and increase the quality of their websites in several different areas.

Abstract Background: Due to the wide influence of public media, they become important communication
channels for changing health beliefs and behaviors. One of the areas that have gained increased
attention in public media is nutritional information. Cancer is one among the diseases related
to nutrition. The goal of this study is to do a content analysis of the popular magazines in Iran
for nutritional information related to cancer in year 2012–2013. Materials and Methods: This
is an applied survey performed using content analysis method. The data gathering tool is a
checklist designed by the researcher. The statistical population consisted of all of the messages
printed in 173 volumes of eight most popular magazines which were selected based on their
characteristics by searching the Iranian publication database using certain inclusion and
exclusion criteria. The sample size calculated using non‑probability – purposive sampling was
295 messages from 96 magazine volumes. Results: Findings showed that prevention trends
had the highest (86.8%) and treatment had the lowest (4.7%) frequency in the messages.
Pomegranate was the most commonly mentioned preventive food, while mayonnaises were
the most commonly mentioned carcinogen and tangerine was the most commonly mentioned
food used for cancer treatment. Among the different types of cancer, more than half of the
messages (51.2%) mentioned “cancer” as a general term. After that, breast cancer (13.2%)
and prostate cancer (10.51%) were the most commonly motioned cancers and messages
regarding pancreatic cancer and hormone‑related cancers were the least frequent (0.3%).
Conclusions: The findings of this study show that the main goal of these messages was to
increase the information provided to the readers, although some doubts regarding the scientific
credibility of the claims made in these messages still remain.

Abstract Background: Lifestyle affects people’s health and life length, however, no sufficient studies
have been done on the effect of lifestyle on middle‑ageing, as the transitional period from
adulthood to old‑ageing, this study has been conducted to study the effect of educational
intervention on health promoting lifestyle of middle‑aged women in Lenjan city of Isfahan
Province, Iran. Methods: This quasi‑experimental study was conducted on 88 middle‑aged
women were selected through randomized sampling from two health centers in Lenjan, and
then were categorized into experimental and control groups. To collect data, a researcher‑made
demographic and life style questionnaire was used. The educational intervention was performed
in five sessions. Data were collected from both groups in two stages: Before the intervention
and 3 months after the education. Data were analyzed with using SPSS‑20 and P < 0.05 were
considered statistically significant. Results: The results showed that educational program had a
positive significant effect on increasing the mean scores in the intervention group, considering
the physical activity, mental health, and interpersonal relationship, P < 0.001. However, regarding
the nutrition, the mean increase was not significant (P = 0.113). Conclusion: According to the
findings, it is evident that educational intervention is beneficial for various aspects of middle‑aged
women’s lifestyle. Therefore, applying a healthy lifestyle seems essential for having a healthy
aging period, and educational intervention can be effective.

Abstract Introduction: Osteoporosis is a multifactorial disease and one of the most important modifiable
factors in the development and maintenance of bone mass are nutrition nutritional status and its
relationship with Bone Mass Density (BMD) in postmenopausal women admitted in osteodensitometry
Center, Isfahan, Iran. Materials and Methods: Seventy‑two postmenopausal osteoporotic women
were studied. BMD of the lumbar spine and total hip were measured using dual‑energy X‑ray
absorptiometry. Demographic and dietary intakes were collected by interview and using a validated
food frequency questionnaires. T‑scores, Pearson correlation and one way analysis of variance
tests were conducted to analyze the data. Results: Mean of age and duration of menopause was
nearly 57.5 ± 7.2 and 10.6 ± 7.1 years, respectively. The mean t‑scores for BMD of spine and hip
were 0.877 ± 0.179 and 0.997 ± 0.21, respectively. The mean of calcium (Ca), phosphorous (P),
fluoride (F), Vitamin D, K and Zn were less than DRI and Na more than it (all P value less than
0.0001). BMD of hip was significantly correlated with dietary Ca, animal protein, Zn (P < 0.05), but
BMD of spine did not show any significant correlation with nutrients (P > 0.05). Conclusion: Most
of the postmenopausal osteoporotic women in this study had a considerable deficiency in terms of
micronutrients such as Ca, vitamin D and P, which can be deleterious for bone health.

Abstract Background: Achieving a balanced and proper nutrition is one of the most important health
objectives in the early years of the child’s life. The aim of this study is to determine the level of
knowledge and attitude of the mothers covered by the urban health centers of Birjand about
nutritional behaviors. Materials and Methods: This descriptive‑analytical study was conducted
on the mothers with children less than five years referring the health centers of Birjand, in 1387.
A questionnaire was prepared for data collection. Data were analyzed using SPSS software,
Chi square, ANOVA, Tukey’s post hoc and Pearson correlation coefficient statistical tests with a
accuracy level of P < 0.05. Results: Two hundred ninety four patients were studied. A meaningful
difference was observed between the knowledge and attitude scores in terms of the mothers’
education stand (P = 0.002). Eighty three point seven percent, 65.6%, 82.7% and 64.6% of
mothers were aware about the importance of iron absorption, the onset of iron supplement drop,
the minerals and vitamins in the body, and the effects of vitamin A deficiency, respectively. The
mothers’ knowledge and attitude about the nutritional behavior was evaluated at the average and
good level, respectively. Conclusions: Considering the average level of the mothers’ knowledge
and attitude about children’s nutritional behaviors, the retraining of family physicians and health
centers staff about the importance of nutritional behaviors is recommended.

Abstract Background and Aim: Adolescents’ overweight problems have been paid much attention due
to their significant increase in recent decades in developed countries. Poor eating patterns
subsequently affect their self‑efficacy and self‑concept. Therefore, paying attention to the
nutritional knowledge of overweight students in this period is essential. This study examines the
relationship between self‑efficacy, self‑concept, and nutritional knowledge of overweight students
in the city of Isfahan. Materials and Methods: The 140 overweight students who participated in
this descriptive, analytical study with were randomly selected from one of five areas of Isfahan
city in the year 2011‑2012. Questionnaires for data collection in this study included demographic
form, nutrition knowledge, Cooper Smith self‑esteem, and general self‑efficacy questionnaire.
Data were analyzed by ANOVA, regression, and Pearson’s correlation coefficient with statistical
package in social sciences version 18. Results: There was a significant correlation between
whole nutritional knowledge and self‑efficacy (r = 0.29, P > 0.001) and self‑concept (r = 0.26,
P = 0.002). There was a significant correlation between self‑efficacy and self‑concept (r = 0.3,
P = 0.001). Furthermore, in the selection of food section there was no significant correlation with the
self‑concept (r = 0.147, P = 0.083). Regression analysis between self‑concept, self‑efficacy, family
dimension, father’s education, mother’s education, father’s occupation, mother’s occupationa
and income with nutrition knowledge showed that these eight variables explain 17.7% of the
variance in health behaviors totally. Conclusion: By conducting this study, and revealing the direct
relationship between nutritional knowledge, self‑concept, and self‑efficacy, we could conclude
that if nutritional knowledge of overweight students is promoted, this factor would lead to an
increase their self‑concept and self‑efficacy in order to adopt healthy behaviors and have the
expected healthy eating and healthy life‑style.

Abstract Introduction: This study estimated the nutritional as well as the severe thinness status (according
to the World Health Organization [WHO]) of a low-income family’s adolescent girl and also
their early age of life in both urban and rural adolescent girls in Bangladesh. Materials and
Methods: This cross-sectional study measured the height, weight and muac by standard
procedure for calculating the body mass index according to the WHO reference. A 2-days,
24-h food recall and food frequency questionnaire was used to estimate the food frequency,
energy intake, protein and carbohydrate. A multistage, multiphase stratified cluster sampling
was used to select the study population from two locations in Bangladesh: Dhaka city and the
east region of Trishal (district of Mymensingh). The study subjects were low-income families’
adolescent girls (n = 214) aged 14–17 years. The two groups contained an equal number of
respondents (n=107/group). Results: Results revealed that economic status had a significant
effect on nutritional status. Nutritional status of low-income families’ adolescent were low
both in urban and rural adolescents, but severe thinness rate according to the WHO of urban
(22.4%) adolescents was much higher than rural (10.3%) adolescents (chi-square = 4.9 and
P-value = 0.01), and was also higher at an earlier age of their life. In food intake distribution and
food consumption status, the same results were seen. The percentage of never eat meat and fish
of low-income families adolescent girls were (29.7%, 11.4%) in urban group and (24.4%, 6.8%)
in rural group. The main food rice consumption of urban adolescents was also about half that
of rural adolescents per day. The study also shows that intake of energy, protein, carbohydrate
and fat were significantly different between urban and rural girls. Only 53% energy was covered
of the recommended daily energy intake in urban adolescents. Conclusion: Based on the food
recall and anthropometric results, we conclude that malnutrition is common in low-income family’s
adolescents, and the severe thinness rate is much higher in urban than in rural adolescents, as
also their early age of life in both low-income family’s adolescents girls in Bangladesh.

Abstract Introduction: Teachers are one of the most influential groups in elevating social health, and their
teaching nutritional points to the students can both affect students’ awareness and the transferring
of such nutritional education to the families. This study was undertaken tosurvey the influence of
nutrition and nutritional health education on the awareness of female elementary school teachers.
Materials and Methods: Fifty‑seven female elementary school teachers were chosen from the
Ferdows City for this quasi‑experimental study. Prior to the outset of the educational workshop,
they were asked to fill out a questionnaire about nutrition and nutritional health, which was followed
by the two‑day workshop. After two months, they were given a second questionnaire. The results
were analyzed by paired t‑test, ANOVA, and McNemar. In all the tests, a significance level a = 0.05
was considered. Results: Findings of the study showed that the mean score of awareness before
interference was 10.98%, which reached up to 18.2% after the interference (P< 0.001). With regard
to theimportance of breakfast intake, the teachers’ awareness increased from 57.9 to 98.2% from
before to after intervention, respectively. Conclusion: Applying interventional methods of education
in teacher training centers in conjunction with medical and educational centers, with regard to
nutrition and nutritional health, can elevate the health of students.