Siamak Alikhani

Publications of Siamak Alikhani

• Effectiveness of diabetes and hypertension management by rural primary health-care workers (Behvarz workers) in Iran: a nationally representative observational study.

  Authors: Farshad Farzadfar, Christopher J L Murray, Emmanuela Gakidou, Thomas Bossert, Hengameh Namdaritabar, Siamak Alikhani, Ghobad Moradi, Alireza Delavari, Hamidreza Jamshidi, Majid Ezzati

  Lancet. 12/2011; 379(9810):47-54.

  Non-communicable diseases and their risk factors are leading causes of disease burden in Iran and other middle-income countries. Little evidence exists for whether the primary health-care system canNon-communicable diseases and their risk factors are leading causes of disease burden in Iran and other middle-income countries. Little evidence exists for whether the primary health-care system can effectively manage non-communicable diseases and risk factors at the population level. Our aim was to examine the effectiveness of the Iranian rural primary health-care system (the Behvarz system) in the management of diabetes and hypertension, and to assess whether the effects depend on the number of health-care workers in the community. We used individual-level data from the 2005 Non-Communicable Disease Surveillance Survey (NCDSS) for fasting plasma glucose (FPG) and systolic blood pressure (SBP), body-mass index, medication use, and sociodemographic variables. Data for Behvarz-worker and physician densities were from the 2006 Population and Housing Census and the 2005 Outpatient Care Centre Mapping Survey. We assessed the effectiveness of treatment on FPG and SBP, and associations between FPG or SBP and Behvarz-worker density with two statistical approaches: a mixed-effects regression analysis of the full NCDSS sample adjusting for individual-level and community-level covariates and an analysis that estimated average treatment effect on data balanced with propensity score matching. NCDSS had data for 65,619 individuals aged 25 years or older (11,686 of whom in rural areas); of these, 64,694 (11,521 in rural areas) had data for SBP and 50,202 (9337 in rural areas) had data for FPG. Nationally, 39·2% (95% CI 37·7 to 40·7) of individuals with diabetes and 35·7% (34·9 to 36·5) of those with hypertension received treatment, with higher treatment coverage in women than in men and in urban areas than in rural areas. Treatment lowered mean FPG by an estimated 1·34 mmol/L (0·58 to 2·10) in rural areas and 0·21 mmol/L (-0·15 to 0·56) in urban areas. Individuals in urban areas with hypertension who received treatment had 3·8 mm Hg (3·1 to 4·5) lower SBP than they would have had if they had not received treatment; the treatment effect was 2·5 mm Hg (1·1 to 3·9) lower FPG in rural areas. Each additional Behvarz worker per 1000 adults was associated with a 0·09 mmol/L (0·01 to 0·18) lower district-level average FPG (p=0·02); for SBP this effect was 0·53 mm Hg (-0·44 to 1·50; p=0·28). Our findings were not sensitive to the choice of statistical method. Primary care systems with trained community health-care workers and well established guidelines can be effective in non-communicable disease prevention and management. Iran's primary care system should expand the number and scope of its primary health-care worker programmes to also address blood pressure and to improve performance in areas with few primary care personnel. None.

• Reduction of secondhand smoke exposure among healthy infants in Iran: randomized controlled trial.

  Authors: Azam Baheiraei, Roghieh Kharaghani, Afshin Mohsenifar, Anoshirvan Kazemnejad, Siamak Alikhani, Hooman Sharifi Milani, Ali Mota, Melbourne F Hovell

  Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco. 04/2011; 13(9):840-7.

  The objective of this study was to assess whether counseling both mothers and fathers reduces their infants' exposure to secondhand smoke (SHS). Participants were 130 nonsmoking children aged lessThe objective of this study was to assess whether counseling both mothers and fathers reduces their infants' exposure to secondhand smoke (SHS). Participants were 130 nonsmoking children aged less than 1 year, exposed to their fathers' or mothers' smoking, and recruited from a health center in southern Tehran. Eligible families were randomly assigned to intervention or control group. Infant urine samples were collected, and parents were interviewed at baseline and at a 3-month follow-up in each of the 2 groups. Mothers of the intervention group were provided 3 counseling sessions, one of which was face to face and 2 of which were by telephone. Fathers were provided 3 counseling sessions by telephone. Parents were also given an educational pamphlet and a sticker depicting a smoke-free home. The control group received usual care. Changes in infant urinary cotinine levels, parental cigarette consumption in the presence of the child, and home- and car-smoking bans were assessed. The intervention was effective in reducing infant urinary cotinine levels (1-tailed p = .029). There was a greater decrease in the total daily cigarette consumption in the presence of the child in the intervention group compared with the control group, and the differences between the 2 groups were statistically significant (1-tailed p = .03). While the differences between home-smoking bans in the 2 groups were statistically significant (1-tailed p = .049), the differences between car-smoking bans did not reach significance. Conclusion: Counseling similar to that employed in other countries can reduce infant exposure to SHS, suggesting generalizability.

• National and subnational mortality effects of metabolic risk factors and smoking in Iran: a comparative risk assessment.

  Authors: Farshad Farzadfar, Goodarz Danaei, Hengameh Namdaritabar, Julie Knoll Rajaratnam, Jacob R Marcus, Ardeshir Khosravi, Siamak Alikhani, Christopher Jl Murray, Majid Ezzati

  Population health metrics. 01/2011; 9(1):55.

  ABSTRACT: Mortality from cardiovascular and other chronic diseases has increased in Iran. Our aim was to estimate the effects of smoking and high systolic blood pressure (SBP), fasting plasma glucoseABSTRACT: Mortality from cardiovascular and other chronic diseases has increased in Iran. Our aim was to estimate the effects of smoking and high systolic blood pressure (SBP), fasting plasma glucose (FPG), total cholesterol (TC), and high body mass index (BMI) on mortality and life expectancy, nationally and subnationally, using representative data and comparable methods. We used data from the Non-Communicable Disease Surveillance Survey to estimate means and standard deviations for the metabolic risk factors, nationally and by region. Lung cancer mortality was used to measure cumulative exposure to smoking. We used data from the death registration system to estimate age-, sex-, and disease-specific numbers of deaths in 2005, adjusted for incompleteness using demographic methods. We used systematic reviews and meta-analyses of epidemiologic studies to obtain the effect of risk factors on disease-specific mortality. We estimated deaths and life expectancy loss attributable to risk factors using the comparative risk assessment framework. In 2005, high SBP was responsible for 41,000 (95% uncertainty interval: 38,000, 44,000) deaths in men and 39,000 (36,000, 42,000) deaths in women in Iran. High FPG, BMI, and TC were responsible for about one-third to one-half of deaths attributable to SBP in men and/or women. Smoking was responsible for 9,000 deaths among men and 2,000 among women. If SBP were reduced to optimal levels, life expectancy at birth would increase by 3.2 years (2.6, 3.9) and 4.1 years (3.2, 4.9) in men and women, respectively; the life expectancy gains ranged from 1.1 to 1.8 years for TC, BMI, and FPG. SBP was also responsible for the largest number of deaths in every region, with age-standardized attributable mortality ranging from 257 to 333 deaths per 100,000 adults in different regions. Management of blood pressure through diet, lifestyle, and pharmacological interventions should be a priority in Iran. Interventions for other metabolic risk factors and smoking can also improve population health.

• Quality of care of diabetes mellitus type II patients in Iran.

  Authors: Alireza Delavari, Siamak Alikhani, Siran Nili, Rosa H Birjandi, Fariba Birjandi

  Archives of Iranian medicine. 10/2009; 12(5):492-5.

  Diabetes is a relatively common ill-health condition in Iran with a prevalence of 7.7% in the age range of 25 - 64 years and with a rather high burden. It is not only a chronic devastating diseaseDiabetes is a relatively common ill-health condition in Iran with a prevalence of 7.7% in the age range of 25 - 64 years and with a rather high burden. It is not only a chronic devastating disease which causes high rates of death directly, but also a strong risk factor for some other common chronic conditions, e.g., cardiovascular diseases. The worst complications of diabetes develop when quality healthcare services are not provided to patients or are not used by them. This study was conducted to depict the first national picture of quality of care provided for known diabetic patients in Iran. The study was conducted alongside the "Iran's National Noncommunicable Diseases Risk Factor Surveillance survey" of 2005; a cross-sectional study with a multistage cluster sampling approach which targeted Iranians older than 15 years of age. Only 6.4% of the respondents had a HbA1c test during the year before questioning and 25.7% reported to have undertaken a lipid profile examination in the same period of time. Positive responses for eye and foot examinations in the year leading to survey were 39.8% and 20.5%, respectively. About 97.4% of the patients had poor control according to their most recent HbA1c levels. About 25% needed an improvement in diabetes control according to their blood levels of low-density lipoproteins, and 45% of them were hypertensive. All measures of quality of care of diabetes type II were poor in Iranian diabetic patients except for eye examination. Healthcare system of the country needs to focus on patients' easier and better access to laboratory facilities together with a strong training program for care providers and patients to help with better implementation of clinical guidelines and standards of care. A follow-up mechanism is needed to check the trend of quality of care of diabetes in Iran.

• The First Nationwide Study of the Prevalence of the Metabolic Syndrome and Optimal Cut-off Points of Waist Circumference in the Middle East: The National Survey of Risk Factors for Non-Communicable Diseases of Iran.

  Authors: Alireza Delavari, Mohammad Hossein Forouzanfar, Siamak Alikhani, Afsaneh Sharifian, Roya Kelishadi

  Diabetes care. 04/2009;

  Objective: To provide the first national estimate on the prevalence of the metabolic syndrome (MetS) and its components, as well as the first ethnic-specific cut-off point for waist circumferenceObjective: To provide the first national estimate on the prevalence of the metabolic syndrome (MetS) and its components, as well as the first ethnic-specific cut-off point for waist circumference (WC) in the Eastern Mediterranean Region. Research Design and Methods: This national survey was conducted in 2007 on 3024 Iranians aged 25-64 years living in urban and rural areas of all 30 provinces in Iran. The MetS was defined by different criteria, namely the definition of the National Cholesterol Education Program-Adult Treatment Panel III (ATP III), the International Diabetes Federation (IDF) criteria, and the modified definition of the NCEP/ATP III (ATPIII/AHA/NHLBI). Results: The age-standardised prevalence of the MetS was about 34.7% (95% CI 33.1, 36.2) based on the ATP III criteria, 37.4% (35.9-39.0%) based on the IDF definition, and 41.6% (40.1-43.2%) based on the ATPIII//AHA/NHLBI criteria. By all definitions, the prevalence of the MetS was higher in women, in urban areas, and in the 55-64-year age group compared to men, rural areas and other age groups, respectively. The burden of the MetS was estimated to affect more than 11 million Iranians. The optimal cut-off point of WC for predicting at least two other components of the MetS as defined by IDF was 89 cm for men and 91 cm for women. Conclusions: The high prevalence of the MetS with considerable burden on the middle-aged population mandates the implementation of national policies for its prevention, notably by tackling obesity. The obtained WC cut-off points can be used in the region.

• Prevalence, awareness, treatment, and risk factors associated with hypertension in the Iranian population: the national survey of risk factors for noncommunicable diseases of Iran.

  Authors: Alireza Esteghamati, Mehrshad Abbasi, Siamak Alikhani, Mohamad M Gouya, Alireza Delavari, Mehdi H Shishehbor, Mehrdad Forouzanfar, Alieh Hodjatzadeh, Rashid D Ramezani

  American journal of hypertension : journal of the American Society of Hypertension. 06/2008; 21(6):620-6.

  BACKGROUND: The prevalence of hypertension in the Middle East is not well defined. We examined the prevalence, awareness, treatment, and control of hypertension in Iran. METHODS: The Survey of RiskBACKGROUND: The prevalence of hypertension in the Middle East is not well defined. We examined the prevalence, awareness, treatment, and control of hypertension in Iran. METHODS: The Survey of Risk Factors of Noncommunicable Diseases was conducted in 2005 and contains a representative sample of the Iranian adult population. Of 70,981 participants, the data of 68,250 adults aged 25-64 years who had two valid blood pressure (BP) readings were analyzed to estimate the total prevalence of hypertension (systolic BP >or= 140 mm Hg, diastolic BP >or= 90 mm Hg, or the concurrent use of antihypertensive agents) in the Iranian adult population. RESULTS: Approximately 25% or 6.6 million Iranians aged 25-64 years had hypertension; additionally 46% or 12 million Iranians aged 25-64 years had prehypertension. Among hypertensive patients, 34% were aware of their elevated BP; 25% were taking antihypertensive medications; and of these treated subjects, only 24% had BP values <140/90 mm Hg. Hypertension and prehypertension were associated with age, male gender, obesity, central obesity, hypercholesterolemia, and diabetes. CONCLUSIONS: The prevalence of hypertension and prehypertension is high, and the rates of awareness, treatment, and control are unacceptably low. These results underscore the urgent need to develop national strategies to improve prevention, detection, and treatment of hypertension in Iran.

• Association of body mass index and abdominal obesitywith marital status in adults.

  Authors: Mohsen Janghorbani, Masoud Amini, Hasan Rezvanian, Mohammad Mehdi Gouya, Alireza Delavari, Siamak Alikhani, Alireza Mahdavi

  Archives of Iranian medicine. 05/2008; 11(3):274-81.

  BACKGROUND: Obesity continues to be an important public health problem worldwide. The objective of this study was to determine the association of body mass index and abdominal obesity with currentBACKGROUND: Obesity continues to be an important public health problem worldwide. The objective of this study was to determine the association of body mass index and abdominal obesity with current marital status among the adult population of Iran. METHODS: A nation-wide cross-sectional survey was conducted from December 2004 through February 2005.The subjects were selected by stratified probability cluster sampling through household family members in Iran. Weight, height, waist circumference, and marital status of 89,404 men and women aged 15 - 65 (mean: 39.2) years were recorded. Four classes of body mass index, i.e., <18.5, 18.5 - 24.9, 25 - 29.9, and >/=30 kg/cm2, and three marital status, i.e., currently-, formerly-, and never-married were used. Abdominal obesity was defined as waist circumference >/=102 cm in men and >/=88 cm in women. RESULTS: The prevalence of overweight was twofold higher in married men (OR: 2.24; 95% CI: 2.08 - 2.41) and women (OR: 2.36; 95% CI: 2.20 - 2.53) than never-married men and women, even when age, educational level, leisure time physical activity, smoking habits, and place of residence were controlled. The multivariate OR of obesity was increased about threefold in married men (2.82; 95% CI: 2.51 - 3.18) and women (3.64; 95% CI: 3.31 - 3.99). The prevalence of abdominal obesity was twofold higher among married men (2.02; 95% CI: 1.79 - 2.29) and about threefold higher among married women (2.87; 95% CI: 2.69 - 3.06). CONCLUSION: The marital status appears to influence the likelihood of developing overweight, obesity, and abdominal obesity in both men and women in Iran.

• Nationwide survey of prevalence and risk factors of prehypertension and hypertension in Iranian adults.

  Authors: Mohsen Janghorbani, Masoud Amini, Mohammad Mehdi Gouya, Alireza Delavari, Siamak Alikhani, Alireza Mahdavi

  Journal of hypertension. 04/2008; 26(3):419-26.

  OBJECTIVE: The aim of this study was to estimate the prevalence and risk factors of prehypertension (Pre-HTN) and hypertension (HTN) among the adult population of Iran. METHODS: A nationwideOBJECTIVE: The aim of this study was to estimate the prevalence and risk factors of prehypertension (Pre-HTN) and hypertension (HTN) among the adult population of Iran. METHODS: A nationwide cross-sectional survey was conducted from December 2004 to February 2005. The selection was conducted by stratified probability cluster sampling through household family members in Iran. Blood pressure (BP) and associated risk factors of 35 048 men and 34 674 women aged 25-65 years (mean 44.1 years) were measured. RESULTS: The prevalence of Pre-HTN was 59.6% in men and 44.5% in women; and 19.8% of men and 26.9% of women were hypertensive, according to Joint National Committee 7 criteria. Pre-HTN was more common among men whereas HTN was more common among women. Multivariate analysis revealed that age, overweight, obesity, abdominal obesity and high cholesterol were strongly associated with Pre-HTN in both genders. In women, low educational attainment, residence in an urban area and high blood glucose were also associated with Pre-HTN. Age, low educational attainment, overweight, obesity, abdominal obesity and high cholesterol and blood glucose were strongly associated with HTN in both genders. CONCLUSION: Pre-HTN and HTN appear to be quiet common in Iran and were associated with obesity. More men than women present with Pre-HTN, whereas more women than men present with HTN. Prevention and treatment strategies are urgently needed to address the health burden of Pre-HTN and HTN and to prevent prehypertensive people from developing HTN and cardiovascular disease.

• Obesity and associated lifestyle behaviours in Iran: findings from the First National Non-communicable Disease Risk Factor Surveillance Survey.

  Authors: Roya Kelishadi, Siamak Alikhani, Alireza Delavari, Farshid Alaedini, Afshin Safaie, Eliyeh Hojatzadeh

  Public health nutrition. 04/2008; 11(3):246-51.

  OBJECTIVE: To assess the national prevalence of overweight and obesity, as well as some associated lifestyle behaviours, for the first time in Iran. DESIGN AND SETTINGS: This population-based studyOBJECTIVE: To assess the national prevalence of overweight and obesity, as well as some associated lifestyle behaviours, for the first time in Iran. DESIGN AND SETTINGS: This population-based study was performed in early 2005 as part of the World Health Organization (WHO) STEPwise approach to non-communicable diseases' risk factor surveillance. Dietary and physical activity habits were assessed by WHO questionnaires. SUBJECTS: The study population comprised 89,532 subjects aged over 15 years living in the 28 provinces of Iran. RESULTS: Overall, 50.4% (n = 45,113) of the participants were male and 64.6% (n = 57 866) were from the urban areas. The national estimates of overweight, obesity and morbid obesity were 28.6%, 10.8% and 3.4%, respectively. Body mass index (BMI) > or = 25 kg m-2 in men, women, urban residents and rural residents were found in 37%, 48%, 46.7% and 35.5%, respectively. Abdominal obesity was present in 43.4% of women, 9.7% of men, 28.5% of the urban residents and 23% of the rural residents. Overweight as well as generalised and abdominal obesity were more prevalent in the 45-64-year age group. Although there was no significant difference in frequency of consumption of the food groups in subjects with different BMI categories, various kinds of physical activities showed a steady decline with increasing BMI. CONCLUSIONS: The findings of the present study provide alarming evidence for health professionals and policy makers about the very high prevalence of generalised and abdominal obesity in Iran. The unhealthy lifestyle habits, notably sedentary lifestyles in our community, are the major contributing factors for this emerging public health problem.

• Prevalence of diabetes and impaired fasting glucose in the adult population of Iran: National Survey of Risk Factors for Non-Communicable Diseases of Iran.

  Authors: Alireza Esteghamati, Mohamad M Gouya, Mehrshad Abbasi, Alireza Delavari, Siamak Alikhani, Farishid Alaedini, Afshin Safaie, Mehrdad Forouzanfar, Edward W Gregg

  Diabetes care. 02/2008; 31(1):96-8.

  OBJECTIVE: Despite concerns regarding a diabetes epidemic in the Middle East, internationally published data on national estimates of prevalent type 2 diabetes in Iran do not exist. With thisOBJECTIVE: Despite concerns regarding a diabetes epidemic in the Middle East, internationally published data on national estimates of prevalent type 2 diabetes in Iran do not exist. With this article, we document a dramatically high prevalence of diabetes in Iran. RESEARCH DESIGN AND METHODS: Our data are based on the results of the first Survey of Risk Factors of Non-Communicable Diseases of Iran, 2005. In this national cross-sectional survey, 70,981 Iranian citizens aged 25-64 years were recruited. RESULTS: We found that 7.7% of adults aged 25-64 years, or 2 million adults, have diabetes, among whom one-half are undiagnosed. An additional 16.8%, or 4.4 million, of Iranian adults have impaired fasting glucose. CONCLUSIONS: The high prevalence of diabetes in working-age adults is an ominous sign for this developing nation. As the relatively young Iranian population ages in the future and urbanization continues or accelerates, the prevalence of diabetes will likely escalate.

• Sexual risk-taking behaviors among boys aged 15-18 years in Tehran.

  Authors: Kazem Mohammad, Farideh Khalaj Abadi Farahani, Mohammad Reza Mohammadi, Siamak Alikhani, Mohammad Zare, Fahimeh Ramezani Tehrani, Ali Ramezankhani, Alireza Hasanzadeh, Hossein Ghanbari

  The Journal of adolescent health : official publication of the Society for Adolescent Medicine. 11/2007; 41(4):407-14.

  PURPOSE: The purpose of this study is to evaluate the extent and potential correlates of sexual risk-taking behaviors among adolescent boys aged 15-18 in metropolitan Tehran. METHODS: Data werePURPOSE: The purpose of this study is to evaluate the extent and potential correlates of sexual risk-taking behaviors among adolescent boys aged 15-18 in metropolitan Tehran. METHODS: Data were collected from a population-based, cross-sectional survey of adolescent males (ages 15-18) residing in Tehran, Iran. Of 1385 subjects, 382 reported sexual experience (27.7%). The article is mainly considering sexually experienced subjects. Two factors were considered as sexual risk-taking behavior ("not using condom or inconsistent condom use in sexual contacts" and "ever had multiple sexual partners in lifetime." Several other factors were considered as independent variables and their relations were assessed using t test, chi2 test, and logistic regression models. RESULTS: Having no access to Internet, feeling regretful at sexual debut, having one sexual partner in lifetime and lower knowledge of condoms are predictors of condom non-use. Older age, using alcoholic drinks, early sexual debut, and poor knowledge of reproductive physiology are predictors of multiple sexual partners among adolescent boys aged 15-18 years. CONCLUSION: Appropriate interventional programs should be implemented for adolescents in Iran to encourage and enable them to delay first sex and abstain unwanted and unplanned penetrative sex, to stress the health risks of alcohol use in terms of sexual health and finally to enhance their knowledge on different aspects of reproductive health particularly prevention against STI/HIV.

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• First nationwide survey of prevalence of overweight, underweight, and abdominal obesity in Iranian adults.

  Authors: Mohsen Janghorbani, Masoud Amini, Walter C Willett, Mohammad Mehdi Gouya, Alireza Delavari, Siamak Alikhani, Alireza Mahdavi

  Obesity (Silver Spring, Md.). 11/2007; 15(11):2797-808.

  OBJECTIVE: The goal was to estimate the prevalence of overweight, obesity, underweight, and abdominal obesity among the adult population of Iran. RESEARCH METHODS AND PROCEDURES: A nationwideOBJECTIVE: The goal was to estimate the prevalence of overweight, obesity, underweight, and abdominal obesity among the adult population of Iran. RESEARCH METHODS AND PROCEDURES: A nationwide cross-sectional survey was conducted from December 2004 to February 2005. The selection was conducted by stratified probability cluster sampling through household family members in Iran. Weight, height, and waist circumference (WC) of 89,404 men and women 15 to 65 years of age (mean, 39.2 years) were measured. The criteria for underweight, normal-weight, overweight, and Class I, II, and III obesity were BMI <18.5, 18.5 to 24.9, 25 to 29.9, 30 to 34.9, 35 to 39.9, and >or=40 (kg/m(2)), respectively. Abdominal obesity was defined as WC >or=102 cm in men and >or=88 cm in women. RESULTS: The age-adjusted means for BMI and WC were 24.6 kg/m(2) in men and 26.5 kg/m(2) in women and 86.6 cm in men and 89.6 cm in women, respectively. The age-adjusted prevalence of overweight or obesity (BMI >or=25) was 42.8% in men and 57.0% in women; 11.1% of men and 25.2% of women were obese (BMI >or=30), while 6.3% of men and 5.2% of women were underweight. Age, low physical activity, low educational attainment, marriage, and residence in urban areas were strongly associated with obesity. Abdominal obesity was more common among women than men (54.5% vs. 12.9%) and greater with older age. DISCUSSION: Excess body weight appears to be common in Iran. More women than men present with overweight and abdominal obesity. Prevention and treatment strategies are urgently needed to address the health burden of obesity.

• Reproductive knowledge, attitudes and behavior among adolescent males in Tehran, Iran.

  Authors: Mohammad Reza Mohammadi, Kazem Mohammad, Farideh K A Farahani, Siamak Alikhani, Mohammad Zare, Fahimeh R Tehrani, Ali Ramezankhani, Farshid Alaeddini

  International family planning perspectives. 04/2006; 32(1):35-44.

  CONTEXT: Iran's culture and religion prohibit sexual contact prior to marriage. Due to the sensitivity of the topic, little is known about the sexual activity of unmarried adolescent males or aboutCONTEXT: Iran's culture and religion prohibit sexual contact prior to marriage. Due to the sensitivity of the topic, little is known about the sexual activity of unmarried adolescent males or about their knowledge of, and attitudes toward, sexuality and reproductive health. METHODS: A population-based study of 1,385 males aged 15-18 in Tehran was conducted using a self-administered questionnaire. Participants were questioned about their beliefs and knowledge regarding reproductive health, and asked whether they had engaged in sexual activity. Bivariate and multivariate analyses were performed to identify factors associated with sexual knowledge, attitudes and behavior. RESULTS: Twenty-eight percent of the sample reported having engaged in sexual activity. Sexual experience was associated with older age, access to satellite television, alcohol consumption and permissive attitudes toward sex. Substantial proportions of respondents held misconceptions regarding condoms, STIs and reproductive physiology. Attitudes toward premarital sex were more permissive among respondents who were older, were not in school, had work experience, had access to the Internet or satellite television, lived separately from their parents, or reported having used alcohol, cigarettes or drugs. CONCLUSION: The relatively high prevalence of sexual activity and the lack of knowledge regarding STIs and contraceptives pose a significant threat to the sexual and reproductive health of adolescent males in Iran. Programs are needed to provide adolescents with the information and skills to make safe sexual decisions.

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• Gender Differential in the Association of Body Mass Index and Abdominal Obesity with Prehypertension and Hypertension in Iranian Adults

  Authors: Mohsen Janghorbani, Masoud Amini, Mohammad Mehdi Gouya, Alireza Delavari, Siamak Alikhani, Alireza Mahdavi

  Nature Precedings.

  *Objective:* The aim of this study was to determine the gender differential in the relationship of body mass index (BMI) and abdominal obesity with blood pressure (BP) and prevalence of hypertension*Objective:* The aim of this study was to determine the gender differential in the relationship of body mass index (BMI) and abdominal obesity with blood pressure (BP) and prevalence of hypertension (HTN) and prehypertension (Pre-HTN) among the adult population of Iran. *Design:* A nationwide cross-sectional survey was conducted from December 2004 to February 2005. The selection was conducted by stratified probability cluster sampling through household family members in Iran. *Subjects and Measurements:* Weight, height, waist circumference (WC), and systolic and diastolic BP of 45,082 men and 44,322 women aged 15-65 (mean 39.2) were measured. *Results:* The prevalence of HTN was 25.2% in men and 24.8% in women; and 50.1% of men and 39.1% of women were pre-hypertensive. WC and BMI were strongly associated with BP in both genders. Multivariate analysis revealed that both WC and BMI had the stronger association with HTN and Pre-HTN in men than women. Compared to men and women with normal weight, the multivariate-adjusted odds ratio (OR) (95% confidence interval) of HTN was 5.75 (5.13, 6.44) for men and 4.29 (3.95, 4.66) for women with BMI ≥ 30. The multivariate OR of prevalence HTN in men with abdominal obesity compared with men without was 3.76 (3.41, 4.22) and in women, 2.92 (2.73, 3.13). *Conclusion:* These data indicate that both BMI and WC had the stronger association with HTN and Pre-HTN in men than women.