Exploring neighborhood inequality in female breast cancer incidence in Tehran using Bayesian spatial models and a spatial scan statistic / 한국역학회지

OBJECTIVES: The aim of this study was to explore the spatial pattern of female breast cancer (BC) incidence at the neighborhood level in Tehran, Iran. METHODS: The present study included all registered incident cases of female BC from March 2008 to March 2011. The raw standardized incidence ratio (SIR) of BC for each neighborhood was estimated by comparing observed cases relative to expected cases. The estimated raw SIRs were smoothed by a Besag, York, and Mollie spatial model and the spatial empirical Bayesian method. The purely spatial scan statistic was used to identify spatial clusters. RESULTS: There were 4,175 incident BC cases in the study area from 2008 to 2011, of which 3,080 were successfully geocoded to the neighborhood level. Higher than expected rates of BC were found in neighborhoods located in northern and central Tehran, whereas lower rates appeared in southern areas. The most likely cluster of higher than expected BC incidence involved neighborhoods in districts 3 and 6, with an observed-to-expected ratio of 3.92 (p < 0.001), whereas the most likely cluster of lower than expected rates involved neighborhoods in districts 17, 18, and 19, with an observed-to-expected ratio of 0.05 (p < 0.001). CONCLUSIONS: Neighborhood-level inequality in the incidence of BC exists in Tehran. These findings can serve as a basis for resource allocation and preventive strategies in at-risk areas.

Exploring neighborhood inequality in female breast cancer incidence in Tehran using Bayesian spatial models and a spatial scan statistic / 한국역학회지

OBJECTIVES: The aim of this study was to explore the spatial pattern of female breast cancer (BC) incidence at the neighborhood level in Tehran, Iran.METHODS: The present study included all registered incident cases of female BC from March 2008 to March 2011. The raw standardized incidence ratio (SIR) of BC for each neighborhood was estimated by comparing observed cases relative to expected cases. The estimated raw SIRs were smoothed by a Besag, York, and Mollie spatial model and the spatial empirical Bayesian method. The purely spatial scan statistic was used to identify spatial clusters.RESULTS: There were 4,175 incident BC cases in the study area from 2008 to 2011, of which 3,080 were successfully geocoded to the neighborhood level. Higher than expected rates of BC were found in neighborhoods located in northern and central Tehran, whereas lower rates appeared in southern areas. The most likely cluster of higher than expected BC incidence involved neighborhoods in districts 3 and 6, with an observed-to-expected ratio of 3.92 (p < 0.001), whereas the most likely cluster of lower than expected rates involved neighborhoods in districts 17, 18, and 19, with an observed-to-expected ratio of 0.05 (p < 0.001).CONCLUSIONS: Neighborhood-level inequality in the incidence of BC exists in Tehran. These findings can serve as a basis for resource allocation and preventive strategies in at-risk areas.

algorithm of smoking stages assessment in adolescents: a validation study using the latent class analysis model

Not withstanding the importance of smoking stages evaluation in adolescents, there is not an appropriate instrument for its measurement. This study aims to introduce an appropriate instrument for measurement of smoking stages in adolescents and to examine its validity using latent class analysis [LCA] model. We designed an algorithm to measure the smoking stages. The relevancy and clarity of the algorithm was examined by experts and lay experts. We assessed the reliability of our algorithm using test retest method. Moreover, using the LCA, we studied the validity of the stages measured by the designed algorithm in 4903 students [ages 14-19], who were randomly selected from grade 10 high school students in Tabriz [North West of Iran]. The algorithm content validity indicates high relevancy and clarity percentages. Intra-class correlation of 0.929 was found in the assessment of the reliability of smoking stages [9 stages] in 154 students within a two week interval. The LCA model revealed nine interpretable classes [G[2] = 0.051, df = 1, P = 0.821] for the measurement of smoking stages. Examination of the smoking cessation stages in a sample of 218 students in the cessation stage demonstrated that the results for five classes could be interpreted [G[2] = 0.001, df = 1, P = 0.975]. The results suggested that this algorithm is clear, valid, and reliable.

Intention to start smoking and its related factors in never smoked adolescents in Tabriz, 2010

Intention to smoking is a strong predictor of future smoking behavior. The aim of this study is identifying the personal, environmental, and psychological factors relating to intention to smoking in adolescents of Tabriz city [Northwest of Iran]. Four thousand nine hundred and three [4903] students were randomly selected and completed a self-administered questionnaire about cigarette smoking, intention to smoking, and the related risk factors through multi-stage sampling. The association of independent variables with intention to smoking was evaluated using the multi-variable logistic regression model. The mean age of student was 15.7 +/- 0.73 years, and 42.9% of the samples were male. The results showed that 95.0% of students were in committer stage [students who had never smoked and were sure never start smoking]. Having general risk-taking behavior [OR 2.90; 95% confidence interval [CI]: 1.21-6.97], smoker in the family [OR 2.60; 95% CI: 1.20-5.61], and positive attitude towards cigarette smoking [OR 1.30; 95% CI: 1.18-1.43] had statistically significant association with intention to start smoking in future. Majority of non-smokers have firm decision to not start smoking in the future. Having general risk-taking behavior, smoker in the family, and positive attitude towards smoking are associated with intention to smoking in adolescents

Smoking stages in an Iranian adolescent population

The aim of this study is determining the prevalence of smoking stages in adolescents of Tabriz city [northwest of Iran] and identifying the personal, environmental, and psychological factors relating to cigarette smoking. Fifty-seven high schools were randomly selected, and 4903 students were completed a self-administered questionnaire about cigarette smoking and the related risk factors. The association of independent variables with cigarette smoking was evaluated using the ordinal logistic regression model. In total, 17.3% of the participants were experimenters [95% CI: 15.8-18.9] and 5.0% were regular smokers [95% CI: 3.7-6.2]. The results showed that the male gender [OR=2.92; CI: 1.94-4.77], age [OR=1.27; CI: 1.02-1.64], having general risk taking behavior [OR=1.50; CI: 1.02-2.21], presence of a cigarette smoker in the family [OR=1.78; CI: 1.23-2.54], friendship with close cigarette smoker friends [OR=2.52; CI: 1.65- 3.86], substance abuse experience [OR=8.27; CI: 2.61-25.61], attitude toward cigarette smoking [OR=1.22; CI: 1.10-1.27] and positive thinking about cigarette smoking [OR=1.05; CI: 1.01-1.14] are associated to cigarette smoking in adolescents. The cigarette smoking prevalence is minimal in Tabriz city adolescents, especially in girls; but the experimenter prevalence is considerable. Findings of this study justifies adopting more serious measures in the pre-adolescence and adolescence period