Methodology and early findings of the fourth survey of childhood and adolescence surveillance and prevention of adult non-communicable disease in Iran: the CASPIAN-IV study

The fourth survey of the surveillance system named ''childhood and adolescence surveillance and prevention of adult non-communicable disease'' [CASPIAN-IV study], was conducted among a national representative sample of Iranian students. This paper describes the methods and early findings of this survey. This nationwide school-based study was conducted in 2011-2012 in 30 provinces of Iran among 13,486 students, 6-18 years [6640 girls, 75.6% from urban areas] and one of their parents. Mean age of students was 12.5 years. Based on the World Health Organization growth curves, 12.2% were underweight, 9.7% overweight and 11.9% were obese. Abdominal obesity was observed in 19.1% of students. The dominant type of cooking oil in urban families was liquid oil and hydrogenated fat [39% and 32%], most rural families used hydrogenated fat [53%], respectively. A total of 18% of students had at least 30 min of daily physical activity; 41% of students used computer in weekdays and 44% used it in weekends. Almost 34.5% of students reported to have at least one cigarette smoker and 21.5% reported to have a waterpipe smoker in their relatives. Moreover, 20.3% of students reported that they had suffered an injury needing the help of school health providers during the year prior to the study. Current evidence on the health risky behaviors among Iranian children and adolescents confirms the importance of conducting comprehensive surveillance surveys to identify health risk behaviors. Data of this survey and the trend of variables provide necessary information for health policy makers to implement action-oriented interventions

Inequality in school readiness and autism among 6-year-old children across Iranian provinces: national health assessment survey results

To assess the national inequality of school readiness and autism among 6-year-old Iranian children before school entry using a national health assessment survey. In a cross-sectional nationwide survey, all Iranian children entering public and private elementary schools were asked to participate in a mandatory national screening program in Iran in 2009 in two levels of screening and diagnostic levels. The study population consisted of 955388 children [48.5% girls and 76.1% urban residents]. Of the whole children 31% of the 6 year old children had impaired vision In addition, 1.2, 1.8, 1.4, 7.6, 0.08, 10, 10.9, 56.7, 0.7, 0.8 and 0.6 percent had color blindness, hearing impaired, speech disorder, school readiness, autism, height to age retardation, body mass index extremes, decayed teeth, disease with special needs, spinal disorders, and hypertension, respectively. The distribution of these disorders was unequally distributed across provinces. Our results confirmed that there is an inequality in distribution of school readiness and autism in 6-year-old children across Iranian provinces. The observed burden of these distributions among young children needs a comprehensive national policy with evidence-based province programs to identity the reason for different inequality among provinces

First report on self-rated health in a nationally-representative sample of Iranian adolescents: the Caspian-III study

To evaluate predictive factors of adolescents' appraisal of their health. The nationwide study, entitled "Childhood and Adolescence Surveillance and Prevention of Adult Non-communicable Diseases [CASPIAN] study," was conducted in 2010 among Iranian school students, aged 10-18. In addition to demographic factors and physical examination, variables as family structure, nutrition habits, physical activity, smoking, hygienic habits, violence, school attachment, family smoking, and family history of chronic diseases were assessed. The dependent variable is the self-rated health [SRH] and it was measured by 12 items, which had already been combined through latent class analysis. We had taken a dichotomous variable, i.e. the higher values indicate better SRH. The dependent variable was regressed on all predictors by generalized additive models. 75% of adolescents had a good SRH. The linear and smooth effects of independent variables on SRH were observed. Among all the variables, physical activity had a positive linear effect on SRH [beta = 0.08, P value = 0.003]. Smoking, violence, and family history of disease associated to SRH non-linearly [P value < 0.05]. Family smoking [beta = -0.01] and hygienic habits [beta = 0.27] related to SRH both linearly and non-linearly. Physical health and high risk behavior, either of linear or non-linear effect, are factors, which seem to shape the adolescents' perception of health

Tooth brushing and cardiometabolic risk factors in adolescents: Is there an association? The CASPIAN-III study

A growing body of evidence supports an association between oral health and cardiovascular diseases and diabetes in adults. This study aimed to investigate the relationship between tooth brushing frequency and cardiometabolic risk factors in adolescents. This nationwide population-based study was conducted among 5258 Iranian students, aged 10-18 years, living in urban and rural areas of 27 provinces in Iran. The association of tooth brushing frequency was assessed with anthropometric indexes and cardiometabolic risk factors after adjustment for potential confounders. Higher frequency of tooth brushing was associated with lower mean levels of low-density lipoprotein cholesterol [LDL-C] in both genders [P < 0.0001] and lower frequency of elevated LDL-C in girls [P = 0.03]. The frequency of elevated blood pressure decreased with higher tooth brushing frequency in boys [P = 0.03]. After adjustment for many potential cofounders such as age, gender, anthropometric indexes, screen time, socioeconomic status, and family history of non-communicable diseases, participants who washed their teeth at least once a day had lower risk of high LDL-C and low high-density lipoprotein cholesterol [HDL-C] levels in comparison to those who reported lower frequency of tooth brushing; some different associations were observed among girls and boys. Our findings suggest an independent and protective role of teeth brushing frequency for some cardiometabolic risk factors in adolescents. Increasing both the general health awareness and improving oral health should be considered in primordial and primary prevention of non-communicable diseases

Methodology and early findings of the third survey of CASPIAN study: a national school-based surveillance of students' high risk behaviors

A school-based surveillance system entitled the childhood and adolescence surveillance and prevention of Adult No communicable disease [CASPIAN] Study is implemented at national level in Iran. This paper presents the methods and primary findings of the third survey of this surveillance system. This national survey was performed in 2009-2010 in 27 provinces of Iran among 5570 students and one of their parents. In addition to physical examination, fasting serum was obtained. Body mass index was categorized based on the World Health Organization growth charts. Data of 5528 students [2726 girls, 69.37% urban, mean age 14.7 +/- 2.4 years] were complete and are reported. Overall, 17.3% [17.3% of girls and 17.5% of boys] were underweight, and 17.7% [15.5% of girls and 19.9% of boys] were overweight or obese. Abdominal obesity was documented in 16.3% of students [17.8% of girls and 15% of boys]. 57.6% of families consumed breads, the staple food for Iranians, prepared with white flour. Most families [43.8% in urban areas and 58.6% in rural areas] used solid hydrogenated fats. 22.7% of students did not add salt to the table food. 14.2% of students reported to have a regular daily physical activity for at least 30 min a day. Overall, 10.4% of students [11.7% in urban areas and 7.3% in rural areas] reported that they used tobacco products, often water pipe. 32.8% of students experienced at least three times of bullying in the previous 3 months. During the year prior to the survey, 14.46% of students had an injury needing the interference by school health providers. This survey is confirmatory evidence on the importance of establishing surveillance systems for risk behaviors to implement action-oriented interventions