مجله آموزش و سلامت جامعه
سال هفتم شماره 2 (بهار 1399)

Dear Editor The international community has been faced with one of the most critical health conditions in recent decades due to the Coronavirus disease (COVID-19) pandemic which experience hundreds of thousands of infected cases and tens of thousands of deaths. Alongside of COVID-19 pandemic we have been faced a new phenomenon of "Infodemic" or “epidemic of false information” about COVID-19. Currently, a huge of unverified information is being disseminated about various aspects of COVID-19 disease, the methods of control and prevention of disease, and about its consequences through social media, television networks, and news agencies. In this regard, the Director General of the World Health Organization (WHO), Mr Tedros, at the Munich Security Conference on February 15, stated that '' We are not just fighting the COVID-19 epidemic,concurrently, we are also struggling with an "infodemic" which it can be a serious problem [1]. In other words, false information is rapidly circulating on social media, and countering fake news is likely to continue as long as the coronavirus spreading. As a result, the WHO is working with social media such as Twitter, Facebook, Tencent, Pinterest, and TikTok to publish the verified news about COVID-19 [2]. To provide verified accurate information, after announcing of COVID-19’s outbreak by China's Public Health Emergency Department, the World Health Organization amid to develop and build a series of mechanisms as a new information platform which it is called "WHO Information Network for Epidemics (EPI-WIN)", to share accurate information to specific target groups. Despite the WHO's efforts to control coronavirus, the international community is now witnessing numerous unverified news about COVID-19 that have led to a global confusion [1]. So that, WHO’s Director of Infectious Diseases, Sylvie Briand stated that “we know that with the spread of any disease, a tsunami of information dissemination occurs and in this published information, there is always false and rumors information [2]. The information tsunami phenomenon has existed even in the Middle Ages, but the difference between the present and the past is another phenomenon which we know it as "social media". Social media is like viruses that travel with people and move even faster and further, which is itself a new challenge, which can have adverse effects alongside the consequences of the COVID-19 epidemic [1]. As Alexandra Kozmanovic, director of social media at WHO Communications, stated "Combating infodemia and the spread of inaccurate information is a common effort between the WHO’s Risk Communications Division and the EPI-WIN platform to produce and disseminate verified information about COID-19. For this reason, as soon as some questions or rumors information are circulated, the WHO's Communications Division seeks to prevent gossip and inaccurate information by finding evidence-based answers and contributing to transparency and accurate information. This seems it's a role that the Bureau of Health Education of the Iranian Ministry of Health must be taken this responsibility. In fact, after the COVID-19 epidemic in China, misleading rumors and false theories about the origin of coronavirus, ways of transmission, methods of controlling and treatment of active cases came up, which was lead to outcomes such as being worried and nervous, shopping and food storage, all of which reflect the impact of a new information ecosystem called "Infodemia" that is a 21st century feature of social media [3]. This crisis is characterized by the simultaneous spread of the virus and the relevant information. In other words, not only the virus is spreading very fast, but also false information about the outbreak of the disease also spread rapidly and as a result of the panic it caused among people. It seems, social media is moving faster than the spread of COVID-19 [3]. However, in Iran, some people, without being worried about this disease, do not attempt to protect him/herself and others. It is also important to distinguish between the use of fear-based theories in the development of health risk messages about COVID-19 and the dissemination of unprofessional authored messages disseminated by social media. Therefore, the key issue that could affect health professionals' efforts to control COVID-19 infection is to counteract the spread of inaccurate and unnecessary information worldwide [4]. In addition to taking urgent steps to cut the transmission chain and provide public health services to tackle this outbreak, health systems must also take the necessary measures to tackle fears circulating on social media. Obviously, governments must also help people by adopting compensatory economic policies and providing financial support, especially to the populations who are faced with economic problems. To counter the spread of large amounts of inaccurate information, the health education bureau of states Ministries and health education Professionals must quickly take appropriate, useful, and necessary measures to control public rumors, misconceptions, false beliefs and inappropriate behaviors surrounding COVID-19 [5]. They also put an end to the rumors and concerns about the spread of Coronavirus worldwide by creating an interactive dashboard, so, public health professionals can rapidly reduce misinformation through appropriate and well-designed health information [1]. The bureau of health education of Ministry of health in all countries can also, in partnership with social media such as the World Health Organization, utilize social media's capacity to disseminate health information that helps break the transmission chain of COVID-19. According to the letter of the Iranian Health Education Scientific Association dated February 25, 2020, the Minister of Health has been advised that, given the prevalence of COVID-19, the largest responsibility of the COVID-19’s National committee and Ministry of Health is transparency, accountability and community outreach to the needed information alongside community awareness and promoting the patterns of preventive behaviors and skills of self-care against COVID-19. This statement also stated that the Iranian Ministry of Health is expected to step in with the support of the formation of committee on health education and promotion , to provide accurate information at all levels , to provide evidence-based information about COVID-19 outbreak, and finally to develop appropriate interventions as the National health priority [6]. In fact, in the present situation, where we have not another choice except than non-pharmacological interventions such as quarantine and social distancing, we must use social media information to reinforce the information needed by the community to follow these procedures. Staying at home, public quarantine, being self-protect not only stop the COVID-19 transmission but also will prevent the transmission of false and unnecessary information. In principle, only by working with communities and citizens and providing accurate guidance and information from credible channels for public participation we can ensure about the effectiveness of interventions, especially quarantine and social distancing, against COVID-19. AS a result, striving to empower people and having informed people who can decide and act from a more informed and confident situation requires the provision of sound and coherent information from the health system and more importantly, to gain public trust.

Dear Editor In recent days, coronavirus disease (COVID-19) as a viral infection caused by the SARS-Cov-2 virus has become a pandemic disease and has created critical conditions worldwide [1]. According to previous studies on pathogenic viruses associated with acute respiratory distress syndrome, each virus has a specific virulence dose, which it is about 2×103-3×103 viral particles for the influenza virus. Given the emergence of the SARSCov-2 virus and no complete information on its virulence dose, it is clear that its very low virulence dose can cause its rapid spread. Regarding the effectiveness of the use of simple cloth filter masks, it can be stated that these masks provide relative safety depending on their type and structure [2]. In this regard, Blachere et al., reported that in multi-stage sampling of influenza viruses, 46% of the viruscontaining particles are trapped in the first filter layer of the sampler with a diameter of 4 microns, 49% of the viral particles are trapped in the second layer filter with a diameter 1 to 4 microns and only 1% of viruses are trapped in the last layer filter with a diameter of about 1 micron [2-4]. Coughing, sneezing, speaking, and breathing create a cloud of particles in the air with varying diameters ranging from a few millimeters to <1 micrometer. Large droplets (larger than 50 microns in diameter) are immediately deposited to the ground. Most respiratory droplets containing viruses are in this size range. Medium droplets (10 to 50μm) remain in the air for several minutes. Small particles (<10μm), including droplets nucleated by larger particles, can evaporate for hours and can be easily inhaled deep into the respiratory tract. On the other hand, the SARS-Co2 virus remains alive in the airborne aerosols for 3 hours [2, 4]. Therefore, the use of simple surgical masks for patients is necessary, especially during admission, to prevent the spread of large respiratory droplet released directly during coughing and sneezing and small droplets that are produced indirectly from the evaporation of the large droplets in the hospital environment. In addition, the use of ventilation systems can prevent the high concentration of these particles in hospital environments. In this regard, it is essential to educate hospital health experts about the necessity of using ventilation systems and their performance. On the other hand, the viability of viruses in the air is highly dependent on environmental conditions. Ambient temperature is one of the key factors influencing the stability of viruses in indoor air. In the case of the influenza virus, it has been reported that a temperature of 70˚C causes complete inactivation of the virus. Also, at 5°C, the viral transmission is significantly increased. While at 30°C, the viral transmission between hosts is obviously decreased. A recent study on the Corona viruses has reported similar results [2, 5]. Moisture factor is another factor influencing the transfer of viruses in the air. The lowest transmission rate occurs at low humidity and dry air (with a relative humidity in the range 20-30%), and the highest transmission rate occurs at high relative humidity (80-50%). Therefore, viruses can be prevented by monitoring and controlling the temperature and relative humidity in hospitals by using natural and mechanical ventilation systems to adjust the temperature and humidity at the appropriate level [2, 6]. According to World Health Organization (WHO) guidelines, it is recommended to use laboratory ventilation systems and if are available heating/cooling systems, fans/air conditioning units and local cooling system with laminar air flow can be used in diagnostic laboratories of hospitals. In this case, the velocity and direction of the air flow must be laminar to prevent turbulent currents. This point should also be considered in the case of natural ventilation [7]. It is also recommended to use of biological safety hoods with HEPA filters that CAN trap 3 microns particles or larger with a 95% efficiency in diagnostic and research laboratories. These hoods are specifically designed for laboratory works on dangerous and respiratory viruses [6]. If the laboratory is not equipped with a ventilation system and a suitable hood, transporting the sample to a reference laboratory instead of using several non-standard laboratories is recommended. For disinfection of hospital interior surfaces, the most effective disinfectants for inactivating viruses include alcohol-based disinfectants (ethanol), chlorine, and aldehydes. Savlon is a well-established antiseptic in Iran. This brand is actually a combination of two disinfectants of Chlorhexidine and Cetrimide. Sovlon is used in rapid disinfection of medical and surgical instruments, as well as surgeons' hand washing and wound cleaning. Its solution (1%) is also very suitable for disinfecting wounds and washing hand and body skin. It is a strong bactericidal, but has low effect on viruses. Two disinfectants that are effective on viruses include sodium hypochlorite and ethanol, which their minimum concentration and contact time should be considered to disable the virus. In a recent study on the SARS-Cov-2 virus, it was reported that the minimum concentration of sodium hypochlorite required to deactivate the virus was 0.21% with a contact time of 1 minute. Hydrogen peroxide is also an effective detergent with a minimal concentration of 0.5% and a 1-minute contact time for inactivation of the new coronavirus [7]. Ethanol or ethyl alcohol in the range of 78-95% requires a minimum contact time of 30-60 sec to deactivate coronavirus types including SARS-CoV and MERS-CoV. However, a risk assessment is required for monitoring all hospital units and identifying critical points that have the potential to spread the infection to personnel, and planning and performing measures according to the WHO guidelines is necessary to reduce the risk of spreading the disease [4, 8, 9]. Considering the importance of prevention in the medical staff, it is recommended to educate these personnel by educational programs, especially hospital health experts.

Water pipe smoking has become very popular among young people. Regarding to the increasing prevalence of water pipe smoking among students, the aim of this study was to determine the effects of an educational intervention based on Theory of Planned Behavior (TPB) and Health Action Process Approach (HAPA) on male students’ intention to quit water pipe smoking.

This semi-experimental study was conducted on 150 male students of the Islamic Azad University of Sabzevar-Iran, in 2017 who were selected by simple random sampling method and allocated to two control and intervention groups (75 people in each group). Data collection tool included a demographic information questionnaire and a researcher-made questionnaire based on motivational phase constructs of health action process approach and theory of planned behavior. Intervention group participants received six sessions of education (45 minutes per session). Both groups completed questionnaires in baseline and one month after the intervention. Data were analyzed in SPSS 23 software using statistical tests.

Before the intervention, there was no significant difference in the mean scores of the constructs of risk perception, outcome expectancy, action self-efficacy, attitude, subjective norms, perceived behavioral control, and behavioral intention to quit water pipe smoking between the two groups (p>0.05). However, after the intervention, these differences were significant except attitude (p<0.05). Also, after the intervention, intention to quit water pipe smoking in the students of intervention group had significant difference compared to the control group (p=0.004).

The educational intervention based on Theory of Planned Behavior (TPB) and Health Action Process Approach (HAPA) is effective in creating the intention to quit water pipe smoking among students.

Today, the prevalence of tobacco smoking among students is increasing. Therefore, the purpose of the present study was to determine the factors related with tobacco smoking among students using extended theory of planned behavior.

This cross-sectional descriptive-analytical study was conducted on 360 students of Universities of Malayer city who were selected by stratified random sampling method in 2017. Data were collected using a self-administered questionnaire including demographic variables and constructs of extended theory of planned behavior. Data were analyzed by SPSS 19 software using Pearson correlation, linear regression and logistic regression tests.

Perceived behavioral control (β=-0.402), positive attitude toward smoking (β=0.164), and parenting styles (β=-0.143) predicted behavioral intention, respectively and totally explained 32% of variance of behavioral intention of tobacco smoking (p<0.05). Also, behavioral intention (β=0.135) and perceived behavioral control (β=-0.098) were the most important predictors of tobacco smoking and totally explained 40% of variance of tobacco smoking among students (p<0.05).

The extended theory of planned behavior is appropriate and useful for identifying the factors affecting tobacco smoking. Perceived behavioral control, positive attitude toward smoking, and parenting styles are predictors of behavioral intention, respectively and behavioral intention and perceived behavioral control are predictors of tobacco smoking among students.

Hypertension is one of the most common health problems with significant consequences. Management of hypertension is mainly related to self-care status. Health literacy is one of the factors in accessing information related to health and better self-care. Therefore, the aim of the present study was to determine the relationship between health literacy and self-care behaviors of hypertensive patients referred to health centers.

In this descriptive-analytical study, 240 patients with hypertension referred to Hamadan Comprehensive Health Centers in 2019 were selected by multistage random sampling method and entered the study. The data were collected by interview and based on standard questionnaires of Health Literacy for Iranian Adults (HELIA) and self-care questionnaire. Data were analyzed by SPSS 24 software using Pearson correlation tests and linear regression.

29.2% of patients had inadequate health literacy and 42.1% had moderate self-care. There was a positive significant correlation between all components of health literacy and self-care in patients (p<0.05). The level of education, economic status and self-care had a statistically significant relationship with patients' health literacy (p<0.05). Also, body mass index and health literacy had a statistically significant relationship with self-care (p<0.05).

Health literacy is one of the important factors in improving the self-care behaviors of patients with hypertension.

Due to there is no immunity to influenza, non-pharmacological measures and prevention are very effective in controlling, reducing complications and mortality. Thus, the aim of the present study was to determine the effect of educational intervention based on Health Belief Model (HBM) on preventive behaviors against influenza A among students.

This experimental study was carried out on 140 high school freshman girl students in Fasa-Iran in 2016 who were selected by cluster random sampling method and divided into experimental and control groups (70 people in each group). Data gathering tool was a questionnaire consisting demographics variables, knowledge, HBM constructs, and preventive behaviors. The educational intervention was implemented in four 1-hour sessions for experimental group. The questionnaires were collected before and one month after the intervention. The collected data were analyzed in SPSS 22 software using chi-square test, independent t-test, and paired t-test.

Before educational intervention there was no significant difference in the mean scores of knowledge, HBM structures, and preventive behaviors between the experimental and control groups (p>0.05). However, after the educational intervention, a significant difference was observed between the experimental and control groups in terms of the mean scores of knowledge, HBM structures, and preventive behaviors (p<0.001).

Implementation of educational interventions based on HBM is an effective educational strategy to promote preventive behaviors against influenza A among students.

Adolescence is a critical step in implementing health interventions to create a healthy lifestyle, including prevention of osteoporosis. The aim of this study was to determine the factors affecting the adoption of osteoporosis preventive behaviors (OPB) among high school female students.

This cross-sectional descriptive study was conducted among 372 female students from Qazvin high schools who were selected by multistage random sampling method in 2019. Data collection tool was a questionnaire including demographic information and the osteoporosis preventive behaviors questionnaire. Data were analyzed using SPSS 23 software by descriptive statistics and logistic regression.

The mean overall score of the adoption of OPB were 22.43±5.62 from 36 and it was low. Variables of maternal education level (p=0.042) and assessment of oneself health status (p=0.039) were effective factors in adoption of OPB, that way the chances of having a desirable level of adoption of OPB in students with mothers with university and diploma level were 2.20 and 1.50 times higher than those with mothers with sub-diploma, respectively. Also, the chances of having a desirable level of adoption of OPB in students with good, average and bad assessment of their health status were 0.67, 0.46 and, 0.33 times higher than students with very bad assessment of their health status, respectively.

Maternal education level and assessment of oneself health status are effective factors in adoption of osteoporosis preventive behaviors among female students.

Lack of adequate sexual knowledge and attitude can lead to women's sexual anxiety. The purpose of this study was to predict the sexual anxiety according to sexual knowledge and attitudes of women on the brink of marriage.

This descriptive cross-sectional study was carried out on 556 women on the brink of marriage referring to the family health center of Hamedan in 2018. The subjects were selected using available sampling method and they completed Davis's Sexual Anxiety Inventory and SKAS's knowledge and attitude. Pearson correlation coefficient was used to analyze the relationships between variables and finally, multivariate linear regression test was used to determine the net effect of the relationship between variables.

There was a negative and significant correlation between sexual anxiety with sexual knowledge (r=-0.358; p<0.001) and with sexual attitude (r=-0.302; p<0.001). Also, the variables of sexual knowledge and attitude could predict 15.3% of variance of sexual anxiety (p<0.001).

The sexual knowledge and attitude of women on the brink of marriage can predict sexual anxiety in them and by increasing sexual knowledge and improving sexual attitude, women's sexual anxiety on the brink of marriage decreases.

Mental health, happiness, and social capital are important factors in optimal performance, entrepreneurship, reducing anxiety and depression, and increasing collaboration, agreement, intimacy, trust, and job satisfaction. The purpose of this study was to determine the relationship between happiness and mental health with social capital of Kermanshah University of Medical Sciences employees.

This cross-sectional descriptive study was conducted on 200 employees of Kermanshah University of Medical Sciences in 2019. Data were collected using GHQ-28 General Health, Oxford Happiness and Social Capital questionnaires. Data were analyzed by SPSS 16 software using independent t-test, one-way analysis of variance, Pearson correlation coefficient, and linear regression.

The mean age of participants was 40.40±8.18 years. The happiness of 57.5% of the participants was moderate, 54.5% had poor mental health, and 60.5% reported high social capital. Happiness and mental health predicted social capital and explained 9.2% of its variance changes. A good place to live had significant relationship with happiness and high social capital (p<0.01), but did not have relationship with mental health (p= 0.294). Also the mean scores of social capital, mental health, and happiness showed significant relationship with self-assessment of individual health, self-assessment of happiness, and life satisfaction (p<0.05).

The healthier and happier people feel and the more satisfied they are with life, the more they enjoy mental health, happiness, and social capital.

Injuries are one of the major health problems among children worldwide. The aim of this study was to determine the factors associated with mothers' behaviors, in injury prevention among premature neonatal, applying Health Belief Model.

The present study is an analytical cross-sectional study that was performed on 358 mothers with preterm infants admitted to Intensive Care Units of a referral hospital of Hamadan city in 2019. Participants were selected through convenient sampling method. The data collection tools were a questionnaire and a behavior-observation checklist. The questionnaire consisted of the questions about demographic variables, awareness and Health Belief Model constructs. Data were analyzed using SPSS 23 software and AMOS 23 software.

Mothers' injury prevention behaviors had the highest percentages (91.2%) and cues to action had the lowest percentage (58.6%) of the maximum score obtainable among the constructs of the model. The constructs of the perceived benefits (p=0.001), perceived severity (p=0.005), self-efficacy (p=0.010) and cues to action (p=0.040) had significant relation with the mothers' behaviors in preventing injury to premature neonatal. The constructs of Health Belief Model could explain 36% of the variations of mothers’ behavior regarding the care of their premature infant against injury (R2=0.36).

The Health Belief Model has a good fit and is useful in investigating mothers' behaviors in caring for their premature neonatal against injuries.

Social marketing is one of the approaches that is effective in promoting healthy eating behaviors by affecting different levels of target audience behaviors. The purpose of the present study was to determine the effectiveness of interventions based on social marketing theory in promoting healthy eating behaviors.

In order to identify interventions, Persian and English databases including Google Scholar, Scopus, Science direct, Web of science, PubMed, SID and, Iran medex were studied. Manual searches were also conducted manually in journals, abstracts of conferences, and dissertations. There were no restrictions when searching the electronic database regarding the language of publication, study time range, duration of intervention, type of participants, and place of study. Also, the quality of articles was evaluated based on the Jadad index.

371 articles were obtained in the initial search. 273 articles remained by deleting duplicate articles. 170 articles with study of title and 80 articles with study of abstract were excluded. Finally, 23 articles remained. Of the 23 studies, 12 interventions covered all of the social marketing criteria. Criteria of determining behavioral goal, customer orientation, exchange, segmentation and mix of methods were considered in all studies. Also, competition was observed in 12 interventions. In all studies, some positive changes in healthy eating behavior were reported (p<0.05).

Social marketing approach can promote healthy eating behaviors.