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BACKGROUND: This study evaluated the outcome of a comprehensive, community-based healthy lifestyle program on cardiometabolic risk factors. The Isfahan Healthy Heart Program (IHHP) was a comprehensive action-oriented, multi-component intervention with a quasi-experimental design and reference area.   METHODS: IHHP targeted the population-at-large (n = 2,180,000) in three districts in central Iran. Data from independent sample surveys before (2000 - 2001) and after (2007) this program were used to compare differences in the intervention area  and reference area over time after controlling for age, education level and income. The samples in 2000 - 2001 and 2007 included 6175 and 4719 participants in intervention area, and 6339 and 4853 in reference area, respectively. Multiple interventional activities were performed based on the four main strategies of healthy nutrition, increased physical activity, tobacco control and coping with stress.  RESULTS: The prevalence of abdominal obesity, hypertension, hypercholesterolemia, hypertriglyceridemia and high LDL-C decreased significantly in the intervention area versus the reference area in both sexes. However the reduction in overweight and obesity was significant only in females (P < 0.05 for all). There were no significant changes in the prevalence of diabetes mellitus.  In the intervention area, the prevalence of hypercholesterolemia decreased from 23.5% to 12.5% among females without any changes in females in the reference area (p < 0.0001). In males, hypercholesterolemia decreased significantly in both intervention area (18.5% to 9.6%) and reference area (14.4% to 9.8%; p = 0.005). Mean triglyceride levels had a significant decrease in the intervention area and a non-significant decrease in the reference area (p < 0.0001).  CONCLUSIONS: A comprehensive healthy lifestyle program comprising preventive and promotional activities that considers both population and high risk approaches can be effective in controlling cardiometabolic risk factors in a middle-income country.

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OBJECTIVE: To assess the impact of gender and living area on cardiovascular risk factors in the context of a comprehensive lifestyle intervention program. DESIGN: Data from independent sample surveys before (2000--2001) and after (2007) a community trial, entitled the Isfahan Healthy Heart Program (IHHP) were used to compare differences in the intervention area (IA) and reference area (RA) by gender and living area. SETTING: The interventions targeted the population living in Isfahan and Najaf-Abad counties as IA and Arak as RA. PARTICIPANTS: Overall, 12 514 individuals who were more than 19 years of age were studied at baseline, and 9570 were studied in postintervention phase. INTERVENTIONS: Multiple activities were conducted in connection with each of the four main strategies of healthy nutrition, increasing physical activity, tobacco control, and coping with stress. MAIN OUTCOMES: Comparing serum lipids levels, blood pressure, blood glucose and obesity indices changes between IA and RA based on sex and living areas during the study. RESULTS: In IA, while the prevalence of hypertension declined in urban and rural females (P < 0.05). In IA, the prevalence of hypercholesterolemia and hypertriglyceridemia decreased in both females and males of urban and rural areas except for hypercholesterolemia in rural males (P < 0.01). In RA, the significant changes include both decrease in the hypercholesterolemia among rural males (P < 0.001) and hypertriglyceridemia in urban females (P < 0.01), while hypertriglyceridemia was significantly increased in rural females (P < 0.01). CONCLUSIONS: This comprehensive community trial was effective in controlling many risk factors in both sexes in urban and rural areas. These findings also reflect the transitional status of rural population in adopting urban lifestyle behaviors.

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BACKGROUND & OBJECTIVES: Smoking cessation advice is known as an important factor in motivating smokers to quit smoking. We investigated the extent, sources and predictors of receiving unsolicited advice and seeking active advice for smoking cessation in Iran. METHODS: A cross-sectional study was performed as a part of Isfahan Healthy Heart Program (IHHP) on 9093 adult individuals (both men and women) in 2004-2005. Demographic characteristics, smoking status, sources and preferences for smoking cessation support were recorded. RESULTS: In the studied population, 66.8 and 14.4 per cent had received and asked for cessation support, respectively. Smokers had received advice from family (92.2%), friends (48.9%), physician (27.9%) and other health care providers (16.2%). Smokers had asked for cessation help more frequently from family (64.5%) and friends (42.0%). Women (OR: 0.59, 95% CI: 0.37-0.94) and singles (OR: 0.51, 95% CI: 0.36-0.71) received less advice. Hookah smokers received (OR: 0.23; 95% CI: 0.14-0.38) and asked (OR: 0.21; 95% CI: 0.06-0.68) for cessation help less than cigarette smokers. Receiving advice increased the odds of seeking support (OR: 7.98; 95% CI: 4.37-14.57). INTERPRETATION & CONCLUSIONS: Smokers` family and friends were more frequent sources for smoking cessation support. Tobacco control programmes can count on smokers` family and friends as available sources for smoking cessation support in countries where smoking cessation counselling services are less available. However, the role of physicians and health care workers in the smoking cessation counselling needs to be strengthened.

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OBJECTIVE: The aim of the present study was to develop reference data for the Iranian population for anthropometric values and cardiometabolic data in comparison with those in Americans, as representative of a Western population. DESIGN: The present cross-sectional survey, conducted as part of the baseline survey of a community-based interventional study (the Isfahan Healthy Heart Programme), used a two-stage clustering design and was conducted in 12 600 randomly selected adults (> or =19 years of age) and 2000 adolescents (aged 11-18 years) living in three cities in the central part of Iran. For comparison with a Western population, comparable data for Americans were derived from the data sets of the Second and Third National Health and Nutrition Examination Surveys (NHANES II and NHANES III). RESULTS: Iranian women had significantly higher mean BMI, waist circumference (WC), hip circumference (HC) and waist:hip ratio (WHR) than Iranian men and American women; but the mean BMI of Iranian men was lower than that of American men. The mean serum TAG level of Iranian men was significantly higher than that of Iranian women, whereas the mean serum total cholesterol (TC), LDL cholesterol (LDL-C) and HDL cholesterol (HDL-C) levels were significantly higher in Iranian women than in men. The Iranian population had lower mean TC, LDL-C and TAG levels than the Americans, but such difference was not documented for HDL-C. Iranian adolescents had significantly lower mean BMI and higher mean TAG than did American adolescents. CONCLUSIONS: Our findings provide serious evidence for health professionals and policy makers about the very high prevalence of generalized and abdominal obesity in Iran. Controlling this emerging health problem, notably in women, should become a national priority in Iran and necessitates comprehensive public health programmes.

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INTRODUCTION: To assess the effect of a comprehensive community-based programme for increasing physical activity (PA) after 2 years of interventions. MATERIAL AND METHODS: A 6-year, action-oriented, comprehensive, and integrated community-based study, entitled the Isfahan Healthy Heart Programme, was conducted in Iran from the year 2000. The interventions targeted the whole population of nearly 2,180,000 living in two cities, and were compared with another city considered as a reference. Educational, environmental and legislative interventions were conducted at the community level. Annual evaluations were performed among 6,000 representative individuals. This paper presents the changes in PA habits after 2 years of interventions for increasing PA. The PA habits were assessed by using the Baecke questionnaire, and an energy expenditure of 150 kcal for daily leisure time physical activity was adopted as a cut-off for defining active and inactive lifestyle. RESULTS: In the intervention and reference areas, respectively 85 and 83% of the population were physically inactive. From 2000 to 2002, the daily PA among both genders decreased in both intervention and reference communities. Meanwhile, the leisure-time PA increased significantly in the intervention area, but decreased in the reference area. The transportation PA did not significantly change in the intervention area, but showed a remarkable decline in the reference area. CONCLUSIONS: We suggest that the synergism resulting from community collaborations has been effective in improving some aspects of PA in our community. The ongoing changes in environmental factors and policies can help in increasing the worksite and transportation PA in later stages of this community-based programme.

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BACKGROUND: Postpartum depression is defined as a major depressive episode that occurs within four weeks after delivery. However, investigators describe a dramatic increase in the incidence of mood disorders after childbirth with the largest risk during 90 days after delivery. We aimed to study the risk factors of postpartum depression in women living in rural areas of Isfahan Province in Iran. METHODS: We assessed 6627 women, two to 12 months after delivery, for depression and putative risk factors. RESULTS: Unemployment, low education, mothers' young age, undesired gender of the child, unplanned pregnancy, and history of depression were the main risk factors of postpartum depression. History of depression, low education, primiparity, unplanned pregnancy, and undesired gender of the child had the highest risk score for postpartum depression in this group of Iranian women. CONCLUSION: Risk factors of postpartum depression in Isfahan Province were very similar to other studies, but the negative impact of low level of education, unplanned pregnancy, and undesired gender of the child on postnatal depression seems to be characteristic of this population.

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OBJECTIVE: To assess the effects of a comprehensive, integrated community-based lifestyle intervention on diet, physical activity and smoking in two Iranian communities. METHODS: Within the framework of the Isfahan Healthy Heart Program, a community trial was conducted in two intervention counties (Isfahan and Najaf-Abad) and a control area (Arak). Lifestyle interventions targeted the urban and rural populations in the intervention counties but were not implemented in Arak. In each community, a random sample of adults was selected yearly by multi-stage cluster sampling. Food consumption, physical exercise and smoking behaviours were quantified and scored as 1 (low-risk) or 0 (other) at baseline (year 2000) and annually for 4 years in the intervention areas and for 3 years in the control area. The scores for all behaviours were then added to derive an overall lifestyle score. FINDINGS: After 4 years, changes from baseline in mean dietary score differed significantly between the intervention and control areas (+2.1 points versus -1.2 points, respectively; P < 0.01), as did the change in the percentage of individuals following a healthy diet (+14.9% versus -2.0%, respectively; P < 0.001). Daily smoking had decreased by 0.9% in the intervention areas and by 2.6% in the control area at the end of the third year, but the difference was not significant. Analysis by gender revealed a significant decreasing trend in smoking among men (P < 0.05) but not among women. Energy expenditure for total daily physical activities showed a decreasing trend in all areas, but the mean drop from baseline was significantly smaller in the intervention areas than in the control area (-68 metabolic equivalent task (MET) minutes per week versus -114 MET minutes per week, respectively; P < 0.05). Leisure time devoted to physical activities showed an increasing trend in all areas. A significantly different change from baseline was found between the intervention areas and the control area in mean lifestyle score, even after controlling for age, sex and baseline values. CONCLUSION: The results suggest that community-based lifestyle intervention programmes can be effective in a developing country setting.

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OBJECTIVE: To examine the risk of breast cancer associated with passive and active smoking and to explore risk heterogeneity among studies. METHODS: We conducted this study in Iran during the year 2006. Fifteen published studies on smoking and breast cancer met the defined criteria. Pooled odds ratio (OR) estimates for female breast cancer were calculated. The active and passive smokers were compared with women categorized as never regularly exposed to tobacco smoke. RESULTS: The pooled risk estimate for breast cancer associated with passive smoking among non-smokers was 1.38 (95% confidence interval [CI]; 1.16-1.65). The pooled OR for active smokers was 1.25 (95% CI; 1.11-1.41). Also, the combined OR for passive and active smokers related to breast cancer was 1.30 (95% CI; 1.17-1.45). CONCLUSION: Based on the results of the pooled analysis, it can be concluded both passive and active smoking equally increase the risk of female breast cancer.

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OBJECTIVE: To evaluate the cumulative prevalence of atherosclerotic cardiovascular disease risk factors in a representative sample of Iranian adolescents. METHODS: The subjects of this cross-sectional study were 1,000 girls and 1,000 boys, ages 11-18 years, selected by multi stage-random cluster sampling from urban and rural areas of three cities in Iran. RESULTS: The prevalence of physical inactivity, dyslipidemia, smoking, high blood pressure and obesity (body mass index >95th percentile) were 66.6, 23.7, 8.7, 5.7 and 2.2%, respectively. Of subjects studied, 79.1% had at least one and 24.6% had two cardiovascular disease risk factors. The prevalence of physical inactivity was significantly lower in boys than girls [53.9 vs. 79.3%, respectively, OR 95%CI, 0.44 (0.39-0.51)]. The prevalence of smoking was higher in boys than girls [13.1 vs. 4.2%, respectively, OR 95%CI, 3.4 (2.4-4.9)]. CONCLUSION: Considering the high prevalence of cardiovascular disease risk factors in adolescents, age-appropriate and culturally sensitive interventions for lifestyle change are warranted, so that preventive measures can be taken in a timely manner.

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OBJETIVO: Avaliar a prevalência cumulativa dos fatores de risco para a doença cardiovascular aterosclerótica numa amostra de adolescentes iranianos. MÉTODOS: Foi realizado um estudo transversal com 1000 meninas e 1000 meninos, com idade entre 11 e 18 anos, selecionados através de uma amostragem aleatória multietapas à base de conglomerados das áreas urbana e rural de três cidades iranianas. RESULTADOS: As taxas de prevalência de inatividade física, dislipidemia, tabagismo, pressão arterial alta e obesidade (índice de massa corporal >P95) foram 66,6, 23,7, 8,7, 5,7 e 2,2 por cento, respectivamente. Dentre os indivíduos estudados, 79,1 por cento apresentaram pelo menos um e 24,6 por cento tiveram dois fatores de risco para doença cardiovascular. A prevalência de inatividade física foi significativamente menor entre os meninos que entre as meninas [53,9 contra 79,3 por cento, respectivamente, OR IC95 por cento, 0,44 (0,39-0,51)]. A prevalência de tabagismo foi maior nos meninos que nas meninas [13,1 contra 4,2 por cento, respectivamente, OR IC95 por cento, 3,4 (2,4-4,9)]. CONCLUSÃO: Considerando a alta prevalência de fatores de risco para doença cardiovascular em adolescentes, deve-se garantir intervenções que sejam adequadas à idade e sensíveis a aspectos culturais para que medidas preventivas possam ser tomadas em tempo hábil.

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