Urban Health Equity Assessment Research Articles

Prevalence of Cigarette Smoking and Associated Factors among Male Citizens in Tehran, Iran.

Cigarette smoking is as the leading cause of cancer mortality and other chronic diseases in males worldwide. The prevalence of cigarette smoking is different across and within countries by age, education level, occupation, and so on. This study aimed to determine the prevalence of cigarette smoking and its relationship with individuals' demographic factors and BMI in adolescent men living in Tehran, Iran. This study involved secondary analysis of the 'Urban Health Equity Assessment and Response Tool-2' survey conducted in Tehran, Iran, among men aged 20+, 2011-2012. Using a multistage sampling method, 45,990 men were included in the study. The cigarette smoking status, BMI and demographic factors measured through a self-administered questionnaire. Chi-square, t-test, and logistic regression model were used to examine the relationships between the independents variables and cigarette smoking behavior, using SPSS software version 21. In the total of 45,990 men, the overall prevalence of cigarette smoking was 14.6% (CI 95%: 14.29- 14.94). Age (OR=0.96; CI 95%:0.94-0.98), house ownership (OR=0.68; CI 95%: 0.64-0.72), job status (OR=0.60; CI 95%: 0.46-0.86), marital status (OR=0.42; CI 95%: 0.39-0.47) and educational levels (OR=0.50; CI95%: 0.45-0.54) were associated with the prevalence of cigarette smoking. However, associations with BMI, family size, residency years, and district were not statistically significant. Given the relatively high prevalence of cigarette smoking in the study population, policy interventions are required to address this major public health issue, with a focus on the population demographic influences.

Association between social capital, health-related quality of life, and mental health: a structural-equation modeling approach.

AimTo explore the association(s) between demographic factors, socioeconomic status (SES), social capital, health-related quality of life (HRQoL), and mental health among residents of Tehran, Iran.MethodsThe pooled data (n = 31 519) were extracted from a population-based survey Urban Health Equity Assessment and Response Tool-2 (Urban HEART-2) conducted in Tehran in 2011. Mental health, social capital, and HRQoL were assessed using the 28-item General Health Questionnaire (GHQ-28), social capital questionnaire, and Short-Form Health Survey (SF-12), respectively. The study used a multistage sampling method. Social capital, HRQoL, and SES were considered as latent variables. The association between these latent variables, demographic factors, and mental health was determined by structural-equation modeling (SEM).ResultsThe mean age and mental health score were 44.48 ± 15.87 years and 23.33 ± 11.10 (range, 0-84), respectively. The prevalence of mental disorders was 41.76% (95% confidence interval 41.21-42.30). The SEM model showed that age was directly associated with social capital (P = 0.016) and mental health (P = 0.001). Sex was indirectly related to mental health through social capital (P = 0.018). SES, HRQoL, and social capital were associated both directly and indirectly with mental health status.ConclusionThis study suggests that changes in social capital and SES can lead to positive changes in mental health status and that individual and contextual determinants influence HRQoL and mental health.

The Prevalence of Overweight and Obesity in Children Under 5 Years in Tehran, Iran, in 2012: A Population-Based Study.

Background:Overweight and obesity in children are a serious problem. They are increasingly prevalent and associated with a wide range of health problems in adulthood. Monitoring their status is essential for effective planning in the health system.Objectives:This study aimed to assess the prevalence of overweight and obesity in children below 5 years in Tehran in 2012.Patients and Methods:This cross-sectional study employed data provided by the urban health equity assessment in Tehran. The sample comprised a total of 4656 children under 5 years, recruited via multistage sampling. Data were collected through questionnaires and anthropometric measures of height and weight. The WHO child growth standards were used to determine overweight and obesity. Data were analyzed using chi-square tests, with SPSS version 11.5.Results:The prevalence of overweight and obesity in children were 12% and 23.7% respectively. The prevalence of overweight was significantly higher in girls than boys and the prevalence of obesity was significantly higher in boys than girls (P = 0.001). Obesity was more prevalent in children from high economic percentiles, but this finding was not statistically significant.Conclusions:The prevalence of overweight and obesity in children under 5 years is high. Overweight and obesity should be considered an epidemic and serious health problem in Tehran. They certainly require more attention and intervention.

The prevalence of overweight and obesity in children under 5 years in Tehran, Iran, in 2012: A population-based study

Background: Overweight and obesity in children are a serious problem. They are increasingly prevalent and associated with a wide range of health problems in adulthood. Monitoring their status is essential for effective planning in the health system. Objectives: This study aimed to assess the prevalence of overweight and obesity in children below 5 years in Tehran in 2012. Patients and Methods: This cross-sectional study employed data provided by the urban health equity assessment in Tehran. The sample comprised a total of 4656 children under 5 years, recruited via multistage sampling. Data were collected through questionnaires and anthropometric measures of height and weight. The WHO child growth standards were used to determine overweight and obesity. Data were analyzed using chi-square tests, with SPSS version 11.5. Results: The prevalence of overweight and obesity in children were 12% and 23.7% respectively. The prevalence of overweight was significantly higher in girls than boys and the prevalence of obesity was significantly higher in boys than girls (P = 0.001). Obesity was more prevalent in children from high economic percentiles, but this finding was not statistically significant. Conclusions: The prevalence of overweight and obesity in children under 5 years is high. Overweight and obesity should be considered an epidemic and serious health problem in Tehran. They certainly require more attention and intervention.

Prioritizing action on health inequities in cities: An evaluation of Urban Health Equity Assessment and Response Tool (Urban HEART) in 15 cities from Asia and Africa

Following the recommendations of the Commission on Social Determinants of Health (2008), the World Health Organization (WHO) developed the Urban Health Equity Assessment and Response Tool (HEART) to support local stakeholders in identifying and planning action on health inequities. The objective of this report is to analyze the experiences of cities in implementing Urban HEART in order to inform how the future development of the tool could support local stakeholders better in addressing health inequities.The study method is documentary analysis from independent evaluations and city implementation reports submitted to WHO. Independent evaluations were conducted in 2011–12 on Urban HEART piloting in 15 cities from seven countries in Asia and Africa: Indonesia, Iran, Kenya, Mongolia, Philippines, Sri Lanka, and Vietnam.Local or national health departments led Urban HEART piloting in 12 of the 15 cities. Other stakeholders commonly engaged included the city council, budget and planning departments, education sector, urban planning department, and the Mayor's office. Ten of the 12 core indicators recommended in Urban HEART were collected by at least 10 of the 15 cities. Improving access to safe water and sanitation was a priority equity-oriented intervention in 12 of the 15 cities, while unemployment was addressed in seven cities.Cities who piloted Urban HEART displayed confidence in its potential by sustaining or scaling up its use within their countries. Engagement of a wider group of stakeholders was more likely to lead to actions for improving health equity. Indicators that were collected were more likely to be acted upon. Quality of data for neighbourhoods within cities was one of the major issues.As local governments and stakeholders around the world gain greater control of decisions regarding their health, Urban HEART could prove to be a valuable tool in helping them pursue the goal of health equity.

Absolute and relative educational inequalities in obesity among adults in Tehran: Findings from the Urban HEART study-2

The prevalence of obesity is increasing in Iran. Previous studies showed mixed results in relation to association between socioeconomic status and obesity in the country. The current study aimed to examine educational inequalities among adults in Tehran in 2011. Data on 90,435 persons 18 years and older from Urban Health Equity Assessment and Response Tool (Urban HEART-2) were analyzed. The Slope Index of Inequality (SII) and the Relative Index of Inequality (RII) were used for assessing educational inequalities in obesity. These measures were quantified using generalized linear models for the binomial family adjusted for sex and age. Subgroup analysis was conducted across sex, age groups and the 22 districts of Tehran. Both SII and RII showed substantial educational inequalities in obesity in favour of more educated adults [RII and SII (95% CI were equal to 2.91 (2.71-3.11) and 0.12 (0.12-0.13)), respectively]. These educational inequalities were persistent even after adjusting for employment, marital status and smoking. Subgroup analysis revealed that educational inequalities were more profound among women. While among men educational inequalities were generally increasing with age, an inverse trend was observed among women. Educational inequalities were observed within all 22 districts of Tehran and generally there were no statistically significant differences between districts. An inverse association between education and obesity was observed in the current study. To decrease educational inequalities in Tehran, priority should be given to younger women and older men. Further analyses are needed to explain these inequalities.

Correlation of Cancer Incidence with Diet, Smoking and Socio-Economic Position Across 22 Districts of Tehran in 2008

Variation in cancer incidence in geographical locations is due to different lifestyles and risk factors. Diet and socio-economic position (SEP) have been identified as important for the etiology of cancer but patterns are changing and inconsistent. The aim of this study was to investigate correlations of the incidence of common cancers with food groups, total energy, smoking, and SEP. In an ecological study, disaggregated cancer data through the National Cancer Registry in Iran (2008) and dietary intake, smoking habits and SEP obtained through a population based survey within the Urban Health Equity Assessment (Urban-HEART) project were correlated across 22 districts of Tehran. Consumption of fruit, meat and dairy products adjusted for energy were positively correlated with bladder, colorectal, prostate and breast and total cancers in men and women, while these cancers were adversely correlated with bread and fat intake. Also prostate, breast, colorectal, bladder and ovarian cancers had a positive correlation with SEP; there was no correlation between SEP and skin cancer in both genders and stomach cancer in men. The incidence of cancer was higher in some regions of Tehran which appeared to be mainly determined by SEP rather than dietary intake. Further individual data are required to investigate reasons of cancer clustering.

The impact of socio economic factors on injuries in Tehran, IR Iran

IntroductionTehran is the capital city of IR Iran with about 12 000 000 inhabitants. Consisting of 22 districts. Injuries happen with different rate and type in different zones.ObjectivesTo improve urban...

Influence of sociodemographic features and general health on social capital: Findings from a large population-based survey in Tehran, Iran (Urban-HEART)

Social capital is associated with a number of sociodemographic characteristics and health outcomes. This study aimed to assess the components of social capital, and determine its association with different demographic features and general health in Tehran. A large population-based cross-sectional survey was conducted using the Urban Health Equity Assessment and Response Tool (Urban-HEART). A comprehensive questionnaire containing 13 sections, including a specific tool to measure social capital, was administered to 22,300 randomly selected clustered sample households within all 22 districts in Tehran between June and September 2008. The social capital questionnaire consists of two main components - structural and cognitive - which measure collective activities, voluntary help, social cohesion, social network, reciprocity and trust. The first question of Short Form-12 was used to evaluate self-rated health. Descriptive statistics, contingency tables, independent sample t-test, analysis of variance, post-hoc test (least squares difference) and multiple linear regression were used to detect differences. A P-value <0.01 was considered to indicate significance. The social capital questionnaire and health-related quality-of-life tool were completed by 21,704 individuals (response rate 97%) in all 22 districts of Tehran. All social capital components apart from participation varied by age group and gender (P < 0.01). An improvement was seen in several social capital components with increased level of education (P < 0.01). All social capital elements apart from volunteering were associated with marital status (P < 0.01). Family size, family assets and length of residence in neighbourhood were considered to be determinants of social capital (P < 0.01), and respondents with better health showed higher levels of social capital (P < 0.0001). Various individual and household characteristics influence social capital. General health and social capital are mutually and independently correlated with other determinants, so improvements in either may lead to higher levels of social capital and well-being.

Revealing mental health status in Iran's capital: Putting equity and efficiency together

Information about urban health is often based on averages, while to better understand health status in urban areas, inequality should also be included. In this paper, we applied an achievement index approach in order to surmount this defect and to examine mental health status in Iran's capital, Tehran. The data we required for this study were taken from the Urban Health Equity Assessment and Response Tool (Urban HEART) survey which was conducted in Tehran in 2007, covering people aged 15 and above. The concentration index, which is a commonly used measure of socioeconomic inequalities in health, was extended to enable the combination of inequality and averages and the formation of a mental health achievement index. Values from the standard concentration indices showed that mental disorders are concentrated disproportionately among the poor in Tehran. An extension of the standard concentration indices revealed that, in most of Tehran's districts, the mental health of populations in the poorest quintile is much worse than that of other groups. In addition, when we computed the achievement index and ranked districts according to this index, the ranking was different from the ranking by averages. These findings imply that mental health varies significantly across the economic groups of the population in Tehran and that efficiency-oriented strategies which target average level of mental health alone are not sufficient to improve mental health of all people especially mental health of the poor. Equity-oriented strategies which target the mental health inequalities should be considered as well.

Understanding determinants of socioeconomic inequality in mental health in Iran's capital, Tehran: a concentration index decomposition approach.

BackgroundMental health is of special importance regarding socioeconomic inequalities in health. On the one hand, mental health status mediates the relationship between economic inequality and health; on the other hand, mental health as an "end state" is affected by social factors and socioeconomic inequality. In spite of this, in examining socioeconomic inequalities in health, mental health has attracted less attention than physical health. As a first attempt in Iran, the objectives of this paper were to measure socioeconomic inequality in mental health, and then to untangle and quantify the contributions of potential determinants of mental health to the measured socioeconomic inequality.MethodsIn a cross-sectional observational study, mental health data were taken from an Urban Health Equity Assessment and Response Tool (Urban HEART) survey, conducted on 22 300 Tehran households in 2007 and covering people aged 15 and above. Principal component analysis was used to measure the economic status of households. As a measure of socioeconomic inequality, a concentration index of mental health was applied and decomposed into its determinants.ResultsThe overall concentration index of mental health in Tehran was -0.0673 (95% CI = -0.070 - -0.057). Decomposition of the concentration index revealed that economic status made the largest contribution (44.7%) to socioeconomic inequality in mental health. Educational status (13.4%), age group (13.1%), district of residence (12.5%) and employment status (6.5%) also proved further important contributors to the inequality.ConclusionsSocioeconomic inequalities exist in mental health status in Iran's capital, Tehran. Since the root of this avoidable inequality is in sectors outside the health system, a holistic mental health policy approach which includes social and economic determinants should be adopted to redress the inequitable distribution of mental health.

P1-113A Epidemiological pattern of injury by district in Tehran

IntroductionTehran is the capital city of IR Iran with about 12 000 000 inhabitants. Consisting of 22 districts. Injuries happen with different rate and type in different zones.Methods10% of population...

P1-312 Socioeconomic inequality and unintentional injuries among children in Tehran, findings of urban heart project

IntroductionThe assessment phase of Urban Health Equity Assessment and Response Tool (urban HEART) project was carried out in Tehran in 2008. The objective of this study is to determine the...