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Article ; Online: Obesity Incidence in U.S. Children and Young Adults: A Pooled Analysis.

Rafei, Ali / Elliott, Michael R / Jones, Rebecca E / Riosmena, Fernando / Cunningham, Solveig A / Mehta, Neil K

2022 Volume 63, Issue 1, Page(s) 51–59

Abstract: Introduction: Obesity prevalence among children and adolescents has risen sharply, yet there is a limited understanding of the age-specific dynamics of obesity as there is no single nationally representative cohort following children into young ... ...

Abstract	Introduction: Obesity prevalence among children and adolescents has risen sharply, yet there is a limited understanding of the age-specific dynamics of obesity as there is no single nationally representative cohort following children into young adulthood. Investigators constructed a pooled data set of 5 nationally representative panels and modeled age-specific obesity incidence from childhood into young adulthood. Methods: This longitudinal prospective follow-up used 718,560 person-years of observation in a pooled data set of 5 high-quality nationally representative panels-National Longitudinal Survey of Youth 1979 and 1997, National Longitudinal Study of Adolescent Health, and Early Childhood Longitudinal Study-Kindergarten cohorts of 1998 and 2011-constructed by the authors, covering 1980-2016. Differences in obesity incidence across birth cohorts and disparities in obesity incidence by sex and race/ethnicity (non-Hispanic Black, Hispanic, and non-Hispanic White) were tested in multivariate models. Data were analyzed from September 2018 to October 2021. Results: Obesity incidence increased by approximately 6% for each 1 year of age (hazard ratio=1.06, 95% CI=1.05, 1.07); however, incidence was nonlinear, exhibiting an inverted "U"-shaped pattern before 15 years of age and then rising from adolescence through 30 years. Obesity incidence more than doubled between the cohorts born in 1957-1965 and those born in 1974-1985 during adolescence. There was no significant change among those born in 1991-1994 and 2003-2006 up to age 15 years. Compared with non-Hispanic White children, non-Hispanic Black and Hispanic children had higher obesity incidence in all study cohorts. The magnitude of these disparities on the relative scale remained stable throughout the study period. Conclusions: Although many children become obese before the age of 10, obesity incidence rises from about 15 years into early adulthood, suggesting that interventions are required at multiple developmental stages.
MeSH term(s)	Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Hispanic or Latino ; Humans ; Incidence ; Longitudinal Studies ; Obesity/epidemiology ; Prospective Studies ; United States/epidemiology ; Young Adult
Language	English
Publishing date	2022-03-04
Publishing country	Netherlands
Document type	Journal Article ; Meta-Analysis ; Research Support, N.I.H., Extramural
ZDB-ID	632646-8
ISSN	1873-2607 ; 0749-3797
ISSN (online)	1873-2607
ISSN	0749-3797
DOI	10.1016/j.amepre.2021.12.021
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Article ; Online: Discriminatory Accuracy of the Gail Model for Breast Cancer Risk Assessment among Iranian Women.

Rostami, Sahar / Rafei, Ali / Damghanian, Maryam / Khakbazan, Zohreh / Maleki, Farzad / Zendehdel, Kazem

Iranian journal of public health

2020 Volume 49, Issue 11, Page(s) 2205–2213

Abstract: Background: The Gail model is the most well-known tool for breast cancer risk assessment worldwide. Although it was validated in various Western populations, inconsistent results were reported from Asian populations. We used data from a large case- ... ...

Abstract	Background: The Gail model is the most well-known tool for breast cancer risk assessment worldwide. Although it was validated in various Western populations, inconsistent results were reported from Asian populations. We used data from a large case-control study and evaluated the discriminatory accuracy of the Gail model for breast cancer risk assessment among the Iranian female population. Methods: We used data from 942 breast cancer patients and 975 healthy controls at the Cancer Institute of Iran, Tehran, Iran, in 2016. We refitted the Gail model to our case-control data (the IR-Gail model). We compared the discriminatory power of the IR-Gail with the original Gail model, using ROC curve analyses and estimation of the area under the ROC curve (AUC). Results: Except for the history of biopsies that showed an extremely high relative risk (OR=9.1), the observed ORs were similar to the estimates observed in Gail's study. Incidence rates of breast cancer were extremely lower in Iran than in the USA, leading to a lower average absolute risk among the Iranian population (2.78, ±SD 2.45). The AUC was significantly improved after refitting the model, but it remained modest (0.636 vs. 0.627, ΔAUC = 0.009, bootstrapped Conclusion: Although the coefficients from the local study improved the discriminatory accuracy of the model, it remained modest. Cohort studies are warranted to evaluate the validity of the model for Iranian women.
Language	English
Publishing date	2020-12-21
Publishing country	Iran
Document type	Journal Article
ZDB-ID	2240935-X
ISSN	2251-6093 ; 2251-6093
ISSN (online)	2251-6093
ISSN	2251-6093
DOI	10.18502/ijph.v49i11.4739
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Article ; Online: A warning threshold for monitoring tuberculosis surveillance data: an alternative to hidden Markov model.

Rafei, Ali / Pasha, Einollah / Jamshidi Orak, Roohangiz

Tropical medicine & international health : TM & IH

2015 Volume 20, Issue 7, Page(s) 919–929

Abstract: Objectives: Although hidden Markov model (HMM) is known as a powerful tool for the detection of epidemics based on the historical data, the frequent use of such a model poses some limitation especially when decision-making is required for new ... ...

Abstract	Objectives: Although hidden Markov model (HMM) is known as a powerful tool for the detection of epidemics based on the historical data, the frequent use of such a model poses some limitation especially when decision-making is required for new observations. This study was aimed to address a warning threshold for monitoring the weekly incidences of tuberculosis as an alternative to HMM. Methods: We extracted the weekly counts of newly diagnosed patients with sputum smear-positive pulmonary TB from 2005 to 2011 nationwide. To detect unexpected incidences of the disease, two approaches: Serfling and HMM, were applied in presence/absence of linear, seasonal and autoregressive components. Models were subsequently evaluated in terms of goodness of fit, and their results were compared in detection of the disease phases. Then, multiple hypothetical thresholds were constructed based on the estimate of models and the optimal one was revealed through ROC curve analysis. Results: Findings from both adjusted R-square (R~2) and Bayesian information criterion (BIC) presented a higher goodness of fit for periodic autoregressive HMM (BIC = -1323.6; R~2=0.74) than other models. According to ROC analysis, better values for both Youden's index and area under curve (0. 96 and 0. 98 respectively) were obtained by the threshold based on the estimate of periodic autoregressive model. Conclusions: As the optimal threshold presented in this study is simple in concept and has no limitation in practice, especially for monitoring new observations, we would recommend such a threshold to be used for monitoring of TB incidence data in the surveillance system.
MeSH term(s)	Algorithms ; Area Under Curve ; Bayes Theorem ; Communicable Diseases/epidemiology ; Disease Outbreaks ; Epidemics ; Humans ; Incidence ; Markov Chains ; Models, Biological ; Models, Statistical ; Population Surveillance/methods ; ROC Curve ; Tuberculosis, Pulmonary/epidemiology
Language	English
Publishing date	2015-07
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1314080-2
ISSN	1365-3156 ; 1360-2276
ISSN (online)	1365-3156
ISSN	1360-2276
DOI	10.1111/tmi.12494
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Article: Validation of Diet History Questionnaire in Assessing Energy and Nutrient Intakes of Iranian Population.

Toorang, Fatemeh / Sasanfar, Bahareh / Razeghi Jahromi, Soodeh / Ebrahimpour Koujan, Soraiya / Narmcheshm, Saba / Rafei, Ali / Zendehdel, Kazem

Iranian journal of public health

2019 Volume 48, Issue 6, Page(s) 1074–1081

Abstract: Background: This study described validity of Diet History Questionnaire (DHQ) for assessing energy and nutrient intake among Iranian population.: Methods: A group of experienced nutritionists translated the DHQ to Farsi language and modified it based ...

Abstract	Background: This study described validity of Diet History Questionnaire (DHQ) for assessing energy and nutrient intake among Iranian population. Methods: A group of experienced nutritionists translated the DHQ to Farsi language and modified it based on Iranian food habits and cooking methods. We recruited 244 healthy adults with a mean age of 42.83 ± 0.75 yrs. from healthy individuals who were friends or relatives of patients in the Cancer Institute of Iran from April 2011 to February 2012. We used the DHQ to assess dietary intakes through interviews as well as at least four 24-h recalls one in every season. Reliability was estimated by comparing data of DHQ with mean intake from 24-hour recalls using deattenuated and energy-adjusted Spearman correlation coefficients. We classified dietary intakes of two methods into three groups to probe if DHQ correctly allocates subjects into different intake groups compared to reference method. The results are reported as percent of disagreement, adjacent agreement, and complete agreement. Results: Deattenuated spearman correlation ranged from 0.18 for vitamin B Conclusion: The DHQ is a valid tool for assessing most nutrients intake among Iranian population. In addition, it is a proper instrument in categorizing individuals based on their dietary intakes.
Language	English
Publishing date	2019-06-03
Publishing country	Iran
Document type	Journal Article
ISSN	2251-6085
ISSN	2251-6085
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Article ; Online: Response to the Letter on the Gap of Cigarette and Hookah Smoking between Socioeconomic Groups in Iran: Effect of Inequalities in Socioeconomic Position.

Ghelichkhani, Parisa / Yaseri, Mehdi / Yousefifard, Mahmoud / Baikpour, Masoud / Asady, Hadi / Oraii, Alireza / Rafei, Ali / Hosseini, Mostafa

Archives of Iranian medicine

2019 Volume 22, Issue 3, Page(s) 166–167

MeSH term(s)	Iran ; Smoking ; Socioeconomic Factors ; Water Pipe Smoking
Language	English
Publishing date	2019-03-01
Publishing country	Iran
Document type	Letter ; Comment
ZDB-ID	2204979-4
ISSN	1735-3947 ; 1029-2977
ISSN (online)	1735-3947
ISSN	1029-2977
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Article ; Online: Oral hygiene status in a general population of Iran, 2011: a key lifestyle marker in relation to common risk factors of non-communicable diseases.

Asgari, Fereshteh / Majidi, Azam / Koohpayehzadeh, Jalil / Etemad, Koorosh / Rafei, Ali

International journal of health policy and management

2015 Volume 4, Issue 6, Page(s) 343–352

Abstract: Background: To estimate Oral Hygiene (OH) status in the Iranian population in 2011, and to determine the influence of socio-economic characteristics on OH, and its interrelation with common risk factors of Non-Communicable Diseases (NCDs).: Methods: ... ...

Abstract	Background: To estimate Oral Hygiene (OH) status in the Iranian population in 2011, and to determine the influence of socio-economic characteristics on OH, and its interrelation with common risk factors of Non-Communicable Diseases (NCDs). Methods: Data including a total of 12,105 individuals aged 6-70 years were obtained from the sixth round of the surveys of NCDs risk factors in Iran. OH was recorded through a structured questionnaire measuring daily frequencies of tooth brushing and dental flossing. Descriptive analyses were performed on demographic characteristics in the complex sample survey setting. We also employed weighted binary logistic regression to compute Odds Ratio (OR) as a measure of association between the response and explanatory factors. Furthermore, to construct an asset index, we utilized Principal Component Analysis (PCA). Results: The percentage with minimum recommended daily OH practices was 3.7% among men and 7.7% among women (OR= 2.3; P<0.001). Urban citizens were more likely to have their teeth cleaned compared to rural people (OR= 2.8; P<0.001). For both genders, a relatively better condition was observed in the 25-34 age group (male: 5.6%; female: 10.3%). In addition, OH status improved significantly by increase in both level of education (P<0.001) and economic status (P<0.001). There were also apparent associations between self-care practices and specific behavioral risk factors, though the correlation with dietary habits and tobacco use could be largely explained by socio-economic factors. Conclusion: OH situation in Iran calls for urgent need to assign proper interventions and strategies toward raising public awareness and reducing disparities in access to health facilities.
MeSH term(s)	Adolescent ; Adult ; Aged ; Child ; Dental Devices, Home Care/utilization ; Female ; Humans ; Iran/epidemiology ; Logistic Models ; Male ; Middle Aged ; Risk Factors ; Rural Health ; Socioeconomic Factors ; Surveys and Questionnaires ; Toothbrushing/statistics & numerical data ; Urban Health ; Young Adult
Language	English
Publishing date	2015-01-30
Publishing country	Iran
Document type	Journal Article
ZDB-ID	2724317-5
ISSN	2322-5939 ; 2322-5939
ISSN (online)	2322-5939
ISSN	2322-5939
DOI	10.15171/ijhpm.2015.18
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Article ; Online: Diseases and Health Outcomes Registry Systems in I.R. Iran: Successful Initiative to Improve Public Health Programs, Quality of Care, and Biomedical Research.

Mojarrab, Shahnaz / Rafei, Ali / Akhondzadeh, Shahin / Jeddian, Alireza / Jafarpour, Maryam / Zendehdel, Kazem

Archives of Iranian medicine

2017 Volume 20, Issue 11, Page(s) 696–703

Abstract: Registration systems for diseases and other health outcomes provide important resource for biomedical research, as well as tools for public health surveillance and improvement of quality of care. The Ministry of Health and Medical Education (MOHME) of ... ...

Abstract	Registration systems for diseases and other health outcomes provide important resource for biomedical research, as well as tools for public health surveillance and improvement of quality of care. The Ministry of Health and Medical Education (MOHME) of Iran launched a national program to establish registration systems for different diseases and health outcomes. Based on the national program, we organized several workshops and training programs and disseminated the concepts and knowledge of the registration systems. Following a call for proposals, we received 100 applications and after thorough evaluation and corrections by the principal investigators, we approved and granted about 80 registries for three years. Having strong steering committee, committed executive and scientific group, establishing national and international collaboration, stating clear objectives, applying feasible software, and considering stable financing were key components for a successful registry and were considered in the evaluation processes. We paid particulate attention to non-communicable diseases, which constitute an emerging public health problem. We prioritized establishment of regional population-based cancer registries (PBCRs) in 10 provinces in collaboration with the International Agency for Research on Cancer. This initiative was successful and registry programs became popular among researchers and research centers and created several national and international collaborations in different areas to answer important public health and clinical questions. In this paper, we report the details of the program and list of registries that were granted in the first round.
MeSH term(s)	Biomedical Research/standards ; Humans ; Iran/epidemiology ; Neoplasms/epidemiology ; Program Evaluation/standards ; Public Health ; Registries/statistics & numerical data
Language	English
Publishing date	2017-11-01
Publishing country	Iran
Document type	Journal Article
ZDB-ID	2204979-4
ISSN	1735-3947 ; 1029-2977
ISSN (online)	1735-3947
ISSN	1029-2977
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Article ; Online: Cigarette and Water-Pipe Use in Iran: Geographical Distribution and Time Trends among the Adult Population; A Pooled Analysis of National STEPS Surveys, 2006-2009.

Nemati, Saeed / Rafei, Ali / Freedman, Neal D / Fotouhi, Akbar / Asgary, Fereshteh / Zendehdel, Kazem

Archives of Iranian medicine

2017 Volume 20, Issue 5, Page(s) 295–301

Abstract: Objective: To assess the geographical distribution and time trends of manufactured cigarette and water-pipe use among Iranian adult population.: Method: Pooled data from four consecutive nationally and provincially representative STEPS surveys, 2006- ... ...

Abstract	Objective: To assess the geographical distribution and time trends of manufactured cigarette and water-pipe use among Iranian adult population. Method: Pooled data from four consecutive nationally and provincially representative STEPS surveys, 2006-2009, were analyzed. Prevalence of current daily manufactured cigarette smokers, current daily water-pipe and current daily dual users and associated 95%CIs were estimated using complex sample analysis techniques. Results: Overall, the prevalence of current daily tobacco use, including cigarette and water-pipe, was estimated 23.7% for men and 3.0% for women, in which 20.2% of men and 0.8% of women were exclusively cigarette smokers, 2.7% and 2.2% were exclusively water-pipe users, and 0.6% and 0.01% smoked both cigarettes and water-pipes. The prevalence of cigarette smoking ranged from 12.3% to 27.7% in men and 0.1% to 1.8% in women, and was generally highest in the northwest of the country. Conversely, the prevalence of water-pipe smoking ranged from 1.7% to 10.9% in men and 0% to 16.8% in women, and was highest in the south and southeast. No secular trends were observed for daily cigarette smoking in either men (P = 0.637) or women (P = 0.308) from 2006 to 2009. However, the prevalence of water-pipe decreased slightly in women (P = 0.012) and men (P = 0.055), though the later was not statistically significant. Conclusion: In Iran, widespread geographical variation in the use of different types of tobacco products should be taken into account when planning for tobacco prevention policies and programs. Iran may serve as an important setting for etiological studies to examine the effects of long-term water pipe use on diseases.
MeSH term(s)	Adolescent ; Adult ; Age Distribution ; Aged ; Cigarette Smoking/epidemiology ; Female ; Health Surveys ; Humans ; Iran/epidemiology ; Middle Aged ; Prevalence ; Rural Population/statistics & numerical data ; Tobacco Use/prevention & control ; Urban Population/statistics & numerical data ; Water Pipe Smoking/epidemiology ; Young Adult
Language	English
Publishing date	2017-05
Publishing country	Iran
Document type	Journal Article
ZDB-ID	2204979-4
ISSN	1735-3947 ; 1029-2977
ISSN (online)	1735-3947
ISSN	1029-2977
DOI	0172005/AIM.007
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Article ; Online: The Gap of Cigarette and Hookah Smoking Between Socioeconomic Groups in Iran: Effect of Inequalities on Socioeconomic Position.

Ghelichkhani, Parisa / Yaseri, Mehdi / Yousefifard, Mahmoud / Baikpour, Masoud / Asady, Hadi / Oraii, Alireza / Rafei, Ali / Hosseini, Mostafa

Archives of Iranian medicine

2018 Volume 21, Issue 9, Page(s) 418–424

Abstract: Background: Hookah and cigarette smoking have adverse effects on individuals' health and therefore place a great burden on public health. The aim of this study was to measure inequalities in socioeconomic position to determine contributing factors on ... ...

Abstract	Background: Hookah and cigarette smoking have adverse effects on individuals' health and therefore place a great burden on public health. The aim of this study was to measure inequalities in socioeconomic position to determine contributing factors on cigarette and hookah smoking in Iran. Methods: In this study, secondary analysis of the Iran's sixth national Surveillance of Risk Factors of Non-Communicable Diseases (SuRFNCD-2011) was conducted for 10,572 individuals aged 15 to 70 years old. Subjects were categorized into three groups according to their socioeconomic status (low, middle and high) in order to assess their inequalities using principal component analysis. At the end, the gap between the low and high socioeconomic groups was decomposed using Blinder-Oaxaca decomposition technique. Results: The prevalence of cigarette and hookah smoking in high, middle, and low socioeconomic groups was 11.8%, 13.2%, and 13.1% (P=0.158), and 2.6%, 3.3% and 4.3%, (P<0.001), respectively. Blinder-Oaxaca decomposition technique showed a lower prevalence of hookah smoking in high socioeconomic group compared to low socioeconomic group (P<0.001). The gap between the two mentioned groups was measured to be 1.7%. However, this gap for cigarette smoking (1.5%) was not significant (P=0.093). Conclusion: The finding indicates the importance of socioeconomic status in hookah smoking. After decomposition of the gap between the 2 socioeconomic groups, age, gender and education level were reported to be the major contributors to the differences observed between the 2 groups.
MeSH term(s)	Adolescent ; Adult ; Age Distribution ; Aged ; Cigarette Smoking/epidemiology ; Female ; Humans ; Iran/epidemiology ; Logistic Models ; Male ; Middle Aged ; Risk Factors ; Sex Distribution ; Social Class ; Water Pipe Smoking/epidemiology ; Young Adult
Language	English
Publishing date	2018-09-01
Publishing country	Iran
Document type	Comparative Study ; Journal Article
ZDB-ID	2204979-4
ISSN	1735-3947 ; 1029-2977
ISSN (online)	1735-3947
ISSN	1029-2977
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Article ; Online: Age, Period and Cohort Analysis of Smoking Prevalence in Iranian Population over a 25-Year Period.

Ghelichkhani, Parisa / Baikpour, Masoud / Mohammad, Kazem / Rahim Fattah, Fattah Hama / Rezaei, Nazila / Ahmadi, Naser / Darvish Noori Kalaki, Simin / Gubari, Mohammed I M / Rafei, Ali / Koohpayehzadeh, Jalil / Gouya, Mohammad Mehdi / Yousefifard, Mahmoud / Jones, Michael E / Hosseini, Mostafa

Archives of Iranian medicine

2021 Volume 24, Issue 1, Page(s) 7–14

Abstract: Background: Current and daily smoking prevalence rates have been have investigated in several cross-sectional studies. However, analyses in terms of age-period-cohort (APC) have not been carried out. We assessed daily smoking dynamics over a 25-year ... ...

Abstract	Background: Current and daily smoking prevalence rates have been have investigated in several cross-sectional studies. However, analyses in terms of age-period-cohort (APC) have not been carried out. We assessed daily smoking dynamics over a 25-year period using the APC model. Methods: In our analyses, we used data from 214,652 people aged 15 to 64 years, collected by national health surveys conducted in 1990-1991, 1999, 2005, 2007, 2011 and 2016. The Intrinsic Estimator model was used to analyze the impact of APC on daily smoking prevalence. Results: Males were found to exhibit a higher prevalence of smoking compared to females (26.0% against 2.7%). Prevalence of smoking increased by age, peaking at the age groups of 40-44 in men and 45-49 in women, followed by a decreasing trend. The 1990 period had the highest prevalence in both genders, and the 2016 period had the lowest. The coefficients of birth cohort effects showed different patter19s of fluctuations in the two genders with the maximum and minimum coefficients for men calculated in the 1966-1970 and 1991-95 birth cohorts, and for females the 1931-1935 and 1971-1975 birth cohorts, respectively. Conclusion: We showed the impact of APC on daily tobacco smoking prevalence, and these factors should be considered when dealing with smoking.
MeSH term(s)	Adolescent ; Adult ; Age Distribution ; Female ; Health Surveys ; Humans ; Iran/epidemiology ; Longitudinal Studies ; Male ; Middle Aged ; Prevalence ; Sex Distribution ; Tobacco Smoking/epidemiology ; Young Adult
Language	English
Publishing date	2021-01-01
Publishing country	Iran
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2204979-4
ISSN	1735-3947 ; 1029-2977
ISSN (online)	1735-3947
ISSN	1029-2977
DOI	10.34172/aim.2021.02
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