Global Burden of Disease Cancer Collaboration IMPORTANCE Cancer and other noncommunicable diseases (NCDs) are now widely recognized as a threat to global development. The latest United Nations high-level meeting on NCDs reaffirmed this observation and also highlighted the slow progress in meeting the 2011 Political Declaration on the Prevention and Control of Noncommunicable Diseases and the third Sustainable Development Goal. Lack of situational analyses, priority setting, and budgeting have been identified as major obstacles in achieving these goals. All of these have in common that they require information on the local cancer epidemiology. The Global Burden of Disease (GBD) study is uniquely poised to provide these crucial data. OBJECTIVE To describe cancer burden for 29 cancer groups in 195 countries from 1990 through 2017 to provide data needed for cancer control planning. EVIDENCE REVIEW We used the GBD study estimation methods to describe cancer incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life-years (DALYs). Results are presented at the national level as well as by Socio-demographic Index (SDI), a composite indicator of income, educational attainment, and total fertility rate. We also analyzed the influence of the epidemiological vs the demographic transition on cancer incidence. FINDINGS In 2017, there were 24.5 million incident cancer cases worldwide (16.8 million without nonmelanoma skin cancer [NMSC]) and 9.6 million cancer deaths. The majority of cancer DALYs came from years of life lost (97%), and only 3% came from years lived with disability. The odds of developing cancer were the lowest in the low SDI quintile (1 in 7) and the highest in the high SDI quintile (1 in 2) for both sexes. In 2017, the most common incident cancers in men were NMSC (4.3 million incident cases); tracheal, bronchus, and lung (TBL) cancer (1.5 million incident cases); and prostate cancer (1.3 million incident cases). The most common causes of cancer deaths and DALYs for men were TBL cancer (1.3 million deaths and 28.4 million DALYs), liver cancer (572 000 deaths and 15.2 million DALYs), and stomach cancer (542 000 deaths and 12.2 million DALYs). For women in 2017, the most common incident cancers were NMSC (3.3 million incident cases), breast cancer (1.9 million incident cases), and colorectal cancer (819 000 incident cases). The leading causes of cancer deaths and DALYs for women were breast cancer (601 000 deaths and 17.4 million DALYs), TBL cancer (596 000 deaths and 12.6 million DALYs), and colorectal cancer (414 000 deaths and 8.3 million DALYs). CONCLUSIONS AND RELEVANCE The national epidemiological profiles of cancer burden in the GBD study show large heterogeneities, which are a reflection of different exposures to risk factors, economic settings, lifestyles, and access to care and screening. The GBD study can be used by policy makers and other stakeholders to develop and improve national and local cancer control in order to achieve the global targets and improve equ...
Adolescent Iranian girls are at high risk for physical inactivity due to cultural barriers such as restrictions regarding exercising in public and research is needed to explore ethnic and gender-related factors associated with physical activity (PA) participation. Using social cognitive theory as the guiding model, the purpose of this study was to test the fit and strength of barriers self-efficacy, outcome expectations, self-regulation and social support in explaining PA in female Iranian adolescents (n 558). Using path analysis, social support was modeled as an antecedent of self-efficacy and outcome expectations, while self-efficacy was modeled as an antecedent of outcome expectations, selfregulatory planning and PA. Outcome expectations and self-regulatory planning were subsequently modeled as additional antecedents of PA. The model explained 52% of the variance in PA. The two significant (P < 0.05) direct effects were from self-efficacy and outcome expectations. Social support from mothers, fathers and friends had significant indirect effects on PA through self-efficacy. These results will allow for future research and interventions not only for female Iranian adolescents but also for similar cultural and immigrant groups that have been neglected to date in the PA literature.
Participation in regular physical activity is associated with a variety of positive outcomes for young people (Strong et al., 2005). Although many of the physiological benefits of physical activity are difficult to establish during youth (Cavill, Biddle, & Sallis, 2001; Riddoch, 1998), longitudinal studies have consistently demonstrated a positive link between an active lifestyle and a number of favorable outcomes during this period (Boreham et al., 2004; Epstein, Paluch, Gordy, & Dorn, 2000; McMurray et al., 2002). Despite the many benefits of an active lifestyle, physical activity levels decline during adolescence (Sallis, 2000). This decline is more pronounced among adolescent girls, who often opt out of compulsory physical activity at the first opportunity (Caspersen, Pereira, & Curran, 2000; U.S. Department of Health & Human Services, 1996). Adolescent Iranian girls are at a particularly high risk for adopting sedentary behavior due to specific cultural barriers, such as restrictions regarding exercising in public. A recent study of adolescent Iranian girls found that only 36% of individuals were in the adoption stages of physical activity (Taymoori, Niknami, Ghofranipour, & Kazemnejad, 2006). Schools have been identified as key institutions for the promotion of physical activity
BackgroundPhysical activity (PA) rates decline precipitously during the high school years and are consistently lower among adolescent girls than adolescent boys. Due to cultural barriers, this problem might be exacerbated in female Iranian adolescents. However, little intervention research has been conducted to try to increase PA participation rates with this population. Because PA interventions in schools have the potential to reach many children and adolescents, this study reports on PA intervention research conducted in all-female Iranian high schools.MethodsA randomized controlled trial was conducted to examine the effects of two six-month tailored interventions on potential determinants of PA and PA behavior. Students (N = 161) were randomly allocated to one of three conditions: an intervention based on Pender's Health Promotion model (HP), an intervention based on an integration of the health promotion model and selected constructs from the Transtheoretical model (THP), and a control group (CON). Measures were administered prior to the intervention, at post-intervention and at a six-month follow-up.ResultsRepeated measure ANOVAs showed a significant interaction between group and time for perceived benefits, self efficacy, interpersonal norms, social support, behavioral processes, and PA behavior, indicating that both intervention groups significantly improved across the 24-week intervention, whereas the control group did not. Participants in the THP group showed greater use of counter conditioning and stimulus control at post-intervention and at follow-up. While there were no significant differences in PA between the HP and CON groups at follow-up, a significant difference was still found between the THP and the CON group.ConclusionThis study provides the first evidence of the effectiveness of a PA intervention based on Pender's HP model combined with selected aspects of the TTM on potential determinants to increase PA among Iranian high school girls.
Breast cancer is a global issue that continues to be the most diagnosed cancer in women. The incidence of breast cancer is increasing, and the incidence age for Iranian women is at least 10 years earlier than in western countries. Beliefs related to breast cancer have been found to be a factor in a woman's decision about breast screening behavior, and a valid and reliable questionnaire is necessary to the development of education interventions in this area. The aim of the current study was to translate the Champion Health Belief Model Scale to Farsi and to examine the psychometric properties of the Farsi version. A random sample of 606 employed women (20-69 years old) from Sanandaj, Iran, participated in the study. Construct validity of the Farsi version was supported through factor analysis. Nine factors emerged for breast self-examination (2 barriers factors, 2 benefits factors, 2 confidence factors, and 1 factor each related to seriousness, motivation, and susceptibly) and 6 factors related to mammography (barriers, seriousness, susceptibly, benefits, and 2 motivation factors). All items loaded on their respective factors except 1 item. It was concluded that the Farsi version of the Champion Health Belief Model Scale has the potential to measure beliefs related to breast self-examination and mammography with Iranian women. Further evaluation of the measure with different populations is warranted.
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