Fatemeh Bakhtari Aghdam

Media Health Literacy (MHL) is essential for individuals to access, evaluate, and apply health information from diverse media sources, particularly in the

The COVID-19 infodemic underscored the urgent need to strengthen media health literacy (MHL) as a cornerstone of public health resilience. This perspective examines MHL within the complex sociopolitical, cultural, and digital landscape of the Middle East and North Africa (MENA) region, where misinformation, inequities, and limited institutional trust amplify health vulnerabilities. It proposes an integrated framework built on 4 pillars—policy and advocacy, multi-sectoral collaboration, empowerment of vulnerable populations, and technology-driven innovation—to foster equitable access to reliable health information. Advancing MHL in MENA is essential to building trust, enhancing informed decision-making, and promoting regional health equity.

Background: Pedestrian injury is a global public health concern. Multi-level community-based health education campaigns offer promise to reduce the burden. The current study investigated the effect of a multi-level intervention based on the socio-ecological model (SEM) to improve pedestrian safety by training health worker supervisors in Iran, with the expectation that they would disseminate their learned knowledge more broadly in the population.Methods: Eighty-two health worker supervisors in Tabriz, Iran were randomized to an intervention or control group, with 41 assigned to each group. Participants in the intervention group received both live pedestrian safety education and offline training through a virtual WhatsApp group. Messages, pictures, and short videos about pedestrian safety were sent to participants, and solutions were discussed in the group settings. The control group had no training. Self-reported pedestrian behavior was assessed before and after the intervention.Results: At baseline, there were no significant differences between the intervention (82.48 ± 8.54) and control (81.05 ± 8.55) groups in pedestrian behavior scores (t = 2.01, p = 0.001). After the intervention, the average score of pedestrians’ behaviors of the intervention group increased significantly compared to the control group (87.98 ± 5.83 vs. 80.37 ± 9.03), (t = 3.61, p = 0.0002). All five subscale scores of PBQ, including adherence to traffic rules and recommendation, violations, positive behaviors, distraction, and aggressive behaviors showed similar and significant changes in the intervention group compared to control group.Conclusion: Application of a multi-level intervention based on the socio-ecological model improved self-reported pedestrian behavior of health worker supervisors. Using multi-level interventions by targeting health workers, who then disseminate their learning to the public, could enhance pedestrian safety across society.

ObjectivePedestrians are one of the most vulnerable users in road traffic injuries (RTIs). The rate of pedestrians' fatality is high in Iran. It is worthwhile to investigate how pedestrians behave. This observational study aimed to investigate pedestrians' unsafe behaviors while crossing.MethodsThis cross-sectional study examined the behavior of 1095 pedestrians (69.7% men) using videotaping when they crossed at two intersections and three non-intersections on a weekend and two working days in the morning, at noon, and in the evening. The information obtained was classified into 5 domains including adherence to traffic rule, violation, environmental barriers, visibility, and distraction. Data were analyzed using Stata version 17.ResultsAbout 60% of the pedestrians ignored the crosswalk and crossed the street wherever they wanted. More than 30% ignored the vehicles passing and crossed the street inattentively. About 60% of the pedestrians committed violations. More than half of pedestrians crossed unsafe crossings diagonally or in a hurry. More than 35% wore dark clothing and had low visibility, and nearly 30% were distracted. Adolescent pedestrians did not adhere traffic rules about 6 times more than the young adult pedestrians. Pedestrians who did not adhere to traffic rules in the morning were significantly more than in the evening. Men committed a violation 1.47 times more than women. The results showed that the pedestrians committed a violation in the morning significantly more than in the evening.ConclusionThe occurrence of pedestrians' unsafe behaviors in Maku was high. Unsafe behaviors were high among men and young adult pedestrians. Therefore, it's essential to implement educational interventions via different media as well as environmental interventions by different organizations to improve safe behavior among pedestrians.

Lack of protection or improper protection, is one of the most important reasons of child passenger’s death and injury in traffic crashes. Based on what we see on the roads, Iranian children are unrestrained inside the car. The aim of this study was to investigate children restrained system (CRS) use rate, its socio-demographic determinants and parents’ knowledge toward CRS use among Iranian parents. Using multi-stage cluster sampling and direct in filed method of observation, the behavior of 700 children in cars was observed in the current cross-sectional study. Socio-demographic determinants and parents’ knowledge, toward using the CRS were evaluated using questionnaires. The study was performed from July to August 2019 in Tabriz city, northwestern Iran. The rate of child safety seat (CSS) use was 15.1% CI 95%:(12.5%,18.0%), and the rate of booster use was 0.6%; CI 95%:(4.3%,8.0%). The majority of parents [e.g. 64.3%; CI 95%: (60.7%,67.9%)], had low knowledge about the use of CRS. The most important reasons for not using CRS was lack of laws and policies [e.g. 59.7%; CI 95%:(12.5%,18.0%)], lack of knowledge [e.g.59.6%; CI 95%:(57.9%, 63.3%)] and the high cost of CRS [e.g. 57.6%; CI 95%:(53.81%,61.2%)]. The most important predictors of not using CRS were the child's age, parental knowledge, and the socioeconomic status of the household (p < 0.05). Most children did not have CRS. The parents with higher education and those with higher socioeconomic status had higher rate of CRS use. Based on the low rate of CRS use and poor parental knowledge about it, education of parents toward boosters use and benefits of using CRS, enforcing mandatory laws and ploicies for CRS use in Iran, and allocation of government subsidies to low-income families for purchasing CRS are suggeted as essential strategies to increase CRS use.

Background: Determining people’s healthy behaviors related to COVID-19 could be effective in providing preventive measures. The present study aims to investigate preventive behaviors associated with COVID-19 including wearing masks and keeping physical distance among the passengers on buses and public taxis measures to evaluate the ventilation systems in these vehicles. Methods: This cross-sectional study was performed on 753 passengers on buses and taxis in Tabriz, northwestern Iran, from 15 February to 1 March 2021. Multistage sampling method was used to select the participants. Tabriz was socioeconomically divided into three areas, including high, moderate, and low socioeconomic status. Three researchers were observed passengers behaviors standing at the selected stations and assessed their behaviors according to study checklist. Results: In total, the data were gathered from 358 (47.5%) female and 395 (52.5%) male in public transport systems. The results of this study indicated that female passengers used masks significantly more than men (P < 0.001). About 40% of men and women did not keep a physical distance of at least one meter in the public transportation system. Failing to keep social distancing was mostly observed among people with low SES (N = 103, 54%) and those who were in city center (N = 88, 48.5%). According to the multivariate regression analysis, for not wearing mask: being male [OR 4.94; 95%CI (2.62–9.28)] and using bus [(OR 3.27, 95%CI (1.73,6.19)], and for not physical distancing: having age under 25 years [OR 2.58; 95%CI (1.53,4.36)] and low socioeconomic status (SES) [OR 5.19; 95%CI (3.25,8.30)], and for no ventilation: using bus [OR 1.57; 95%CI (1.05,2.34)] were significant predictors. Conclusion: Our results suggest that gender, type of vehicle, age, and SES were significant predictors of non-adherence to COVID-19 preventive behaviors in public transport during the pandemic. Given that social distancing is less observed in the public transportation system in Tabriz, Iran, it is necessary for government to consider and monitor guidelines to protect the passengers from COVID-19 infections by providing measures to maintain physical distance in public transportation systems. It may be possible to force vehicle owners who do not comply with health protocols to keep some distance by imposing fines.

Background: Elderly pedestrians are among the most vulnerable groups in terms of traffic-related injuries. This study aimed to investigate traffic behavior and its determinants among elderly pedestrians in Iran.Methods: This cross-sectional study examined the traffic behavior of 600 elderly pedestrians in Zanjan, northwestern Iran. Pedestrian traffic behavior was evaluated in five domains (traffic violations, traffic distraction, adherence to traffic rules, aggressive behaviors, and positive behaviors) using the Pedestrian Behavior Questionnaire (PBQ). Participants’ socioeconomic status (SES) was assessed by an SES questionnaire, and cognitive function was assessed by the Abbreviated Mental Test score (AMTS). The participants were selected using the multistage random sampling method.Results: 50% of elders were man. 488 (81.3%) of them had 60-74 and 112 (18.7%) were 75 years old and above. More than 90% of elderly pedestrians showed unsafe traffic behavior. This included traffic violations and failure to adhere to traffic rules. Almost half the elders were aggressive and distracted when walking and crossing the street. Higher SES was associated with both higher cognitive status and safer traffic behavior. Higher SES, healthy cognitive function, male sex, walking more than 1 hour a day, higher levels of education, and being married were among the determinants of safe traffic behavior.Conclusion: The majority of the elders showed unsafe traffic behavior Elderly pedestrians with high SES and healthy cognitive function were more likely to exhibit safe behavior than those with low SES and cognitive dysfunction. . Interventions are needed to improve the traffic behavior of elderly pedestrians special with low SES.

Objective: Pedestrians are among the most vulnerable groups in traffic accidents. In this cross-sectional study, the behavior of 600 pedestrians in Iran, using a pedestrian traffic behavior questionnaire. Cluster sampling was conducted among 30% of the health centers in each district of the city. Thereafter, individuals were randomly selected from each center depending on the covered population. Results: Although 17% of the pedestrians demonstrated safe traffic behaviors, over 85% were distracted, more than 80% did not comply with traffic laws, the majority violated rules and displayed no positive traffic behaviors, and half of the participants were aggressive. Age, gender, marital status, education level, daily walking rate, and transportation mode were significant predictors of traffic behavior.

Background: Pedestrians are among the most vulnerable groups in traffic accidents. This study investigates the determinants of traffic behaviors of pedestrians. Methods: In this cross-sectional study, the behavior of 600 pedestrians in the city of Urmia, northwestern Iran, was evaluated from May to October 2018, using a pedestrian traffic behavior questionnaire consisting of five dimensions: traffic violations, traffic distraction, adherence to traffic rules, aggressive behavior, and positive behaviors. Cluster sampling was conducted among 30% of the health centers in each district of the city. Thereafter, individuals were randomly selected from each center depending on the covered population. Results: Although 17% of the pedestrians demonstrated safe traffic behaviors, over 85% were distracted, more than 80% did not comply with traffic laws, the majority violated rules and displayed no positive traffic behaviors, and half of the participants were aggressive. Age, gender, marital status, education level, daily walking rate, and transportation mode were significant predictors of traffic behavior.Conclusion: Most pedestrians demonstrate unsafe traffic behaviors. The youth, those who were single, those with lower education, and those with less walking rate showcased higher unsafe behaviors. Training and intervention programs should be implemented to improve all domains of pedestrian traffic behaviors factoring in age and other predictors.