1. Title: The effect of education on promoting behaviors of Preventing Cardiovascular Diseases in Yazd Restaurant Chefs By: Shahbazi H 1 *, Mazloomi Mahmoodabad SS 2 1 PhD Student,Tarbiat Modares University 2 Professor, Shahid Sadoughi University of Medical Sciences

3. Introduction Cardiovascular Diseases

4.  CVDs are the number 1 cause of death globally.  The mortality portion of CVDs at the start of 20 th century was 10% of all deaths, but at the end of century this rate had been increased to 25%.  17.5 million people died from CVDs in 2012, representing 31% of all global deaths.  If policy makers don`t design preventive programs, this rate will be increased to 24.8 millions of deaths till 2020. Introduction

5.  Over three quarters of CVD deaths take place in low- and middle-income countries, including Iran.  Gersh et al has placed Middle East as region that 35-65% of all deaths are due to CVDs.  The Global Burden of Disease study has reported that the share of deaths due to cardiovascular diseases in Iran increased from 31.9% in 1990 to 46.8% in 2010.  Based on Naghavi & et al and Kadivar & et al studies, CVDs are the leading cause of mortality in Yazd. Introduction

6.  cardiovascular diseases can be prevented by addressing behavioral risk factors such as tobacco use, unhealthy diet and obesity, physical inactivity and harmful use of alcohol using population-wide strategies. Introduction

7. Chefs and Cardiovascular Diseases????? Introduction

8.  Are important for two reasons: 1- Chefs, like other members of the community, are at risk for cardiovascular disease.  Hartung et al, found that Chefs are in higher risk of CVDs, compared to the office-workers. Introduction

9.  Are important for two reasons: 2- Chefs have important roles and responsibilities in public health.  Recent research showed that unhealthy eating is the main cause of cardiovascular disease.  Many studies have shown that tendency of people to using foods in restaurants is increasing. Introduction

10.  They can maintain the taste and aroma of foods but add fiber like vegetables and fruits and lower the fats of foods and then help to decrease the total calories of served food.  Total fat in food can be decreased from 57% to 30% without any sense of change in natural taste and aroma of food.  quality of foods that are serving in restaurants reflects the knowledge and practice of chefs and staffs of restaurant. Introduction

11. Materials and Methods

12.  Samples: All chefs of restaurants and hotels Yazd city. Totally 78 chefs were divided into two groups with 39 cases. During study 3 chefs discontinues the study and were excluded. Interventional factor was education using lecture, poster and film. A written consent was taken from each chef. Data were gathered through a questionnaire researcher made that confirmed validity following health education and cardiovascular Professionals and reliability were calculated by pilot and Cronbach's alpha (α=0.75). Materials and Methods

13. Pre-test questionnaire was consisted of questions about demographic variables and also specific questions to evaluate knowledge attitude and CVDs preventive behaviors before intervention. Before entrance the class an educational package including poster and educational film about CVDs and also some white papers and a pen for noting during class were given to subjects. Contents of Educational program were taken from analyzed data of pre-test study and training needs assessment. Materials and Methods

14. Education was designed in two weeks programs. It was asked from subjects to check and view the film and posters were in their packages at home. For each subject in intervention group, questionnaire was completed at two times, immediately after education program and three months after education. Post test questionnaires of control group were competed at the same times with intervention group. 29 questions about knowledge of cause, symptoms and risk factors of CVDs, 14 questions on attitude and 12 questions on practice evaluation were designed. Materials and Methods

15. For knowledge the possible obtainable score range was 0-29 (false question 0 and right question 1 score). For attitude, questions were designed based on three-grades Likert scales (from agree to disagree and scores from 0-2) and possible obtainable score range was 0-28. For practice each subject could gain 0-14 scores, good practice got score 1, moderate got 0.5 and bad practice got score 0. Data were then analyzed through SPSS 16 software using statistical tests such as Chi- square, Mann-Whitney U, Wilcoxon, McNamara, Marginal Homogeneity and Spearman correlation. Materials and Methods

16. results

17. Mean SD P Knowledge Before Case19.425.07 0.682 Control19.443.90 Immediately Case24.033.68 0.0001** Control19.723.92 Three month after Case23.693.69 0.0001** Control19.494.06 results

18. Mean SD P Attitude Before Case23.255.88 0.479 Control24.464.06 Immediately Case25.972.98 0.065 Control24.773.36 Three month after Case25.562.84 0.365 Control24.563.83 results

19. Mean SD P Practice Before Case7.972.37 0.924 Control8.111.85 Three month after Case9.431.74 0.019* Control8.232.07 results

20. Groups Variables Case Mean SD P Control Mean SD P Knowledge Before Immediately 19.42 24.3 5.07 3,68 0.0001** 19.44 19.73 3.9 3.92 0.062 Before Three month after 19.42 23.69 5.07 3.69 0.0001** 19.44 19.49 3.9 4.06 0.717 Immediately Three month after 24.03 23.69 3.68 3.69 0.475 19.72 19.49 3.92 4.06 0.256 results

21. Groups Variables Case Mean SD P Control Mean SD P Attitude Before Immediately 23.25 25.97 5,88 2.98 0.0001** 24.46 19.72 4.06 3.36 0.063 Before Three month after 23.25 25.56 5.88 2.84 0.017* 24.46 24.56 4.06 3.83 0.052 Immediately Three month after 25.97 25.56 2.98 2.84 0.032* 24.77 24.56 3.36 3.83 0.063

22. results Groups Variables Case Mean SD P Control Mean SD P Practice Before Three month after 7.97 9.43 2.37 1.74 0.0001** 8.11 8.23 1.85 2.07 0.233

23. Discussion

24. The education can increase the knowledge but the maintaining the level of this awareness is important. The results of this study showed that before education the knowledge of participants about prevention of risk factors of cardiovascular diseases was moderate that after education increased and didn’t decreased after three month. Discussion

25. In another study by Angeles, results showed that education by lecturing increased knowledge of participants, but decreased after one month that is different with our results.perhaps, maintaining the knowledge of our participants, possibly was of our education method was by lecturing, education film, pamphlet. Also we asked chefs to see the film in their free times more and also try to use its recommendations in their work that this caused them to maintain information much time. Discussion

26. The attitude of participants about the effect of foods in cardiovascular diseases was good that after education and three month after that was not changed. In a study attitude of participants was not good and they did not try to give healthy foods to customers. Discussion

27. More than 80% 0f participants knew that smoking, don’t doing exercise, obesity and over weigh, diabetes, stress and blood pressure are strongest risk factors of cardiovascular diseases. About 43% of chefs were fat and over weigh and only 22% of them doing exercise and more than 36% of them were smokers. Discussion