Diet-Related Stomach Cancer Behavior Among Iranian College Students: A Text Messaging Intervention

  • Dehdari, Tahereh (Department of Health Education and Health Promotion, Faculty of Health, Iran University of Medical Sciences) ;
  • Dehdari, Laleh (Department of Nutrition, Faculty of Health, Iran University of Medical Sciences) ;
  • Jazayeri, Shima (Department of Statistics, Faculty of Mathematics Sciences, Yazd University)
  • Published : 2016.12.01


Background: Stomach cancer is one of the five most common cancers in Iran. This study examined the effectiveness of a mobile telephone short-message service (SMS) based-education intervention using Health Belief Model (HBM) variables in improving dietary behavior in terms of stomach cancer prevention among a sample of Iranian female college students. Materials and Methods: In this quasi-experimental study, 124 female college students in the dormitories of Yazd University, Yazd, Iran were randomly selected and assigned to either the intervention (n=62) or the control group (n=62). Information (data) regarding HBM variables and dietary behavior related to stomach cancer prevention was collected by a self-administrated questionnaire. Forty eight messages were designed and sent to the participants' phones in the intervention group during the 48-day intervention period. Two groups were followed-up one month after the intervention delivered via SMS. Results: There were significant differences in HBM variables (except for the perceived severity) and the preventive dietary behaviors for stomach cancer in the intervention group compared to the comparison group following the education intervention delivered via SMS. Conclusions: SMS-delivered nutrition education intervention can be a practical strategy to improve dietary behavior related to stomach cancer prevention.


Supported by : Iran University of Medical Sciences


  1. Anetor GO, Ogundele BO, Oyewole OE (2013). Effect of nutrition education on factors influencing food choices in relation to prevention of stomach cancer among undergraduates in South-West, Nigeria. Anthropologist, 15, 185-91.
  2. Alidosti M, Sharifirad G, Hemate Z, et al (2011). The effect of education based on health belief model for nutritional behaviors associated with gastric cancer in housewives of Isfahan city. J Shahed Univ, 94, 1-11.
  3. Arroyave WD, Clipp EC, Miller PE, et al (2008). Childhood cancer survivors' perceived barriers to improving exercise and dietary behaviors. Oncol Nurs Forum, 35,121-30.
  4. Babaei M, Pourfarzi F, Yazdanbod A, et al (2010). Gastric cancer in Ardabil, Iran: a review and update on cancer registry data. Asian Pacific J Cancer Prev, 11, 595-99.
  5. Behnampour N, Hajizadeh E, Zayeri, F, Semnani S (2014). Modeling of influential predictors of gastric cancer incidence rates in Golestan Province, North Iran. Asian Pac J Cancer Prev, 15, 1111-17.
  6. Buckland G, Travier N, Huerta JM, et al (2015). Healthy lifestyle index and risk of gastric adenocarcinoma in the EPIC cohort study. Int J Cancer, 137, 598-606.
  7. Cronbach L (1951). Coefficient alpha and the internal structure of tests. Psychometrika, 16, 297-34.
  8. Suggs S, Odermatt P (2012). Short message service (SMS) applications for disease prevention in developing countries. J Med Internet Res, 14, e3.
  9. Dehdari T, Hassani L, Hajizadeh E, et al. (2014). Effects of an educational intervention based on the protection motivation theory and implementation intentions on first and second Pap test practice in Iran. Asian Pac J Cancer Prev, 15, 7257-61.
  10. Fahey JW, Stephenson KK, Wallace AJ (2015). Dietary amelioration of Helicobacter infection. Nutr Res, 35, 461-73.
  11. Flanagan D, Mahler H, Cohen S (2016). How to conduct effective pretests. The AIDSCAP Behavior Change Communication Unit. Available from: (Assessed 2016 August 30).
  12. Free C, Phillips G, Galli L, et al (2013). The effectiveness of mobile-health technology-based health behaviour change or disease management interventions for health care consumers: a systematic review. PLoS Med, 10, e1001362.
  13. Guggenheim DE, Shah MA (2013). Gastric cancer epidemiology and risk factors. J Surg Oncol, 107, 230-36.
  14. Harnack L, Block G, Subar A, et al (1997). Association of cancer prevention-related nutrition knowledge, beliefs, and attitudes to cancer prevention dietary behavior. J Am Diet Assoc, 97, 957-65.
  15. Hingle MD, Snyder AL, McKenzie NE, et al (2014). Effects of a short messaging service-based skin cancer prevention campaign in adolescents. Am J Prev Med, 47, 617-23.
  16. Jones KR, Lekhak N, Kaewluang N (2014). Using mobile phones and short message service to deliver self-management interventions for chronic conditions: a meta-review. Worldviews Evid Based Nurs, 11, 81-8-.
  17. Knekt P, Jarvinen R, Dich J, Hakulinen T (1999). Risk of colorectal and other gastro-intestinal cancers after exposure to nitrate, nitrite and N-nitroso compounds: a follow-up study. Int J Cancer, 80, 852-56.<852::AID-IJC9>3.0.CO;2-S
  18. Kodali RT, Eslick GD (2015). Meta-analysis: does garlic intake reduce risk of gastric cancer?. Nutr Cancer, 67, 1-11.
  19. Kolahdoozan S, Sadjadi A, Radmard AR, Khademi H (2010). Five common cancers in Iran. Arch Iran Med, 13, 143-46.
  20. Koosirirat C, Linpisarn S, Changsom D, Chawansuntati K, Wipasa J (2010). Investigation of the anti-inflammatory effect of Curcuma longa in Helicobacter pylori-infected patients. Int Immunopharmacol, 10, 815-18.
  21. Kye SY, Yoo J, Lee MH, et al (2014). Effects of a cancer prevention advertisement on beliefs and knowledge about cancer prevention. Asian Pac J Cancer Prev, 16, 5793-800.
  22. Lakkis NA, Atfeh AM, EL-Zein YR, et al (2011). The effect of two types of sms-texts on the uptake of screening mammogram: A randomized controlled trial. Prev Med, 53, 325-27.
  23. Landis JR, Koch GG (1997). The measurement of observer agreement for categorical data. Biometrics, 33, 159-74.
  24. Lawshe CH (1975). A quantitative approach to content validity. Pers Psychol, 28, 563-75.
  25. Lee HY, Koopmeiners JS, Rhee TG, et al (2014). Mobile phone text messaging intervention for cervical cancer screening: changes in knowledge and behavior pre-post intervention. J Med Internet Res, 16, e196.
  26. Lopez-Carrillo L, Hernandez Avila M, Dubrow R (1994). Chili pepper consumption and gastric cancer in Mexico: a casecontrol study. Am J Epidemiol, 139, 263-71.
  27. Mahady GB, Pendland SL, Yun GS, Lu ZZ, Stoia A (2003). Ginger (Zingiber officinale Roscoe) and the gingerols inhibit the growth of Cag A+ Strains of helicobacter pylori. Anticancer Res, 23, 3699-3702.
  28. Mehrabian AA, Esna-Ashari F, Zham H, et al. (2010). Gastric cancer prevalence, according to survival data in Iran (national study-2007). Iranian J Publ Health, 39, 27-31.
  29. Mirzaei F, Dehdari T, Saki Malehi A (2016). Prevention of esophageal cancer: experience of an educational campaign for reducing hot tea consumption in Iran. Asian Pac J Cancer Prev, 17, 305-10.
  30. Navarro Silvera SA, Mayne ST, Risch H, et al (2008). Food group intake and risk of subtypes of esophageal and gastric cancer. Int J Cancer, 123, 852-60.
  31. Nir Y, Potasman I, Stermer E, Tabak M, Neeman I (2000). Controlled trial of the effect of cinnamon extract on Helicobacter pylori. Helicobacter, 5, 94-7.
  32. Pakseresht M, Forman D, Malekzadeh R, et al (2011). Dietary habits and gastric cancer risk in north-west Iran. Cancer Causes Control, 22, 725-36.
  33. Polit DF, Beck CT (2004). Nursing research: principles and methods, 46th ed., pp. 416-45.
  34. Philadelphia PA, Lippincott PF, Whelan A, Kaldor J, Malekzadeh R (2009). The role of diet and other environmental factors in the causation of gastric cancer in Iran: A population based study. Int J Cancer, 125, 1953-60.
  35. Quintiliani LM, Carbone ET (2005). Impact of diet-related cancer prevention messages written with cognitive and affective arguments on message characteristics, stage of change, and self-efficacy. J Nutr Educ Behav, 37, 12-19.
  36. Riboli E, Norat T (2003). Epidemiologic evidence of the protective effect of fruit and vegetables on cancer risk. Am J Clin Nutr, 78, 559-69.
  37. Stadtlander CT, Waterbor JW (1999). Molecular epidemiology, pathogenesis and prevention pf gastric cancer. Carcinogenesis, 20, 2195-2208.
  38. Salvador I, Mercado A, Liliana Bravo G, Baldeon M, Fornasini M (2015). Risk and protective factors for gastric metaplasia and cancer: a hospital-based case-control study in Ecuador. Nutr Hosp, 32, 1193-99.
  39. Shakeel AK, Madompoyil B, Dulari Ahi J, et al (2014). Study on the transmission of helicobacter pylori from food prepared and consumed under hygienic and unhygienic conditions: A first study using biopsy samples. Health, 6, 274-83.
  40. Shapiro JR, Bauer S, Hamer RM, et al (2008). Use of text messaging for monitoring sugar-sweetened beverages, physical activity, and screen time in children: a pilot study. J Nutr Educ Behav, 40, 385-91.
  41. Shobeiri F, Taravati JM, Parsa P, et al (2016). Effects of group training based on the health belief model on knowledge and behavior regarding the Pap smear test in Iranian women: a quasi-experimental study. Asian Pac J Cancer Prev, 17, 2871-76.
  42. Tsugane S, Sasazuki S (2007). Diet and the risk of gastric cancer: review of epidemiological evidence. Gastric Cancer, 10, 75-83.
  43. Van den Brandt PA, Botterweck AA, Goldbohm RA (2003). Salt intake, cured meat consumption, refrigerator use and stomach cancer incidence: a prospective cohort study (Netherlands). Cancer Causes Control, 14, 427-38.
  44. Wang ZH, Gao QY, Fang JY (2013). Meta-Analysis of the efficacy and safety of lactobacillus-containing and bifidobacteriumcontaining probiotic compound preparation in Helicobacter pylori eradication therapy. J Clin Gastroenterol, 47, 25-32.
  45. Watanable S, Tsugane S, yamaguchi N (1997). Etiology. In Sugimura, T. and Sasako M (eds) Gastric cancer. Oxford University Press. Oxford, UK, pp.87-99.
  46. World Health Organization (2012). Nitrate and nitrite in drinking-water: background document for development of WHO Guidelines for Drinking-water Quality. Available from: .
  47. WHO I Cancer - World Health Organization. Available from: http:// /factsheets/fs297/en.
  48. Youl PH, Soyer HP, Baade PD, et al (2015). Can skin cancer prevention and early detection be improved via mobile phone text messaging? A randomized, attention control trial. Prev Med, 71, 50-6.