Journal of Preventive Medicine

Introduction
Prevention of diseases and improvement of people’s health has always been the focus of the health system in Iran. At the global level, this goal is also of interest, such that the fourth ten-year plan, in addition to emphasizing more on the goals of the previous plans, has focused on two new goals. In today’s world, health is considered as an important achievement that people are seeking to increase their quality of life and well-being and avoid chronic diseases and premature death. People’s choices and lifestyle patterns affect their health and longevity. Therefore, by having health-promoting behaviors, people can maintain and control their health and prevent many diseases. Prevention and provision of health through improving lifestyle includes proper nutrition, having physical activity, stress management, responsibility for health, and spiritual growth, as well as eliminating factors that have a negative impact on the health. health-promoting behaviors includes eating properly, exercises regularly, avoids harmful behaviors and substance abuse, recognizing the symptoms of illness in time (physical aspect), controlling emotions and thoughts and coping with stress and problems (psychological aspect), independence & adaptability and modification of interpersonal relationships (social aspect). The present study sims to determine the mediating role of cognitive emotion regulation in the relationship of distress tolerance and self-compassion with health-promoting behaviors.
Methods
The is a descriptive-analytical study. The study population consists of all people over 15 years of age in Bandar Abbas, Iran in 2019. Sampling was done online using a convenience method. Due to the fact that determining the minimum sample size to collect data related to structural equation modeling (SEM) is very important [1], and the minimum sample size of 200 required for factor analysis and SEM [2, 3], the sample size in our study was determined 306. The data collection tools were Simmons and Gaher’s distress tolerance scale [4], Raes et al.’s Self-Compassion Scale-Short Form [5], and Walker et al.’s health-promoting lifestyle profile [6]. 
First, the collected data were described using descriptive statistics (mean, standard deviation, correlation matrix). Then, data preparation and screening were conducted and the main assumptions of SEM including missing values, normality, linearity, multicollinearity, and homoscedasticity were examined [7]. Finally, to examine the research hypotheses, a multivariate analysis was performed using SEM. To measure the questionnaires, Cronbach’s alpha and confirmatory factor analysis were used in SPSS and AMOS software.
Results
The results showed that all fit indices confirmed the good fit of the SEM model to the collected data (X2/df=2.50, CFI=0.912 , GFI=0.907, AGFI=0.863 and RMSEA=0.070). The total path coefficient for the correlation of self-compassion (β=0.308, P<0.01) and distress tolerance (β=0.288, P<0.01) with positive health-promoting behaviors was significant. The path coefficient between maladaptive emotional regulation strategies and health-promoting behaviors was negative and significant (β=-0.560, P<0.01), and the path coefficient between adaptive emotional regulation strategies and health-promoting behaviors was positive and significant (β=0.451, P<0.01). The indirect path coefficient for the correlation of self-compassion (β=0.196, P<0.01) and distress tolerance (β=0.350, P<0.01) with health-promoting behaviors was positive and significant. Indirect path coefficient between self-compassion and health- promoting behaviors through adaptive emotion regulation strategies (β=0.162, P<0.01) was positive and significant, while it was not significant through maladaptive strategies (β=0.034, p>0.05). Moreover, the indirect path coefficient between distress tolerance and health- promoting behaviors through adaptive (P<0.01, β=0.113) and maladaptive strategies (P<0.01, β=0.235) were positive and significant. Therefore, it can be said that adaptive emotional regulation strategies positively and meaningfully mediate the relationship of self-compassion and distress tolerance with health- promoting behaviors. Maladaptive emotion regulation strategies only positively and significantly mediate the relationship between distress tolerance and health- promoting behaviors. Figure 1 shows the SEM of the relationships between distress tolerance, self-compassion, emotion regulation, and health- promoting behaviors. Discussion
Since one of the goals set by the World Health Organization until 2020 was to promote a healthy lifestyle in society, and considering the fact that the COVID-19 is a new and unknown disease with no effective treatment, countries should use strategies that are effective for the people and reduce the risk factors that cause unhealthy lifestyle. Health planners and health service providers, by being aware of the effects of distress tolerance, self-compassion, and emotion regulation, can take useful steps to promote the healthy behaviors of people.

Ethical Considerations
Compliance with ethical guidelines
This article is taken from the doctoral dissertation of Bandar Abbas Branch, Islamic Azad University (Ethics Code: IR.IAU.BA.REC.1401.005).

Funding
This article is taken from the doctoral thesis of Seyede Sarira Hashemipour in the field of general psychology, Psychology Department, Faculty of Humanities, Bandar Abbas Branch, Islamic Azad University, and it was not financially supported by any organization or institution, and all its financial resources were provided by the first author or authors.

Authors' contributions
Collection of samples and analysis and preparation of the draft: Seyede Sarira Hashemipour; Study design, results analysis and writing: Eghbal Zarei; Collaboration in sample preparation, primary data analysis and writing: Sholeh Namazi; Advisor and revision of the article: Azita Amirfakhraei.

Conflicts of interest
The authors declared no conflict of interest.

Acknowledgements
The authors thank all the people who participated in the study.


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