Objectives Fathering is known to foster child development and health, yet evidence on Hispanic im... more Objectives Fathering is known to foster child development and health, yet evidence on Hispanic immigrant fathers' involvement with their young children is sparse. This study assessed disparities in pregnancy intendedness and father involvement with children ages 0-4 among Hispanic immigrant co-resident fathers versus two reference groups: US-born Hispanic and US-born White fathers. We hypothesized that differentials in involvement were associated with socioeconomic and cultural factors. Methods Using 2011-2013 data from the National Survey of Family Growth (N = 598), we performed bivariate, logistic and linear regression analyses to assess disparities in pregnancy intendedness and five father involvement outcomes (physical care, warmth, outings, reading and discipline). The models controlled for socio-economic, structural, health and cultural covariates. Results Pregnancy intendedness did not differ significantly between Hispanic immigrant fathers and the two reference groups. Compared with US-born Hispanics, unadjusted models showed that immigrant fathers were less likely to engage in physical care, warmth and reading, (p ≤ 0.05) though the differences were attenuated when controlling for covariates. Hispanic immigrant fathers were less likely than US-born White fathers to engage in each of the father involvement outcomes (p ≤ 0.05), with the disparity in reading to their child persisting even after controlling for all covariates. Conclusions for Practice We found marked socio-economic and cultural differences between Hispanic immigrant and USborn Hispanic and White fathers which contribute to disparities in father involvement with their young children. Hispanic immigrant status is an important determinant of involved fathering and should be taken into account when planning public health policies and programs.
Objective Analyze the association between household food security status and diet quality during ... more Objective Analyze the association between household food security status and diet quality during pregnancy. Methods Cross-sectional analysis of pregnant women from the National Health and Nutrition Examination Survey from 1999 to 2008. Of the 1158 pregnant women with complete household food security information, we analyzed 688 women who had complete dietary information and household incomes B300 % of the Federal Poverty Level (FPL). Diet quality was measured by the Alternate Healthy Eating Index modified for Pregnancy (AHEI-P) from 1 to 2 24 h dietary recalls. Multivariate linear and logistic regression models were implemented to assess the association between household food security status and AHEI-P, adjusting for age, nativity, marital status, race/ ethnicity, education, and household income. Results Among women with household incomes B300 % of the FPL, 19 % were food insecure and 4 % were marginally food secure. The mean AHEI-P score was 41.9 (95 % CI 40.4, 43.3). Household food insecurity was not associated with overall diet quality. However, living in a food insecure household compared to a food secure household was associated with a 2.3 (1.3, 4.1) greater odds of having a calcium component score greater than the median intake of calcium scores among food secure women in the sample. Conclusions for Practice In a nationally representative sample of pregnant women, 80 % lived in a fully food secure household. Improving household food security during pregnancy is a public health opportunity to improve health outcomes; however household food security status may not be associated with overall diet quality.
Journal of Urban Health-bulletin of The New York Academy of Medicine, Oct 16, 2017
Racial and ethnic segregation has been linked to a number of deleterious health outcomes, includi... more Racial and ethnic segregation has been linked to a number of deleterious health outcomes, including violence. Previous studies of segregation and violence have focused on segregation between African Americans and Whites, used homicide as a measure of violence, and employed segregation measures that fail to take into account neighborhood level processes. We examined the relationship between neighborhood diversity and violent injury in Oakland, California. Violent injuries from the Alameda County Medical Center Trauma Registry that occurred between 1998 and 2002 were geocoded. A local measure of diversity among African American, White, Hispanic, and Asian populations that captured interactions across census block group boundaries was calculated from 2000 U.S. Census data and a Geographic Information System. The relationship between violent injuries and neighborhood level of diversity, adjusted for covariates, was analyzed with zero-inflated negative binomial regression. There was a significant and inverse association between level of racial and ethnic diversity and rate of violent injury (IRR 0.30; 95% CI: 0.13-0.69). There was a similar relationship between diversity and violent injury for predominantly African American block groups (IRR 0.23; 95% CI: 0.08-0.62) and predominantly Hispanic block groups (IRR 0.08; 95% CI: 0.01-0.76). Diversity was not significantly associated with violent injury in predominantly White or Asian block groups. Block group racial and ethnic diversity is associated with lower rates of violent injury, particularly for predominantly African American and Hispanic block groups. Keywords Segregation . Social determinants of health . Violent injury . Neighborhood
Background: Gestational diabetes mellitus (GDM) is a significant contributor to the development o... more Background: Gestational diabetes mellitus (GDM) is a significant contributor to the development of diabetes (DM2) post-partum, with higher rates amongst low-income and Latina women. Understanding one's risk perception for developing DM2 postpartum amongst women with GDM can help target preventive interventions that promote positive health behaviors and lifestyle changes. This study aims to assess how the interplay of individual level factors, healthcare based factors, and structural factors influence risk perception for developing DM2 amongst low-income, primarily migrant Latina women with recent gestational diabetes mellitus. Methods: Data is from the baseline assessment of the STAR MAMA intervention. Women (N=171) receiving prenatal care at low-income urban clinics in San Francisco Bay Area were surveyed for basic demographics, healthcare access, and health-related behaviors. The outcome variable, risk perception for developing DM2 post-partum, was measured using the RPS-DM tool. Associations between risk perception for developing DM2 and individual, health-care based and structural (eg. health insurance, food insecurity, educational attainment) covariates were estimated using descriptive statistics and logistic regression. Results: Although all participants had a high risk for subsequently developing DM2, 76% reported lower risk perception for developing diabetes within the next 1, 5, and 10 years. Migrant status, less than high school education, and food insecurity were associated with lower risk perception (p<0.05). Spanish-speaking women with GDM who did not have family histories of DM2 were at greatest risk of underestimating their DM2 risk (OR=6.5; CI= (1.149, 11.795)). On the other hand, Spanish-speaking women who had family histories of DM2 were more likely to correctly assess their DM2 risk (OR=0.16; CI= (0.031, 0.824)). Conclusions: Structural and individual factors, rooted in migrant status and cultural backgrounds, influence personal risk perception. The majority of high-risk GDM women in this sample underestimate their risk for developing diabetes. This poses an opportunity for the healthcare system to improve patient-provider communication to improve risk perceptions and motivation for behavioral risk reduction. Improved counseling regarding risk perception for vulnerable, migrant populations with 4 GDM is critical to accurately convey risk and engage individuals in preventive behaviors. Trial Registration: The clinical trial registration number is: NCT02240420 and date of registration: 9/11/2014.
Background Monitoring clients’ experiences with contraceptive care is vital to inform quality imp... more Background Monitoring clients’ experiences with contraceptive care is vital to inform quality improvement efforts and ensure fulfillment of individuals’ human rights. The Quality of Contraceptive Counseling (QCC) Scale is a previously validated scale that comprehensively measures individuals’ experiences receiving counseling in three subscales: Information Exchange, Interpersonal Relationship, and Disrespect and Abuse. We sought to better understand the correlation of client, provider, and visit factors with client-reported quality of contraceptive counseling in the public sector in two Mexican states using the QCC Scale. Methods This cross-sectional survey study used the QCC Scale total score and subscale scores as outcome variables. Explanatory variables included clients’ age, LGBTTTIQ status, relationship status, number of children, education, and occupation; providers’ gender and type of provider; and the reason for visit. Linear and logistic regression models assessed bivariate...
Background Over recent decades, Vietnam has experienced rapid economic growth, a nutrition transi... more Background Over recent decades, Vietnam has experienced rapid economic growth, a nutrition transition from the traditional diet to highly-processed and calorie-dense foods and beverages, and an increasing prevalence of childhood overweight/obesity (ow/ob). The goal of this study is to describe the patterns of ow/ob in a longitudinal sample of Vietnamese children from ages 1 to 8, and the sociodemographic and behavioral factors associated with ow/ob at age 8. Methods This study is a secondary data analysis of a geographically-representative, longitudinal cohort of 1961 Vietnamese children from the Young Lives Cohort Study from 2002 to 2009. Thirty-one communities were selected with oversampling in rural communities, and children age 1 were recruited from each community using simple random sampling. Surveys of families and measurements of children were collected at child ages 1, 5, and 8. Our specified outcome measure was childhood ow/ob at age 8, defined by the World Health Organizat...
Journal of Health Care for the Poor and Underserved, 2022
AIMS To evaluate a bi-national consulate-based teleophthalmology screening service for diabetic r... more AIMS To evaluate a bi-national consulate-based teleophthalmology screening service for diabetic retinopathy (DR) among Mexican migrants in the U.S. METHODS Adult visitors (n=508) at Mexican consulates in California with self-reported diabetes underwent questionnaires and fundus photography. Photographs were graded for DR by retina fellows in Mexico via teleophthalmology. Participants were contacted with results and provided referrals when necessary. RESULTS Nearly all (97.6%) participants were aware that diabetes can cause vision loss. One-quarter (24.4%) had undergone an eye examination in the past year. Barriers to care were cost (53.9%) and insurance (45.6%). Most (85.4-91.1%) reported that Spanish-speaking providers and provision of screening in primary care would increase participation in screening. Any DR, vision-threatening DR, or proliferative DR were found in 30.2%, 9.9%, and 5.4% of participants, respectively. Nearly one-fifth (19.5%) received referrals. CONCLUSIONS Screening in Mexican consulates may improve DR detection and treatment among Mexican migrants in the U.S.
Psychological empowerment (PE) is conceptualized as a context-dependent construct, yet few have s... more Psychological empowerment (PE) is conceptualized as a context-dependent construct, yet few have studied its applicability to youth in international settings. The current study used a participatory approach to design a measure of empowerment for youth from a rural, Indigenous community in Guatemala and aimed to compare this new measure to extant measures. Youth co-researchers (aged 19-22) collaborated in the development of four culturally relevant empowerment scales through a formative process involving classroom observations and focus groups. Newly developed scales and two widely used, extant scales were administered to a school-based sample of 273 youth (mean age = 14.7, SD = 1.6). Exploratory factor analysis (EFA) showed that one of the newly developed PE scales called Self-Efficacy for Community Action (SECA), which was moderately correlated with the extant scales, appeared to more effectively capture empowerment in the local context than the extant measures. These results suppor...
For decades, Africa has been plagued by political and ethnic conflict, the health ramifications o... more For decades, Africa has been plagued by political and ethnic conflict, the health ramifications of which are often not investigated. A crisis occurred recently in Kenya following the 2007 presidential election. Ethnic violence ensued, targeting the incumbent President Kibaki's Kikuyu people. The violence occurred primarily in Nairobi and the Rift Valley of Kenya. We sought to examine the association between exposure to the 2007/2008 Kenyan Crisis and birthweight. Using the 2008/2009 Kenyan Demographic and Health Survey (KDHS), we compared birth weights of infants in utero or not yet conceived during the 15 months after the political turmoil following the 2007 presidential election (exposed) to those who were born before the crisis (unexposed). There were 663 "exposed" and 687 "unexposed" infants. Multivariate regression was used. We examined the possibility of two-way and three-way interactions between exposure status, ethnicity (Kikuyu versus non-Kikuyu), and region (violent region versus not). Overall, exposure to the Kenyan Crisis was associated with lower birthweight. Kikuyu women living in a violent region who were exposed during their 2 nd trimester had the greatest difference in birthweight in comparison to all unexposed infants: 564.4 grams lower (95% CI 285.1, 843.6). Infants of Kikuyu exposed during the 2 nd trimester and living in a violent region weighed 603.6 grams less (95% CI 333.6, 873.6) than Kikuyu infants born during the unexposed period. Political unrest may have implications for the birthweight of infants, particularly among targeted populations. Given the adverse sequelae associated with lowered birth weight, these results suggest that particular attention should be paid to pregnant women and targeted ethnic groups following such events.
Standard methods to monitor tuberculosis (TB) treatment response rely on sputum microscopy and cu... more Standard methods to monitor tuberculosis (TB) treatment response rely on sputum microscopy and culture conversion. Alternatives to these methods are needed for those patients whose sputum tests are smear or culture negative. Here, we examine anti-phospholipid IgM antibody level changes as a biomarker for treatment response in smear positive TB patients. Serum samples were obtained from 40 pulmonary TB patients at the start and end of the intensive phase treatment (IPT) from the CDC-TB Trials Consortium randomized clinical trial in Kampala, Uganda. Samples were screened by ELISA for IgM levels against five phospholipids found in Mycobacterium tuberculosis and host cells. Lipid antigens included cardiolipin (CL), phosphatidyl inositol (PI), phosphatidyl ethanolamine (PE), phosphatidyl choline (PTC), and sphingolipid (SL). Levels of IgM against all phospholipids significantly decreased (p = 0.034, 0.001, 0.008 0.008, 0.040, respectively) following anti-TB drug treatment in patients wit...
Early return to work after childbirth has been increasing among working mothers in the US. We ass... more Early return to work after childbirth has been increasing among working mothers in the US. We assessed the relationship between access to employer-offered maternity leave (EOML) (both paid and unpaid) and uptake and duration of maternity leave following childbirth in a socioeconomically diverse sample of full-time working women. We focus on California, a state that has long provided more generous maternity leave benefits than those offered by federal maternity leave policies through the State Disability Insurance program. The sample included 691 mothers who gave birth in Southern California in 2002-2003. Using weighted logistic regression, we examined the EOML-maternity leave duration relationship, controlling for whether the leave was paid, as well as other occupational, personality and health-related covariates. Compared with mothers who were offered more than 12 weeks of maternity leave, mothers with \6 weeks of EOML and those offered 6-12 weeks had five times higher odds of returning to work within 12 weeks; those offered no leave had six times higher odds of an early return. These relationships were similar after controlling for whether the leave was paid and after controlling for other occupational and health characteristics. Access to and duration of employer-offered maternity leave significantly determine timing of return to work following childbirth, potentially affecting work-family balance. Policy makers should recognize the pivotal role of employers in offering job security during and after maternity leave and consider widening the eligibility criteria of the Family and Medical Leave Act.
JAIDS Journal of Acquired Immune Deficiency Syndromes, 2010
Objective: To measure HIV prevalence and characterize associated risk behaviors among injection d... more Objective: To measure HIV prevalence and characterize associated risk behaviors among injection drug users (IDU) upon detention in Tehran, Iran. Methods: A cross-sectional survey included 459 male IDU arrested by police during a police sweep in Tehran in 2006. A questionnaire was completed, and blood was collected for HIV testing. Results: Overall HIV prevalence was 24.4% (95% confidence interval 20.5-28.6). Factors independently associated with HIV infection included history of using an opioid in jail (adjusted odds ratio 2.11, 95% confidence interval 1.26-3.53) and older age (adjusted odds ratio 2.79 for 25-34, 3.01 for 35-44, 4.62 for $ 45 yr). Conclusions: This study supports that incarceration is contributing to the increased spread of HIV. Harm reduction programs should be urgently expanded, particularly among incarcerated IDU.
We thank D. Barnes for his valuable input into the data collection and modeling methodology and S... more We thank D. Barnes for his valuable input into the data collection and modeling methodology and S. Lim and M. Ezzati for their contribution to the discussion on modeling approaches. This work was funded in part by the U.S. Environmental Protection Agency and the Shell Foundation. The work leading to the results presented in the article has been developed, conducted, and imple mented by the World Health Organization (WHO). This article reflects activities conducted by the Comparative Risk Assessment Expert Group for Household Air Pollution and undertaken for official reporting by the WHO. Some authors are staff mem bers of the WHO. Those authors alone are responsi ble for the views expressed in this publication, which do not necessarily represent the views, decisions, or policies of the WHO. This article should not be reproduced for use in association with the promotion of commercial products, services or any legal entity. The WHO does not endorse any specific organiza tion or products. Any reproduction of this article cannot include the use of the WHO logo. The authors declare they have no actual or potential competing financial interests.
Perspectives on Sexual and Reproductive Health, 2012
Available contraceptives are not meeting many women's needs, as is evident by high levels of typi... more Available contraceptives are not meeting many women's needs, as is evident by high levels of typical-use failure, method switching and discontinuation. To improve women's satisfaction with contraceptive methods, determining what features they prefer and how these preferences are satisfi ed by available methods and methods under development is crucial. METHODS: The importance of 18 contraceptive method features was rated by 574 women seeking abortionsa group at high risk of having unprotected intercourse and unintended pregnancies-at six clinics across the United States in 2010. For each available and potential method, the number of features present was assessed, and the percentage of these that were "extremely important" to women was calculated. RESULTS: The three contraceptive features deemed extremely important by the largest proportions of women were eff ectiveness (84%), lack of side eff ects (78%) and aff ordability (76%). For 91% of women, no method had all of the features they thought were extremely important. The ring and the sponge had the highest percentage of features that women deemed extremely important (67% each). Some streamlined modes of access and new contraceptive technologies have the potential to satisfy women's preferences. For example, an over-the-counter pill would have 71% of extremely important features, and an over-the-counter pericoital pill, 68%; currently available prescription pills have 60%. CONCLUSION: The contraceptive features women want are largely absent from currently available methods. Developing and promoting methods that are more aligned with women's preferences presumably could help increase satisfaction and thereby encourage consistent and eff ective use.
Objectives-Life course theory suggests that early life experiences can shape health over a lifeti... more Objectives-Life course theory suggests that early life experiences can shape health over a lifetime and across generations. Associations between maternal pregnancy experience and daughters' age at menarche are not well understood. We examined whether maternal prepregnancy BMI and gestational weight gain (GWG) were independently related to daughters' age at menarche. Consistent with a life course perspective, we also examined whether maternal GWG, birth weight, and prepubertal BMI mediated the relationship between pre-pregnancy BMI and daughter's menarcheal age. Methods-We examined 2,497 mother-daughter pairs from the 1979 National Longitudinal Survey of Youth. Survival analysis with Cox proportional hazards was used to estimate whether maternal pre-pregnancy overweight/obesity (BMI 25.0 kg/m 2 ) and GWG adequacy (inadequate, recommended, and excessive) were associated with risk for earlier menarche among girls, controlling for important covariates. Analyses were conducted to examine the mediating roles of GWG adequacy, child birth weight and prepubertal BMI. Results-Adjusting for covariates, pre-pregnancy overweight/obesity (HR= 1.20, 95% CI 1.06, 1.36) and excess GWG (HR=1.13, 95% CI 1.01, 1.27) were associated with daughters' earlier menarche, while inadequate GWG was not. The association between maternal pre-pregnancy weight and daughters' menarcheal timing was not mediated by daughter's birth weight, prepubertal BMI or maternal GWG. Conclusions-Maternal factors, before and during pregnancy, are potentially important determinants of daughters' menarcheal timing and are amenable to intervention. Further research is needed to better understand pathways through which these factors operate. Menarche; weight gain; body mass index; pregnancy; cohort studies Over the past several decades there has been a downward trend in the average age at menarche in the United States and other developed nations (1-4). Girls enter puberty earlier and start menstruating at younger ages than in the past (5). Significant racial disparities exist, with black girls reaching menarche earlier than non-Hispanic white girls . Life course theory posits that early life experiences influence health over a lifetime and potentially across generations
Purpose: Native American adolescents in the United States suffer from significant health disparit... more Purpose: Native American adolescents in the United States suffer from significant health disparities in depression, substance use and suicide. Research regarding culturally competent, community based, youth positive interventions that promote youth connection is needed to inform a response. The Gathering of Native Americans (GONA) is a strengths-based intervention intended to promote adolescent wellbeing and resiliency. Published research regarding its effects is extremely limited. Our evaluation of the GONA intervention in two California sites in 2012-2014 employs mixed-methods in order to answer the primary research question: Among adolescent Native Americans, what is the relationship between participation in GONA and resilience?
Objectives Fathering is known to foster child development and health, yet evidence on Hispanic im... more Objectives Fathering is known to foster child development and health, yet evidence on Hispanic immigrant fathers' involvement with their young children is sparse. This study assessed disparities in pregnancy intendedness and father involvement with children ages 0-4 among Hispanic immigrant co-resident fathers versus two reference groups: US-born Hispanic and US-born White fathers. We hypothesized that differentials in involvement were associated with socioeconomic and cultural factors. Methods Using 2011-2013 data from the National Survey of Family Growth (N = 598), we performed bivariate, logistic and linear regression analyses to assess disparities in pregnancy intendedness and five father involvement outcomes (physical care, warmth, outings, reading and discipline). The models controlled for socio-economic, structural, health and cultural covariates. Results Pregnancy intendedness did not differ significantly between Hispanic immigrant fathers and the two reference groups. Compared with US-born Hispanics, unadjusted models showed that immigrant fathers were less likely to engage in physical care, warmth and reading, (p ≤ 0.05) though the differences were attenuated when controlling for covariates. Hispanic immigrant fathers were less likely than US-born White fathers to engage in each of the father involvement outcomes (p ≤ 0.05), with the disparity in reading to their child persisting even after controlling for all covariates. Conclusions for Practice We found marked socio-economic and cultural differences between Hispanic immigrant and USborn Hispanic and White fathers which contribute to disparities in father involvement with their young children. Hispanic immigrant status is an important determinant of involved fathering and should be taken into account when planning public health policies and programs.
Objective Analyze the association between household food security status and diet quality during ... more Objective Analyze the association between household food security status and diet quality during pregnancy. Methods Cross-sectional analysis of pregnant women from the National Health and Nutrition Examination Survey from 1999 to 2008. Of the 1158 pregnant women with complete household food security information, we analyzed 688 women who had complete dietary information and household incomes B300 % of the Federal Poverty Level (FPL). Diet quality was measured by the Alternate Healthy Eating Index modified for Pregnancy (AHEI-P) from 1 to 2 24 h dietary recalls. Multivariate linear and logistic regression models were implemented to assess the association between household food security status and AHEI-P, adjusting for age, nativity, marital status, race/ ethnicity, education, and household income. Results Among women with household incomes B300 % of the FPL, 19 % were food insecure and 4 % were marginally food secure. The mean AHEI-P score was 41.9 (95 % CI 40.4, 43.3). Household food insecurity was not associated with overall diet quality. However, living in a food insecure household compared to a food secure household was associated with a 2.3 (1.3, 4.1) greater odds of having a calcium component score greater than the median intake of calcium scores among food secure women in the sample. Conclusions for Practice In a nationally representative sample of pregnant women, 80 % lived in a fully food secure household. Improving household food security during pregnancy is a public health opportunity to improve health outcomes; however household food security status may not be associated with overall diet quality.
Journal of Urban Health-bulletin of The New York Academy of Medicine, Oct 16, 2017
Racial and ethnic segregation has been linked to a number of deleterious health outcomes, includi... more Racial and ethnic segregation has been linked to a number of deleterious health outcomes, including violence. Previous studies of segregation and violence have focused on segregation between African Americans and Whites, used homicide as a measure of violence, and employed segregation measures that fail to take into account neighborhood level processes. We examined the relationship between neighborhood diversity and violent injury in Oakland, California. Violent injuries from the Alameda County Medical Center Trauma Registry that occurred between 1998 and 2002 were geocoded. A local measure of diversity among African American, White, Hispanic, and Asian populations that captured interactions across census block group boundaries was calculated from 2000 U.S. Census data and a Geographic Information System. The relationship between violent injuries and neighborhood level of diversity, adjusted for covariates, was analyzed with zero-inflated negative binomial regression. There was a significant and inverse association between level of racial and ethnic diversity and rate of violent injury (IRR 0.30; 95% CI: 0.13-0.69). There was a similar relationship between diversity and violent injury for predominantly African American block groups (IRR 0.23; 95% CI: 0.08-0.62) and predominantly Hispanic block groups (IRR 0.08; 95% CI: 0.01-0.76). Diversity was not significantly associated with violent injury in predominantly White or Asian block groups. Block group racial and ethnic diversity is associated with lower rates of violent injury, particularly for predominantly African American and Hispanic block groups. Keywords Segregation . Social determinants of health . Violent injury . Neighborhood
Background: Gestational diabetes mellitus (GDM) is a significant contributor to the development o... more Background: Gestational diabetes mellitus (GDM) is a significant contributor to the development of diabetes (DM2) post-partum, with higher rates amongst low-income and Latina women. Understanding one's risk perception for developing DM2 postpartum amongst women with GDM can help target preventive interventions that promote positive health behaviors and lifestyle changes. This study aims to assess how the interplay of individual level factors, healthcare based factors, and structural factors influence risk perception for developing DM2 amongst low-income, primarily migrant Latina women with recent gestational diabetes mellitus. Methods: Data is from the baseline assessment of the STAR MAMA intervention. Women (N=171) receiving prenatal care at low-income urban clinics in San Francisco Bay Area were surveyed for basic demographics, healthcare access, and health-related behaviors. The outcome variable, risk perception for developing DM2 post-partum, was measured using the RPS-DM tool. Associations between risk perception for developing DM2 and individual, health-care based and structural (eg. health insurance, food insecurity, educational attainment) covariates were estimated using descriptive statistics and logistic regression. Results: Although all participants had a high risk for subsequently developing DM2, 76% reported lower risk perception for developing diabetes within the next 1, 5, and 10 years. Migrant status, less than high school education, and food insecurity were associated with lower risk perception (p<0.05). Spanish-speaking women with GDM who did not have family histories of DM2 were at greatest risk of underestimating their DM2 risk (OR=6.5; CI= (1.149, 11.795)). On the other hand, Spanish-speaking women who had family histories of DM2 were more likely to correctly assess their DM2 risk (OR=0.16; CI= (0.031, 0.824)). Conclusions: Structural and individual factors, rooted in migrant status and cultural backgrounds, influence personal risk perception. The majority of high-risk GDM women in this sample underestimate their risk for developing diabetes. This poses an opportunity for the healthcare system to improve patient-provider communication to improve risk perceptions and motivation for behavioral risk reduction. Improved counseling regarding risk perception for vulnerable, migrant populations with 4 GDM is critical to accurately convey risk and engage individuals in preventive behaviors. Trial Registration: The clinical trial registration number is: NCT02240420 and date of registration: 9/11/2014.
Background Monitoring clients’ experiences with contraceptive care is vital to inform quality imp... more Background Monitoring clients’ experiences with contraceptive care is vital to inform quality improvement efforts and ensure fulfillment of individuals’ human rights. The Quality of Contraceptive Counseling (QCC) Scale is a previously validated scale that comprehensively measures individuals’ experiences receiving counseling in three subscales: Information Exchange, Interpersonal Relationship, and Disrespect and Abuse. We sought to better understand the correlation of client, provider, and visit factors with client-reported quality of contraceptive counseling in the public sector in two Mexican states using the QCC Scale. Methods This cross-sectional survey study used the QCC Scale total score and subscale scores as outcome variables. Explanatory variables included clients’ age, LGBTTTIQ status, relationship status, number of children, education, and occupation; providers’ gender and type of provider; and the reason for visit. Linear and logistic regression models assessed bivariate...
Background Over recent decades, Vietnam has experienced rapid economic growth, a nutrition transi... more Background Over recent decades, Vietnam has experienced rapid economic growth, a nutrition transition from the traditional diet to highly-processed and calorie-dense foods and beverages, and an increasing prevalence of childhood overweight/obesity (ow/ob). The goal of this study is to describe the patterns of ow/ob in a longitudinal sample of Vietnamese children from ages 1 to 8, and the sociodemographic and behavioral factors associated with ow/ob at age 8. Methods This study is a secondary data analysis of a geographically-representative, longitudinal cohort of 1961 Vietnamese children from the Young Lives Cohort Study from 2002 to 2009. Thirty-one communities were selected with oversampling in rural communities, and children age 1 were recruited from each community using simple random sampling. Surveys of families and measurements of children were collected at child ages 1, 5, and 8. Our specified outcome measure was childhood ow/ob at age 8, defined by the World Health Organizat...
Journal of Health Care for the Poor and Underserved, 2022
AIMS To evaluate a bi-national consulate-based teleophthalmology screening service for diabetic r... more AIMS To evaluate a bi-national consulate-based teleophthalmology screening service for diabetic retinopathy (DR) among Mexican migrants in the U.S. METHODS Adult visitors (n=508) at Mexican consulates in California with self-reported diabetes underwent questionnaires and fundus photography. Photographs were graded for DR by retina fellows in Mexico via teleophthalmology. Participants were contacted with results and provided referrals when necessary. RESULTS Nearly all (97.6%) participants were aware that diabetes can cause vision loss. One-quarter (24.4%) had undergone an eye examination in the past year. Barriers to care were cost (53.9%) and insurance (45.6%). Most (85.4-91.1%) reported that Spanish-speaking providers and provision of screening in primary care would increase participation in screening. Any DR, vision-threatening DR, or proliferative DR were found in 30.2%, 9.9%, and 5.4% of participants, respectively. Nearly one-fifth (19.5%) received referrals. CONCLUSIONS Screening in Mexican consulates may improve DR detection and treatment among Mexican migrants in the U.S.
Psychological empowerment (PE) is conceptualized as a context-dependent construct, yet few have s... more Psychological empowerment (PE) is conceptualized as a context-dependent construct, yet few have studied its applicability to youth in international settings. The current study used a participatory approach to design a measure of empowerment for youth from a rural, Indigenous community in Guatemala and aimed to compare this new measure to extant measures. Youth co-researchers (aged 19-22) collaborated in the development of four culturally relevant empowerment scales through a formative process involving classroom observations and focus groups. Newly developed scales and two widely used, extant scales were administered to a school-based sample of 273 youth (mean age = 14.7, SD = 1.6). Exploratory factor analysis (EFA) showed that one of the newly developed PE scales called Self-Efficacy for Community Action (SECA), which was moderately correlated with the extant scales, appeared to more effectively capture empowerment in the local context than the extant measures. These results suppor...
For decades, Africa has been plagued by political and ethnic conflict, the health ramifications o... more For decades, Africa has been plagued by political and ethnic conflict, the health ramifications of which are often not investigated. A crisis occurred recently in Kenya following the 2007 presidential election. Ethnic violence ensued, targeting the incumbent President Kibaki's Kikuyu people. The violence occurred primarily in Nairobi and the Rift Valley of Kenya. We sought to examine the association between exposure to the 2007/2008 Kenyan Crisis and birthweight. Using the 2008/2009 Kenyan Demographic and Health Survey (KDHS), we compared birth weights of infants in utero or not yet conceived during the 15 months after the political turmoil following the 2007 presidential election (exposed) to those who were born before the crisis (unexposed). There were 663 "exposed" and 687 "unexposed" infants. Multivariate regression was used. We examined the possibility of two-way and three-way interactions between exposure status, ethnicity (Kikuyu versus non-Kikuyu), and region (violent region versus not). Overall, exposure to the Kenyan Crisis was associated with lower birthweight. Kikuyu women living in a violent region who were exposed during their 2 nd trimester had the greatest difference in birthweight in comparison to all unexposed infants: 564.4 grams lower (95% CI 285.1, 843.6). Infants of Kikuyu exposed during the 2 nd trimester and living in a violent region weighed 603.6 grams less (95% CI 333.6, 873.6) than Kikuyu infants born during the unexposed period. Political unrest may have implications for the birthweight of infants, particularly among targeted populations. Given the adverse sequelae associated with lowered birth weight, these results suggest that particular attention should be paid to pregnant women and targeted ethnic groups following such events.
Standard methods to monitor tuberculosis (TB) treatment response rely on sputum microscopy and cu... more Standard methods to monitor tuberculosis (TB) treatment response rely on sputum microscopy and culture conversion. Alternatives to these methods are needed for those patients whose sputum tests are smear or culture negative. Here, we examine anti-phospholipid IgM antibody level changes as a biomarker for treatment response in smear positive TB patients. Serum samples were obtained from 40 pulmonary TB patients at the start and end of the intensive phase treatment (IPT) from the CDC-TB Trials Consortium randomized clinical trial in Kampala, Uganda. Samples were screened by ELISA for IgM levels against five phospholipids found in Mycobacterium tuberculosis and host cells. Lipid antigens included cardiolipin (CL), phosphatidyl inositol (PI), phosphatidyl ethanolamine (PE), phosphatidyl choline (PTC), and sphingolipid (SL). Levels of IgM against all phospholipids significantly decreased (p = 0.034, 0.001, 0.008 0.008, 0.040, respectively) following anti-TB drug treatment in patients wit...
Early return to work after childbirth has been increasing among working mothers in the US. We ass... more Early return to work after childbirth has been increasing among working mothers in the US. We assessed the relationship between access to employer-offered maternity leave (EOML) (both paid and unpaid) and uptake and duration of maternity leave following childbirth in a socioeconomically diverse sample of full-time working women. We focus on California, a state that has long provided more generous maternity leave benefits than those offered by federal maternity leave policies through the State Disability Insurance program. The sample included 691 mothers who gave birth in Southern California in 2002-2003. Using weighted logistic regression, we examined the EOML-maternity leave duration relationship, controlling for whether the leave was paid, as well as other occupational, personality and health-related covariates. Compared with mothers who were offered more than 12 weeks of maternity leave, mothers with \6 weeks of EOML and those offered 6-12 weeks had five times higher odds of returning to work within 12 weeks; those offered no leave had six times higher odds of an early return. These relationships were similar after controlling for whether the leave was paid and after controlling for other occupational and health characteristics. Access to and duration of employer-offered maternity leave significantly determine timing of return to work following childbirth, potentially affecting work-family balance. Policy makers should recognize the pivotal role of employers in offering job security during and after maternity leave and consider widening the eligibility criteria of the Family and Medical Leave Act.
JAIDS Journal of Acquired Immune Deficiency Syndromes, 2010
Objective: To measure HIV prevalence and characterize associated risk behaviors among injection d... more Objective: To measure HIV prevalence and characterize associated risk behaviors among injection drug users (IDU) upon detention in Tehran, Iran. Methods: A cross-sectional survey included 459 male IDU arrested by police during a police sweep in Tehran in 2006. A questionnaire was completed, and blood was collected for HIV testing. Results: Overall HIV prevalence was 24.4% (95% confidence interval 20.5-28.6). Factors independently associated with HIV infection included history of using an opioid in jail (adjusted odds ratio 2.11, 95% confidence interval 1.26-3.53) and older age (adjusted odds ratio 2.79 for 25-34, 3.01 for 35-44, 4.62 for $ 45 yr). Conclusions: This study supports that incarceration is contributing to the increased spread of HIV. Harm reduction programs should be urgently expanded, particularly among incarcerated IDU.
We thank D. Barnes for his valuable input into the data collection and modeling methodology and S... more We thank D. Barnes for his valuable input into the data collection and modeling methodology and S. Lim and M. Ezzati for their contribution to the discussion on modeling approaches. This work was funded in part by the U.S. Environmental Protection Agency and the Shell Foundation. The work leading to the results presented in the article has been developed, conducted, and imple mented by the World Health Organization (WHO). This article reflects activities conducted by the Comparative Risk Assessment Expert Group for Household Air Pollution and undertaken for official reporting by the WHO. Some authors are staff mem bers of the WHO. Those authors alone are responsi ble for the views expressed in this publication, which do not necessarily represent the views, decisions, or policies of the WHO. This article should not be reproduced for use in association with the promotion of commercial products, services or any legal entity. The WHO does not endorse any specific organiza tion or products. Any reproduction of this article cannot include the use of the WHO logo. The authors declare they have no actual or potential competing financial interests.
Perspectives on Sexual and Reproductive Health, 2012
Available contraceptives are not meeting many women's needs, as is evident by high levels of typi... more Available contraceptives are not meeting many women's needs, as is evident by high levels of typical-use failure, method switching and discontinuation. To improve women's satisfaction with contraceptive methods, determining what features they prefer and how these preferences are satisfi ed by available methods and methods under development is crucial. METHODS: The importance of 18 contraceptive method features was rated by 574 women seeking abortionsa group at high risk of having unprotected intercourse and unintended pregnancies-at six clinics across the United States in 2010. For each available and potential method, the number of features present was assessed, and the percentage of these that were "extremely important" to women was calculated. RESULTS: The three contraceptive features deemed extremely important by the largest proportions of women were eff ectiveness (84%), lack of side eff ects (78%) and aff ordability (76%). For 91% of women, no method had all of the features they thought were extremely important. The ring and the sponge had the highest percentage of features that women deemed extremely important (67% each). Some streamlined modes of access and new contraceptive technologies have the potential to satisfy women's preferences. For example, an over-the-counter pill would have 71% of extremely important features, and an over-the-counter pericoital pill, 68%; currently available prescription pills have 60%. CONCLUSION: The contraceptive features women want are largely absent from currently available methods. Developing and promoting methods that are more aligned with women's preferences presumably could help increase satisfaction and thereby encourage consistent and eff ective use.
Objectives-Life course theory suggests that early life experiences can shape health over a lifeti... more Objectives-Life course theory suggests that early life experiences can shape health over a lifetime and across generations. Associations between maternal pregnancy experience and daughters' age at menarche are not well understood. We examined whether maternal prepregnancy BMI and gestational weight gain (GWG) were independently related to daughters' age at menarche. Consistent with a life course perspective, we also examined whether maternal GWG, birth weight, and prepubertal BMI mediated the relationship between pre-pregnancy BMI and daughter's menarcheal age. Methods-We examined 2,497 mother-daughter pairs from the 1979 National Longitudinal Survey of Youth. Survival analysis with Cox proportional hazards was used to estimate whether maternal pre-pregnancy overweight/obesity (BMI 25.0 kg/m 2 ) and GWG adequacy (inadequate, recommended, and excessive) were associated with risk for earlier menarche among girls, controlling for important covariates. Analyses were conducted to examine the mediating roles of GWG adequacy, child birth weight and prepubertal BMI. Results-Adjusting for covariates, pre-pregnancy overweight/obesity (HR= 1.20, 95% CI 1.06, 1.36) and excess GWG (HR=1.13, 95% CI 1.01, 1.27) were associated with daughters' earlier menarche, while inadequate GWG was not. The association between maternal pre-pregnancy weight and daughters' menarcheal timing was not mediated by daughter's birth weight, prepubertal BMI or maternal GWG. Conclusions-Maternal factors, before and during pregnancy, are potentially important determinants of daughters' menarcheal timing and are amenable to intervention. Further research is needed to better understand pathways through which these factors operate. Menarche; weight gain; body mass index; pregnancy; cohort studies Over the past several decades there has been a downward trend in the average age at menarche in the United States and other developed nations (1-4). Girls enter puberty earlier and start menstruating at younger ages than in the past (5). Significant racial disparities exist, with black girls reaching menarche earlier than non-Hispanic white girls . Life course theory posits that early life experiences influence health over a lifetime and potentially across generations
Purpose: Native American adolescents in the United States suffer from significant health disparit... more Purpose: Native American adolescents in the United States suffer from significant health disparities in depression, substance use and suicide. Research regarding culturally competent, community based, youth positive interventions that promote youth connection is needed to inform a response. The Gathering of Native Americans (GONA) is a strengths-based intervention intended to promote adolescent wellbeing and resiliency. Published research regarding its effects is extremely limited. Our evaluation of the GONA intervention in two California sites in 2012-2014 employs mixed-methods in order to answer the primary research question: Among adolescent Native Americans, what is the relationship between participation in GONA and resilience?
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