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Background: Little is known about how to tailor implementation of mental health services in low- and middle-income countries (LMICs) to the diverse settings encountered within and between countries. In this paper we compare the baseline context, challenges and opportunities in districts in five LMICs (Ethiopia, India, Nepal, South Africa and Uganda) participating in the PRogramme for Improving Mental health carE (PRIME). The purpose was to inform development and implementation of a comprehensive district plan to integrate mental health into primary care. Methods: A situation analysis tool was developed for the study, drawing on existing tools and expert consensus. Cross-sectional information obtained was largely in the public domain in all five districts. Results: The PRIME study districts face substantial contextual and health system challenges many of which are common across sites. Reliable information on existing treatment coverage for mental disorders was unavailable. Particularly in the low-income countries, many health service organisational requirements for mental health care were absent, including specialist mental health professionals to support the service and reliable supplies of medication. Across all sites, community mental health literacy was low and there were no models of multi-sectoral working or collaborations with traditional or religious healers. Nonetheless health system opportunities were apparent. In each district there was potential to apply existing models of care for tuberculosis and HIV or non-communicable disorders, which have established mechanisms for detection of drop-out from care, outreach and adherence support. The extensive networks of community-based health workers and volunteers in most districts provide further opportunities to expand mental health care. Conclusions: The low level of baseline health system preparedness across sites underlines that interventions at the levels of health care organisation, health facility and community will all be essential for sustainable delivery of quality mental health care integrated into primary care. [ABSTRACT FROM AUTHOR]

Objectives: To extend existing research on the US health disadvantage relative to Europe by studying the relationships of disability with age from midlife to old age in the US and four European regions (England/Northern and Western Europe/Southern Europe/Eastern Europe) including their wealth-related differences, using a flexible statistical approach to model the age-functions. Methods: We used data from three studies on aging, with nationally representative samples of adults aged 50 to 85 from 15 countries (N = 48225): the US-American Health and Retirement Study (HRS), the English Longitudinal Study of Ageing (ELSA) and the Survey of Health, Ageing and Retirement in Europe (SHARE). Outcomes were mobility limitations and limitations in instrumental activities of daily living. We applied fractional polynomials of age to determine best fitting functional forms for age on disability in each region, while controlling for socio-demographic characteristics and important risk factors (hypertension, diabetes, obesity, smoking, physical inactivity). Results: Findings showed high levels of disability in the US with small age-related changes between 50 and 85. Levels of disability were generally lower in Eastern Europe, followed by England and Southern Europe and lowest in Northern and Western Europe. In these latter countries age-related increases of disability, though, were steeper than in the US, especially in Eastern and Southern Europe. For all countries and at all ages, disability levels were higher among adults with low wealth compared to those with high wealth, with largest wealth-related differences among those in early old age in the USA. Conclusions: This paper illustrates considerable variations of disability and its relationship with age. It supports the hypothesis that less developed social policies and more pronounced socioeconomic inequalities are related to higher levels of disability and an earlier onset of disability. [ABSTRACT FROM AUTHOR]

Objective: Excess mortality from diseases and medical conditions (natural death) in persons with psychiatric disorders has been extensively reported. Even in the Nordic countries with well-developed welfare systems, register based studies find evidence of an excess mortality. In recent years, cardiac mortality and death by diseases of the circulatory system has seen a decline in all the Nordic countries, but a recent paper indicates that women and men in Denmark, Finland, and Sweden, who had been hospitalised for a psychotic disorder, had a two to three-fold increased risk of dying from a cardiovascular disease. The aim of this study was to compare the mortality by diseases of the circulatory system among patients with bipolar disorder or schizophrenia in the three Nordic countries Denmark, Sweden, and Finland. Furthermore, the aim was to examine and compare life expectancy among these patients. Cause specific Standardized Mortality Rates (SMRs) were calculated for each specific subgroup of mortality. Life expectancy was calculated using Wiesler’s method. Results: The SMR for bipolar disorder for diseases of the circulatory system was approximately 2 in all countries and both sexes. SMR was slightly higher for people with schizophrenia for both genders and in all countries, except for men in Denmark. Overall life expectancy was much lower among persons with bipolar disorder or schizophrenia, with life expectancy being from 11 to 20 years shorter. Conclusion: Our data show that persons in the Nordic countries with schizophrenia or bipolar disorder have a substantially reduced life expectancy. An evaluation of the reasons for these increased mortality rates should be prioritized when planning healthcare in the coming years. [ABSTRACT FROM AUTHOR]

Objectives: The paper describes the creation of a new scale to measure intimate partner violence (IPV) among gay and bisexual men. Methods: Seven focus group discussions were held with gay and bisexual men, focusing on defining intimate partner violence: 30 forms of IPV were identified. A venue-recruited sample of 912 gay and bisexual men was surveyed, examining definitional understanding and recent experiences of each of the 30 forms of IPV. Participants were also asked questions from the CDC definition of intimate partner violence and the short-form of the Conflicts Tactics Scale (CTS2S). Factor analysis of responses to the definitional questions was used to create the IPV-GBM scale, and the prevalence of intimate partner violence was compared with that identified by the CDC and CTS2S measures of intimate partner violence. Results: A 23-item scale, with 5 unique domains, was created, with strong internal reliability (Cronbach Alpha >.90). The IPV-GBM scale mirrored both the CDC and CTS2S definitions of intimate partner violence, but contained additional domains such as controlling violence, monitoring behaviors, emotional violence, and HIV-related violence. The new scale identified a significantly higher prevalence of IPV than either of the more commonly used measures. Conclusions: The results presented here provide encouraging evidence for a new, more accurate measure of intimate partner violence among gay and bisexual men in the U.S. [ABSTRACT FROM AUTHOR]

There has been little work that comprehensively compared the relationship between prenatal care and infant health across multiple countries using similar data sources and analytical models. Such comparative analyses are useful for understanding the background of differences in infant health between populations. We evaluated the association between prenatal care visits and fetal growth measured by birth weight (BW) in grams or low birth weight (<2500 grams; LBW) adjusted for gestational age in eight South American countries using similarly collected data across countries and the same analytical models. OLS and logistic regressions were estimated adjusting for a large set of relevant infant, maternal, and household characteristics and birth year and hospital fixed effects. Birth data were acquired from 140 hospitals that are part of the Latin American Collaborative Study of Congenital Malformations (ECLAMC) network. The analytical sample included 56,014 live-born infants (∼69% of total sample) with complete data born without congenital anomalies in the years 1996–2011 in Brazil, Argentina, Chile, Venezuela, Ecuador, Colombia, Bolivia, and Uruguay. Prenatal care visits were significantly (at p<.05) and positively associated with BW and negatively associated with LBW for all countries. The OLS coefficients ranged from 9 grams per visit in Bolivia to 36 grams in Uruguay. The association with LBW was strongest for Chile (OR = 0.87 per visit) and lowest for Argentina and Venezuela (OR = 0.95). The association decreased in the recent decade compared to earlier years. Our findings suggest that estimates of association between prenatal care and fetal growth are population-specific and may not be generalizable to other populations. Furthermore, as one of the indicators for a country’s healthcare system for maternal and child health, prenatal care is a highly variable indicator between countries in South America. [ABSTRACT FROM AUTHOR]

Objective: To identify patterns of perception of front-of-pack (FOP) nutrition labels and determine dietary, lifestyle and health profiles related to such patterns. Design: Cross-sectional. Participants/Setting: 28,952 French adults participating in the web-based Nutrinet-Santé cohort. Outcome measures: Perception was measured using indicators of understanding and acceptability for three simple FOP labels (“green tick”, the logo of the French Nutrition and Health Program and “simple traffic lights” (STL)), and two detailed FOP formats (“multiple traffic lights” (MTL) and “color range” logo (CR)), placed on ready-to-eat soup packages. Dietary intake data were collected using three web-based 24 h records. Statistical analyses: Associations of perception patterns with individual characteristics, including diet, lifestyle and health status, were examined using analysis of covariance and logistic regression, adjusted for socio-demographic and economic factors. Results: No clear trend emerged concerning differences in dietary intake between perception groups. Low physical activity and obesity were more frequent in the ‘favorable to STL’ group (respectively, 20.7% and 10.7%). The ‘favorable to MTL’ group included the highest percentage of individuals who declared type 2 diabetes (2.2%). Persons with hypertension were proportionally more numerous in the ‘favorable to MTL’ and the ‘favorable to CR logo’ groups (respectively, 9.5% and 9.3%). Conclusions: After adjustment for socio-demographic and economic factors, no FOP label stood out as being more suitable than another for reaching populations with poor diet. However, both STL and MTL may be most appropriate for increasing awareness of healthy eating among groups at higher risk of nutrition-related chronic diseases. [ABSTRACT FROM AUTHOR]

Background: Depression and suicidal thinking occur frequently alongside HIV/AIDS, triggering profound detrimental impacts on quality of life, treatment adherence, disease progression, and mortality. Yet the psychosocial factors contributing to these psychiatric comorbidities remain underexplored, particularly in the developing country context. This study thus examined different dimensions of perceived family support in relation to depression and suicidal ideation among people living with HIV/AIDS (PLWHA) in Nepal. Methods: A cross-sectional survey of 322 adult PLWHA residing in the Kathmandu Valley, Nepal was conducted. Data were analyzed using multiple logistic regressions for correlates of Beck Depression Inventory (BDI)-Ia-defined depressive symptoms and suicidal ideation in the past 2 weeks. Perceived family support, measured using the 10-item Nepali Family Support and Difficulty Scale, was entered into separate models, in turn, as a composite score, for each sub-scale (emotional, instrumental, and negative support), and for each individual item. Results: Overall, 25.5% of participants registered BDI-Ia-defined depression, with significantly lower rates among those with perceived family support scores in the highest (AOR = 0.19; 95% CI = 0.07, 0.55) and middle (AOR = 0.38; 95% CI = 0.17, 0.86) tertiles relative to those with lowest-tertile scores. Meanwhile, 14.0% reported suicidal thinking, with significantly lower rates among those in the highest perceived family support tertile relative to the lowest (AOR = 0.25; 95% CI = 0.07, 0.91). Broken down by support sub-scale, only negative support (i.e. family difficulty) was significant in its correlations with both outcomes – a trend similarly reflected in the item-wise analyses. Conclusions: Our findings highlight an important role for family support in determining experiences of depression and suicidality among PLWHA. Incorporating family counseling and support services – with special focus on ameliorating negative interaction and bolstering emotional support – into HIV care and treatment services may help to improve mental health along with overall wellness and treatment outcomes for HIV-positive populations in Nepal and similar settings. [ABSTRACT FROM AUTHOR]

Background: Education and wealth may have different associations with female obesity but this has not been investigated in detail outside high-income countries. This study examines the separate and inter-related associations of education and household wealth in relation to obesity in women in a representative sample of low- and middle-income countries (LMICs). Methods: The seven largest national surveys were selected from a list of Demographic and Health Surveys (DHS) ordered by decreasing sample size and resulted in a range of country income levels. These were nationally representative data of women aged 15–49 years collected in the period 2005–2010. The separate and joint effects, unadjusted and adjusted for age group, parity, and urban/rural residence using a multivariate logistic regression model are presented Results: In the four middle-income countries (Colombia, Peru, Jordan, and Egypt), an interaction was found between education and wealth on obesity (P-value for interaction <0.001). Among women with no/primary education the wealth effect was positive whereas in the group with higher education it was either absent or inverted (negative). In the poorer countries (India, Nigeria, Benin), there was no evidence of an interaction. Instead, the associations between each of education and wealth with obesity were independent and positive. There was a statistically significant difference between the average interaction estimates for the low-income and middle-income countries (P<0.001). Conclusions: The findings suggest that education may protect against the obesogenic effects of increased household wealth as countries develop. Further research could examine the factors explaining the country differences in education effects. [ABSTRACT FROM AUTHOR]

Background: A psychological disorder called ‘Internet addiction’ has newly emerged along with a dramatic increase of worldwide Internet use. However, few studies have used population-level samples nor taken into account contextual factors on Internet addiction. Methods and Findings: We identified 57,857 middle and high school students (13–18 year olds) from a Korean nationally representative survey, which was surveyed in 2009. To identify associated factors with addictive Internet use, two-level multilevel regression models were fitted with individual-level responses (1st level) nested within schools (2nd level) to estimate associations of individual and school characteristics simultaneously. Gender differences of addictive Internet use were estimated with the regression model stratified by gender. Significant associations were found between addictive Internet use and school grade, parental education, alcohol use, tobacco use, and substance use. Female students in girls' schools were more likely to use Internet addictively than those in coeducational schools. Our results also revealed significant gender differences of addictive Internet use in its associated individual- and school-level factors. Conclusions: Our results suggest that multilevel risk factors along with gender differences should be considered to protect adolescents from addictive Internet use. [ABSTRACT FROM AUTHOR]

Background: Research examining the impact of neighborhoods on asthma has shown an increased interest in the role of the psychosocial environment. We examined the associations between various measures of neighborhood safety, individual and family characteristics, and asthma outcomes among children in Los Angeles. Methods: Multilevel logistic regression models were used to analyze data on 3,114 children across 65 neighborhoods from Wave 1 of the Los Angeles Family and Neighborhood Survey (2000 to 2002). Primary caregivers reported asthma outcome and all individual covariates; home environmental characteristics were observed by the interviewer. Results: In fully adjusted models, parents who reported their neighborhood fairly safe or somewhat dangerous had lower odds of reported lifetime asthma compared to those who reported their neighborhood completely safe (OR 0.71; 95% CI 0.52–0.96 and OR 0.60; 95% CI 0.42–0.88 respectively). Conversely, parents who reported they could not trust their neighbors to keep their children safe had a nearly 40% increase in lifetime asthma compared to those who reported they could trust their neighbors to keep their children safe (OR 1.39; 95% CI 1.07–1.81). Conclusions: The study demonstrates a complex pattern between various measures of neighborhood safety and asthma and suggests that these relationships may operate differently in Los Angeles. As an increasing proportion of children are growing up in newer Western and Southwestern cities, which have different physical layouts and residential segregation patterns compared to Northeast and Midwestern cities, future studies should continue to examine neighborhood psychosocial stressors and asthma in diverse contexts. [ABSTRACT FROM AUTHOR]

Objective: We validate an online, personalized mortality risk measure called “RealAge” assigned to 30 million individuals over the past 10 years. Methods: 188,698 RealAge survey respondents were linked to California Department of Public Health death records using a one-way cryptographic hash of first name, last name, and date of birth. 1,046 were identified as deceased. We used Cox proportional hazards models and receiver operating characteristic (ROC) curves to estimate the relative scales and predictive accuracies of chronological age, the RealAge score, and the Framingham ATP-III score for hard coronary heart disease (HCHD) in this data. To address concerns about selection and to examine possible heterogeneity, we compared the results by time to death at registration, underlying cause of death, and relative health among users. Results: The RealAge score is accurately scaled (hazard ratios: age 1.076; RealAge-age 1.084) and more accurate than chronological age (age c-statistic: 0.748; RealAge c-statistic: 0.847) in predicting mortality from hard coronary heart disease following survey completion. The score is more accurate than the Framingham ATP-III score for hard coronary heart disease (c-statistic: 0.814), perhaps because self-reported cholesterol levels are relatively uninformative in the RealAge user sample. RealAge predicts deaths from malignant neoplasms, heart disease, and external causes. The score does not predict malignant neoplasm deaths when restricted to users with no smoking history, no prior cancer diagnosis, and no indicated health interest in cancer (p-value 0.820). Conclusion: The RealAge score is a valid measure of mortality risk in its user population. [ABSTRACT FROM AUTHOR]

The aim of this study is to assess whether the Government of Kenya's Cash Transfer for Orphans and Vulnerable Children (Kenya CT-OVC) can reduce the risk of HIV among young people by postponing sexual debut. The program provides an unconditional transfer of US$20 per month directly to the main caregiver in the household. An evaluation of the program was implemented in 2007–2009 in seven districts. Fourteen Locations were randomly assigned to receive the program and fourteen were assigned to a control arm. A sample of households was enrolled in the evaluation in 2007. We revisited these households in 2011 and collected information on sexual activity among individuals between 15–25 years of age. We used logistic regression, adjusted for the respondent's age, sex and relationship to caregiver, the age, sex and schooling of the caregiver and whether or not the household lived in Nairobi at baseline, to compare rates of sexual debut among young people living in program households with those living in control households who had not yet entered the program. Our results, adjusted for these covariates, show that the program reduced the odds of sexual debut by 31 percent. There were no statistically significant effects on secondary outcomes of behavioral risk such as condom use, number of partners and transactional sex. Since the CT-OVC provides cash to the caregiver and not to the child, and there are no explicit conditions associated with receipt, these impacts are indirect, and may have been achieved by keeping young people in school. Our results suggest that large-scale national social cash transfer programs with poverty alleviation objectives may have potential positive spillover benefits in terms of reducing HIV risk among young people in Eastern and Southern Africa. [ABSTRACT FROM AUTHOR]

Background: Obesity is increasing dramatically in the Asia-Pacific region particularly China. The population of Hong Kong was exposed to modernization far earlier than the rest of China, reflecting conditions that are likely to be replicated as other Chinese cities undergo rapid change. This study examined the relationship between television viewing and obesity in a Hong Kong sample. Information about the relationship between a key sedentary behavior, TV viewing, and obesity, and its moderation by demographic characteristics may identify sectors of the population at highest risk for excess weight. Methods: Data were from Hong Kong Family and Health Information Trends Survey (2009–2010), a population-based survey on the public's use of media for health information and family communication by telephone interviews with 3,016 Hong Kong adults (age≥18 years). TV viewing time, body mass index (BMI), physical activity and other lifestyle variables were analyzed. Results: Viewing time was longer in women, increased with age but decreased with education level and vigorous physical activity (all P<0.01). Longer TV viewing time was significantly associated with higher BMI (Coefficients B = 0.17, 95% CI: 0.11, 0.24) after adjusting for age, gender, employment status, marital status, education level, smoking activity and vigorous physical activity. This association was stronger in women than men (Coefficients B: 0.19 versus 0.15) and strongest in those aged 18 to 34 years (Coefficients B = 0.35). Furthermore, an hour increase in daily TV viewing was associated with 10% greater odds of being obese. Conclusions: A significant socioeconomic gradient in television viewing time was observed. TV viewing time positively associated with BMI and obesity. The TV viewing – BMI associations were strongest in women and young adults, suggesting vulnerable groups to target for obesity prevention by decreasing TV viewing. [ABSTRACT FROM AUTHOR]

Context: Substantive equity-focused policy changes in Ontario, Canada have yet to be realized and may be limited by a lack of widespread public support. An understanding of how the public attributes inequalities can be informative for developing widespread support. Therefore, the objectives of this study were to examine how Ontarians attribute income-related health inequalities. Methods: We conducted a telephone survey of 2,006 Ontarians using random digit dialing. The survey included thirteen questions relevant to the theme of attributions of income-related health inequalities, with each statement linked to a known social determinant of health. The statements were further categorized depending on whether the statement was framed around blaming the poor for health inequalities, the plight of the poor as a cause of health inequalities, or the privilege of the rich as a cause of health inequalities. Results: There was high agreement for statements that attributed inequalities to differences between the rich and the poor in terms of employment, social status, income and food security, and conversely, the least agreement for statements that attributed inequalities to differences in terms of early childhood development, social exclusion, the social gradient and personal health practices and coping skills. Mean agreement was lower for the two statements that suggested blame for income-related health inequalities lies with the poor (43.1%) than for the three statements that attributed inequalities to the plight of the poor (58.3%) or the eight statements that attributed inequalities to the privilege of the rich (58.7%). Discussion: A majority of this sample of Ontarians were willing to attribute inequalities to the social determinants of health, and were willing to accept messages that framed inequalities around the privilege of the rich or the plight of the poor. These findings will inform education campaigns, campaigns aimed at increasing public support for equity-focused public policy, and knowledge translation strategies. [ABSTRACT FROM AUTHOR]

Using the 1980 to 2002 General Social Survey, a repeated cross-sectional study that has been linked to the National Death Index through 2008, this study examines the changing relationship between self-rated health and mortality. Research has established that self-rated health has exceptional predictive validity with respect to mortality, but this validity may be deteriorating in light of the rapid medicalization of seemingly superficial conditions and increasingly high expectations for good health. Yet the current study shows the validity of self-rated health is increasing over time. Individuals are apparently better at assessing their health in 2002 than they were in 1980 and, for this reason, the relationship between self-rated health and mortality is considerably stronger across all levels of self-rated health. Several potential mechanisms for this increase are explored. More schooling and more cognitive ability increase the predictive validity of self-rated health, but neither of these influences explains the growing association between self-rated health and mortality. The association is also invariant to changing causes of death, including a decline in accidental deaths, which are, by definition, unanticipated by the individual. Using data from the final two waves of data, we find suggestive evidence that exposure to more health information is the driving force, but we also show that the source of information is very important. For example, the relationship between self-rated health and mortality is smaller among those who use the internet to find health information than among those who do not. [ABSTRACT FROM AUTHOR]

Objective: To identify which physician and patient characteristics are associated with physicians' estimation of their patient social status. Design: Cross-sectional multicentric survey. Setting: Forty-seven primary care private offices in Western Switzerland. Participants: Random sample of 2030 patients ≥16, who encountered a general practitioner (GP) between September 2010 and February 2011. Main measures: Primary outcome: patient social status perceived by GPs, using the MacArthur Scale of Subjective Social Status, ranging from the bottom (0) to the top (10) of the social scale.Secondary outcome: Difference between GP's evaluation and patient's own evaluation of their social status. Potential patient correlates: material and social deprivation using the DiPCare-Q, health status using the EQ-5D, sources of income, and level of education. GP characteristics: opinion regarding patients' deprivation and its influence on health and care. Results: To evaluate patient social status, GPs considered the material, social, and health aspects of deprivation, along with education level, and amount and type of income. GPs declaring a frequent reflexive consideration of their own prejudice towards deprived patients, gave a higher estimation of patients' social status (+1.0, p = 0.002). Choosing a less costly treatment for deprived patients was associated with a lower estimation (−0.7, p = 0.002). GP's evaluation of patient social status was 0.5 point higher than the patient's own estimate (p<0.0001). Conclusions: GPs can perceive the various dimensions of patient social status, although heterogeneously, according partly to their own characteristics. Compared to patients' own evaluation, GPs overestimate patient social status. [ABSTRACT FROM AUTHOR]

In the absence of reliable systems for registering rare types of vital events large surveys are required to measure changes in their rates. However some events such as maternal deaths are widely known about in the community. This study examined the utility of asking respondents about events in their neighbourhood as an efficient method for measuring relative rates of rare health events such as maternal and infant deaths. A survey was conducted in the health and demographic surveillance system (HDSS) in Matlab, Bangladesh, which includes two areas with different health care regimes. Adult women were asked about any maternal deaths; multiple births; infant deaths, live births and some other events they knew of in a small specified area around their home. Agreement between HDSS records and survey responses was moderate or better (kappa≥0.44) for all the events and greatest for maternal deaths (kappa = 0.77) with 84% being reported. Most events were more likely to be reported if they were recent (p<0.05). Infant mortality rate in one area was 0.56 times that in the other which was well reflected by the ratio of survey results (0.53). Simulations were used to study the ability of the method to detect differences in maternal mortality ratio. These suggested that a sample size around 5000 would give 80% power to detect a 50% decrease from a baseline of 183 which compared well with an estimated sample size around 10 times larger using the direct sisterhood method. The findings suggest that the Neighbourhood Method has potential for monitoring relative differences between areas or changes over time in the rates of rare demographic events, requiring considerably smaller sample sizes than traditional methods. This raises the possibility for interventions to demonstrate real effects on outcomes such as maternal deaths where previously this was only feasible by indirect methods. [ABSTRACT FROM AUTHOR]

Introduction: Stigma constitutes a critical challenge to the rising rates of HIV among Chinese men who have sex with men (MSM). It reduces willingness to disclose one’s sexual orientation and can lead to concurrent sexual partnerships. Disclosure decisions are also affected by cultural norms that place pressures on sons to marry. In this manuscript, we characterize how stigma and cultural factors influenced Chinese MSM’s decisions around disclosure and marriage. We seek to show that MSM’s actions were motivated by moral considerations, even when those choices posed HIV transmission risks. Methods: We conducted qualitative interviews with 30 MSM in Beijing, China. Interviews were audio-recorded, transcribed, and translated into English for analysis. Transcripts were coded using a procedure that allowed for themes to emerge organically. Results: Participants struggled with feelings of shame and believed that others possessed stigmatizing attitudes about homosexuality. They had experienced relatively little discrimination because they infrequently disclosed their MSM status. In response to marital pressures, participant had to reconcile same-sex attractions with filial expectations. Their choices included: not being involved with women; putting on the appearance of a heterosexual relationship by marrying a lesbian; or fulfilling family expectations by marrying a heterosexual woman. Regardless of the decision, many rooted the justifications for their choices in the considerations they had given to others’ needs. Conclusion: The growing epidemic among MSM in China requires action from the public health community. As programs are scaled up to serve these men, it is critical to remember that MSM, who often fear social sanction if they were to reveal their sexual orientation, continue to face the same pressures from culturally normative social duties as heterosexual men. Interventions must find ways to help men navigate a balance between their own needs and the responsibilities they feel toward their parents and others. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study was to examine, first, the relationship of having a rural vs. urban background with suicidal ideation in Chinese college students, and second, whether a potential relationship was mediated by depression. Methods: A survey was conducted among 1,145 undergraduate students at a university in China. Suicidal ideation and depressive symptoms were measured by the revised Hopkins’ Symptom checklist (SCL-90-R). Associations between rural vs. urban background, depression and suicidal ideation were estimated by multivariable linear regression-based β coefficients, logistic regression-based odds ratios (ORs), and corresponding 95% confidence intervals (CIs). The magnitude of indirect effect and bias-corrected 95% CIs were obtained through bootstrap techniques. Results: Rural background was positively associated with depression, which was in turn associated with suicidal ideation. The OR for rural status and suicidal ideation equaled 2.15 (95% CI = 1.36–3.41). This OR was slightly, though significantly (p<0.05) attenuated by additional adjustment for depressive symptoms (OR = 1.99, 95% CI = 1.15–3.44). Conclusion: Having a rural background is a determinant of suicidal ideation in Chinese college students. Depression may only marginally mediate this association. [ABSTRACT FROM AUTHOR]

Alcohol availability has been linked to drunk driving, but research has not examined whether this relationship is the same for first-time and repeat offenses. We examined the relationship between the business hours of alcohol outlets licensed to serve alcohol for on-premises consumption and misdemeanor-level (first offense) and felony-level drunk driving (repeat offense) charges in New York State in 2009. Longer outlet business hours were associated with more misdemeanor drunk driving charges, but were not associated with felony drunk driving charges. The per capita density of on-premises alcohol outlets did not affect misdemeanor or felony drunk driving charges. The results suggest that temporal alcohol availability may be an impelling factor for first-time drunk driving, but other factors likely influence repeat drunk driving behaviors. [ABSTRACT FROM AUTHOR]

We formulated a network-based model to understand how risk behavior change in conjunction with failure of prophylactic interventions can lead to unintended outcomes where “less (intervention) is more (effective).” Our model captures the distinction between one- and two-sided risk behavior change. In one-sided situations (e.g. influenza/H1N1) it is sufficient for either individual in an interaction to exhibit risk behavior change whereas in two-sided situations (e.g. AIDS/HIV) it is necessary for both individuals in the interaction to exhibit risk behavior change, for a potential transmission of the disease. A central discovery is that this phenomenon occurs at differing levels of intervention coverage depending upon the “sidedness” of the interaction. We find that for one-sided interactions, sufficiently high vaccination coverage is necessary for mitigating the effects of risk behavior; for two-sided interactions, it is essential to combine prophylactic treatments with programs aimed at reducing risky behavior. Furthermore, again dependent on the “sidedness,” targeting highly connected nodes can be strictly worse than uniformly random interventions at the same level of coverage. [ABSTRACT FROM AUTHOR]

Background: In the evaluation of a healthcare system, it is of interest to identify factors associated with the usage of different healthcare facilities and with different levels of medical expenditure. Methods: A survey was conducted in January and February of 2012 in China. It focused on the middle-aged and elderly with age of 45 and above. A total of 2,093 people from 1,152 households were surveyed. Results: For inpatient treatment, the probability of using grade III hospitals, which had the highest level of care, was positively associated with age, being married, living in urban areas, and having higher income. For outpatient treatment, the probability of using grade III hospitals was positively associated with age, being married, working in enterprises, living in urban areas, living in central and western regions, and having higher income, and negatively associated with being farmers. The total and out-of-pocket (OOP) medical expenses were analyzed separately. It was found that the expense level was associated with age, education, occupation, living in urban areas, type of hospital used, insurance being used, and per capita income. Conclusion: The access to healthcare and level of medical expenditure were found as associated with demographic characteristics. In addition, differences between areas and regions were observed. Such results may be useful for identifying vulnerable population and for tuning future healthcare development policies. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the awareness of, and willingness to use, HIV Pre-Exposure Prophylaxis (PrEP), and willingness to take part in a PrEP study among gay and bisexual men in Scotland. Methods: Cross-sectional survey of 17 gay commercial venues in Glasgow and Edinburgh in May 2011 (N = 1515, 65.2% response rate); 1393 are included in the analyses. Results: Just under one-third of participants had heard of PrEP (n = 434; 31.2%), with awareness associated with being aged older than 35 years, talking to UAI partners about HIV, and with having had an HIV or STI test in the previous 12 months. Around half were willing to take part in a PrEP study (n = 695; 49.9%) or to take PrEP on a daily basis (n = 756; 54.3%). In multivariate analysis, willingness to take PrEP was associated with lower levels of education, regular gay scene attendance, ‘high-risk’ unprotected anal intercourse (UAI) and testing for HIV or STI in the previous 12 months. Reasons for not wanting to participate in a PrEP study or take PrEP included perceptions of low personal risk of HIV and concerns with using medication as an HIV prevention method. Conclusions: There is a willingness to engage in new forms of HIV prevention and research amongst a significant number of gay and bisexual men in Scotland. Future biomedical HIV interventions need to consider the links between sexual risk behaviour, testing, and potential PrEP use. [ABSTRACT FROM AUTHOR]

Background: The relationship between smoking and risk of kidney failure, especially in people of Chinese origin, is not clear. We analyzed data from the Singapore Chinese Health Study to investigate whether smoking increases the risk of kidney failure. Methods: The Singapore Chinese Health Study is a population-based cohort of 63,257 Chinese adults enrolled between 1993 and 1998. Information on smoking status was collected at baseline. Incidence of kidney failure was identified via record linkage with the nationwide Singapore Renal Registry until 2008. Kidney failure was defined by one of the following: 1) serum creatinine level of more than or equal to 500 µmol/l (5.7 mg/dl), 2) estimated glomerular filtration rate of less than 15 ml/min/1.73 m2, 3) undergoing hemodialysis or peritoneal dialysis, 4) undergone kidney transplantation. Cox proportional hazard regression analysis was performed for the outcome of kidney failure after adjusting for age, education, dialect, herbal medications, body mass index, sex, physician-diagnosed hypertension and diabetes mellitus. Results: The mean age of subjects was 55.6 years at baseline, and 44% were men. Overall 30.6% were ever smokers (current or former) at baseline. A total of 674 incident cases of kidney failure occurred during a median follow-up of 13.3 years. Among men, smokers had a significant increase in the adjusted risk of kidney failure [hazard ratio (HR): 1.29; 95% CI: 1.02–1.64] compared to never smokers. There was a strong dose-dependent association between number of years of smoking and kidney failure, (p for trend = 0.011). The risk decreased with prolonged cessation (quitting ≥10 years since baseline). The number of women smokers was too few for conclusive relationship. Limitation: Information on baseline kidney function was not available. Conclusions: Cigarette smoking is associated with increased risk of kidney failure among Chinese men. The risk appears to be dose- and duration-dependent and modifiable after long duration of cessation. [ABSTRACT FROM AUTHOR]

Online social networking usage is growing rapidly, especially among at-risk populations, such as men who have sex with men (MSM). However, little research has studied the relationship between online social networking usage and sexual risk behaviors among at-risk populations. One hundred and eighteen Facebook-registered MSM (60.1% Latino, 28% African American; 11.9% other) were recruited from online (social networking websites and banner advertisements) and offline (local clinics, restaurants and organizations) venues frequented by minority MSM. Inclusion criteria required participants to be men who were 18 years of age or older, had had sex with a man in the past 12 months, were living in Los Angeles, and had a Facebook account. Participants completed an online survey on their social media usage and sexual risk behaviors. Results from a multivariable regression suggest that number of sexual partners met from online social networking technologies is associated with increased: 1) likelihood of having exchanged sex for food, drugs, or a place to stay within the past 3 months; 2) number of new partners within the past 3 months; 3) number of male sex partners within the past 3 months; and 4) frequency of engaging in oral sex within the past 3 months, controlling for age, race, education, and total number of sexual partners. Understanding the relationship between social media sex-seeking and sexual risk behaviors among at-risk populations will help inform population-focused HIV prevention and treatment interventions. [ABSTRACT FROM AUTHOR]

Though the HIV/AIDS epidemic in Southeastern Europe is one of low reported prevalence, numerous studies have described the pervasiveness of medical providers’ lack of knowledge of HIV/AIDS in the Balkans. This study sought to culturally adapt an instrument to assess medical providers’ knowledge of and attitudes towards HIV/AIDS in Albania. Cultural adaptation was completed through development of a survey from previously validated instruments, translation of the survey into Albanian, blinded back translation, expert committee review of the draft instrument, focus group pre-testing with community- and University Hospital Center of Tirana-based physicians and nurses, and test-retest reliability testing. Blinded back translation of the instrument supported the initial translation with slight changes to the idiomatic and conceptual equivalences. Focus group pre-testing generally supported the instrument, yet some experiential and idiomatic changes were implemented. Based on unweighted kappa and/or prevalence adjusted bias adjusted kappa (PABAK), 20 of the 43 questions were deemed statistically significant at kappa and/or PABAK ≥0.5, while 12 others did not cross zero on the 95% confidence interval for kappa, indicating their probable significance. Subsequently, an instrument to assess medical providers’ knowledge of and attitudes toward HIV/AIDS for an Albanian population was developed which can be expanded within Albania and potentially to other countries within the Balkans, which have an Albanian-speaking population. [ABSTRACT FROM AUTHOR]

We set out to examine the material, psychological, and sociological pathways mediating the income gradient in health and mortality. We used the 2008 General Social Survey-National Death Index dataset (N = 26,870), which contains three decades of social survey data in the US linked to thirty years of mortality follow-up. We grouped a large number of variables into 3 domains: material, psychological, and sociological using factor analysis. We then employed discrete-time hazard models to examine the extent to which these three domains mediated the income-mortality association among men and women. Overall, the gradient was weaker for females than for males. While psychological and material factors explained mortality hazards among females, hazards among males were explained only by social capital. Poor health significantly predicted both income and mortality, particularly among females, suggesting a strong role for reverse causation. We also find that many traditional associations between income and mortality are absent in this dataset, such as perceived social status. [ABSTRACT FROM AUTHOR]

Background: Associations between socio-economic status (SES), personality and inflammation were examined to determine whether low SES subjects scoring high on neuroticism or hostility might suffer relatively higher levels of inflammation than affluent subjects. Methods: In a cross-sectional design, 666 subjects were recruited from areas of high (most deprived – “MD”) and low (least deprived – “LD”) deprivation. IL-6, ICAM-1, CRP and fibrinogen were measured along with demographic and health-behaviour variables, and personality traits of neuroticism, extraversion and psychoticism (hostility). Regression models assessed the prediction of inflammation as a function of personality, deprivation and their interaction. Results: Levels of CRP and IL-6 were an increasing function of neuroticism and extraversion only in LD subjects opposite trends were seen in MD subjects. The result was ascribed parsimoniously to an inflammatory ceiling effect or, more speculatively, to SES-related health-behaviour differences. Psychoticism was strongly associated with ICAM-1 in both MD and LD subjects. Conclusions: The association between neuroticism, CRP and IL-6 may be reduced in MD subjects confirming speculation that the association differs across population sub-groups. The association between psychoticism and ICAM-1 supports evidence that hostility has adverse effects upon the endothelium, with consequences for cardiovascular health. Health interventions may be more effective by accounting for personality-related effects upon biological processes. [ABSTRACT FROM AUTHOR]

Background: Hepatitis C virus (HCV) emerged as sexually transmitted infection among HIV-infected men who have sex with men (MSM). We studied whether HCV circulated in identifiable high-risk MSM subcultures and performed phylogenetic analysis. Methods: HIV-infected MSM were recruited at the sexually transmitted infections (STI) outpatient clinic and a university HIV clinic in Amsterdam, the Netherlands, 2008–2009. Participants completed a detailed questionnaire and were tested for HCV antibodies and RNA, with NS5B regions sequenced for analysis of clusters. Results: Among 786 participants, the median age was 43 (IQR 37–48) years, and 93 (11.8%) were HCV-positive. Seropositivity was associated with belonging to subcultures identified as leather (aOR 2.60; 95% CI 1.56–4.33), rubber/lycra (aOR 2.15; 95% CI 1.10–4.21), or jeans (aOR 2.23; 95% CI 1.41–3.54). The two largest HCV-RNA monophyletic clusters were compared; MSM in cluster I (genotype 1a, n = 13) reported more partners (P = 0.037) than MSM in cluster II (genotype 4d, n = 14), but demographics, subculture characteristics and other risk behaviors did not differ significantly between the two clusters. Discussion: HCV infection is associated with identifiable groups of leather/rubber/lycra/jeans subcultures among HIV-infected MSM. Separate epidemiological HCV transmission networks were not revealed. Active HCV screening and treatment within specific subcultures may reduce HCV spread among all MSM. [ABSTRACT FROM AUTHOR]

Despite the high prevalence of adolescent food insecurity in Ethiopia, there is no study which documented its association with suboptimal dietary practices. The objective of this study is to determine the association between adolescent food insecurity and dietary practices. We used data on 2084 adolescents in the age group of 13–17 years involved in the first round survey of the five year longitudinal family study in Southwest Ethiopia. Adolescents were selected using residence stratified random sampling methods. Food insecurity was measured using scales validated in developing countries. Dietary practices were measured using dietary diversity score, food variety score and frequency of consuming animal source food. Multivariable regression models were used to compare dietary behaviors by food security status after controlling for socio-demographic and economic covariates. Food insecure adolescents had low dietary diversity score (P<0.001), low mean food variety score (P<0.001) and low frequency of consuming animal source foods (P<0.001). After adjusting for other variables in a multivariable logistic regression model, adolescent food insecurity (P<0.001) and rural residence (P<0.001) were negatively associated with the likelihood of having a diversified diet (P<0.001) and frequency of consuming animal source foods, while a high household income tertile was positively associated. Similarly, multivariable linear regression model showed that adolescent food insecurity was negatively associated with food variety score, while residence in semi-urban areas (P<0.001), in urban areas (P<0.001) and high household income tertile (P = 0.013) were positively associated. Girls were less likely to have diversified diet (P = 0.001) compared with boys. Our findings suggest that food insecurity has negative consequence on optimal dietary intake of adolescents. Food security interventions should look into ways of targeting adolescents to mitigate these dietary consequences and provide alternative strategies to improve dietary quality of adolescents in Southwest Ethiopia. [ABSTRACT FROM AUTHOR]

Objective: To describe the socioeconomic and geographic distribution of smoking behaviour in Canada among 19,383 individuals (51% women) aged 15–85 years. Methods: Current smoking and quitting were modeled using standard and multilevel logistic regression. Markers of socioeconomic status (SES) were education and occupation. Geography was defined by Canadian Provinces. Results: The adjusted prevalence of current smoking was 20.2% (95% confidence interval [CI]: 18.8–21.7) and 63.7% (95% CI: 61.1–66.3) of ever smokers had quit. Current smoking decreased and quitting increased with increasing SES. The adjusted prevalence of current smoking was 32.8% (95% CI: 28.4–37.5) among the least educated compared to 11.0% (95% CI: 8.9–13.4) for the highest educated. Among the least educated, 53.0% (95% CI: 46.8–59.2) had quit, rising to 68.7% (95% CI: 62.7–74.1) for the most educated. There was substantial variation in current smoking and quitting at the provincial level; current smoking varied from 17.9% in British Columbia to 26.1% in Nova Scotia, and quitting varied from 57.4% in Nova Scotia to 67.8% in Prince Edward Island. Nationally, increasing education and occupation level were inversely associated with current smoking (odds ratio [OR] 0.64, 95% CI: 0.60–0.68 for education; OR 0.82, 95% CI: 0.77–0.87 for occupation) and positively associated with quitting (OR 1.27, 95% CI: 1.16–1.40 for education; OR 1.20, 95% CI: 1.12–1.27 for occupation). These associations were consistent in direction across provinces although with some variability in magnitude. Conclusion: Our findings indicate that socioeconomic inequalities in smoking have persisted in Canada; current smoking was less likely and quitting was more likely among the better off groups and in certain provinces. Current prevention and cessation policies have not been successful in improving the situation for all areas and groups. Future efforts to reduce smoking uptake and increase cessation in Canada will need consideration of socioeconomic and geographic factors to be successful. [ABSTRACT FROM AUTHOR]

Introduction: The economic recession which began in 2008 has resulted in a substantial increase in unemployment across many countries, including the United Kingdom. Strong association between unemployment and poor health status among individuals is widely recognised. We investigated whether the prevalence of poor health at a population level increased concurrent to the rise in unemployment during the economic recession, and whether the impact on health varied by geographical and socioeconomic circumstances. Method: Health, demographic and socioeconomic measures on 1.36 million survey responses aged 16–64 were extracted from the Quarterly Labour Force Survey of the United Kingdom, collected every three months, from January 2006 to December 2010. The likelihood of self-reporting poor health status and specific types of health problems (depression, mental illness, cardiovascular and respiratory) across time were estimated separately using logistic regression. Explanatory variables included economic status (International Labour Organization definition), occupational class, age, gender, country of birth, ethnicity, educational qualifications, couple status, household tenure, number of dependents, and geographical region. Results: Unemployment (age-gender adjusted) rose from 4.5% in January 2008 to 7.1% by September 2009. The reporting of poor health status increased from 25.7% in July 2009 to 29.5% by December 2010. Similar increases were found for cardiovascular and respiratory health problems; not depression or mental illness. The prevalence of poor health status among the unemployed decreased from 28.8% in July 2008, to 24.9% by March 2009; but this was followed by an increase in poor health experienced across all regions and by all socioeconomic groups, including those who remained employed, regardless of their occupational class. Interpretation: Although our study found no exacerbation of pre-recession health inequalities, the rise in poor health status not only for the unemployed, but also among people who remained employed, regardless of their occupational class, justifies concern voiced among many public health commentators. [ABSTRACT FROM AUTHOR]

Background: Few studies have investigated the relationship between HIV-related stigma and quality life at the dyadic level. The objective of this study was to examine the actor and partner effects of stigma that was perceived by people living with HIV/AIDS (PLWHAs) and caregivers on quality of life at the dyadic level. Method: A survey was conducted among 148 dyads consisting of one PLWHA and one caregiver (296 participants) in Nanning, China. The interdependent relationship between a pair of dyadic members that influences the associations between stigma and quality of life was analyzed, using an innovative dyadic analysis technique: the Actor-Partner Interdependence Model (APIM). Results: We found in this dyadic analysis that (1) PLWHAs compared to their caregivers exhibited a higher level of perceived HIV stigma and lower level of quality of life measured in four domains; (2) both PLWHAs' and caregivers' perceived HIV stigma influenced their own quality of life; (3) The quality of life was not substantially influenced by their partners' perceived stigma; and (4) Both actor and partner effects of stigma on quality of life were similar among PLWHAs and their caregivers. Conclusion: As HIV stigma and quality of life are complex phenomena rooted in cultures, intervention programs should be carefully planned based on social or cognitive theories and should be culturally adopted. [ABSTRACT FROM AUTHOR]