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Nutrition-sensitive agriculture programs hold substantial promise for improving access to nutritious food in contexts like rural Nepal. Yet, implementing such programs in geographically and culturally diverse settings can be challenging. To better understand the contextual factors that influence the ability of program participants to benefit from agriculture-nutrition interventions, we qualitatively examined the implementation of Helen Keller International’s Homestead Food Production program (HFP) in far-western Nepal. Data collection consisted of shadowing program staff for three months, interviewing program participants (n = 31) and staff (n = 10), and conducting three focus-group discussions with female community health volunteers (n = 28). An integrated food and nutrition system framework guided thematic analysis. Participants demonstrated high levels of knowledge about the program’s nutrition messages and expressed interest in and motivation to engage in the HFP program. However, access to water, land, and time determined the extent to which their full participation in the program was feasible. Factors within the biophysical and sociocultural environments interacted to influence access to these crucial resources. Some program participants and staff provided examples of ways in which they overcame these contextual constraints. These included investing in micro-irrigation equipment, arranging land-sharing agreements, and demonstrating more equitable gender norms. Successfully implementing nutrition-sensitive agriculture requires addressing context-specific structural barriers, particularly when aiming to benefit the most vulnerable. Long-term solutions to the barriers faced by the most marginalized households will require broad structural changes. However, problem-solving strategies used by program participants and staff also point towards immediate actions that programs can take to expand the potential for marginalized households to fully participate.

Couple communication and joint decision-making are widely recommended in the family planning and reproductive health literature as vital aspects of fertility management. Yet, most studies continue to rely on women’s reports to measure couple concordance. Moreover, the association between communication and decision-making is often assumed and very rarely studied. Arguably, associations between dyadic communication and shared decision-making constitute a missing link in our understanding of how communication affects fertility-related practices. Informed by Carey’s notions of transmission and ritual communication, this study sought to address those gaps with two complementary studies in Nepal: a qualitative study of married men and women and a quantitative study of 737 couples. To assess spousal concordance on matters of family planning-related communication and decision-making in the quantitative study, responses from the couple were compared for each question of interest and matched responses were classified as concordant. Quantitative results found that more than one-third of couples reported spousal communication on all measured family planning-related topics. Nearly, 87% of couples reported joint decision-making on both family planning use and method type. Partner communication was significantly and positively associated with concordant family planning decision-making in both bivariate and multivariate models. Couples communicating about three family planning topics had more than twice the odds of concordant family planning decision-making than did those not reporting such communication. The qualitative findings provided insights into discordant as well as concordant interactions, revealing that decision-making, even when concordant, is not necessarily linear and is often complex.

Limited attention has been given to the effects of labour migration on the reproductive lives of women 'left behind' as their partners travel for work. Drawing on two rounds of qualitative interviews with 20 women in the central hill region of Nepal, this paper examines how global economic processes that lead Nepali men to travel for work also affect women's reproductive work, including childrearing and reproductive decision-making. Women understood their husband's migration to engage in the wage economy as a response to both immediate and long-term goals for their children and family. As a result, such productive work was intrinsically linked to reproductive work. Men's migration patterns played a pivotal role in reinforcing women's immediate childrearing roles and affecting whether and when women used a contraceptive method and what methods they considered. During periods of spousal migration, women's reproductive lives became targets of gossip and rumours as their intimate and reproductive practices and use of remittances were socially monitored. This complex understanding of women's lived experiences at the nexus of (re)productive work and labour migration can be practically applied to address the reproductive health needs of women with migrant spouses in Nepal.

Suaahara, a nutrition-enhancement program in Nepal, conducted participatory community theater (CT) dramas with the goal of improving nutrition-related practices. To evaluate CT, a pre/posttest with randomized intervention and matched control sites was used. Dramas were conducted in Nawalparasi, Bajhang, and Sindhupalchowk Districts to represent the mountain, hill, and terai/plains regions. Within each study district, two intervention sites were randomly selected and two matched comparison sites were identified for inclusion in the study. At both baseline and endline, 600 individuals aged 18-59 (100 men and 100 women/district × 3 districts) were interviewed in the control sites and 600 in the intervention sites (1200 total respondents). Multivariate logistic analysis controlling for background characteristics found that CT attendance was significantly and positively associated with improved nutrition-related knowledge (adjusted odds ratio ratio [aORR] 10.2, p 0.001) and communication (aORR 2.4, p 0.001), hand washing after cleaning a defecating child (aORR 1.49, p 0.05), feeding children eggs (aORR 1.83, p 0.01), and feeding children meat and/or fish (aORR 2.10, p 0.01). This is the first study to rely on a pre/post matched intervention-control design to assess CT effects in a low-income setting. By testing the "difference-in-differences"-or the difference between intervention groups at baseline and endline minus that between controls at baseline and endline-the argument that the effects can be causally attributed to the intervention itself is strengthened. These findings support the continued and expanded use of CT to improve nutrition-related knowledge, communication, efficacy, and feeding practices as a valuable community-based, public health approach.

Background The extent of coronary disease affects clinical outcomes and may predict the effectiveness of coronary revascularization with either coronary artery bypass graft (CABG) surgery or percutaneous coronary intervention (PCI). The SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score quantifies the extent of coronary disease. Objectives This study sought to determine whether SYNTAX scores predicted outcomes and the effectiveness of coronary revascularization compared with medical therapy in the BARI-2D (Bypass Angioplasty Revascularization Investigation 2 Diabetes) trial. Methods Baseline SYNTAX scores were retrospectively calculated for BARI-2D patients without prior revascularization (N = 1,550) by angiographic laboratory investigators masked to patient characteristics and outcomes. The primary outcome was major cardiovascular events (a composite of death, myocardial infarction, and stroke) over 5 years. Results A mid/high SYNTAX score (≥23) was associated with a higher risk of major cardiovascular events (hazard ratio: 1.36, confidence interval: 1.07 to 1.75, p = 0.01). Patients in the CABG stratum had significantly higher SYNTAX scores: 36% had mid/high SYNTAX scores compared with 13% in the PCI stratum (p Conclusions Among patients with diabetes and stable ischemic heart disease, higher SYNTAX scores predict higher rates of major cardiovascular events and were associated with more favorable outcomes of revascularization compared with medical therapy among patients suitable for CABG. (Bypass Angioplasty Revascularization Investigation in Type 2 Diabetes; NCT00006305)

Communication between Nepali women and their migrating spouses affects the transregional or transnational social fields of women "left behind" and may have implications for their reproductive health. We explored women's interactions with their absent spouses using data gathered from qualitative interviews. Conversations with migrant husbands were frequent, organized around husbands' schedules, and focused on children's needs and expenses. Couple power dynamics were challenged and reinforced in such conversations. Communication about family planning and childbearing was often delayed until the husband's return. In an increasingly mobile world, encouraging partner communication should be integral to reproductive health programs working with migrant couples.

Background Women’s sexuality may be adversely affected during the menopausal transition. This exploratory qualitative study was conducted to explore how women assign meaning to and process sexual motivation during the menopausal transition. Methods We purposefully approached 22 married women ages 44–59 (52.81 ± 3.6 years) in urban health care centers and workplaces in Tabriz city, located in northwest Iran. Individual face-to-face interviews were performed at a place and time convenient to the women. All interviews were audio recorded and then transcribed to create verbatim written accounts. Inspiring Graneheim and Lundman approach, we employed conventional content analysis to derive coding categories directly from our row data. Findings Four main themes emerged from data analysis: “Diminished sexual capacity” (effect of menopause, Illnesses associated with mid-life, desire discrepancy); “intimate coupling” (lack of physical and/or emotional intimacy, couple communication and romance); “sociocultural scripts” (sexual script, parental responsibilities); and “sense of youthfulness” (having an active and happy life, maintaining physically attractiveness). Conclusion The qualitative findings suggest that providing sexual health education and counseling, to encourage critical discussions regarding current sociocultural scripts and to create an environment that would enable men and women alike to adopt a healthy and happy lifestyle for eliminating barriers and preserving and enhancing motivational factors associated with sexuality.

Female sex workers (FSWs) in sub-Saharan Africa are disproportionately affected by HIV and gender-based violence (GBV). Substance use overlaps with these co-occurring epidemics to further increase FSWs’ risk for negative health outcomes. We explored the relationship between substance use, GBV, and consistent condom use utilizing baseline data from a cohort of 496 FSWs in Tanzania. Results demonstrate high levels of alcohol use and GBV, and low levels of consistent condom use. Frequent intoxication during sex work was associated with increased odds of recent GBV (aOR: 1.64, 95% CI: 1.07, 2.49; p-value: 0.02) and reduced odds of consistent condom use with clients (aOR: 0.58, 95% CI: 0.37, 0.92; p-value: 0.02). We adapt the Risk Environment Framework to contextualize our findings in the social and structural context and to gain insight into intervention approaches to address the intersecting challenges of substance use, GBV, and HIV among FSWs in Tanzania and similar settings.

OBJECTIVES: As the primary cause of disability worldwide, depression is a significant contributor to global morbidity and mortality and often disproportionately affects older adults. Several studies have demonstrated a link between urban residence and depression, but few studies have examined this association among older adult populations, and even fewer have studied it within an African context. Given that African societies are aging and urbanizing at rapid rates, this study aimed to assess the relationship between urbanicity and depression within older adult populations in two African countries. METHOD: Data were drawn from the Ghana and South Africa samples of the World Health Organization Study on Global AGEing and Adult Health (SAGE) wave 1 (2007–2008). Depression over the past 12 months was measured using self-reported treatment and depressive symptoms based on ICD-10 criteria in 4,209 Ghanaian and 3,148 South African adults aged 50 years and older residing in their current location for over one year. RESULTS: The 12-month prevalence of depression was 7.5% and 4.0% in Ghana and South Africa, respectively; 41.1% and 65.6%, respectively, lived in urban areas. Comparing urban to rural residents, the adjusted odds ratio (OR) for depression in multivariable analysis was 1.13 (95% CI: 0.71–1.79) in South Africa and 0.85 (95% CI: 0.55–1.31) in Ghana. CONCLUSION: Results do not support a significant urban-rural difference in 12-month depression among Ghanaian or South African SAGE participants. Mental health resources in rural areas should therefore be enhanced in these countries for more equitable distributions between the two settings given similar need.

Past research documents multiple factors associated with girls' susceptibility to human immunodeficiency virus transmission; yet a literature review found no systematic approach to measure vulnerability. This study characterized, developed and tested a set of indicators to measure girls' vulnerability, resulting in the vulnerable girls index (VGI). A quasi- experimental, separate-sample pre-/post-test design was used to test the index. Adolescent girls were randomly drawn for the pre-test (2277 respondents) and post-test (1418 respondents) from 16 purposively selected communities in Botswana, Malawi and Mozambique. The higher the VGI score-or the more vulnerable the girl-the more likely she was to report premarital sexual experience across the three countries and the more likely she was to report low agency to insist upon condom use in Botswana and Mozambique. The VGI can be used to assess girls' vulnerability levels across time and space for policy and programme planning purposes, and as part of programme evaluations.

BACKGROUND In developing countries, breast cancer is generally diagnosed late. Two companion quantitative studies found that health system shortages were a major cause of delayed diagnosis together with poor health literacy. Yet, patients' perceptions regarding the delays were missing. OBJECTIVE We conducted a qualitative study to deepen our understanding of women's experiences with diagnosis and treatment delays and highlight nuances not identifiable in the quantitative studies. INTERVENTIONS/METHODS Fifteen women recruited from the quantitative study were interviewed. Information on diagnosis/treatment delays collected in the quantitative study constituted the basis for the selection of participants, the aim being to ensure a maximum of variability in the types of delays. RESULTS In addition to women's health literacy challenges, which likely resulted from the interactions of individual, interpersonal, and systemic factors, barriers attributable to healthcare system weaknesses and financial constraints were revealed to be key factors. CONCLUSIONS To reduce late-stage diagnosis, tackling women's "lack of breast cancer awareness" is far from sufficient. Although the majority of health professionals are not in a position to address structural and policy barriers, it is nonetheless important for them to be cognizant of these barriers so that they can better advise and guide their patients. IMPLICATIONS FOR PRACTICE Our study aimed to provide a deeper understanding of the social, cultural, and structural barriers patients face in Egypt. Such knowledge should help nurses and other health professionals develop a nonjudgmental, compassionate, and perceptive approach to care.

Addressing community-level factors (CLFs) is integral to the ongoing effort to design multilevel, effective, and sustainable interventions to address each element of the HIV/AIDS treatment cascade. This review, the first critical review of this topic, identified 100 articles that (1) assessed CLFs in relation to the HIV/AIDS treatment cascade, (2) had been peer-reviewed, and (3) were based on studies conducted in low- or middle-income countries. Social support and social networks, cultural norms, gender norms, and stigma were the key CLFs associated with treatment and care. This extensive review found only 5 evaluations of interventions designed to affect CLFs, reflecting a major gap in the literature. All were communication interventions designed to create a more positive environment for HIV testing and access to treatment and care, thus pointing to some of the potential extraindividual effects of communication interventions. The qualitative data are rich and vital for understanding the context; yet, more quantitative analysis to provide evidence regarding the distribution of these factors is essential, as only 19 of the studies were quantitative. There is a pressing need to (1) collect community-level data, (2) validate social and gender norm scales, and (3) better use available data regarding social norms, gender norms, and other CLFs. These data could be aggregated at the cluster, neighborhood, or community levels and incorporated into multilevel analysis to help clarify the pathways to enhanced outcomes across the treatment cascade and thereby mitigate HIV sequelae.

In Irbid, Jordan, a combination of community outreach, using home visits, plays, women's groups, and religious leaders, and improved client-provider counseling based on the “Consult and Choose” approach increased family planning demand and client satisfaction. Service statistic trends suggest increased contraceptive use., Background: High levels of unmet need for family planning and high contraceptive discontinuation rates persist in Jordan, prompting the Jordan Health Communication Partnership (JHCP) to initiate a client-centered family planning service program called “Consult and Choose” (CC), together with community-based activities to encourage women with unmet need to visit health centers. Methods: We held exit interviews with 461 family planning clients between November–December 2011 to assess, from the clients' perspective, whether trained providers followed the CC protocol and used the CC tools, as well as to measure client satisfaction. We also tracked referral card information from community-based activities to health centers and examined service statistics to explore trends in family planning use. Results: On average, clients reported that providers performed 5.6 of the 7 steps outlined in the CC protocol. Nearly 83% of respondents were very satisfied with their clinic visits. Logistic regression analysis found that the odds of being “very satisfied” increases by 20% with each additional counseling protocol step performed and by 70% with each increase in the number of CC materials used. Between June 2011 and August 2012, 14,490 referral cards from community-based activities were collected in health centers, 59% of which were for family planning services. Service statistic trends indicate an increase in the number of new family planning users and in couple-years of protection after starting the CC program. Conclusions: Implementation of the CC program at health centers nationally, in tandem with community-based interventions, could play a key role in attaining Jordan's goal of reducing its total fertility rate to 2.1 by 2030. Although this initiative would likely be replicated most readily in other middle-income countries, lower-resource countries could also adapt the tested CC approach.

The burden of undernutrition in South Asia is greater than anywhere else. Policies and programmatic efforts increasingly address health and non‐health determinants of undernutrition. In Nepal, one large‐scale integrated nutrition program, Suaahara, aimed to reduce undernutrition among women and children in the 1,000‐day period, while simultaneously addressing inequities. In this study, we use household‐level process evaluation data (N = 480) to assess levels of exposure to program inputs and levels of knowledge and practices related to health, nutrition, and water, sanitation, and hygiene (WASH). We also assess Suaahara's effect on the differences between disadvantaged (DAG) and non‐disadvantaged households in exposure, knowledge, and practice indicators. All regression models were adjusted for potential confounders at the child‐, maternal‐, and household levels, as well as clustering. We found a higher prevalence of almost all exposure and knowledge indicators and some practice indicators in Suaahara areas versus comparison areas. A higher proportion of DAG households in Suaahara areas reported exposure, were knowledgeable, and practiced optimal behaviors related to nearly all maternal and child health, nutrition, and WASH indicators than DAG households in non‐Suaahara areas and sometimes even than non‐DAG households in Suaahara areas. Moreover, differences in some of these indicators between DAG and non‐DAG households were significantly smaller in Suaahara areas than in comparison areas. These results indicate that large‐scale integrated interventions can influence nutrition‐related knowledge and practices, while simultaneously reducing inequities.

Summary Background Families have been shown to be dissatisfied with the frequency of doctor communication in the Critical Care setting. Discussions with families are often conducted in an ad-hoc fashion. We hypothesised that the offer of a formal daily weekday clinic for the relatives of Critical Care patients would increase the relatives’ satisfaction. Methods All patients admitted to a 12-bedded Critical Care Unit over a 6-month period in a 480-bed hospital in the East of England were included in the study. The design was a time-interrupted prospective trial assessing the impact of an offered relatives’ clinic on the satisfaction of the next-of-kin. Satisfaction was assessed 4 weeks following discharge from the Critical Care Unit by mail survey using the validated Critical Care Family Satisfaction Survey (1–5 scoring scale). Results Three hundred twenty-one patients met inclusion criteria. Survey return rate was 46%. The control and intervention groups were similar in size and demographics. Mean satisfaction of the control group was 4.50, and that of the intervention group was 4.55 (p = 0.35). Conclusion Offering a relatives’ clinic does not significantly improve the satisfaction of the next-of-kin in this setting. Other means of improving satisfaction have been highlighted as a result of the study.

Background: Children and adolescents are among the most vulnerable groups affected by natural and man-made disaster. To better understand research and practice concerning mental health and psychosocial support efforts in humanitarian settings, the authors conducted a comprehensive review of all intervention programmes within the past decade that universally targeted children and adolescents who were exposed to a natural and/or man-made disaster.Methods: We searched PubMed, PsychINFO, Cochrane Library and CINAHL for mental health and psychosocial interventions (MHPSS) involving children and adolescents. A total of 11 studies, 4 from natural disasters and 7 from conflict-affected areas met the inclusion criteria. Effect sizes were calculated using a random effects model for studies in post-natural disaster and war/terrorist-affected settings separately.Results: The weighted mean effect sizes for interventions in both settings were statistically significant: −0.308, 95% CI = −0.54– −0.07, z = −2.58, p = 0.010 after a natural disaster, and −0.514, 95% CI = −0.80 to −0.23, z = −3.57, p < 0.001 in conflict areas. This indicates that MHPSS interventions in both disaster settings resulted in a reduction in PTSD symptoms compared to the control.Conclusions: This review suggests that school-based, universal programmes that are conducted by teachers or local paraprofessionals are effective in reducing PTSD symptoms in children and adolescents. The few studies meeting the inclusion criteria of this study demonstrate the need for further expansion of statistical methods and study designs to test for the effects of interventions in challenging humanitarian settings.

We sought to determine the effectiveness of uncovered stents with aneurysm transstent coil embolization compared with endografts for percutaneous abdominal aortic aneurysm (AAA) repair. Thirty-six patients with AAA considered inoperable underwent endovascular repair using the Ancure bifurcated endograft or overlapping uncovered stents with transstent coil embolization. Procedural success, outcomes, serial aneurysm size, aneurysm blood flow, and growth ratios were compared between groups. One patient in each group died due to the procedure and two patients in the endograft cohort required acute surgical repair. After 2.0 ± 0.8 years of follow-up, three patients required endograft placement, four surgical repair, three had AAA rupture, with two AAA-related deaths in the uncovered stent group. No late deaths or surgical conversion occurred in the endograft group. The primary AAA flow exclusion and aneurysm expansion rate and growth were superior in the endograft group and during follow-up. In high-risk patients with AAA, the use of endografts was superior compared to uncovered stents with transstent coil embolization for endovascular repair. Catheter Cardiovasc Interv 2005;64:283–290. © 2005 Wiley-Liss, Inc.

Background.Research has shown less aggressive treatment and poorer control of cardiovascular disease (CVD) risk factors in women than men.Methods.We analyzed sex differences in pharmacotherapy strategies and attainment of goals for hemoglobin A1c (HbA1c), blood pressure (BP), and low density lipoprotein cholesterol (LDL-C) in patients with type 2 diabetes and established coronary artery disease enrolled into the BARI 2D trial.Results.Similar numbers of drugs were prescribed in both women and men. Women were less frequent on metformin or sulfonylurea and more likely to take insulin and to be on higher doses of hydroxymethylglutaryl-CoA reductase inhibitors (statins) than men. After adjusting for baseline differences and treatment prescribed, women were less likely to achieve goals for HbA1c (OR = 0.71, 95% CI 0.57, 0.88) and LDL-C (OR = 0.64, 95% CI 0.53, 0.78). More antihypertensives were prescribed to women, and yet BP ≤ 130/80 mmHg did not differ by sex.Conclusions.Women entering the BARI 2D trial were as aggressively treated with drugs as men. Despite equivalent treatment, women less frequently met targets for HbA1c and LDL-C. Our findings suggest that there may be sex differences in response to drug therapies used to treat diabetes, hypertension, and hyperlipidemia.

This three-phase study characterized, validated, and applied community capacity domains in a health communication project evaluation in Zambia. Phase I explored community capacity domains from community members' perspectives (16 focus groups, 14 in-depth interviews, 4 sites. These were validated in Phase II with 720 randomly selected adults. The validated domains were incorporated into a program evaluation survey (2,462 adult women, 2,354 adult men; October 2009). The results indicated that the intervention had direct effects on community capacity; enhanced capacity was then associated with having taken community action for health. Finally, community capacity mediated by community action and controlling for confounders, had a significant effect on women's contraceptive use, children's bed net use, and HIV testing. The results indicate that building community capacity served as a means to an end—improved health behaviors and reported collective action for health—and an end-in-itself, both of which are essential to overall wellbeing.

The Bard Atherectomy Catheter is a new rotational atherectomy device that consists of a flexible, hollow, thin-walled cutting catheter that, while rotated at 1,500 revolutions per minute, is advanced across the lesion over a special spiral guidewire system. We report the initial clinical experience with this device in 20 peripheral lesions in ten patients. The majority of patients were treated for limb salvage. All lesions were successfully intervened on by atherectomy followed by adjunctive balloon angioplasty. A reduction to less than 50% stenosis was achieved in 13 of the 20 lesions (65%) after atherectomy but in all 20 lesions (100%) after adjunctive angioplasty for all lesions and stenting for dissections in two. Baseline minimal lesion lumen diameter was 0.8 ± 0.7 mm with a reference vessel diameter of 4.2 ± 1.7 mm (75 ± 21% stenosis). The lumen improved to 2.0 ± 0.8 mm (45 ± 19% stenosis) (P < 0.001) following atherectomy and to 3.9 ± 1.9 mm (13 ± 16% stenosis) (P < 0.001) after adjunctive angioplasty. The average weight of removed atheroma was 45 ± 58 mg. All ten patients had initial improvement in symptoms. At 6 months follow-up there was persistent improvement in eight patients and two subjects had undergone amputations. Our early clinical experience with this low profile, flexible atherectomy device, that enables extraction of a large amount of atheroma, suggests that it will become a valuable addition to current atherectomy technologies in small- and medium-sized vessels. The value of this device in coronary vessels is under investigation. © 1996 Wiley-Liss, Inc.

Although some cultural practices have been identified as a determinant of HIV transmission, research investigating how specific practices affect HIV risk is lacking. In Malawi, initiation rites, in which young people attend ceremonies around the time of puberty, have received little attention. In this qualitative study, we explored whether communities in southern Malawi perceive initiation rites to be an HIV risk factor for girls. Twelve focus group discussions were held with adolescents and adults in a rural community of Thyolo district and a peri-urban community of Mangochi district. Community members observed that certain aspects of traditional initiation rites propel girls into sexual roles expected of adulthood, without facilitating their adaption to the emerging landscape of HIV, thereby increasing HIV risk. HIV prevention programming needs to address the role of initiation rites in adolescent girls' vulnerability to HIV and help young girls navigate the conflicting messages they receive from a wide range of channels about expected sexual behavior.

Purpose The purpose of this study was to evaluate phase I of a theoretically informed media campaign designed by youth in Zambia to encourage their peers to adopt risk-reduction practices to protect themselves from sexually transmitted infections and human immunodeficiency virus (HIV). The Helping Each other Act Responsibly Together (HEART) campaign conveys information for young people ages 13 to 19 years about sexually transmitted infections, HIV, and acquired immune deficiency syndrome transmission and prevention, and promotes abstinence, a return to abstinence, or consistent condom use as viable risk-reduction practices. Methods Separate sample baseline and follow-up designs were used to evaluate phase I of the HEART campaign among adolescents aged 13 to 19 years. The 1999 baseline survey had a sample of 368 male and 533 female adolescents; the 2000 follow-up survey comprised 496 male and 660 female adolescents. Results Controlling for age, sex, educational attainment, and urban or rural residence, logistic regression analyses demonstrated that, compared with nonviewers, campaign viewers were 1.61 times more likely to report primary or secondary abstinence and 2.38 times more likely to have ever used a condom. The odds ratio of condom use during last sex was 2.1 for respondents who recalled at least 3 television spot advertisements compared with other respondents. Conclusions The positive correlations between HEART campaign viewership and HIV risk-reduction practices demonstrate that mediated messages can influence adolescents. The HEART campaign is among a range of programs in Zambia designed to enable young people to protect their reproductive health. Future research should capture the independent as well as the synergistic effects of multiple campaigns and interventions.

Results: Eighty percent of men, 86% of women, 82% of male religious leaders and 98% of female religious leaders believe that family planning is in keeping with the tenets of Islam. Among religious leaders, 36% reported that they had preached about family planning in the year preceding the survey. Seventy-five percent of women and 62% of men in the general public said that they had spoken about family planning with their spouse, and 9% and 17%, respectively, reported having spoken with a religious leader On a scale of 0- 10 measuring agreement with statements regarding the benefits of family planning (with 10 being complete agreement), women averaged 9.4 and men 8.8, while male religious leaders averaged 6.5 and female religious leaders 7.2. Among the general public, 74 % of women and 58% of men said that deciding to practice contraception is a ]oint decision between husband and wife. About 90% of religious leaders agreed or agreed strongly with the statement that contraceptive decisions should be made jointly by husband and wife. Women were significantly more likely than men to believe that specific contraceptive methods are permitted under Islam, and male religious leaders were more likely than were men in the general population to find specific methods acceptable. Only 26% of men cited interpersonal communication as a source of family planning information, compared with 66% of women, 73% of male reilgious leaders and 89% of female religious leaders. Almost threequarters of men and women said they want to know more about family planning. Conclusion: Although Islamic religious leaders in Jordon cite different reasons than the general public to justify the use of contraceptives, they are as likely as others in the population to approve of family planning. International Family Planning Perspectives, 2000, 26(3):110-117 & 136 M v Xuslim religious leaders are often assumed to hold more conservative attitudes than the general population about family planning, yet a review of the literature finds no research that has specifically compared the two groups. Indeed, Muslim religious leaders' stance toward family planning is often misinterpreted. While they can be expected to refer to religious texts for guidance as they seek to interpret the acceptability of new ideas, religious leaders may prove no more opposed than other members of society to innovation, unless a new idea is perceived to contravene religious tenets. Muslim religious leaders in Jordan, who as members of social networks are intimately involved in the everyday lives of their congregations, probably share ways of thinking that are prevalent within their community. A social group can be expected to have a single worldview, yet the

ObjectiveTo assess the effect of a training program designed to enhance the role of Muslim religious leaders (RLs) in promoting family welfare, including reproductive health generally and family planning more specifically.MethodsA panel study design was utilized; 136 and 115 RLs completed the self-administered questionnaires at baseline (pre-training) and endline (6months post-training), respectively. Scales were generated to assess RLs’ knowledge of the number of family-planning methods deemed to be acceptable according to Islamic teachings (9 methods, Cronbach α=0.85), attitudes toward family planning (7 statements, Cronbach α=0.67), and preaching and/or counseling on family-planning topics (7 topics, Cronbach α=0.85).ResultsLinear regressions controlling for sex, age, and educational attainment showed that, on average, RLs cited more methods deemed acceptable according to Islamic teachings (β=1.381; P