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Background: Sexual health among older adults is a major public health concern globally. The syphilis burden is increasing in older adults in China. This study aimed to describe factors associated with syphilis infection and diagnosis among older adults in China during a 16 year period.Methods: Using 16 years of data (2004–2019) from the syphilis case report system of Guangdong, China, we compared data from older adults (aged ≥50 years) with those from younger people (aged 15–49 years). We compared the two age group with the Chi-square test for difference, and Joinpoint regression models to assess the temporal trends.Results: During the study period, 242,115 new syphilis diagnoses were reported in older adults. The mean notification rate of new diagnoses was 64.1 per 100,000 population across the entire 16-year period, which significantly increased over time (average annual percent change [AAPC] 16.2%, 95% CI 13.7–18.7). Syphilis diagnoses increased significantly over time among less developed cities and older women. In 2019, compared with younger adults, newly diagnosed older adults were more likely to be male, native to reporting city, had unknown transmission routes, and were diagnosed late.Conclusion: Our findings call for an urgent need to deliver more targeted prevention interventions for older adults, such as strengthen awareness among health care providers, and integration of syphilis services and primary health care for older adults.

Background The social-ecological systems theory, with its unique conception of resilience (social-ecological systems & resilience, SESR), provides an operational framework that currently best meets the need for integration and adaptive governance as encouraged by the Sustainable Development Goals. SESR accounts for the complex dynamics of social-ecological systems and operationalizes transdisciplinarity by focusing on community engagement, value co-creation, decentralized leadership and social innovation. Targeting Social Innovation (SI) in the context of implementation research for vector-borne diseases (VBD) control offers a low-cost strategy to contribute to lasting and contextualized community engagement in disease control and health development in low and middle income countries of the global south. In this article we describe the processes of community engagement and transdisciplinary collaboration underpinning community-based dengue management in rural primary schools and households in two districts in Cambodia. Methods Multiple student-led and community-based interventions have been implemented focusing on empowering education, communication for behavioral change and participatory epidemiology mapping in order to engage Cambodian communities in dengue control. We describe in particular the significance of the participatory processes that have contributed to the design of SI products that emerged following iterative consultations with community stakeholders to address the dengue problem. Results The SI products that emerged following our interaction with community members are 1) adult mosquito traps made locally from solid waste collections, 2) revised dengue curriculum with hands-on activities for transformative learning, 3) guppy distribution systems led by community members, 4) co-design of dengue prevention communication material by students and community members, 5) community mapping. Conclusions The initiative described in this article put in motion processes of community engagement towards creating ownership of dengue control interventions tools by community stakeholders, including school children. While the project is ongoing, the project’s interventions so far implemented have contributed to the emergence of culturally relevant SI products and provided initial clues regarding 1) the conditions allowing SI to emerge, 2) specific mechanisms by which it happens and 3) how external parties can facilitate SI emergence. Overall there seems to be a strong argument to be made in supporting SI as a desirable outcome of project implementation towards building adaptive capacity and resilience and to use the protocol supporting this project implementation as an operational guiding document for other VBD adaptive management in the region.

Background Both physical exercise and the built environment are associated with cardiovascular diseases (CVDs). Yet, the influence of the multiple dimensions of the built environment and different types of physical exercise on CVDs is not well understood. Further, little is known about the joint effects of physical exercise and the built environment, nor whether one mediates the effect of the other on the risk of CVDs. We aim to investigate the risk of CVDs on middle aged and older Chinese adult populations by analyzing the independent effects, as well as potential interactions and mediation effects of different types of physical exercise and two dimensions of the built environment; namely, greenness and walkability. Methods Data were collected from a community-based cross-sectional study (n = 1944). The study participants, aged 40 years or older, came from 32 communities across urban, suburban, and rural areas in Longzihu district of Bengbu, a typical second-tier city in eastern China. Physical exercise data were obtained from the International Physical Activity Questionnaire (IPAQ) question survey. We used a satellite-based Normalized Difference Vegetation Index (NDVI) score to assess greenness exposure. We used both the Walk Score index and the Neighborhood Environment Walkability Scale (NEWS) to assess walkability. Multilevel logistic regression, also known as mixed-effects logistic regression, was used to estimate the associations between physical exercise and the built environment (greenness and walkability) on CVD outcomes while accounting for within-community and within-subdistrict correlations. We followed Baron and Kenny's framework and used bootstrapping to quantify the mediation of physical exercise between built environment and CVD outcomes. Stratified analysis was conducted by age (middle aged and older adults) and gender. Results Compared to the reference group with little to low physical activities, we found a significantly reduced risk of hypertension (about 20–45% reduction) and coronary heart disease (about 35–55% reduction) among those with moderate to high activities in walking/square dancing or morning exercising/Tai Chi, and a significantly reduced risk of stroke (about 25% reduction) among those with moderate to high activities in walking/square dancing. Compared to the reference group with low NDVI-based greenness exposure, we found a significant reduction in risk of hypertension (about 55–85% reduction), coronary heart disease (about 75% reduction) and stroke (about 45% reduction) among those with moderate to high levels of exposure. Compared to the reference groups with low walkability, we observed about 30–60% lower risk of hypertension and coronary heart disease associated with moderate to high levels of Walk score, and about 20–30% lower risk of hypertension and stroke associated with moderate to high levels of NEWS-based walkability. We found no interactions between physical exercise and the built environment. The associations of greenness and walkability with CVDs were partially explained by physical exercise (up to 55% of the total effect). Conclusions Both physical exercise and built environment factors were associated with the risk of CVDs. Our observed association between CVDs and neighborhood greenness exposure and walkability was explained, in part, by physical exercises. Such a role, if confirmed in future studies, could have important implications for policies and programs aimed at increasing green spaces and improving walkability in both urban and rural settings as strategies to promote physical exercise in middle aged and older population.

Author(s): Sami, Mojgan; Smith, Megan; Ogunseitan, Oladele A | Abstract: IntroductionIncreases in physical activity can lead to decreases in the prevalence of chronic diseases. Parks provide an ideal setting for physical activity. We investigated the effect of a fitness equipment installation on the intensity of park users' physical activity at a community park.MethodsWe used the System for Observing Play and Recreation in a Community to record physical activity in Eastgate Park in Garden Grove, California, in August 2015 (preintervention [n = 1,650 person-periods]) and in February 2016 (postintervention [n = 1,776 person-periods]). We quantified physical activity in target areas of the park during 15-minute observation periods in 2 ways: 1) we categorized each user's activity level during the period (sedentary, walking, vigorous), and 2) we converted activity levels to numeric metabolic equivalent task (MET) scores and calculated the period-average score across users. We used mixed-effects regression models to assess 1) the proportional odds of higher activity level at postintervention and 2) the association between intervention status (pre vs post) and mean period-average MET scores.ResultsIn the immediate zone around the fitness equipment, the odds ratio for a higher activity level was 1.58 (95% confidence interval [CI], 1.14-2.18; P = .006) and the mean period-average MET score was 0.33 (95% CI, -0.07 to 0.74; P = .11) units higher at postintervention. Across the park as a whole, the odds ratio for a higher activity level was 1.41 (95% CI, 1.21-1.63; P l .001), and the mean period-average MET score was 0.34 (95% CI, 0.12-0.56; P = .003) units higher at postintervention.ConclusionInstalling fitness zones appears to be an effective intervention for increasing physical activity of park users. Further studies need to be conducted to understand the sustained impact of fitness zones over time.

High smoking prevalence among Korean American (KA) males place KA family members and co-workers at an elevated risk of involuntary tobacco smoke exposure (ITSE). KA emerging adults (EAs) face an additional risk of ITSE by their peers, as emerging adulthood is associated with increased smoking. This paper explores health behaviors, attitudes and beliefs of ITSE among KAEA. Qualitative data analysis was conducted on transcripts from ten focus groups (N = 67). Themes related to attitudes and perceptions of ITSE were identified: high level of cultural tolerance, lack of knowledge/insufficient information, perceived benign health effects, and perceived hopelessness/indifference. Themes related to culturally-held beliefs include: tolerance of male family smokers, allowance of indoor smoking and misconceptions of practices perceived to minimize ITSE. The dissemination of culturally relevant ITSE information is needed in KA communities. Failure to implement indoor smoking bans in ethnic enclaves calls for increased enforcement of regulations by public health officials.

A sequential mixed methods study was conducted to identify factors influencing perceived norms about smoking and to examine the association of acculturative contexts and normative beliefs among Korean American young adults (KAYA) who face increased risk of smoking. Content analysis of data from 67 participants in 10 focus groups in 2010 led to the development of an online survey in 2012 (N = 475). KAYA overestimated smoking prevalence, reporting Korean-owned businesses (KOB) as primary places of exposure. Our findings revealed that visits to KOB predicted perceived norms about smoking. Modifying perceptions about social norms and involuntary tobacco exposure may be critical in reducing smoking among KAYA. The study's limitations are noted.

Korean American emerging adults (KAEA) constitute an understudied, at-risk group for smoking and related health consequences. The cultural meanings of smoking and cessation among KAEA were explored. Sixty-seven KAEA participated in 10 focus groups. Themes from the sessions were identified and domain analysis was conducted. Regarding reasons for smoking, we identified (a) association between the culture of origin and gender identification, (b) access/availability of cigarettes in homes/community, and (c) competing social environments where KAEA adjust their health behaviors. Regarding contexts for cessation, we identified (a) a sense of invincibility/denial, (b) lack of role models or pressure to quit, and (c) lack of significant life events. Using cessation aids represented lacking personal discipline/willpower. The results show that smoking among KAEA is highly contextualized in the culture of origin, despite U.S. tobacco control policies. Implications for culturally sensitive prevention/cessation programs for KAEA include modifying culturally based norms and social spaces regarding cigarettes and cessation.

This issue of the journal is devoted to the social determinants of health in urban settings and associated interventions that protect health and promote health equity. The great disparity in health opportunities and health status between and within different population groups in and between countries at different economic development levels is one of the great challenges for the global community at the beginning of the 21st century. The international community debated the issues of poverty, economic development, and health at a number of major summits toward the end of the 20th century, including the Rio Earth Summit in 1992 and the Copenhagen Social Summit in 1995. However, without specific targets or agreed dates for achieving those targets, progress on social and health equity was insufficient. One major reason was the lack of financial resources because of the noncompliance of affluent countries with the agreed aid target of 0.7% of their GDP. At the turn of the century, the international community took up the challenge of achieving better equity by formulating the Millennium Development Goals at the Millennium Summit in 2000, many of which include priority health issues. Progress is visible for some of the goals, but not enough for them to be met by the target year: 2015. The targets address the needs of the poorest people, but economic and social inequities and associated health inequities remain. It should also be remembered that the Universal Declaration on Human Rights, which almost all countries have signed, expressly states that all people have a right to live in conditions that promote health and protect life.

Discount snuff, known for its cheap price, high nicotine content, and popularity among youth, has increased substantially in market share in the United States. As a likely result, the leading manufacturer of premium snuff has supported legislation changing the basis for taxing snuff from price to weight. To determine which public health issues arose in legislative debates, we transcribed 17 of 52 bills from US state legislatures and coded for arguments broadly categorized into public health, fair taxation, tax revenue, tax efficiency, and anti-competitiveness. State legislators expressed frustration that equitable taxation, revenue generation, and prevention of youth tobacco use were frequently conflated in the debates. Public health advocates expressed concerns over youths' incentives to purchase low-weight snuff, but seldom discussed youths' growing preference for discount snuff. The evolving market of moist snuff is a critical consideration for US state legislators as well as policy makers from other countries who may evaluate taxation methods for alternate tobacco products.

Existing survey data indicate that most smokers are not receptive to harm reduction incentives of switching to smokeless tobacco (SLT). Little is known about the underlying reasons for these views. To explore smokers' perceptions of SLT, we conducted a focus group (eight in total) study of daily smokers between 2009 and 2010 at the University of California, Irvine. We transcribed each 2-hour focus group verbatim and analyzed it using domain analysis. The discussions revealed several reasons why smokers are not receptive to SLT. First, smokers associated new spit-less SLT (that is, Snus) with historic images of chewing tobacco. Second, smokers viewed smoking as an incentive to take a break from their daily routine. Third, smokers expressed lack of control over nicotine delivery when using SLT, relative to cigarettes. These findings challenge tobacco manufacturers' strategies to market a smokeless alternative as a growing number of smoke-free policies are introduced.

The World Health Organization (WHO) Commission on Social Determinants of Health (CSDH) has posed a provocative question for public health: “Why do we keep treating people for illnesses only to send them back to the conditions that created illness in the first place?”1 For the WHO Centre for Health Development (WHO Kobe Centre), hub of the Commission’s Knowledge Network on Urban Settings (KNUS), this represents a challenge to the public health sector not only to acknowledge the pervasiveness of urban poverty as a critical pathway to ill health and health inequities, but to address this as an urgent public health issue affecting a billion people living in informal settlements, or “slums.”1 People who live in informal settlements are often systematically excluded from opportunities, decent employment, security, capacity, and empowerment3 that would enable them to gain better control over their health and lives. As noted in the Interim Report by the Millennium Development Goals (MDG) Task Force, which focuses on improving the lives of urban slum dwellers: Much of urban poverty is not because of distance from infrastructure and services but from exclusion. They are excluded from the attributes of urban life that remain a monopoly of a privileged minority—political voice, secure good-quality housing, safety and the rule of law, good education, health services, decent transport, adequate incomes, access to goods and services, credit—in short, the attributes of full citizenship.4 The issue of urban poverty is not new, but it is often narrowly viewed as an economic issue that is best addressed by economic policies and interventions. Urban poverty today, as driven by globalization and rapid uncontrolled urbanization, also needs to be recognized as a social, political, and cultural process that has profound impacts on public health. Exclusion of the urban poor from the benefits of urban life fosters discontent and political unrest. Within the broader context of health and human development, rapid urbanization of poverty and ill health have been characterized as a new human security threat.5 Rapid uncontrolled urbanization results from the interaction between global and local forces. The interconnectedness of cities through trade, business, industry, tourism, international travel, information technology, and media is reshaping social determinants of health that are manifest at the city level. On the other hand, local and national governance capacity in relation to health systems, housing, transport, property rights, migration, land use policy, working conditions, and employment may be unable to cope with the speed of change brought about by global economic restructuring. Inequity in cities that leads to urban poverty, and poor health, therefore, are also products of global and local forces in the urban setting. Public health can play an important role in ameliorating urban poverty through social processes (participation, social capital, social accountability, and social inclusion) that influence urban governance at multiple nodes6 of power. Addressing urban poverty as an urgent public health issue opens a policy space for fairer health opportunities and healthier and more equitable cities.