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COVID-19 remains a public health emergency with prevention guidelines and mitigation strategies being constantly updated to curb the rapid spread of the disease. Despite proven successes of recommended preventive behaviors, there is low uptake of wearing a mask, washing of hands, and social distancing in the United States (US). The purpose of this study was to examine factors that influence COVID-19 preventive behaviors. We used data from the nationally representative COVID-19 Household Impact Survey (n = 19,815) conducted in the US from April to June 2020. Chi-square (χ2) test and bivariate analyses were performed to compare study participants who used all COVID-19 related preventive behaviors and those who did not, and multivariate logistic regressions to determine associations across demographic and social characteristics. Of the 19,815 participants, 79.2% of participants reported practicing the aforementioned COVID-19 preventive behaviors. Further, non-Hispanic white, Spanish speaking, living in urban areas, of older age (60+), being female, having an education above an undergraduate, those with income levels $100K or more, living in the urban northeast region that trust and communicate frequently with family and neighbors were more likely to use all three preventive behaviors. Findings suggest a need for continued provision of information on prevention and vaccination importance, but expand efforts to target adopters of these behaviors and encourage them to share their uptake and adherence efforts. This type of horizontal communication where information is shared within trusted social networks can shape social norms that influence the uptake of COVID-19 preventive behaviors and slowly curb communal spread.

To achieve the 2030 goal of ending the HIV epidemic, we must consider social network- along with individual-level factors related to HIV prevention among young Black women (YBW). This cross-sectional study examined egocentric social network- and individual-level data of 180 YBW aged 18–24. Multivariable logistic regression models were used to study social network characteristics and individual sexual behaviors related to HIV prevention behaviors (e.g., HIV testing, condom use, and interest in preexposure prophylaxis, or PrEP). On average, YBW nominated 11 social network members (SNMs; seven friends, two family members, and one sex partner). About 92% of YBW spoke to at least one SNM about condom use and 58% spoke to at least one SNM about HIV testing. Respondents who spoke to a sex partner about condom use had 70% lower odds of being interested in PrEP, but 2.99 times the odds of reporting condom use during last sex. Odds of being tested for HIV in the prior 3 months were significantly increased by 3.97 times for those who spoke to at least one sex partner about HIV testing. However, odds of being interested in PrEP were significantly decreased by 63% for YBW who were tested for HIV in the prior 3 months. Findings underscore that understanding network- and individual-level factors is crucial in increasing HIV testing, condom use, and interest in PrEP among YBW.

Objective: To determine the efficacy of using a narrative-based intervention to reduce HIV stigma among members of the general public in a rural community in Ecuador. Design: This cross-sectional intervention study involved a convenience sample of 133 participants from Cariamanga, Ecuador. We used a post-test only comparison group design. Setting: The number of adults living with HIV in Ecuador is increasing. Stigma and discrimination are among the greatest barriers to HIV prevention, access to treatment, care and support. Stigma is also associated with negative health outcomes. The study took place in the rural community of Cariamanga, Loja, Ecuador. Method: The intervention included (1) a fact-based presentation, (2) video stories from two individuals living with HIV and (3) a structured group discussion. Data were collected using an HIV Stigma Scale and an HIV Knowledge Assessment. Data were analysed using independent t-test and multivariate analysis of variance (MANOVA). Results: Participants who received the intervention had higher HIV knowledge scores ( p < .001; d = 2.06) and lower stigma scores (0.59) subsequent to the intervention than the comparison group (1.02, p < .001; d = 1.05). Conclusion: This narrative-based educational intervention was effective in reducing HIV-related stigma. Public health practitioners should consider including narratives as a component of future health education interventions aimed at reducing HIV-related stigma.

Objective: To explore the perceived experience of polycystic ovary syndrome (PCOS) among PCOS-diagnosed Bangladeshi women with examination of the influence of culture. Methods: This qualitative study included 25 Bangladeshi women who had been diagnosed with PCOS. The qualitative interviews were completed via Skype and/or phone between December 2017 to March 2018. Transcriptions of recorded, de-identified responses were analyzed using qualitative manual coding and thematic analysis. Results and discussion: Three overarching themes were identified from the narratives: PCOS diagnosis experience, PCOS knowledge, and role of religion and culture in relation to PCOS. The women expressed an unsatisfactory experience with their PCOS diagnosis including having to change healthcare professionals, inadequate access to resources, and concerns related to infertility and pregnancy complications. Lack of available evidence-based information was associated with limited knowledge of PCOS among the PCOS-diagnosed Bangladeshi women and their families. The respondents perceived that culture influenced refraining from sharing of information about PCOS thereby limiting knowledge, muting women’s health experience, and contributing to a negative perception on PCOS and related conditions. Participants felt that cultural expectations and emphasis on childbearing placed constant pressure on women and stigmatized PCOS. Conclusions: Bangladeshi women with PCOS perceive various challenges and limited access to information and resources. To minimize some of the challenges associated with PCOS, public health efforts should focus on increasing awareness, education, and resources for women and their families.

Introduction:intimate partner violence (IPV) is a global concern not only among adults but also adolescents. It has been reported that 35% of adolescent women have ever experienced IPV - occuring more so in non-industrialized countries. This study sought to understand the correlates associated with experiencing IPV among adolescent women between the ages 15 and 24 in five East African countries: Burundi, Kenya, Rwanda, Tanzania, and Uganda. Methods:this was a secondary analysis of Demographic and Health Survey (DHS) data on adolescent women aged 15-24 years in five East African countries. IPV was measured as a composite variable of emotional, physical, and sexual violence. Other sociodemographic, income, maternal, sexual, knowledge, behavioral, and partner-related variables were included in the analysis. Results:the prevalence of ever experiencing IPV was 45.1% (n=2380). A higher proportion of women who reported experiencing IPV had their first sexual encounter when they were less than 18 years of age (p

Background: Immigrants in the US are at higher risk of Human Papilloma Virus (HPV) infection and cervical cancer compared to the general US population. Low awareness surrounding cervical cancer inhibits associated preventive practices. Purpose: This cross-sectional study examined the association between knowledge, attitude, and utilization of health services for cervical cancer screening and HPV vaccine among immigrant and refugee women in Ohio. Method: Preliminary analyses were conducted on a total of 70 participants recruited from immigrant and refugee organizations and community centers, using a validated paper survey. Results: There was a statistically significant association between cervical cancer screening and general knowledge on cervical cancer (p = 0.038). The study also revealed association between screening age (p < 0.001) and insurance status (p = 0.033). Majority of the participants perceived HPV vaccine to be ineffective at preventing cervical cancer, and 40.8% participants had never heard of the vaccine and consequently had not been vaccinated. 94% participants did not receive the HPV vaccine, however, 65.3% participants indicated willingness to be vaccinated against HPV for free or at reduced cost. Conclusion: Culturally appropriate interventions are warranted to develop effective strategies that will influence HPV screening behavior and vaccine uptake in this target population.

Background/Objectives: Nearly 4 million women experience pregnancy every year in the United States. While there is research about medical outcomes related to pregnancy, especially in the context of disease, there is a dearth of research related to pregnancy expectations. Methods: This qualitative study explored women’s expectations and experiences of pregnancy in Southeast Ohio. Participants attending a clinic were recruited for individual interviews onsite at the physician's office. Interviews were audio recorded and transcribed verbatim. Codes, in the form of descriptive labels such as words or brief phrases, were developed based on entire interviews. Results: Results indicate that women experience pregnancy on a continuum, some women enjoyed the experience, some were ambivalent, while others did not enjoy the experience. Furthermore, some women reported that their expectations for pregnancy matched their experience(s), while others felt that their expectations did not match their experience. Some women also felt “judged” by other women and even health care providers if they did not “love” the experience. Conclusions: Women experience pregnancy in a variety of ways, therefore, it is important that health care providers be sensitive to the notion that not all women enjoy the process, but they all want the same outcome of a healthy child. While it is important for health care providers to assess the physical health of the mother and the unborn child, this study demonstrated that it is also important to assess what an expectant mother knows about pregnancy and what she expects to happen.

Rural areas are underserved in terms of the availability of and access to health care services. According to Healthy People 2020, access to health care continues to be the most frequently identified rural health priority in the United States. Purpose The purpose was to develop an efficient approach for standardizing and prioritizing strategies to improve access to health care in rural areas across the United States. The rubric provides a quantitative metric of the effectiveness of each strategy in terms of impact and feasibility and allows community health departments and other access to care groups to compare strategies and facilitate discussion of various strategies’ ability to meet the needs of diverse communities. Framework The Plan, Do, Check, Act (PDCA) cycle was used to create the rubric. The research team constructed a plan for creating a rubric to measure each strategy’s impact and feasibility. We checked the rubric by applying it to selected access to care improvement strategies evaluated by the Robert Wood Johnson Foundation (RWJF). Members of a rural community Access to Care Workgroup applied the rubric to several RWJF What Works for Health strategies. The final step was to compare the results of the application phase through facilitated conversations with the goal of determining which strategy or strategies would best meet the needs of the rural community. Discussion A rubric is a valuable tool to facilitate assessment and discussion and for assisting community members in determining access to care priorities. After applying the rubric in a community setting, we identified two important tactics: 1) the rubric is best applied to strategies when they are summarized consistently and cohesively; and 2) it is important to involve community stakeholders early in the process of identifying strategies for evaluation. The next step is to apply the rubric to similar strategies in other rural communities to further validate the rubric’s effectiveness.

This study examined the factors affecting HIV testing among women during pregnancy while on ANC visits in Kenya, using the 2014 Kenya Demographic and Health Survey data. The sample included 3,747 (weighted

Immigrants in the US work in diverse professions and contribute to the economy. They play an important role in the economies in which they settle by complementing the skills lacking and create a level playing field for wages in the labor market. The U.S. Midwest has seen exceptionally high growth in immigrant populations in recent decades. While employment leads to a better quality of life when workers can afford basic necessities, immigrants encounter dire health challenges due to unemployment, underemployment, extreme working conditions, long work hours, and no paid leave. There is limited research examining the connection between career development experiences with the health of immigrant workers. This chapter examines the impact that employment circumstances have on skilled immigrants' health outcomes in the Midwest.

Background Optimization of innovative approaches is required for estimating the intimate partner violence (IPV) burden among adolescents and young adults (AYA). Further investigation is required to identify risk and protective factors associated with IPV among AYA. There remain significant gaps in understanding these factors among this vulnerable population. Objective The goal of our study was to determine the prevalence of IPV among an urban population of AYA and to identify factors associated with IPV among AYA. Methods A cross-sectional study design utilizing respondent-driven sampling was adopted. The study was conducted among 887 AYA, aged 15 to 24 years, residing in Nairobi, Kenya. Data were collected through a phone-based survey using the REACH (Reaching, Engaging Adolescents and Young Adults for Care Continuum in Health)-AYA app. Questions on behavioral and psychosocial factors were adopted from different standardized questionnaires. Descriptive, bivariate, and multivariable statistics were used to describe the characteristics of the study sample. Results Of the 887 participants, a higher proportion were male (540/887, 60.9%) compared to female (347/887, 39.1%). The prevalence of IPV was 22.3% (124/556). IPV was associated with being unsure if it was okay for a boy to hit his girlfriend, living in a home with physical violence or abuse, and being bullied (P=.005). The likelihood of experiencing IPV was higher among respondents whose friends and family members used alcohol (odds ratio [OR] 1.80, 95% CI 1.09-2.98) and among those who had repeated a class at school in the past two years (OR 1.90, 95% CI 1.11-3.23). Respondents who visited a health facility or doctor for reproductive health services were 2 times more likely to experience IPV (OR 2.23, 95% CI 1.40-3.70). Respondents who had used illicit drugs were 2 times more likely to experience IPV (OR 4.31, 95% CI 2.64-7.04). The probability of experiencing IPV decreased by 63% (OR 0.37, 95% CI 0.16-0.85) among respondents who refused to have sex with someone who was not prepared to use a condom. Conclusions IPV remains a significant public health priority because of its impact to society. Our results are in congruence with other similar studies. Efforts toward incorporating appropriate IPV core measures into the comprehensive care package for every AYA seeking health services should be explored. Programs need to address constellations of risk and protective factors linked to IPV in an effort to prevent its occurrence.

Young people aged 15–24 years account for half of all new sexually transmitted infections (STIs) in the United States. The aim of this study was to examine the cross-sectional associations of factors linked to STIs among US young adults (18–25 years). This study used the 2015–2018 pooled National Survey on Drug Use and Health data on 55,690 young adults. Almost 3.4% of the respondents reported having an STI in the past year. Among the participants, 38.4% used illicit drugs and 3.7% reported a history of delinquency in the past year. In the survey-weighted logistic regression model, odds for contracting STIs in the preceding year was higher among adults aged 22–25 versus 18–21 years (OR:1.26, 95%CI:1.12–1.42); male versus female (OR:2.44, 95%CI:2.11–2.82); non-Hispanic African American versus non-Hispanic White (OR:1.77, 95%CI:1.55–2.02); widowed/separated/divorced (OR:1.93, 95%CI:1.36–2.75) and never married (OR:1.29, 95%CI:1.07–1.55) versus married; full-time/part-time employed (aOR:1.17, 95% CI:1.04–1.31) compared to unemployed/other; history of delinquency (OR:2.31, 95%CI:1.89–2.83); and use of illicit drugs in the last year (OR:3.10, 95%CI:2.77–3.47). High incidence of illicit drug use by the young adults and its strong association with STI incidence in recent years warrant special attention. Tailored preventive measures should be focused on key predictors.

BACKGROUND Optimization of innovative approaches is required for estimating the intimate partner violence (IPV) burden among adolescents and young adults (AYA). Further investigation is required to identify risk and protective factors associated with IPV among AYA. There remain significant gaps in understanding these factors among this vulnerable population. OBJECTIVE The goal of our study was to determine the prevalence of IPV among an urban population of AYA and to identify factors associated with IPV among AYA. METHODS A cross-sectional study design utilizing respondent-driven sampling was adopted. The study was conducted among 887 AYA, aged 15 to 24 years, residing in Nairobi, Kenya. Data were collected through a phone-based survey using the REACH (Reaching, Engaging Adolescents and Young Adults for Care Continuum in Health)-AYA app. Questions on behavioral and psychosocial factors were adopted from different standardized questionnaires. Descriptive, bivariate, and multivariable statistics were used to describe the characteristics of the study sample. RESULTS Of the 887 participants, a higher proportion were male (540/887, 60.9%) compared to female (347/887, 39.1%). The prevalence of IPV was 22.3% (124/556). IPV was associated with being unsure if it was okay for a boy to hit his girlfriend, living in a home with physical violence or abuse, and being bullied (P=.005). The likelihood of experiencing IPV was higher among respondents whose friends and family members used alcohol (odds ratio [OR] 1.80, 95% CI 1.09-2.98) and among those who had repeated a class at school in the past two years (OR 1.90, 95% CI 1.11-3.23). Respondents who visited a health facility or doctor for reproductive health services were 2 times more likely to experience IPV (OR 2.23, 95% CI 1.40-3.70). Respondents who had used illicit drugs were 2 times more likely to experience IPV (OR 4.31, 95% CI 2.64-7.04). The probability of experiencing IPV decreased by 63% (OR 0.37, 95% CI 0.16-0.85) among respondents who refused to have sex with someone who was not prepared to use a condom. CONCLUSIONS IPV remains a significant public health priority because of its impact to society. Our results are in congruence with other similar studies. Efforts toward incorporating appropriate IPV core measures into the comprehensive care package for every AYA seeking health services should be explored. Programs need to address constellations of risk and protective factors linked to IPV in an effort to prevent its occurrence.

Background Most neonatal, infant, and child deaths occur in low- and middle-income countries (LMICs), where incidence of intimate partner violence (IPV) is highest in the world. Despite these facts, research regarding whether the two are associated is limited. The main objective was to examine associations between IPV amongst East African women and risk of death among their neonates, infants, and children, as well as related variables. Methods Analysis was conducted on data drawn from the Demographic and Health Surveys (DHS) conducted by ICF Macro/MEASURE DHS in five East African countries: Burundi, Kenya, Rwanda, Tanzania, and Uganda. The analytical sample included 11,512 women of reproductive age (15–49 years). The outcome variables, described by proportions and frequencies, were the presence or absence of neonatal, infant, and under-five mortality. Our variable of interest, intimate partner violence, was a composite variable of physical, sexual, and emotional abuse; chi-square tests were used to analyze its relationship with categorical variables. Adjusted odds ratios (aOR) were also used in linking sexual autonomy to independent variables. Results Children born to women who experienced IPV were significantly more likely to die as newborns (aOR = 1.3, 95% confidence interval [CI]: 1.4–2.2) and infants (aOR = 1.9, 95% CI: 1.6–2.2), and they were more likely to die by the age of five (aOR = 1.5, 95% CI: 1.01–1.55). Socioeconomic indicators including area of residence, wealth index, age of mother/husband, religion, level of education, employment status, and mass media usage were also significantly associated with IPV. After regression modelling, mothers who were currently using contraceptives were determined less likely to have their children die as newborns (aOR = 0.5, 95% CI: 0.3–0-7), as infants (aOR = 0.5, 95% CI: 0.3–06), and by age five (aOR = 0.4, 95% CI: 02–0.6). Conclusion Understanding IPV as a risk indicator for neonatal, infant, and child deaths can help in determining appropriate interventions. IPV against women should be considered an urgent priority within programs and policies aimed at maximizing survival of infants and children in East Africa and the wellbeing and safety of their mothers.

In general, U.S. college students have low perceived susceptibility of acquiring HIV infection while 15–25 percent of youth have had negative perceptions towards HIV positive individuals. Factors associated with HIV stigma among college students were examined in a convenience sample of 200 students. Descriptive and inferential statistics were utilized to summarize the data. Only four percent of participants responded correctly to HIV transmission knowledge items. HIV transmission knowledge scores were significantly higher for participants who were single with partner and those who resided outside university residential dorms (p < 0.05). There was a significant negative correlation between composite HIV knowledge scores and stigma scores r = −0.18 (p < 0.05). After adjusting for confounders, a marginal significant negative linear relationship emerged (β = −0.09, p = 0.06) between HIV knowledge and stigma. HIV prevention education among college students needs to be addressed with nuance to minimize HIV knowledge gaps, stigma and student risk perception that impacts HIV prevention and stigma against those living with HIV.

Adequate knowledge of sexual health among young adults is a critical step in prevention of sexually transmitted diseases and maintenance of adult sexual health. Knowledge of specific barriers to accessing sexual health knowledge can help tailor approaches appropriately. The purpose of this paper was to identify sexual health knowledge barriers among Somali young adults in Ohio.In-depth interviews were conducted with a convenience sample of 27 Somali young adults aged 18-25 years. Using a grounded theory approach, a semi-structured interview guide comprising open-ended questions and probes was utilized to collect data. Data were analyzed and coded using constant comparative analysis.Findings revealed sexual health knowledge barriers in the following broad categories: religion, culture and stigma. Cultural and religious norms were deemed an important influence on the community norms largely impacting sexual health knowledge due to stigma and fear of judgment. Participants overcame barriers by seeking information from external sources such as doctors, Internet and peers.Study findings support an approach that will address sexual health barriers in the Somali immigrant young community at multiple levels: individual, interpersonal and community levels. A collaborative effort across religious, cultural and educational setting is necessary to tailor approaches that meet the needs of the priority group.

In Botswana, an estimated 350 000 people live with HIV/AIDS. HIV/AIDS testing rates are low, suggesting that many other people remain undiagnosed. Stigma related to HIV/AIDS is prevalent and contributes to low testing rates and under-diagnosis of the virus. Identifying factors that contribute to stigma, such as insufficient or inaccurate knowledge of HIV/AIDS, may be critical in increasing early identification and treatment. This cross-sectional study used nationally representative data from the 2013 Botswana AIDS Impact Survey (BAIS) IV to examine the relationship between HIV/AIDS knowledge and stigmatising attitudes toward people living with HIV/AIDS (PLWHA). The mean (standard error) for stigma towards PLWHA score and HIV/AIDS knowledge score were 0.99 (0.02) and 5.90 (0.03) respectively. HIV/AIDS knowledge score and stigma towards PLWHA score were strongly positively correlated r (4,4045) = 0.415, p < 0.001). After adjusting for potential confounders, HIV/AIDS knowledge score significantly predicted stigma towards PLWHA score [coefficient β (95% CI)] [−0.25 (−0.29, −0.20), p < 0.001]. These findings imply that programmes and interventions that increase HIV/AIDS knowledge may reduce the pervasive apprehension, blame, and stigmatising attitude held towards PLWHA in Botswana.Keywords: BAIS, HIV knowledge, prevention, social stigma, sub-Saharan Africa, transmission

Despite the high prevalence of risky sexual behavior among college students, HIV risk perception in this population remains low. Overall, there is a dearth of studies examining HIV risk perception among college students. We examined HIV risk perception among college students at a University in the Midwest. Students enrolled in undergraduate and graduate courses were recruited for this pilot study (n = 200). The outcome of interest was perceived HIV risk perception. Descriptive and inferential statistical analyses were utilized to examine the association between HIV risk perception and four measures namely: perceived severity of/susceptibility to HIV, perceived benefits of safe sex, perceived barriers to safe sex and self-efficacy, measured using validated instruments. Overall, greater proportion of students perceived that they are not at risk of HIV infection (81.5 %). Participants had high scores for all measures, except for perceived barriers to safe sex [mean score (standard deviation) 24.5 (15.3)]. The multivariable model showed a statistically significant negative association between composite severity of/susceptibility to HIV/AIDS score and moderate perceived HIV risk (OR, 95 % confidence interval) (0.96, 0.93–0.99, p = 0.04). In addition, the odds of having moderate perceived HIV risk were higher among students who currently have a dating partner compared to students who currently do not have a dating partner (3.19, 1.24–8.18, p = 0.01). College level HIV prevention efforts should continue to address HIV risk. Additional research examining risk perception in a much larger, and more diverse, student population is needed.

Women residing in Eastern Africa are disproportionately affected by cervical cancer. Previous studies have identified risky sexual behavior as a major risk factor for cervical cancer. However, population-based studies examining the relationship between sexual behavior and cervical cancer screening are currently lacking. This descriptive cross-sectional study utilized nationally representative secondary data from the 2014 Kenya Demographic and Health Survey (n = 6104) to examine the association between risky sexual behavior and cervical cancer screening among sexually active women. Both descriptive and inferential statistical methods were utilized. Overall, 20.2% of the study sample reported having cervical cancer examination. Approximately 13.1% of the participants reported involvement in risky sexual behavior. Significantly lower proportion of women engaged in risky sexual behavior reported having cervical cancer examination (14.5 vs. 21.0%; p = 0.001). In the multivariable model, we found a significant interaction between risky sexual behavior and marital status on cervical cancer examination. Among women who were married/living together, risky sexual behavior was negatively associated with cervical cancer examination after adjusting for potential confounders (Prevalence Ratio, 95% CI) (0.42; 0.24–0.74; p = 0.002). The prevalence of having visual inspection with VIA or VILI were lower among women who were involved in risky sexual behavior (0.39; 0.18–0.87; p = 0.022). However, we were unable to detect any significant association between risky sexual behavior and having Papanicolaou test. With increasing incidence of cervical cancer in resource-limited settings, it is critical to identify populations at increased risk of infection and provide effective screening and follow-up services.

Approximately 30% of the Tanzanian women in the reproductive age group are iron deficient. At population-level, there is a dearth of research on the relationship between hormonal contraceptive use and iron deficiency. The study objective was to examine the relationship between history of hormonal contraceptive use and iron status among women in Tanzania.We conducted a cross-sectional study analysis including 4186 women who participated in the population-based 2010 Tanzania Demographic and Health Survey.Iron status determined by iron deficiency, anemia, and iron deficiency anemia.Almost 19.0% women reported history of hormonal contraceptive use. Nearly, 30.0%, 39.5%, and 14.3% women had iron deficiency, anemia and iron deficiency anemia respectively. History of hormonal contraceptive use was negatively associated with iron deficiency, anemia and iron deficiency anemia, independent of potential confounders. Compared to non-users, the multivariable-adjusted odds ratio OR (95% CI) among hormonal contraceptive users was 0.73 (0.56-0.94, p0.05) for iron deficiency, 0.58 (0.46-0.72, p0.001) for anemia, and 0.53 (0.37-0.74; p0.001) for iron deficiency anemia. Longer duration of hormonal contraceptive use (2years) had lesser odds of iron deficiency 0.63 (0.43-0.91, p for trend 0.005), anemia 0.51 (0.36-0.73, p for trend0.001) and iron deficiency anemia 0.35 (0.19-0.65, p for trend0.001).Our finding has important implications for educating healthcare providers and women about additional nutritional benefits of the use of hormonal contraceptives.

Objective:The present study reports on the results of a 2.5-year college-wide, coordinated intervention that was implemented from June 2007 to December 2009 to reduce the amount and frequency of students’ alcohol consumption.Design:Quasi-experimental study using a one-group (freshmen living on campus) pretest/posttest design ( N = 6,815 in 2007–2008 and N = 7,550 in 2008–2009) with a pseudo comparison group (non-freshmen living off campus).Setting:Indiana University-Bloomington, USA.Method:The social-ecological framework, a multi-tiered strategy that considers the individual, the social milieu, and the environment, was used to guide the selection and implementation of interventions in a university setting to target individuals, the student population, the college, and the surrounding community to reduce high-risk drinking. Freshmen, who were mandated to live on campus, comprised the intervention group while non-freshmen living off campus comprised the pseudo comparison group that received only the environmental-level intervention.Results:A larger decrease was observed in the amount and frequency of alcohol consumption in freshmen than in non-freshmen for the intervention period (mean drinks consumed per week: −15.9% versus −7.5%; percentage of students who drank at least once a week: −17.5% versus −6.7%; and binge drinking: −12.2% versus −1.0%).Conclusion:An ecologically guided campus-wide intervention that is multi-tiered appears to be effective in reducing drinking behaviour.

Summary In Kenya, there was a reported decline in HIV incidence and prevalence among those aged 15 to 64 years and children. Despite the decline, closer assessment of psychosocial issues like depression, contextual factors (family and community), and social support is necessary given the likely impact on overall health and HIV prevention. This paper examines an association between symptoms of depression and social support on overall health among HIV-positive participants recruited from an HIV clinic in Kenya. Descriptive statistics and logistic regression analyses were utilized. Findings reveal that compared to those with minimal depression (referent category) participants with mild, moderate, moderately severe/severe depression had higher odds of having poor health. For social support, compared with participants with no social support (referent category), participants with high social support had lower odds of having poor overall health in both unadjusted and multivariable-adjusted models. In conclusion, this study suggests that HIV clinics and interventions need to focus more on the psychological and/or mental health status of HIV-infected individuals while providing avenues such as social support groups that can be a buffer against the negative impact of HIV infection and depression on overall health outcomes.

Psychometric properties of an 18-item HIV felt stigma questionnaire were evaluated utilizing data collected from a diverse ethnic and socioeconomic group of 370 people living with HIV/AIDS and receiving HIV/AIDS-related health services at an HIV clinic in Kenya. Factor analyses revealed a four factor solution (public attitudes, ostracize, discrimination, personal life disrupted) based on the Scree plot with explained variance of 44% that had Eigen values greater than 1.00. The retained felt stigma items revealed a Cronbach's alpha coefficient of 0.828, while the four factors had coefficient alphas ranging from 0.675 to 0.799. The adapted retained questionnaire was deemed a practical guide for measuring felt stigma in a Kenyan cultural context to necessitate provision of the most effective HIV-related mental health services to individuals living with HIV in Kenya.

In general, an initial diagnosis of HIV is likely to be correlated with the onset of HIV stigma. HIV-positive individuals are likely to internalize stigma, may suffer from psychosocial issues, or engage in maladaptive behaviors to cope with the diagnosis. Internalized stigma stems from fear of stigmatization also known as felt stigma. The current study examined the impact of HIV felt stigma on overall health and success of HIV prevention behaviors among 370 participants living with HIV and receiving care at an urban HIV clinic in Kenya. An 18-item instrument was cross culturally adapted to measure felt stigma. Descriptive and logistic regression analyses examined the data. Findings indicate that 25.9% (n=96) of participants who reported experiencing high levels of felt stigma related to other people's attitudes toward their condition, ostracizing, and a disruption of their personal life, were likely to not adhere to prescribed HIV medication and not disclose their HIV serostatus to one other person. Those who also experienced felt stigma related to a disruption of their personal lives while mediated by depression were likely to report poor overall health. Findings support having HIV clinics and interventions develop relevant HIV prevention strategies that focus on the emerging dimensions of felt stigma which can significantly impact disclosure of serostatus, medication adherence, and overall health.