Impact and Effectiveness of Legislative Smoking Bans and Anti-Tobacco Media Campaigns in Reducing Smoking among Women in the US: A Systematic Review and Meta-Analysis.

BACKGROUND: The purpose of this study is to systematically review the literature addressing the effectiveness of legislative smoking bans and anti-tobacco media campaigns in reducing smoking among women. METHODS: MEDLINE, PubMed, CINAHL, and ABI/INFORM were searched for studies published from 2005 onwards. Meta-analysis was conducted using a random effects model and subgroup analysis on pre-selected characteristics. RESULTS: In total, 652 articles were identified, and five studies satisfied the inclusion criteria. The studies varied from school-based to workplace settings and had a total of 800,573 women participants, aged 12 to 64 years old. Three studies used legislative bans, one study used anti-tobacco campaigns and another one used both as their intervention. The overall pooled effect of the five studies yielded an odds ratio (OR) = 1.137 (C.I. = 0.976-1.298 and I2 = 85.6%). Subgroup analysis by intervention revealed a significant pooled estimate for studies using legislative smoking bans OR = 1.280 (C.I. = 1.172-1.389 and I2 = 0%). CONCLUSION: Legislative smoking bans were found to be associated with a reduction in the smoking rates among women compared to anti-tobacco media campaigns. Further research in this area is needed.

Preference in the use of full childhood immunizations in Ethiopia: the role of maternal health services.

BACKGROUND: Immunizations represent a successful and cost-effective public health strategy in preventing common childhood diseases. Ethiopia has made remarkable progress in increasing its full immunization coverage, but significant gaps remain. This study aims to measure the preference in the use of full immunizations for children aged 12-23 months in Ethiopia and examine the role of key maternal health services. METHODS: This is a cross-sectional study and uses data from a nationally generalizable survey, the Ethiopian Demographic and Health Survey, 2016. It includes a representative sample of 2,168 children aged 12-23 months. The main outcome was full immunization, measured based on the WHO guidelines (Bacillus Calmette-Guérin [BCG], diphtheria, tetanus, and pertussis [DPT], polio, and measles vaccines). The main exposure variables were provision of three key maternal health services (antenatal care, delivery services, and tetanus vaccine) as well as other sociodemographic factors. Descriptive statistics and multivariate logistic regression analyses were conducted. RESULTS: This study found the overall full immunization coverage in Ethiopia to be much lower (39%) than the WHO-recommended rate (≥90%). There were distinctive differences in the preference in the use of full immunization coverage for various vaccines (BCG 70.0%, polio 56.5%, measles 55.3%, and DPT 53.9%). The maternal health service variables (antenatal care, delivery services, and tetanus vaccine) were significantly associated with the full immunization of children aged 12-23 months (P<0.001). In the full model, the maternal health service variables remained significant, along with other socioeconomic predictors of full immunization, including sex of the household head (P<0.001), maternal education (P<0.05), wealth index (P<0.01), and religion (P<0.001). CONCLUSION: Full immunization coverage has been identified as a critical factor in the prevention of morbidity and mortality from childhood diseases. Future progress in the provision of key maternal health services can have a positive impact in narrowing the gap in immunization coverage.

Substance use preferences and sexually transmitted infections among Canadian post-secondary students.

BACKGROUND: In Canada, substance use is one of the key predisposing factors that may lead to risky sexual behaviors among post-secondary students. There is considerable economic burden and significant public health concern posed by substance use and sexually transmitted infections (STIs). The purpose of this study was to examine the prevalence of substance use preferences (alcohol, cannabis, and other drugs) and its association with STIs among Canadian post-secondary students. MATERIALS AND METHODS: This is a cross-sectional study using data from the National College Health Assessment II, Spring 2016 survey conducted by the American College Health Association. There were 31,642 sexually active participants, representing 41 post-secondary institutions in Canada. Descriptive analysis and logistic regression were conducted to estimate the effect of substance use preferences on STIs. RESULTS: This study found that participants reported being current users of alcohol (80%), cannabis (23%), and other drugs (8%). Additionally, 3.96% of the participants self-reported being diagnosed or treated for an STI in the last 12 months. Multivariate logistic analysis revealed current cannabis use to be significantly associated with self-reported STIs (aOR, 1.34; 95% CI, 1.12-1.6). There was a significant association between current drug use and STIs among male (aOR, 3.04; 95% CI, 2.27-4.06) and female participants (aOR, 1.87; 95% CI, 1.52-2.30). Having multiple sexual partners, a history of sexual assault, being homosexual, Black, and >21 years old were also found to have a significant association with self-reported STIs (P-value <0.001). CONCLUSION: In this study, significant associations were found between cannabis and other drug use and STIs among post-secondary students in Canada. The results of this study can help inform institutions of higher learning and public health professionals in the design, implementation, and evaluation of substance use and STI policies and effective school-based health programming.

Examining the Association and Directionality between Mental Health Disorders and Substance Use among Adolescents and Young Adults in the U.S. and Canada-A Systematic Review and Meta-Analysis.

BACKGROUND: The purpose of this systematic review was to examine the association and directionality between mental health disorders and substance use among adolescents and young adults in the U.S. and Canada. METHODS: The following databases were used: Medline, PubMed, Embase, PsycINFO, and Cochrane Library. Meta-analysis used odds ratios as the pooled measure of effect. RESULTS: A total of 3656 studies were screened and 36 were selected. Pooled results showed a positive association between depression and use of alcohol (odds ratio (OR) = 1.50, 95% confidence interval (CI): 1.24⁻1.83), cannabis (OR = 1.29, 95% CI: 1.10⁻1.51), and tobacco (OR = 1.65, 95% CI: 1.43⁻1.92). Significant associations were also found between anxiety and use of alcohol (OR = 1.54, 95% CI: 1.19⁻2.00), cannabis (OR = 1.36, 95% CI: 1.02⁻1.81), and tobacco (OR = 2.21, 95% CI: 1.54⁻3.17). A bidirectional relationship was observed with tobacco use at baseline leading to depression at follow-up (OR = 1.87, CI = 1.23⁻2.85) and depression at baseline leading to tobacco use at follow-up (OR = 1.22, CI = 1.09⁻1.37). A unidirectional relationship was also observed with cannabis use leading to depression (OR = 1.33, CI = 1.19⁻1.49). CONCLUSION: This study offers insights into the association and directionality between mental health disorders and substance use among adolescents and young adults. Our findings can help guide key stakeholders in making recommendations for interventions, policy and programming.

The association between depression, anxiety and substance use among Canadian post-secondary students.

PURPOSE: This study aims to examine the association between depression, anxiety and substance use among Canadian post-secondary students. METHODS: This study used data from the spring 2016, American College Health Association - National College Health Assessment II (ACHA-NCHA II) survey. It includes 43,780 college students from 41 Canadian post-secondary institutions. The exposure variables of interest were alcohol, cannabis and tobacco use, and the outcome variables of interest were diagnosis or treatment for depression and/or anxiety. Descriptive statistics, univariate and multivariate logistic regression models were used to analyze our data. RESULTS: Our study found that 14.7% of post-secondary students were diagnosed or treated for depression and 18.4% for anxiety within the past 12 months. Among current (past 30 days) substance use, it was reported that alcohol (69.3%), cannabis (17.9%) and tobacco (11%) were the most common. There was a significant association between depression and current tobacco use (OR =1.36, 95% CI: 1.22-1.52, P<0.001) and current cannabis use (OR =1.17, 95% CI: 1.05-1.31, P<0.001). There was also a gender-specific association between anxiety and female alcohol users (OR =1.41, 95% CI: 1.24-1.62, P<0.001). CONCLUSION: The results of this study found significant associations between depression, tobacco use and cannabis use, and anxiety and alcohol use among post-secondary students. These conditions should be screened concurrently for improved outcomes among this vulnerable population.

Examining the association between diabetes, depressive symptoms, and suicidal ideation among Aboriginal Canadian peoples living off-reserve: a cross-sectional, population-based study.

BACKGROUND: Diabetes is a prevalent chronic condition that has been linked to depression and suicidal behavior. The Aboriginal peoples of Canada are known to suffer from significant health disparities and higher burden of physical and mental illnesses. The purpose of this study was to assess whether diabetes is associated with higher depressive symptoms and lifetime suicidal ideation among Aboriginal Canadian peoples living off-reserve. METHODS: Data were obtained from the Aboriginal Peoples Survey, 2012. Depressive symptoms were evaluated by a modified version of the previously validated K-10 scale, while diabetes and suicidal ideation were self-reported. A secondary analysis was conducted on a weighted sample of 689,860 participants for depressive symptoms (9.25% diabetics) and 694,960 for suicidal ideation (9.39% diabetics). Descriptive statistics and multiple logistic regression analysis were conducted. RESULTS: Our study found that the prevalence of depressive symptoms was higher among diabetics (17.53%) compared with nondiabetics (11.12%; OR =1.70, 95% CI: 1.22-1.61). After adjusting for sociodemographic variables, smoking/alcohol use/drug use, anxiety disorders, and other chronic illnesses, diabetes was still significantly associated with depressive symptoms (aOR =1.46, 95% CI: 1.03-2.07). Additionally, diabetics (23.86%) were more likely to report suicidal ideation compared with nondiabetics (18.71%; OR =1.36, 95% CI: 1.05-1.77). Controlling for the effect of sociodemographics and health-related behaviors, diabetes was still associated with higher risk of reporting suicidal ideation (aOR =1.40, 95% CI: 1.05-1.88). CONCLUSION: Our results suggest that the Aboriginal Canadian diabetic patients living off-reserve are at higher risk of depressive symptoms and suicidal ideation. Culturally appropriate co-screening strategies need to be implemented in primary health care settings to provide the supports necessary for this vulnerable population. Further research is needed to fully elucidate the nature of these associations in order to develop effective intervention and treatment approaches.

STI Health Disparities: A Systematic Review and Meta-Analysis of the Effectiveness of Preventive Interventions in Educational Settings.

The purpose of this systematic review and meta-analysis was to address disparities related to sexual health among students by examining the effectiveness of sexually transmitted infection (STI) preventive interventions in educational settings. PubMed, Medline, Cochrane Library, Public Health Database, and EMBASE databases were used to conduct searches. Information relating to studies, programs, participants, and quantitative outcome variables were extracted. Risk of bias was assessed and meta-analysis was conducted. This systematic review included 16 articles. The outcomes were classified into behavioral and psychosocial categories. The behavioral category included sexual partners, sexual activity, condom use, STI/HIV testing, and alcohol/drug use before sex. The psychosocial category consisted of knowledge, motivational factors, and skills. Interventions had a significantly positive impact on both behavioral (OR, 1.28; 95% CI, 1.17⁻1.39) and psychosocial (OR, 1.92; 95% CI, 1.36⁻2.72) outcomes. Among the psychosocial outcomes, the interventions were most effective at promoting knowledge (OR, 3.17; 95% CI, 2.13⁻4.72), followed by enhancing motivational factors (OR, 1.69; 95% CI, 1.04⁻2.75) and increasing behavioral skills (OR, 1.43; 95% CI, 1.13⁻1.81). The results of this systematic review provide empirical evidence for public health professionals and policy makers regarding planning, implementation, evaluation, and modification of STI preventive intervention programs in educational settings.

Risk of Depression and Suicidality among Diabetic Patients: A Systematic Review and Meta-Analysis.

The purpose of this study is to conduct a systematic review and meta-analysis to evaluate the risk of depression and suicidality among diabetic patients. METHODS: Medline, PubMed, EMBASE, Cochrane library, and Psych INFO were searched for studies published from 2008 onwards. Meta-analysis was conducted to estimate the pooled effect size. Sources of heterogeneity were investigated by subgroup analysis and meta-regression. RESULTS: In total, 5750 articles were identified and of those, 17 studies on suicidality and 36 on depression were included in this study. Our analysis suggests a positive relationship between diabetes and depression (cohort studies odds ratio (OR) 1.49, 95% confidence interval (CI): 1.36⁻1.64 and cross-sectional studies OR 2.04, 95% CI, 1.73⁻2.42). Pooled OR values for suicidal ideation, attempted suicide, and completed suicide were 1.89 (95% CI: 1.36⁻2.63), 1.45 (95% CI: 1.07⁻1.96), and 1.85 (95% CI: 0.97⁻3.52), respectively. All findings were statistically significant except for completed suicide. CONCLUSIONS: The increased risk of depression and suicidality in diabetic patients highlights the importance of integrating the evaluation and treatment of depression with diabetes management in primary healthcare settings. Further research in this area is needed.

Ethno-specific preferences of cigarette smoking and smoking initiation among Canadian immigrants - a multi-level analysis.

BACKGROUND: Cigarette smoking is the leading cause of preventable morbidity and mortality worldwide. Over the last decade, increased immigration has significantly shifted Canada's demographic profile. According to a 2011 National Household Survey, approximately 20.6% of the Canadian population was immigrants, the highest among the G8 countries. It is estimated that by 2031, one-in-three Canadian's will be an immigrant. This study examined the ethno-specific preference of cigarette smoking and smoking initiation among Canadian immigrants. METHODS: This study used data from the 2013 to 2014 combined cycles of the Canadian Community Health Survey. This was a nationally generalizable, telephone-based survey that included a total of 130,000 respondents, aged 12 years or older. Ethnic differences in the preference of cigarette use among Canadian immigrant groups were determined. A three-level mixed effects logistic regression model was used to estimate the effect of ethnicity on the likelihood of smoking initiation after migration to Canada. RESULTS: In our study, 82% of respondents were native-born Canadians (one group), while the rest were immigrants (six groups=18%). Results of the logistic regression analysis revealed statistically significant differences in the number of cigarettes smoked daily (P=0.0001), age of smoking onset (P=0.0001), and smoking initiation (P=0.0001) between Canadian-born and immigrant participants. Immigrant smokers in Canada were significantly more likely to be younger, single, Caucasian, females with high income and post-secondary education (P=0.0001). CONCLUSION: The results of our study suggest that Caucasian female immigrants in Canada initiated smoking at a younger age and smoked more cigarettes than any other immigrant group or native-born Canadians. This is a particularly interesting finding as Caucasian female immigrants may not be considered a vulnerable or at-risk population. To be effective, tobacco strategies specifically tailored for this overlooked population would require increased awareness, culturally appropriate initiatives, and gender-specific interventions.

The Healthy Weights Initiative: results from the first 2,000 participants.

BACKGROUND: A free, comprehensive, adult obesity reduction program was initiated in the cities of Moose Jaw and Regina, Saskatchewan, Canada. OBJECTIVE: This study aimed to determine the short-term and long-term adherence outcomes, identify factors that impact long-term adherence, and measure health outcomes. METHODS: The Healthy Weights Initiative (HWI) attendance was determined by using an electronic swipe card. An on-site exercise therapist also documented physical activity, duration, and intensity, as well as attendance of dietary and cognitive behavioral therapy education classes. Logistic regression determined which factors were associated with long-term adherence (exercising three times per week at 1 year) and various health outcomes. RESULTS: In this study, 2,167 participants started and 2,000 completed the 24-week program (92.3%). Upon 24-week completion, the majority of the participants in Moose Jaw (59.0%) and Regina (63.1%) purchased 1-year fitness memberships at the YMCA. At 1 year, 79.8% of the participants were exercising three times a week or more at the Moose Jaw YMCA. Logistic regression revealed that participants who did not exercise three times a week at 1 year at the YMCA were more likely to have a spouse/partner who did not support the program (OR=2.01; 95% CI=1.81-2.22) and more likely to have a medical comorbidity (OR=1.22; 95% CI=1.03-1.49). At 24 weeks, average weight loss was modest (12.7 pounds) and regressed slightly at 1 year (10.4 pounds). However, at 24 weeks, many health gains were statistically significant and were maintained for 1 year. For example, the prevalence of depressed mood reduced from 49.0% at baseline to 13.0% at 24 weeks and increased to 19.0% at 1 year (P=0.000). Conclusion: We found that the availability of a community-based weight management program (Healthy Weights Initiative) demonstrated good adherence, modest weight loss, and positive health outcomes.

Primary nonadherence to chronic disease medications: a meta-analysis.

BACKGROUND: Medication nonadherence is a global problem that requires urgent attention. Primary nonadherence occurs when a patient consults with a medical doctor, receives a referral for medical therapy but never fills the first dispensation for the prescription medication. Nonadherence to chronic disease medications costs the USA ~$290 billion (USD) every year in avoidable health care costs. In Canada, it is estimated that 5.4% of all hospitalizations are due to medication nonadherence. OBJECTIVES: The objective of this study was to quantify the extent of primary nonadherence for four of the most common chronic disease medications. The second objective was to identify factors associated with primary nonadherence to chronic disease medications. MATERIALS AND METHODS: We conducted an extensive systematic literature review of eight databases with a wide range of keywords. We identified relevant articles for primary nonadherence to antihypertensives, lipid-lowering agents, hypoglycemics, and antidepressants. After further screening and assessment of methodologic quality, relevant data were extracted and analyzed using a random-effects model. RESULTS: Twenty-four articles were included for our meta-analysis after full review and assessment for risk of bias. The pooled primary nonadherence rate for the four chronic disease medications was 14.6% (95% CI: 13.1%-16.2%). Primary medication nonadherence was higher for lipid-lowering medications among the four chronic disease medications assessed (20.8%; 95% CI: 16.0%-25.6%). The rates in North America (17.0%; 95% CI: 14.4%-19.5%) were twice those from Europe (8.5%; 95% CI: 7.1%-9.9%). The absence of social support (20%; 95% CI: 14.4%-26.6%) was the most common sociodemographic variable associated with chronic disease medication primary nonadherence. CONCLUSION: Evidence suggests that a considerable percentage of patients do not initially fill their medications for treatable chronic diseases or conditions. This represents a major health care problem that can be successfully addressed. Efforts should be directed toward proper medication counseling, patient social support, and clinical follow-up, especially when the indications for the prescribed medication aim to provide primary prevention.

Human Papillomavirus Vaccination Uptake in Canada: A Systematic Review and Meta-analysis.

Human papillomavirus (HPV) is the most commonly sexually transmitted infection in the world and the primary cause of cervical cancer. Canada introduced publicly funded HPV vaccination programs in 2006. The objectives of this study are twofold and aim to (1) determine the levels and (2) examine the various factors influencing vaccine uptake among the general Canadian population. A literature search was conducted on seven databases, followed by screening, methodological quality review (using modified Newcastle-Ottawa Scale), and data extraction. Pooled meta-analysis and a subgroup analysis were conducted stratifying by a number of variables (age, sex, type of program, and method of payment) determined apriori. A total of 718 peer-reviewed articles were initially identified with 12 remaining after screening and underwent methodological quality review. HPV vaccination uptake in Canada varied from 12.40% (95% confidence interval [CI] 6.77-20.26) to 88.20% (95% CI 85.72-90.39). The pooled random effects model showed the HPV vaccination uptake to be 55.92% (95% CI 44.87-66.65). The subgroup analysis showed that vaccination uptake was 66.95% (95% CI 55.00-77.89) in participants ≤ 18 years as compared to 13.58% (95% CI 10.93-16.46) in participants > 18 years. Uptake for females was higher 57.23% (95% CI: 45.40-68.66) when compared to that of 47.01% (95% CI: 0.82-97.75) in males. HPV vaccine uptake among school-based programs was 69.62% (95% CI 57.27-80.68) as compared to 18.66% (95% CI 6.66-34.92) for community-based programs. Vaccination uptake for publicly funded programs was significantly higher 66.95% (95% CI 55.00-77.89) when compared to 13.58% (95% CI 10.92-16.46) for programs where participants had to pay out of pocket. To prevent infections and reduce the burden of HPV-related diseases (including cervical cancer), communities should be made aware and encouraged to vaccinate their children. There is a documented need to direct effort and focus interventions toward improving HPV vaccination uptake in Canada.

Prevalence and associated factors of COPD among Aboriginal peoples in Canada: a cross-sectional study.

BACKGROUND: COPD among Aboriginal peoples in Canada is a major public health concern. This study was conducted in order to determine the prevalence and association between certain risk factors and COPD among the 35-year-old or older Aboriginal peoples in Canada. METHODS: This is a cross-sectional study. It uses data from Statistics Canada's Aboriginal Peoples Survey (APS), 2012. It consists of 8,117 self-identified Aboriginal peoples, aged 35 years old or older from all Canadian provinces and territories. The study outcomes centered on evaluating the prevalence and associated factors of COPD. RESULTS: This study found that 6.80% of the participants self-reported having COPD. Results of the logistic regression analysis show that COPD was significantly higher among daily smokers (odds ratio [OR], 2.28; 95% confidence interval [95% CI], 1.65-3.14), aged 55 years or older (OR, 3.04; 95% CI, 2.14-4.30), who earned $5,000-$9,999 per annum (OR, 4.21; 95% CI, 2.39-7.41) and needed health care over the past 12 months and did not receive it (OR, 1.83; 95% CI, 1.27-2.65). CONCLUSION: The findings of our study show that COPD is strongly associated with Aboriginal peoples, who are older, smoke, have a low socioeconomic status (SES) and do not have access to health care when needed. Clinicians, health care professionals, medical/public health organizations, researchers and patients will greatly benefit from additional research in this common, serious and often overlooked disease among Aboriginal peoples in Canada.

Prevalence and characteristics of flavoured tobacco use among students in grades 10 through 12: a national cross-sectional study in Canada, 2012-2013.

BACKGROUND: Tobacco use is the leading cause of preventable death in Canada and the world. Despite documented decreases in the prevalence of smoking in Canada, increases in flavoured tobacco use by its youth poses a serious public health concern. This study examined the prevalence and characteristics of flavoured tobacco use among a national sample of Canadian students in grades 10 through 12. METHODS: This study used a cross-sectional design on a nationally generalizable, school-based, Youth Smoking Survey (YSS), 2012-2013. It incorporated data from a representative sample of 19,979 students in grades 10-12 from across Canada. Univariate and multivariate logistic regression models were used to examine differences in flavoured tobacco use (menthol cigarettes, flavoured little cigar or cigarillo, flavoured cigar, flavoured tobacco in water pipe [hookah]) by demographic (sex, grade and ethnicity) and social characteristics (friends, siblings, parents/guardians who are smokers and weekly personal spending money). RESULTS: This study found that 14.8% of the participating students used flavoured tobacco in the past 30-days. Results of the logistic regression analysis show that flavoured tobacco use was significantly higher among male students [(OR = 1.63; 95% CI = 1.36-1.95)], who had at least one friend or sibling who smoke [(OR = 2.20; CI = 1.62 to 2.99) and (OR = 1.51; CI = 1.22 to 1.88), respectively] and who received greater than $20/week in personal spending money [(OR = 1.76; CI = 1.26 to 2.45)]. CONCLUSIONS: The results of our study indicate that flavoured tobacco use is a growing public health concern and has a strong appeal among youth in Canada. This is a particularly troubling finding, especially in light of the fact that there is a national ban on certain flavoured tobacco products. To be effective, strategies specifically tailored for youth using flavoured tobacco would require appropriate educational/prevention initiatives, more comprehensive legislation and better regulatory mechanisms.

The effects of household income distribution on stroke prevalence and its risk factors of high blood pressure and smoking: a cross-sectional study in Saskatchewan, Canada.

BACKGROUND: Stroke is a major chronic disease and a common cause of adult disability and mortality. Although there are many known risk factors for stroke, lower income is not one that is often discussed. AIMS: To determine the unadjusted and adjusted association of income distribution on the prevalence of stroke in Saskatchewan, Canada. METHODS: Information was collected from the Canadian Community Health Survey conducted by Statistics Canada for 2000-2008. In total, 178 variables were analysed for their association with stroke. RESULTS: Prior to statistical adjustment, stroke was seven times more common for lower income residents than higher income residents. After statistical adjustment, only four covariates were independently associated with stroke prevalence, including having high blood pressure (odds ratio (OR) = 2.62; 95% confidence interval (CI) = 2.12-3.24), having a household income below CAD$30,000 per year (OR = 2.49; 95% CI = 1.88-3.29), being a daily smoker (OR = 1.36; 95% CI = 1.16-1.58) and being physically inactive (OR = 1.27; 95% CI = 1.13-1.43). After statistical adjustment, there were five covariates independently associated with high blood pressure prevalence, including having a household income below CAD$30,000 per year (OR = 1.52; 95% CI = 1.41-1.63). After statistical adjustment, there were five covariates independently associated with daily smoking prevalence, including having a household income below CAD$30,000 per year (OR = 1.29; 95% CI = 1.25-1.33). CONCLUSIONS: Knowledge of disparities in the prevalence, severity, disability and mortality of stroke is critically important to medical and public health professionals. Our study found that income distribution was strongly associated with stroke, its main disease intermediary - high blood pressure - and its main risk factor - smoking. As such, income is an important variable worthy of public debate as a modifiable risk factor for stroke.

Third-world realities in a first-world setting: A study of the HIV/AIDS-related conditions and risk behaviors of sex trade workers in Saskatoon, Saskatchewan, Canada.

The transmission and prevalence of Human Immunodeficiency Virus (HIV) among those employed as sex trade workers (STW) is a major public health concern. The present study describes the self-reported responses of 340 STW, at-risk for contracting HIV. The participants were recruited by selective targeting between 2009 and 2010 from within the Saskatoon Health Region (SHR), Saskatchewan, Canada. As of 2012, the SHR has the highest incidence rate of positive test reports for HIV in Canada, at more than three times the national average (17.0 vs. 5.9 per 100,000 people). Additionally, the epidemiology of HIV/AIDS in the SHR is different from that seen elsewhere in Canada (still mostly men having sex with men and Caucasians), with its new HIV cases predominantly associated with injection drug use and Aboriginal cultural status. The purpose of this study was to (a) describe the demographic and socio-economic characteristics of the STW in the SHR, (b) identify their significant life events, self-reported problems, knowledge, attitudes, behaviors, self-efficacy, and barriers regarding HIV, and (c) determine the significant independent risk indicators for STW self-reporting a chance of greater than 50% of becoming infected with HIV/AIDS. The majority of the study participants were females, who were never married, of Aboriginal descent, without a high school diploma, and had an annual income of less than $10,000. Using multivariate regression analysis, four significant independent risk indicators were associated with STW reporting a greater that 50% chance of acquiring HIV/AIDS, including experiencing sexual assault as a child, injecting drugs in the past four weeks, being homeless, and a previous Chlamydia diagnosis. These findings provide important evidence of the essential sexual and drug-related vulnerabilities associated with the risk of HIV infection among STW and offer insight into the design and implementation of effective and culturally sensitive public health intervention and prevention efforts. To be most effective, it is recommended that such intervention and prevention initiatives: (1) use specifically tailored community-based outreach to high risk STW who are drug users and link them with appropriate drug treatment and HIV/AIDS prevention and treatment services, (2) provide free and confidential, routine HIV counseling and testing in substance abuse programs, and (3) build capacity among the local, Aboriginal NGOs so as to address with cultural sensitivity both the drug and HIV-related risk factors prevalent among this vulnerable population.

Sexual attitudes, norms, condom use, and adherence of Hispanic and non-Hispanic undergraduate students: a cross-sectional study of three community colleges in southwestern US.

OBJECTIVE: To measure the sexual attitudes, norms, condom use, and adherence of Hispanic and non-Hispanic undergraduate students in three community colleges in the southwestern US. METHODS: A previously validated instrument was used in this study (sexual risk behavior beliefs and self-efficacy survey). Statistical analyses included chi-square and one-way analysis of variance with post hoc multiple comparisons using the Statistical Program for the Social Sciences. RESULTS: The study participants included 234 first and second year community college students. Nearly 91% of them were sexually active and 95% reported healthy sexual attitudes. However, only 29% reported adhering to consistent condom use. More females believed that condoms should always be used, even if the two people knew each other very well, when compared to males (P=0.04). Hispanic female participants were less confident they could abstain from sex when compared to non-Hispanics (P=0.00). Non-Hispanic females were more confident they could use or explain to their partner how to use a condom correctly and go to the store to buy condoms than their Hispanic female (P=0.01) and male counterparts (P=0.00). CONCLUSION: Our study findings indicate that adherence to consistent condom use was low among Hispanic college students. This may help explain why they are more likely to report unwanted pregnancies and sexually transmitted infections. There is a documented need to introduce culturally sensitive health promotion programming specifically designed to meet the needs of this at-risk and understudied population.

Weight loss intervention adherence and factors promoting adherence: a meta-analysis.

BACKGROUND: Adhering to weight loss interventions is difficult for many people. The majority of those who are overweight or obese and attempt to lose weight are simply not successful. The objectives of this study were 1) to quantify overall adherence rates for various weight loss interventions and 2) to provide pooled estimates for factors associated with improved adherence to weight loss interventions. METHODS: We performed a systematic literature review and meta-analysis of all studies published between January 2004 and August 2015 that reviewed weight loss intervention adherence. RESULTS: After applying inclusion and exclusion criteria and checking the methodological quality, 27 studies were included in the meta-analysis. The overall adherence rate was 60.5% (95% confidence interval [CI] 53.6-67.2). The following three main variables were found to impact adherence: 1) supervised attendance programs had higher adherence rates than those with no supervision (rate ratio [RR] 1.65; 95% CI 1.54-1.77); 2) interventions that offered social support had higher adherence than those without social support (RR 1.29; 95% CI 1.24-1.34); and 3) dietary intervention alone had higher adherence than exercise programs alone (RR 1.27; 95% CI 1.19-1.35). CONCLUSION: A substantial proportion of people do not adhere to weight loss interventions. Programs supervising attendance, offering social support, and focusing on dietary modification have better adherence than interventions not supervising attendance, not offering social support, and focusing exclusively on exercise.

Pulmonary effects of active smoking and secondhand smoke exposure among adolescent students in Juárez, Mexico.

BACKGROUND: Youth smoking trends among Latin American countries, including Mexico, are on the rise. Notably, although the high prevalence of smoking in teens has been well documented in the literature, few studies have evaluated the impact of smoking and secondhand smoke (SHS) exposure on their respiratory system. OBJECTIVE: To investigate the effects of smoking and SHS exposure on the respiratory health and lung function among eighth-grade students in Juárez, Mexico. METHODS: A cross-sectional study was undertaken on a sample of convenience. The study outcomes centered on evaluating 300 students' lung function by spirometry (forced expiratory volume in 1 second [FEV1], forced expiratory volume in 1 second/forced vital capacity ratio [FEV1/FVC], and forced mid-expiratory flow rate [FEF25%-75%]) and their respiratory health (smoking behavior and SHS exposure) by their self-reported responses to a standardized respiratory questionnaire. The study outcomes were compared among three distinct groups: 1) nonsmokers/nonexposed to SHS; 2) nonsmokers/exposed to SHS; and 3) smokers. RESULTS: The majority of the study participants were 14 years old (85%), females (54%), who attended eighth grade in a public school setting (56%). Approximately, half reported being of low socioeconomic status (49%) and nonsmokers/exposed to SHS (49%). The lung function parameters of smokers were found to be lower (FEV1 =62.88±10.25; FEV1/FVC =83.50±14.15; and FEF25%-75% =66.35±12.55) than those recorded for the nonsmokers/exposed to SHS (FEV1 =69.41±11.35; FEV1/FVC =88.75±15.75; and FEF25%-75% =78.90±14.65) and significantly reduced when compared to the nonsmokers/nonexposed to SHS (FEV1 =79.14±13.61; FEV1/FVC =94.88±21.88; and FEF25%-75% =87.36±17.02) (P<0.001). Similarly, respiratory complaints were more prevalent among smokers and those exposed to SHS when compared to nonsmokers/nonexposed to SHS. CONCLUSION: Our findings suggest that initiation of cigarette smoking and, to a lesser extent, exposure to SHS in adolescence leads to increased respiratory symptoms and reduction of pulmonary function test values. Public health initiatives that aim to prevent smoking initiation, assist in cessation, and lessen SHS exposure of adolescents need to be school-based and employed as early as middle school.

Adolescents' smoking experiences, family structure, parental smoking and socio-economic status in Ciudad Juárez, Mexico.

BACKGROUND: Cigarette smoking is the leading cause of preventable death worldwide. Tobacco use and secondhand-tobacco smoke (SHS) exposure are classified as a pediatric disease. In Mexico, the prevalence of smoking has decreased among adults but paradoxically increased among adolescents, particularly among young females. This study was designed to determine the association between adolescents' smoking experiences (smoking behaviors and second hand smoke [SHS] exposure), family structure, parental smoking and socio-economic status (SES) in Ciudad Juárez, Mexico. METHODS: This is a cross-sectional, population-based study. Data was collected from sixth-grade students (N = 506) attending school in Ciudad Juárez, Mexico. Descriptive analyses were conducted. The relationship between key outcome variables (adolescents smoking and SHS exposure) and independent variables (family structure, parental smoking, and SES level) were examined. Adjusted odds ratios were calculated. Multiple logistic regression analysis was performed while controlling for possible confounders (i.e. gender and age). RESULTS: The overall prevalence of ever/lifetime smoking and SHS exposure at home was 29.6 and 41.1 %, respectively. Results of the logistic regression analysis show that being a member of a non-intact family [(OR = 2.20; 95 % CI = 1.21-3.90) and (OR = 2.45; 95 % CI = 1.19-4.10) respectively], having parents who smoke [(OR = 4.41; 95 % CI = 2.15-5.46) and (OR = 4.95; 95 % CI = 2.25-7.12) respectively], and living in low SES setting [(OR = 1.73; 95 % CI = 1.43-3.30) and (OR = 1.99; 95 % CI = 1.16-4.00) respectively] are significantly associated with ever smoking and SHS exposure at home among sixth grade students. CONCLUSIONS: The findings of our study show that tobacco use and SHS exposure are strongly associated with adolescents living in low SES, non-intact households that have parents that smoke. To be effective, tobacco strategies specifically tailored for this particularly vulnerable group of adolescents would require a comprehensive, multi-faceted approach centered on prevention, cessation and protection.