Advocacy, Strategy and Tactics Used to Confront Corporate Power: The Nestlé Boycott and International Code of Marketing of Breast-milk Substitutes.

Douglas A. Johnson began his career as a human rights activist while earning his undergraduate degree in philosophy (1975) at Macalester College in the United States. He lived at Gandhi's ashram in India to study nonviolent organizing (1969 to 1970). He served as the director of the Third World Institute in Minneapolis, MN, USA (1973-1979), which functioned as the international social justice program of the Archdiocese of Minneapolis and St. Paul. Johnson's work included creating and running a political collective; leading development study tours into villages in Guatemala and Honduras; and investigating how transnational companies (e.g., Nestlé) were penetrating the developing world. He was the co-founder of the Infant Formula Action Coalition (INFACT), elected national chairperson (1977-1985), and appointed as Executive Director (1978-1984). His role included representing INFACT before national and international organizations, the human milk substitute industry, the US Congress and Executive Branch, and the press. He initiated and coordinated the first international grass-roots consumer boycott (against Nestlé) in ten nations. He was also a co-founder of the International Nestlé Boycott Committee and the International Baby Food Action Network (IBFAN). He earned a Master's in Public and Private Management at Yale University (1988). Then he became the first Executive Director of the Center for Victims of Torture, in Minneapolis (1988-2012), the first treatment center for torture victims in the US. Since 2013, he has been teaching human rights theory and practice, and sharing lessons he has learned, as a Lecturer in Public Policy at the Harvard Kennedy School, Harvard University (US). (This interview was conducted via Zoom and transcribed verbatim. It has been edited for ease of readability. DJ refers to Doug Johnson and LD refers to Laura Duckett.).

Religious Coping, Symptoms of Depression and Anxiety, and Well-Being Among Somali College Students.

This study examined the associations between positive and negative religious coping, symptoms of depression and anxiety, physical and emotional well-being among Somali college students in Minnesota. In this online cross-sectional survey study, 156 participants (ages 18-21, M = 21, SD = 2.3) were recruited. Participants reported using more positive religious coping methods. Negative religious coping was associated with an increase in symptoms of both depression (b = .06, p = .003) and anxiety (b = .04, p = .05), and positive religious coping was associated with a decrease in symptoms of depression (b = -.04, p = .05).

Development of a photographic scale for consistency and guidance in dermatologic assessment of forearm sun damage.

OBJECTIVES: To develop a photographic sun damage assessment scale for forearm skin and test its feasibility and utility for consistent classification of sun damage. DESIGN: For a blinded comparison, 96 standardized 8 × 10 digital photographs of participants' forearms were taken. Photographs were graded by an expert dermatologist using an existing 9-category dermatologic assessment scoring scale until all categories contained photographs representative of each of 4 clinical signs. Triplicate photographs were provided in identical image sets to 5 community dermatologists for blinded rating using the dermatologic assessment scoring scale. SETTING: Academic skin cancer prevention clinic with high-level experience in assessment of sun-damaged skin. PARTICIPANTS: Volunteer sample including participants from screenings, chemoprevention, and/or biomarker studies. MAIN OUTCOME MEASURES: Reproducibility and agreement of grading among dermatologists by Spearman correlation coefficient to assess the correlation of scores given for the same photograph, κ statistics for ordinal data, and variability of scoring among dermatologists, using analysis of variance models with evaluating physician and photographs as main effects and interaction effect variables to account for the difference in scoring among dermatologists. RESULTS: Correlations (73% to >90%) between dermatologists were all statistically significant (P < .001). Scores showed good to substantial agreement but were significantly different (P < .001) for each of 4 clinical signs and the difference varied significantly (P < .001) among photographs. CONCLUSIONS: With good to substantial agreement, we found the development of a photographic forearm sun damage assessment scale highly feasible. In view of significantly different rating scores, a photographic reference for assessment of sun damage is also necessary.

No te entiendo y tú no me entiendes: language barriers among immigrant Latino adolescents seeking health care.

PURPOSE: Immigrant Latino adolescents experience health disparities and barriers to accessing health care. The purpose of this study is to describe barriers experienced by immigrant Latino adolescents seeking U.S. health care. DESIGN: Focused ethnography using one-to-one interviews. RESULTS: Participants identified language barriers to accessing care at all stages in the process. DISCUSSION: Immigrant Latino youth experience barriers when accessing U.S. health care, resulting in negative perceptions and likelihood of reduced health seeking. IMPLICATIONS FOR PRACTICE: Health care providers can lead positive change in health care delivery resulting in minimized language barriers and improved culturally relevant care for immigrant Latino youth and their families.

Expression of vascular endothelial growth factor in early cutaneous melanocytic lesion progression.

BACKGROUND: A considerable body of evidence supports the concept that a significant number of cutaneous malignant melanomas progress through a precursor lesion or dysplastic melanocytic nevi (DN). Tumor angiogenesis likely plays a critical role in early development of melanoma, and intermediate biomarkers of angiogenesis could be useful as chemoprevention and prognostic markers. METHODS: Markers of angiogenesis that included expression of the vascular endothelial growth factor A (VEGF-A) and microvessel density counts (MVD) were evaluated in 13 prospectively collected benign nevi (BN) and 19 DN from 16 individuals and in a comparison group of 17 primary melanomas (16 archival samples and 1 prospective melanoma). RESULTS: VEGF expression in melanocytic cells (mean+/-standard error [SE]) was low or absent in BN (3.4+/-1.4), increased significantly in DN (41.0+/-10.1; P=.0003 for BN vs DN), and increased further in primary melanoma (119.9+/-28.3; P = .06 for DN vs melanoma). MVD using CD31 (mean+/-SE [percentage x intensity]) followed a similar pattern with similarity between BN (2.6+/-0.7; N=13) and DN (2.2+/-0.8; N=19; P=.4 for BN vs DN), whereas primary melanomas were significantly higher (39.4+/-6.4; N=17; P=.0001 for BN or DN vs melanoma). CONCLUSIONS: In a prospective setting, the current data suggested that increased VEGF-A expression in DN may be a good indicator of preneoplastic change in melanocytic lesions with the potential for improving the understanding and prevention of the transformation of DN to melanoma.

Perceptions of health among immigrant Latino adolescents from Mexico.

PURPOSE: This ethnographic study describes the health-related perceptions of immigrant Latino adolescents from Mexico. METHOD: Fourteen adolescents, purposively recruited from two non-health-based community settings, participated. Each was interviewed twice and completed a visual narrative project using disposable cameras. Audiotaped transcripts and photographs were inductively analyzed. FINDINGS: Being healthy is holistically perceived by these adolescents and includes physical, mental, spiritual, social, and environmental factors. Pictures portrayed healthy and unhealthy influences and behaviors, including eating habits, exercise, self-care, relationships, garbage, and pollution. Personal responsibility was important in being healthy and in promoting one's health. Family was identified as an important source of health-related information. IMPLICATIONS: Nurses recognizing the holistic, comprehensive health-related perceptions of immigrant Latino adolescents can promote their health and design culturally and developmentally appropriate educational strategies and health interventions aimed at eliminating health disparities.

Mothering during war and postwar in Bosnia.

The study aim was to describe displaced Bosnian mothers' experiences caring for their children during and immediately after the war (1992-1995). Mothers described their progression into war, through war, and into vastly changed lives. Using ethnographic methods, narrative data were collected near Sarajevo, Bosnia, from 14 displaced women who participated in one to three interviews each between 1996 and 1999. Data from the semistructured interviews were analyzed to determine patterns in participants' descriptions of mothering during war. Four common themes of mothering were identified in the data: "on the move," "I have to feed them," "living somewhere in between," and "still living the war inside." As care providers and policy makers develop initiatives to improve the health of women and children during complex humanitarian emergencies, there is much to learn from the narratives of Bosnian women about their extraordinary struggle to protect the lives of their children amid violence and loss.

Risk group, skin lesion history, and sun sensitivity reliability in squamous cell skin cancer progression.

In studies of skin cancer, participants are often classified into risk groups based on self-reported history of sun exposure or skin characteristics. We sought to determine the reliability of self-reported skin characteristics among participants of a study to evaluate markers for nonmelanoma skin cancer (NMSC). Multiple questionnaires and screening protocols were administered over a 3-month period to individuals from three risk groups: existing sun damage on forearms but no visible actinic keratoses (n = 91), visible actinic keratoses (n = 38), and history of resected squamous cell skin cancer in the last 12 months (n = 35). We assessed consistency of risk group assignment between telephone screen and study dermatologist assignment, self-reported sun sensitivity (telephone recruitment form versus participant completed profile), and self-reported history of NMSC skin lesions (telephone recruitment form versus health history). There was substantial agreement between probable risk group and final assignment (kappa = 0.76; 95% confidence interval, 0.65-0.85) and agreement did not differ by gender. Agreement for self-reported sun sensitivity was moderate (kappa weighted = 0.46; 95% confidence interval, 0.36-0.56) with higher agreement for women. For self-reported NMSC lesion history between two interviews, 24 days apart, kappa estimates ranged from 0.66 to 0.78 and were higher for women than men. Overall, there was evidence for substantial reproducibility related to risk group assignment and self-reported history of NMSC, with self-reported sun sensitivity being less reliable. In all comparisons, women had higher kappa values than men. These results suggest that self-reported measures of skin cancer risk are reasonably reliable for use in screening subjects into studies.

Reproducibility and expression of skin biomarkers in sun-damaged skin and actinic keratoses.

OBJECTIVES: To explore p53 and proliferating cell nuclear antigen (PCNA) expression and polyamine content as biomarkers in skin cancer chemoprevention trials, we evaluated their expression in early stages of UV-induced squamous cell tumorigenesis. METHODS: Biopsies were collected from three groups: 78 subjects with sun damage on forearms, 33 with actinic keratosis (AK) on forearms, and 32 with previous squamous cell carcinoma. Participants with sun damage were randomized to sunscreen or no sunscreen. RESULTS: We found significant differences in p53 and polyamines in forearms from the sun-damaged group (11.5 +/- 1.2% for p53, 65.5 +/- 1.9 nmol/g for putrescine, and 187.7 +/- 3.3 nmol/g for spermidine) compared with the group with sun damage plus AK (20.9 +/- 2.3% for p53, P = 0.0001; 81.7 +/- 3.9 nmol/g for putrescine, P = 0.0001; 209.4 +/- 8.2 nmol/g for spermidine, P < 0.06). PCNA was not different. When lesion histology was considered, there was a stepwise significant increase in p53 in biopsies without characteristics of AK compared with early AK (P = 0.02) and AK (P = 0.0006) and a similar pattern for PCNA with the only significant difference between early AK and AK. There was a stepwise increase in putrescine and spermidine in normal, sun-damaged forearm, forearm from subjects with AK, and the AK lesion itself (P < 0.0001). No significant differences in p53 or polyamines were seen in 3-month biopsies or, as a result of sunscreen use, although PCNA in the sun-damaged group not using sunscreen decreased significantly. CONCLUSIONS: p53 expression and polyamines in skin were elevated in early stages of skin tumorigenesis and were not affected by sunscreen, adding validity to their use as biomarkers in skin cancer chemoprevention trials.

Safety and efficacy of dose-intensive oral vitamin A in subjects with sun-damaged skin.

PURPOSE: Previously, we reported the results of a Phase III, placebo-controlled trial in 2297 randomized participants with moderately severe actinic keratoses wherein 25000 IU/day vitamin A caused a 32% risk reduction in squamous cell skin cancers. We hypothesized that dose escalation of vitamin A to 50000 or 75000 IU/day would be both safe and more efficacious in skin cancer chemoprevention. EXPERIMENTAL DESIGN: One hundred and twenty-nine participants with severely sun-damaged skin on their lateral forearms were randomized to receive placebo or 25000, 50000, or 75000 IU/day vitamin A for 12 months. The primary study end points were the clinical and laboratory safety of vitamin A, and the secondary end points included quantitative, karyometric image analysis and assessment of retinoid and rexinoid receptors in sun-damaged skin. RESULTS: There were no significant differences in expected clinical and laboratory toxicities between the groups of participants randomized to placebo, 25000 IU/day, 50000 IU/day, and 75000 IU/day. Karyometric features were computed from the basal cell layer of skin biopsies, and a total of 22600 nuclei from 113 participants were examined, showing statistically significant, dose-response effects for vitamin A at the 25000 and 50000 IU/day doses. These karyometric changes correlated with increases in retinoic acid receptor alpha, retinoic acid receptor beta, and retinoid X receptor alpha at the 50000 IU/day vitamin A dose. CONCLUSIONS: The vitamin A doses of 50000 and 75000 IU/day for 1 year proved safe and equally more efficacious than the 25000 IU/day dose and can be recommended for future skin cancer chemoprevention studies.

Theory of planned behavior-based models for breastfeeding duration among Hong Kong mothers.

BACKGROUND: The theory of planned behavior (TPB) has been used to explain breastfeeding behaviors in Western cultures. Theoretically-based investigations in other groups are sparse. OBJECTIVE: To evaluate cross-cultural application of TPB-based models for breastfeeding duration among new mothers in Hong Kong. METHOD: First-time breastfeeding mothers (N = 209) with healthy newborns provided self-reports of TPB predictor variables during postpartum hospitalization and information about breastfeeding experiences at 1, 3, 6, 9, and 12 months postdelivery or until they weaned. Three predictive models were proposed: (a) a strict interpretation of the TPB with two added proximal predictors of breastfeeding duration; (b) a replication with modification of the TPB-based model for more fully employed breastfeeding mothers from a previous study (Duckett et al., 1998); and (c) a model that posited perceived control (PC) as a mediating factor linking TPB motivational variables for breastfeeding with breastfeeding intentions and behavior. LISREL was used for the structural equation modeling analyses. RESULTS: Explained variance in PC and duration was high in all models. Overall fit of the strict TPB model was poor (GOFI = 0.85). The TPB for breastfeeding employed women and the PC-mediated models fit equally well (GOFI = 0.94; 0.95) and residuals were small (RMSR = 0.07). All hypothesized paths in the PC-mediated model were significant (p <.05); explained variance was 0.40 for perceived control and 0.36 for breastfeeding duration. DISCUSSION: Models were interpreted in light of the TPB, previous findings, the social context for breastfeeding in Hong Kong, and statistical model-building. Cross-cultural measurement issues and the need for prospective designs are continuing challenges in breastfeeding research.

An ecological perspective of breastfeeding in an indigenous community.

PURPOSE: To describe the sociocultural patterns that promote breastfeeding or weaning in the Ojibwe community, which has very low breastfeeding rates compared to the general population. DESIGN: A focused ethnographic approach with an ecological framework provided community level data. Semi-structured interviews (N = 52) were conducted in an urban Ojibwe community and with three groups of women: health or social service providers, women currently breastfeeding, or people who acted as resources. METHODS: Data were analyzed using an ethnographic approach. Group summaries were compiled and community-level patterns were identified. FINDINGS: Four patterns were identified that encompassed the influences of (a) Ojibwe and mainstream cultures (traditions), (b) communication-related barriers from a variety of sources (mixed messages), (c) socioeconomic issues (life circumstances) and (d) social support (nurturing and supporting). CONCLUSIONS: The values and practices of the studied group were not always congruent with those of the larger mainstream culture. Successful breastfeeding promotion and intervention programs based on culturally relevant perspectives are needed.