Identification of Key Beliefs Explaining Male Circumcision Motivation Among Adolescent Boys in Zimbabwe: Targets for Behavior Change Communication.

Male circumcision (MC) significantly reduces HIV acquisition among men, leading WHO/UNAIDS to recommend high HIV and low MC prevalence countries circumcise 80% of adolescents and men age 15-49. Despite significant investment to increase MC capacity only 27% of the goal has been achieved in Zimbabwe. To increase adoption, research to create evidence-based messages is greatly needed. The Integrated Behavioral Model (IBM) was used to investigate factors affecting MC motivation among adolescents. Based on qualitative elicitation study results a survey was designed and administered to a representative sample of 802 adolescent boys aged 13-17 in two urban and two rural areas in Zimbabwe. Multiple regression analysis found all six IBM constructs (2 attitude, 2 social influence, 2 personal agency) significantly explained MC intention (R2 = 0.55). Stepwise regression analysis of beliefs underlying each IBM belief-based construct found 9 behavioral, 6 injunctive norm, 2 descriptive norm, 5 efficacy, and 8 control beliefs significantly explained MC intention. A final stepwise regression of all the significant IBM construct beliefs identified 12 key beliefs best explaining intention. Similar analyses were carried out with subgroups of adolescents by urban-rural and age. Different sets of behavioral, normative, efficacy, and control beliefs were significant for each sub-group. This study demonstrates the application of theory-driven research to identify evidence-based targets for the design of effective MC messages for interventions to increase adolescents' motivation. Incorporating these findings into communication campaigns is likely to improve demand for MC.

Evidence-Based Identification of Key Beliefs Explaining Infant Male Circumcision Motivation Among Expectant Parents in Zimbabwe: Targets for Behavior Change Messaging.

Slow adult male circumcision uptake is one factor leading some to recommend increased priority for infant male circumcision (IMC) in sub-Saharan African countries. This research, guided by the integrated behavioral model (IBM), was carried out to identify key beliefs that best explain Zimbabwean parents' motivation to have their infant sons circumcised. A quantitative survey, designed from qualitative elicitation study results, was administered to independent representative samples of 800 expectant mothers and 795 expectant fathers in two urban and two rural areas in Zimbabwe. Multiple regression analyses found IMC motivation among fathers was explained by instrumental attitude, descriptive norm and self-efficacy; while motivation among mothers was explained by instrumental attitude, injunctive norm, descriptive norm, self-efficacy, and perceived control. Regression analyses of beliefs underlying IBM constructs found some overlap but many differences in key beliefs explaining IMC motivation among mothers and fathers. We found differences in key beliefs among urban and rural parents. Urban fathers' IMC motivation was explained best by behavioral beliefs, while rural fathers' motivation was explained by both behavioral and efficacy beliefs. Urban mothers' IMC motivation was explained primarily by behavioral and normative beliefs, while rural mothers' motivation was explained mostly by behavioral beliefs. The key beliefs we identified should serve as targets for developing messages to improve demand and maximize parent uptake as IMC programs are rolled out. These targets need to be different among urban and rural expectant mothers and fathers.

Tu Amigo Pepe: Evaluation of a Multi-media Marketing Campaign that Targets Young Latino Immigrant MSM with HIV Testing Messages.

Latino immigrant men who have sex with men (MSM) are at risk for HIV and delayed diagnosis in the United States. This paper describes the evaluation of a pilot of the Tu Amigo Pepe, a multimedia HIV testing campaign aimed at Latino MSM in Seattle, WA particularly targeting immigrants who may not identify as gay, ages 18-30 years old. The 16-week campaign included Spanish-language radio public service announcements (PSAs), a Web site, social media outreach, a reminder system using mobile technology, print materials and a toll-free hotline. In developing the PSAs, the Integrated Behavioral Model was used as a framework to reframe negative attitudes, beliefs and norms towards HIV testing with positive ones as well as to promote self-efficacy towards HIV testing. The campaign had a significant and immediate impact on attitudes, beliefs, norms and self-efficacy towards HIV testing as well as on actual behavior, with HIV testing rates increasing over time.

Evidence-based identification of key beliefs explaining adult male circumcision motivation in Zimbabwe: targets for behavior change messaging.

Male circumcision (MC) reduces HIV acquisition among men, leading WHO/UNAIDS to recommend a goal to circumcise 80 % of men in high HIV prevalence countries. Significant investment to increase MC capacity in priority countries was made, yet only 5 % of the goal has been achieved in Zimbabwe. The integrated behavioral model (IBM) was used as a framework to investigate the factors affecting MC motivation among men in Zimbabwe. A survey instrument was designed based on elicitation study results, and administered to a representative household-based sample of 1,201 men aged 18-30 from two urban and two rural areas in Zimbabwe. Multiple regression analysis found all five IBM constructs significantly explained MC Intention. Nearly all beliefs underlying the IBM constructs were significantly correlated with MC Intention. Stepwise regression analysis of beliefs underlying each construct respectively found that 13 behavioral beliefs, 5 normative beliefs, 4 descriptive norm beliefs, 6 efficacy beliefs, and 10 control beliefs were significant in explaining MC Intention. A final stepwise regression of the five sets of significant IBM construct beliefs identified 14 key beliefs that best explain Intention. Similar analyses were carried out with subgroups of men by urban-rural and age. Different sets of behavioral, normative, efficacy, and control beliefs were significant for each sub-group, suggesting communication messages need to be targeted to be most effective for sub-groups. Implications for the design of effective MC demand creation messages are discussed. This study demonstrates the application of theory-driven research to identify evidence-based targets for intervention messages to increase men's motivation to get circumcised and thereby improve demand for male circumcision.

[Comparative analysis of three length based methods for estimating growth of the tilapia Oreochromis aureus (Perciformes: Cichlidae) in a tropical lake of Mexico]. / Comparación de tres métodos indirectos para estimar el crecimiento de la tilapia Oreochromis aureus (Perciformes: Cichlidae) en un lago tropical de México.

A comparative analysis of three length based methods for estimating growth of the tilapia Oreochromis aureus (Perciformes: Cichlidae) in a tropical lake of Mexico. Several methods are now available to estimate fish individual growth based upon the distribution of body lengths in a population. Comparative analyses of length-based methods have been undertaken mainly for marine species; nevertheless, limited information is available for inland species. Tilapia is one of the most important freshwater fisheries and its growth parameters have been estimated by several authors, usually using one length-based method. Thus, the main objectives of this study were: a) to estimate growth parameters of O. aureus from Chapala lake, Mexico, using three length-based methods ELEFAN, PROJMAT and SLCA; b) to quantify the effect of input data variations in growth parameters estimates by the jackknife technique; and c) to compare the new estimates with those previously reported, through the standard growth index phi. We collected and analyzed a total of 1,973 specimens from commercial landings from January to December 2010. The three length-base methods used in the present study resulted in parameter estimates within the range of those reported in other studies. Results derived from jackknife analysis revealed lowest values in the error percentage and coefficient of variation for L infinity when applying ELEFAN, while PROJMAT showed lowest values in the precision estimators for K, which was very similar to ELEFAN. Estimates of the comparative growth index phi were also very similar to those reported for the same species when studied in different reservoirs. Considering our results, we suggest the use of ELEFAN rather than SLCA due to its accuracy to estimate growth parameters for O. aureus.

Neural dynamics underlying associative learning in the dorsal and ventral hippocampus.

Animals associate cues with outcomes and update these associations as new information is presented. This requires the hippocampus, yet how hippocampal neurons track changes in cue-outcome associations remains unclear. Using two-photon calcium imaging, we tracked the same dCA1 and vCA1 neurons across days to determine how responses evolve across phases of odor-outcome learning. Initially, odors elicited robust responses in dCA1, whereas, in vCA1, odor responses primarily emerged after learning and embedded information about the paired outcome. Population activity in both regions rapidly reorganized with learning and then stabilized, storing learned odor representations for days, even after extinction or pairing with a different outcome. Additionally, we found stable, robust signals across CA1 when mice anticipated outcomes under behavioral control but not when mice anticipated an inescapable aversive outcome. These results show how the hippocampus encodes, stores and updates learned associations and illuminates the unique contributions of dorsal and ventral hippocampus.

Concurrent partnerships, acute infection and HIV epidemic dynamics among young adults in Zimbabwe.

This paper explores the roles of acute infection and concurrent partnerships in HIV transmission dynamics among young adults in Zimbabwe using realistic representations of the partnership network and all published estimates of stage-specific infectivity. We use dynamic exponential random graph models to estimate partnership network parameters from an empirical study of sexual behavior and drive a stochastic simulation of HIV transmission through this dynamic network. Our simulated networks match observed frequencies and durations of short- and long-term partnerships, with concurrency patterns specific to gender and partnership type. Our findings suggest that, at current behavior levels, the epidemic cannot be sustained in this population without both concurrency and acute infection; removing either brings transmission below the threshold for persistence. With both present, we estimate 20-25% of transmissions stem from acute-stage infections, 30-50% from chronic-stage, and 30-45% from AIDS-stage. The impact of acute infection is strongly moderated by concurrency. Reducing this impact by reducing concurrency could potentially end the current HIV epidemic in Zimbabwe.

The Dentate Gyrus Classifies Cortical Representations of Learned Stimuli.

Animals must discern important stimuli and place them onto their cognitive map of their environment. The neocortex conveys general representations of sensory events to the hippocampus, and the hippocampus is thought to classify and sharpen the distinctions between these events. We recorded populations of dentate gyrus granule cells (DG GCs) and lateral entorhinal cortex (LEC) neurons across days to understand how sensory representations are modified by experience. We found representations of odors in DG GCs that required synaptic input from the LEC. Odor classification accuracy in DG GCs correlated with future behavioral discrimination. In associative learning, DG GCs, more so than LEC neurons, changed their responses to odor stimuli, increasing the distance in neural representations between stimuli, responding more to the conditioned and less to the unconditioned odorant. Thus, with learning, DG GCs amplify the decodability of cortical representations of important stimuli, which may facilitate information storage to guide behavior.

What about the partners of women with abnormal Pap or positive HPV tests?

BACKGROUND: Because high-risk HPV is highly prevalent in the general population, usually transient, and rarely causes clinical symptoms, and because diagnostic and treatment options for HPV in men are lacking, partner notification is not useful for preventing transmission or protecting the health of male partners. METHODS: We conducted a nationally representative survey of clinicians in 7 specialties that perform cervical cancer screening. Providers were asked whether they recommend that women with an abnormal Pap or positive HPV test inform sex partners of the infection or refer partners to a clinician. RESULTS: A large proportion of providers in all 7 specialties encourage women with either an abnormal Pap or a positive HPV test to tell their sex partners to see a clinician, ranging from 48% to 73% across specialties. Providers who perform reflex HPV testing were more likely to recommend that patients with an ASCUS Pap inform their partners of test results if an HPV test was positive than if it was negative (66%-83% vs. 29%-50%); providers who perform adjunct HPV testing were more likely to recommend that patients with a normal Pap inform their partners if an HPV test was positive than if it was negative (72%-92% vs. 30%-52%). CONCLUSIONS: Most providers advise patients with cervical cancer screening tests suggestive of HPV infection to notify their sex partners and to refer them to a clinician. Guidelines are needed for providers to clarify any rationale for clinical evaluation of male partners, including that informing partners has a limited role in the control of HPV transmission or in preventing adverse health outcomes in the male partner.

Access of Black, Hispanic, and nonprivately insured women to liquid-based cytology, human papillomavirus DNA testing, and on-site colposcopy in the United States.

OBJECTIVE: To determine whether patient race, ethnicity, or insurance status was associated with access to cervical cancer screening with liquid-based cytology (LBC) and with human papillomavirus (HPV) DNA testing and with access to on-site colposcopy at the provider's principal practice site. MATERIALS AND METHODS: We conducted a nationally representative survey of clinicians in specialties that provide cervical cancer screening. Adjusted odds ratios (OR) were estimated for the associations between race, ethnicity, and insurance status of patients and provider use of LBC, HPV DNA testing, and on-site colposcopy. RESULTS: Providers who cared for >or=20% Hispanic patients were less likely to use LBC (OR 0.60, 95% CI=0.42-0.84). Providers who cared for >or=25% black women (OR 0.71, 95% CI=0.51-0.98) and providers who cared for <75% privately insured patients (OR 0.66, 95% CI=0.46-0.95) were less likely to use HPV DNA testing. Providers who cared for <75% privately insured patients were less likely to have on-site colposcopy (OR 0.57, 95% CI=0.37-0.89), but those who cared for >or=20% Medicaid patients were more likely to have on-site colposcopy (OR 1.86, 95% CI=1.26-2.73). CONCLUSIONS: Given the high rates of cervical cancer in minority women, access to cervical cancer screening and diagnostic follow-up must be ensured. It may also be beneficial to ensure affordable access to technologies such HPV DNA testing that increases the sensitivity of disease detection and to on-site colposcopy that facilitates follow-up of abnormal cytology.

Field-based evaluation of malaria outbreak detection and response in Mudzi and Goromonzi districts, Zimbabwe - 2017.

National-level evaluations may fail to identify capacity improvements for detecting and responding to outbreaks which begin and are first detected at the local level. In response to this issue, we conducted a field-based assessment of the malaria outbreak surveillance system in Mashonaland East, Zimbabwe. We visited eleven clinics in Mudzi and Goromonzi districts. Twenty-one interviews were conducted with key informants from the provincial (n = 2), district (n = 7), and clinic (n = 12) levels. Interviews focused on surveillance system activities, preparedness, data quality, timeliness, stability, and usefulness. Main themes were captured utilising standard qualitative data analysis techniques. While the surveillance system detects malaria outbreaks at all levels, we identified several gaps. Clinics experience barriers to timely and reliable reporting of outbreaks to the district level and staff cross-training. Stability of resources, including transportation (33% of informants, n = 7) and staff capacity (48% of informants, n = 10), presented barriers. Strengthening these surveillance barriers may improve staff readiness to detect malaria outbreaks, resulting in timelier outbreak response and a reduction in malaria outbreaks, cases, and deaths. By focusing at the local level, our assessment approach provides a framework for identifying and addressing gaps that may be overlooked when utilising tools that evaluate surveillance capacity at the national level.

Cervical cancer screening, abnormal cytology management, and counseling practices in the United States.

OBJECTIVE: We assessed clinician knowledge and practices since the marketing of tests for sexually transmitted human papillomavirus (HPV) and the release of HPV testing guidelines for two indications: 1) as an adjunct to cytologic screening and 2) to guide colposcopic triage of patients with atypical squamous cells of undetermined significance (ASC-US) cytology results. METHODS: In mid-2004, we surveyed nationally representative, random samples of clinicians practicing specialties that provide cytologic screening. Mail surveys addressed HPV-related knowledge, screening, abnormal cytology management, HPV testing, and counseling practices. RESULTS: The overall adjusted response rate was 82%. Of the 2,980 (89%) clinicians providing cytologic screening, 99% knew that HPV infection increases cervical cancer risk, and 91% were aware of HPV tests. Of the 21% who reported ever using HPV tests as an adjunct to cytology, more reported usually testing patients aged less than 30 years (which guidelines do not recommend) than older patients (which guidelines do recommend). Of the 63% of clinicians who ever ordered HPV tests for abnormal cytology results, 84% usually ordered tests for ASC-US results and preferentially advised colposcopy if HPV tests were positive, as guidelines recommend. However, more than 60% usually ordered HPV tests for higher-grade abnormalities, which is not recommended for colposcopy triage. Although few sought HPV test consent, most discussed sexually transmitted HPV with patients with abnormal cytology or positive HPV tests despite potentially negative psychosocial consequences. CONCLUSION: New HPV tests and testing guidelines have transformed screening, abnormal cytology management, and counseling practices. Although many U.S. clinicians reported using HPV tests according to guidelines, many also reported inappropriate use.

Screening for colorectal cancer in Uruguay with an immunochemical faecal occult blood test.

An observational prospective study was carried out in Uruguay to evaluate the feasibility of colorectal cancer screening using immunochemical faecal occult blood tests with no dietary restrictions in an average-risk population. An automated system was used for processing the samples with a cut-off haemoglobin level of 100 ng/ml. Of the 11,734 study participants who received an immunochemical test kit (OC-Hemodia), 10,573 (90.1%) returned samples for screening. The results of 1170 (11.1%) of the responders were positive. Subsequently, colonoscopy was performed on 879 (75.1%) of the participants with a positive test result and showed neoplasia in 330 participants. Fifty four had advanced cancer, 47 had early cancer, 131 had high-risk adenoma and 98 had low-risk adenoma. The detection rates and the positive predictive values were 0.95 and 8.6% for cancer, and 1.24 and 11.2% for high-risk adenoma, respectively. The high compliance and high detection rates for cancer and high-risk adenoma achieved in the colorectal cancer screening programme verifies the feasibility of an immunochemical faecal occult blood test in screening an average-risk population in Uruguay, a country with a small population, but with high morbidity and mortality rates for this disease.

Family physicians' knowledge of genital human papillomavirus (HPV) infection and HPV-related conditions, United States, 2004.

BACKGROUND AND OBJECTIVES: Information about human papillomavirus (HPV) has evolved rapidly and HPV DNA tests are now available. Little is known about family physicians' knowledge about HPV and how it relates to HPV test use and counseling practices. METHODS: In mid-2004, confidential surveys were mailed to a nationally representative sample of 760 family physicians. We assessed and analyzed relationships between knowledge about HPV, HPV test use, and counseling messages provided when collecting cervical cytology and managing anogenital warts. RESULTS: The adjusted response rate was 68% (n=368). Ninety-one percent provided cervical cancer screening, and 90% had managed genital warts. Responses indicated that more than 90% had up-to-date knowledge about several issues: HPV infection is common, persistent infection increases risk of cervical neoplasia, and treatment does not eliminate the causative infection. However, fewer than 50% were aware that HPV infections may clear spontaneously and that the HPV types associated with warts and cervical neoplasia differ. Only 57% had ever used HPV tests. Some HPV knowledge varied by clinician characteristics, and knowledge was associated with HPV test use but not counseling messages. CONCLUSIONS: Most physicians were aware of new information about HPV infection, but some were unaware of important information relevant for patient counseling. These topics have been highlighted in new clinical training and patient education materials.

A Phase II Randomized Controlled Trial Comparing Safety, Procedure Time, and Cost of the PrePex™ Device to Forceps Guided Surgical Circumcision in Zimbabwe.

BACKGROUND: The World Health Organization (WHO) and the Joint United Nations Program on HIV/AIDS promote MC (male circumcision) as a key HIV prevention strategy where HIV prevalence and incidence are high and MC prevalence is low. In Zimbabwe, to achieve the 1.26 million circumcisions needed to be performed by 2015 to achieve optimal MC coverage, a new approach was needed. The primary objective of the current trial was to assess the performance (safety, procedure time, and cost) of the PrePex device compared to forceps-guided surgical circumcision. METHODS AND FINDINGS: This Phase II, randomized, open-label trial in Zimbabwe involved healthy, non-circumcised adult male volunteers who were randomly assigned to the PrePex device (n = 160) or surgical arm (n = 80). Three doctors and 4 nurses, all certified on both circumcision methods, performed the procedures. The PrePex device procedure involves a plastic ring with a rubber O-ring that necrotizes the foreskin to facilitate easy and minimally invasive removal. Total procedure time was the primary endpoint. Adverse event (AE) data were also gathered for 90 days post-procedure. All 80 participants in the surgical arm and 158 participants in the PrePex arm achieved complete circumcision. The total procedure time for the PrePex device was approximately one-third of the total surgical procedure (4.8 minutes, Standard Deviation [SD]: 1.2 versus 14.6 minutes; SD: 4.2; p<0.00001). There were 2 AEs for 2 participants (rate of 1.3%, 95% Confidence Interval: 0.0025-4.53%), which were resolved with simple intervention. The AEs were device related, including 1 case of pain leading to device removal and 1 case of removal of the device. CONCLUSIONS: The trial supports previous studies' conclusions that the PrePex procedure is safe, quick, easy to apply, and effective in terms of procedure time as an alternative to traditional surgical circumcision. The PrePex device has great potential for use in overburdened health systems and in resource-limited settings and is recommended for use in rapid scale-up of adult MC in Zimbabwe. TRIAL REGISTRATION: ClinicalTrials.gov NCT01956370.

Psychosocial Results from a Phase I Trial of a Nonsurgical Circumcision Device for Adult Men in Zimbabwe.

Male circumcision (MC), an effective HIV prevention tool, has been added to Zimbabwe's Ministry of Health and Child Care HIV/AIDS Prevention Program. A Phase I safety trial of a nonsurgical male circumcision device was conducted and extensive psychosocial variables were assessed. Fifty-three men (18 and older) were recruited for the device procedure; 13 follow-up clinical visits were completed. Interviews conducted three times (before the procedure, at 2 weeks and 90 days post-procedure) assessed: Satisfaction; expectations; actual experience; activities of daily living; sexual behavior; and HIV risk perception. Using the Integrated Behavioral Model, attitudes towards MC, sex, and condoms, and sources of social influence and support were also assessed. Men (mean age 32.5, range 18-50; mean years of education = 13.6; 55% employed) were satisfied with device circumcision results. Men understand that MC is only partially protective against HIV acquisition. Most (94.7%) agreed that they will continue to use condoms to protect themselves from HIV. Pain ratings were surprisingly negative for a procedure billed as painless. Men talked to many social networks members about their MC experience; post-procedure (mean of 14 individuals). Minimal impact on activities of daily living and absenteeism indicate possible cost savings of device circumcisions. Spontaneous erections occurred frequently post-procedure. The results had important implications for changes in the pre-procedure clinical counseling protocol. Clear-cut counseling to manage pain and erection expectations should result in improved psychosocial outcomes in future roll-out of device circumcisions. Men's expectations must be managed through evidence-based counseling, as they share their experiences broadly among their social networks.

Sexually transmitted disease screening by United States obstetricians and gynecologists.

OBJECTIVE: To assess compliance with practice guidelines and to determine the extent of missed opportunities for sexually transmitted disease (STD) prevention by describing screening practices of a national sample of obstetricians and gynecologists and comparing them to the practices of other specialists. METHODS: Physicians (n = 7300) in five specialties that diagnose 85% of STDs in the United States were surveyed. Obstetrics and gynecology (n = 647) was one of the five specialties. Besides providing demographic and practice characteristics, respondents answered questions about who they screen (nonpregnant females, pregnant females) and for which bacterial STDs (syphilis, gonorrhea, chlamydia). RESULTS: Responding obstetricians and gynecologists were most likely to be non-Hispanic white (75%), male (66%), and in their 40s (mode 43 years old). They saw an average of 90 patients per week during 47 hours of direct patient care. Approximately 95% practiced in private settings. Almost all (96%) screened some patients for at least one STD. Obstetricians and gynecologists screened women more frequently than other specialties, but no specialty screened all women or all pregnant women. CONCLUSION: Obstetricians and gynecologists screen women for STDs at a higher rate than other specialties represented in this study. Consistent with published guidelines, most obstetricians and gynecologists in our survey screened pregnant women for chlamydia, gonorrhea, and syphilis. Nonetheless, only about half of obstetricians and gynecologists screened nonpregnant women for gonorrhea or chlamydia, and fewer screen nonpregnant women for syphilis.

STD care: variations in clinical care associated with provider sex, patient sex, patients' self-reported symptoms or high-risk behaviors, partner STD history.

Sexually transmitted diseases in the United States are frequently diagnosed by private, as well as public, physicians. However, we know little about the decision processes that physicians employ when faced with people who may or may not be infected. To address this gap, we compared physicians' responses to different patient vignettes to assess how variations in patients' presentations affect physicians' clinical behavior. We systematically varied reported symptoms, behavioral risk, partner STD, and sex of patients in 16 different vignettes, with one vignette randomly presented to each physician in a national survey. Physicians rated the likelihood of 12 clinical management actions they might take with the patient vignette presented. Responses varied with self-reported symptoms, high-risk behavior, and report of an STD infected partner such that female physicians were more attentive to sexual health, and all physicians were more likely to treat female patients aggressively, relative to their male patients. Overall behavior was broadly congruent with sound medical practice, although we discuss several caveats to this general statement.

Alcohol use and abuse among rural Zimbabwean adults: a test of a community-level intervention.

BACKGROUND: Understanding what factors contribute to alcohol abuse in resource-poor countries is important given its adverse health consequences. Past research shows that social peers influence substance abuse, suggesting that the social environment may be an effective target for reducing alcohol abuse across a population. This study investigates the determinants of alcohol use and abuse in rural Zimbabwe and tests a community popular opinion leader (CPOL) community-based intervention partly directed at reducing alcohol abuse. METHODS: Tests were conducted on the impact of the CPOL intervention on alcohol use patterns across communities in rural Zimbabwe over three waves from 2003 to 2007, including community- and individual-level tests using data based on in-person interviews of adult men and women (ages 18-30; N=5543). Data were analyzed using paired-sample t-tests, as well as logistic and ordinary least-squares regression with random effects. RESULTS: Higher drinking (any use, more frequent use, greater quantity, and/or frequent drunkenness) was generally associated with being male, older, not married, more highly educated, of Shona ethnicity, away from home frequently, employed, having no religious affiliation, or living in areas with a higher crude death rate or lower population density. Over the study period, significant declines in alcohol use and abuse were found in intervention and control sites at relatively equal levels. CONCLUSIONS: Although no support was found for the effectiveness of the CPOL study in reducing alcohol abuse, Zimbabwe is similar to other countries in the impact of socio-demographic and cultural factors on alcohol use and abuse.

Colorectal cancer screening use among insured primary care patients.

OBJECTIVE: To compare colorectal cancer (CRC) screening use, including changes over time and demographic characteristics associated with screening receipt, between 2 insured primary care populations. STUDY DESIGN: Clinical and administrative records from 2 large health systems, one in New Mexico and the other in Michigan, were used to determine use of CRC screening tests between 2004 and 2008 among patients aged 51 to 74 years. METHODS: Generalized estimating equations were used to evaluate trends in CRC screening use over time and the association of demographic and other factors with screening receipt. RESULTS: Rates of CRC screening use ranged from 48.1% at the New Mexico site to 68.7% at the Michigan site, with colonoscopy being the most frequently used modality. Fecal occult blood test was used inconsistently by substantial proportions of patients who did not meet the definition of screening users. Screening use was positively and significantly associated with older age, male sex, and more periodic health examinations and other types of primary care visits; at the Michigan site, it was also associated with African American race, married status, and higher annual estimated household income. CONCLUSIONS: Among insured primary care patients, CRC screening use falls short. Further research is needed to determine what factors are barriers to routine fecal occult blood test or colonoscopy use among insured patients who have access to and regularly use primary care and how those barriers can be eliminated.