Sociodemographic patterns of preterm birth and low birth weight among pregnant women in rural Mysore district, India: A latent class analysis.

Few studies have utilized person-centered approaches to examine co-occurrence of risk factors among pregnant women in low-and middle-income settings. The objective of this study was to utilize latent class analysis (LCA) to identify sociodemographic patterns and assess the association of these patterns on preterm birth (PTB) and/or low birth weight (LBW) in rural Mysore District, India. Secondary data analysis of a prospective cohort study among 1540 pregnant women was conducted. Latent class analysis was performed to identify distinct group memberships based on a chosen set of sociodemographic factors. Binary logistic regression was conducted to estimate the association between latent classes and preterm birth and low birth weight. LCA yielded four latent classes. Women belonging to Class 1 "low socioeconomic status (SES)/early marriage/multigravida/1 child or more", had higher odds of preterm birth (adjusted Odds Ratio (aOR): 95% Confidence Intervals (CI): 1.77, 95% CI: 1.05-2.97) compared to women in Class 4 "high SES/later marriage/primigravida/no children". Women in Class 2 "low SES/later marriage/primigravida/no children" had higher odds of low birth weight (aOR: 2.52, 95% CI: 1.51-4.22) compared to women in Class 4. Women less than 20 years old were twice as likely to have PTB compared to women aged 25 years and older (aOR: 2.00, 95% CI: 1.08-3.71). Hypertension (>140/>90 mm/Hg) was a significant determinant of PTB (aOR: 2.28, 95% CI: 1.02-5.07). Furthermore, women with a previous LBW infant had higher odds of delivering a subsequent LBW infant (aOR: 2.15, 95% CI: 1.40-3.29). Overall study findings highlighted that woman belonging to low socioeconomic status, and multigravida women had increased odds of preterm birth and low birth weight infants. Targeted government programs are crucial in reducing inequalities in preterm births and low birth weight infants in rural Mysore, India.

The association between sleep duration, napping, and stroke stratified by self-health status among Chinese people over 65 years old from the China health and retirement longitudinal study.

PURPOSE: Stroke is a major cause of death in China. This study aimed to investigate the association between sleep duration (nighttime sleep and daytime napping) and stroke in elderly Chinese individuals with self-reported health status. METHODS: A total of 4785 Chinese adults over 65 years from the 2011 China Health and Retirement Longitudinal Study (CHARLS) were included. Binary logistic regression was used to estimate odds ratios and 95% confidence intervals of the association between sleep duration and stroke stratified by self-reported health status. RESULTS: A significant association between short sleep duration (< 7 h per day) and the risk of stroke (aOR = 2.05; 95% CI 1.31-3.19), after controlling for sociodemographic characteristics, lifestyle factors, health status, and comorbidities. There was no significant association between short and long sleep duration and stroke in the individuals who reported good general health status. However, in individuals who reported poor health status, short sleep duration (aOR = 2.11; 95% CI 1.30-3.44) and long sleep duration (aOR = 1.86; 95% CI 1.08-3.21) were significantly associated with increased risk of stroke, compared with normal sleep duration (7-8 h per day). Disability was significantly associated with stroke in both self-reported good and poor health groups. Rural residence was significantly associated with a lower risk of stroke among individuals who reported poor health status. CONCLUSIONS: Both short and long sleep duration were significantly associated with stroke among individuals who reported poor health. Stroke prevention should be focused on elderly individuals who believe that they have health problems.

The association between social support through contacts with Accredited Social Health Activists (ASHAs) and antenatal anxiety among women in Mysore, India: a cross-sectional study.

PURPOSE: In India, antenatal anxiety prevalence estimates range from 6 to 48%. Social support is strongly associated with mental wellbeing, yet most studies have examined the impact of support from partners and family members rather than peers, community members, or health care providers. This study explores the supportive role of Accredited Social Health Activists (ASHA) contacts for antenatal anxiety. METHODS: Data were analyzed from the Saving Children, Improving Lives project, a quasi-experimental study conducted among rural, pregnant women in India. Regression models were used to estimate adjusted prevalence ratios (aPRs) and 95% confidence intervals for the relationship frequency of ASHA contacts and antenatal anxiety. Antenatal anxiety was measured using a subscale of the Edinburgh Postnatal Depression Scale. RESULTS: The sample consisted of 480 pregnant women. Reported antenatal anxiety prevalence was 27% (95% CI 23%, 31%). Participants who were more frequently visited by ASHAs at home (aPR: 0.90; 95% CI 0.76, 0.98) and more frequently accompanied by ASHAs to their antenatal care visits (aPR: 0.86, 95% CI 0.78, 0.95) were less likely to report antenatal anxiety. ASHA home visits were protective for the most vulnerable women (primigravida and those experiencing domestic violence) and ASHA accompaniment to antenatal care visits was equally protective for all women. CONCLUSIONS: ASHAs are valued for their contribution towards maternal health education and linking women of reproductive age to healthcare services. Our findings additionally suggest the important role ASHAs play in providing social support to pregnant women, particularly those who are most vulnerable to experiencing antenatal anxiety.

Barriers to Accessing and Engaging in HIV Preventive Care and Pre-Exposure Prophylaxis Experienced by Transgender Women in Florida.

BACKGROUND: PrEP, a biomedical HIV prevention option, continues to be underutilized among transgender women who could benefit from sustained use, especially women of color and those who identify as Latina and/or reside in the southeastern US. OBJECTIVE: We explored the barriers and facilitators experienced by transgender women who live in Florida regarding accessing, using, and/or staying on PrEP. METHODS: In-depth interviews and focus groups were conducted in either Spanish or English with adult transgender women living in Florida (N = 22). The interviews were audio-recorded, transcribed, and coded in ATLAS.ti using thematic analyses. RESULTS: The mean age of the participants was 42.2 years. Among the participants, 73% were Hispanic/Latina, 59% were foreign-born, and approximately one-third were living with HIV (but had past experience with PrEP). Transgender women cited the following barriers to accessing or considering PrEP: (1) costs and benefits of PrEP use; (2) under-representation in clinical trials resulting in unknown or misinformation regarding PrEP side effects; (3) chronic poverty; and (4) trauma and discrimination. Other stressors, such as behavioral healthcare needs, were identified. CONCLUSIONS: Our analysis revealed interlocking systems of oppression like transphobia, discrimination, and misgendering, which were common barriers experienced by our participants. These synergistically epidemic (i.e., syndemic) barriers contributed to their feelings of being systematically excluded in social spaces, research, public health planning and policies, laws, and social programs related to PrEP. These structural barriers are impediments to HIV preventive care but also act as a source of stress that contributes to mental health problems, financial vulnerability, substance abuse, and other deleterious health outcomes.

Evaluating the moderating role of accredited social health activists on adverse birth outcomes in rural India.

BACKGROUND: The Indian government established the Accredited Social Health Activists (ASHA) program in 2006 to improve access and healthcare coverage in rural regions. The objective of this study was to examine the moderating role of ASHA home visits and ASHA-accompanied antenatal care visits (ANC) on the relationship between sociodemographic latent classes of pregnant women and preterm birth and low birth weight infants in rural Mysore District, India. METHODS: Utilizing a prospective cohort study conducted between 2011 and 2014, secondary data analysis was performed among 1540 pregnant women in rural Mysore, India. Latent class analysis was performed to identify sociodemographic distinct patterns. Multivariable logistic regression was performed to examine the moderating effects of ASHA-accompanied ANC visits and ASHA home visits on preterm birth and low birth weight. RESULTS: Among women who never/rarely had ASHA-accompanied ANC visits, women in Class 1 "low socioeconomic status (SES)/early marriage/multigravida/1 child or more" had higher odds of preterm birth (adjusted odds ratio [aOR]: 2.62, 95% confidence interval [CI]: 1.12-6.12 compared to Class 4 "high SES/later marriage/primigravida/no children.". Women in Class 3 "high SES/later marriage/multigravida/1 child or more" had higher odds of preterm birth compared to class 4. Women in Class 2 "low SES/later marriage/primigravida/no children" had higher odds of low birth weight infant. CONCLUSION: The findings demonstrate that ASHA accompanying women to ANC moderates the risk of preterm births among women in high-risk SES groups. Targeted policies and interventions in improving and strengthening the ASHA program are needed to reduce inequalities in adverse birth outcomes in rural India.

We Aren't Just 'Slack'ing Off: Utilizing a Digital Tool to Connect Emerging Women Leaders in Global Health.

Background: Investing in women leaders in global health catalyzes growth and positive outcomes for individuals and their communities, yet large gender disparities persist in leadership within the field due to several barriers. The use of digital tools facilitates cross-institutional and international collaborations to allow individuals or groups to create or share information, ideas, career interests, and other forms of expression via virtual communities. Digital tools can dramatically expand access to and the quantity and quality of opportunities for networking, mentoring, and collaboration to support women in their professional development. Objectives: The objective of this paper is to document tangible examples of positive experiences, connections, or collaborations resulting from connecting with other participants in a Slack network. We aimed to evaluate this network to understand how to better build, model, and scale advantageous digital networks of women leaders in global health moving forward. Methods: Semi-structured interviews were conducted virtually with seven members of the Slack network from Africa and North America who volunteered to share their experiences. Transcripts of six of these interviews were analyzed for key points using thematic analysis to derive short vignettes from each interview. Findings: The findings of this study indicate that Slack is a highly beneficial tool for women in global health to use for facilitating job searches, mentoring opportunities, promoting project collaborations, and proposing programming and outreach ideas in a remote environment. We found distinct recommendations for utilizing this digital networking tool in a way that best supports and engages women in global health. It is important to spread awareness and ensure visibility of the network to recruit and maintain members, design the network in a way that inspires internal motivation, encourage consistent and meaningful engagement, send weekly emails, and maintain accessibility for a global membership base. Conclusions: The Slack network provides an engaging digital tool that facilitates communication, opportunities, and growth among women in global health. Digital tools such as Slack can help to increase opportunities for participants from low- and-middle-income countries to engage in the same networking and leadership opportunities as individuals from high-income countries. It remains critical to continue to build, advance, and scale advantageous networks like Slack to promote equity and accessibility among women leaders in the global north and south into the post-pandemic world.

Strategies to Improve Women's Leadership Preparation for Early Career Global Health Professionals: Suggestions from Two Working Groups.

Background: Despite advances in gender equality, women still experience inequitable gaps in global health leadership, and barriers to women's advancement as leaders in global health have been well described in the literature. In 2021, the Johns Hopkins Center for Global Health conducted two virtual working groups for emerging women leaders to share challenges and suggest solutions to advance women's leadership in global health. In this paper, we present emerging themes from the working groups, provide a framework for the results, and discuss strategies for advancing women's leadership in global health. Objectives: The objective of this paper is to synthesize and share the themes of the two working group sessions to provide strategies for improving women's leadership training and opportunities in the field of global health. Methods: Approximately 182 women in the global health field participated in two virtual working group sessions hosted by the Johns Hopkins Center for Global Health using the Zoom platform. Participants were divided into virtual breakout rooms and discussed pre-assigned topics related to women's leadership in global health. The participants then returned to share their ideas in a plenary session. Notes from the breakout rooms and transcripts from the plenary session were analyzed through a participatory and iterative thematic analysis approach. Findings: We found that the working group participants identified two overarching themes that were critical for emerging women leaders to find success in global health leadership. First, the acquisition of individual essential skills is necessary to advance in their careers. Second, the institutional environments should be setup to encourage and enable women to enter and succeed in leadership roles. The participants also shared suggestions for improving women's leadership opportunities such as including the use of virtual technologies to increase training and networking opportunities, intersectionality in mentorship and sponsorship, combatting impostor syndrome, and the importance of work-life balance. Conclusions: Investing in women and their leadership potential has the promise to improve health and wealth at the individual, institutional, and community levels. This manuscript offers lessons and proposes solutions for increasing women's leadership through improving individual level essential skills and fostering environments in which women leaders can emerge and thrive.

Exposure to famine in early life and self-rated health status among Chinese adults: a cross-sectional study from the Chinese Health and Retirement Longitudinal Study (CHARLS).

OBJECTIVE: China's Great Famine between 1959 and 1961 has contributed to numerous adverse health outcomes in Chinese. This study aimed to examine the association between exposure to famine in early life and self-rated health (SRH) in adulthood. METHODS: 4418 Chinese adults from the 2011 China Health and Retirement Longitudinal Study were included in the analysis. Multivariable logistic regression was conducted to estimate adjusted ORs (aORs) and 95% CIs of the association between exposure to famine in early life and SRH, stratified by sex. RESULTS: Participants exposed to famine during infancy were more likely to report poor SRH (aOR 1.33; 95% CI 1.04 to 1.70) compared with the non-exposed group, adjusting for confounders. Males were 32% less likely than females to report poor SRH (aOR 0.68; 95% CI 0.54 to 0.86). Participants diagnosed with chronic diseases (aOR 3.11; 95% CI 2.68 to 3.61), disability (aOR 1.82; 95% CI 1.38 to 2.38) and vision impairment (aOR 2.07; 95% CI 1.72 to 2.49) were more likely to report poor SRH. Participants who were current alcohol users and with abnormal weight were less likely to report poor SRH. Stratification by sex showed no significant association between famine and SRH among males, but a consistently significant association was observed among females (aOR 1.46; 95% CI 1.02 to 2.12). CONCLUSIONS: Findings from this study indicated that females exposed to famine in China during infancy were more likely to report poor SRH in their adulthood. Implementing interventions to those who were exposed to famine in early life, especially for females, may improve their long-term consequences.

A review investigating the relationship between cannabis use and adolescent cognitive functioning.

Given varying state-level laws regarding cannabis use, the objective of the review was to summarize contemporary literature on the relationship between adolescent cognitive function and academic performance with cannabis use. Frequency and quantity of cannabis use were associated with decreased functional connectivity of the brain. Earlier age at cannabis initiation and more frequent use was associated with poorer executive control and academic performance. Social determinants such as minimal parental monitoring, peer use and low social cohesion were associated with more frequent adolescent use. Race/ethnicity and residence were other factors influencing cannabis use. To prevent cannabis use disorders among adolescents, interventions should aim to prevent early initiation that can lead to chronic use in youth who may be more at risk.

Evaluating a Conditional Cash Transfer Scheme in a Maternal Health Care Utilization Program Among Rural Pregnant Women in Mysore District, India.

Background: According to the World Bank report in 2015, the maternal death rate in India was 174 per 100,000, which is among the highest in the world. The Indian Government launched the Janani Suraksha Yojana (JSY) conditional cash transfer program in 2005 to curb the adverse birth outcomes by promoting institutional delivery and providing antenatal care (ANC) services for pregnant women. This study evaluates the factors associated with JSY conditional cash transfer program in rural Mysore, India. Methods: Between 2011 and 2014, a prospective cohort study was conducted to examine the feasibility and acceptability of integrated ANC and HIV testing using mobile clinics in rural Mysore. Pregnant women in the Mysore Taluk provided an informed consent and answered an interviewer-administered questionnaire in local language, Kannada. All women underwent routine ANC services and were followed-up immediately after delivery, and 6 months and 12 months after delivery. Binary logistic regression was performed to identify factors associated with JSY benefits. Results: The mean age of the 1,806 mothers was 21.2 ± 2.2 years and 58.9% of the mothers had primary education. Nearly half (51.6%) of the women reported having received JSY benefits. Factors associated with receiving JSY benefits included pregnant woman's partner not having any formal education (adjusted odds ratio [AOR]: 1.35; 95% confidence interval [CI]: 1.01-1.80), having income ≤4,000 Indian Rupees (AOR: 1.47; 95% CI: 1.04-2.09), rare visits (once in 3 months visit) with Accredited Social Health Activists (AOR: 3.55; 95% CI: 1.55-8.51), and delivery in a public institution (AOR: 1.23; 95% CI: 1.01-1.51). Conclusions: While JSY has been operational in India since 2005, there continue to remain major gaps in the receipt of JSY services in rural India. Future interventions should include targeted services and expansion of JSY scheme, specifically among rural pregnant women, who are most at need of these services.

The Impact of COVID-19 on African American Communities in the United States.

Purpose: The purpose of this ecological study was to understand the impact of the density of African American (AA) communities on coronavirus disease 2019 (COVID-19) prevalence and death rate within the three most populous counties in each U.S. state and territory (n=152). Methods: An ecological design was employed for the study. The top three most populous counties of each U.S. state and territory were included in analyses for a final sample size of n=152 counties. Confirmed COVID-19 cases and deaths that were accumulated between January 22, 2020 and April 12, 2020 in each of the three most populous counties in each U.S. state and territory were included. Linear regression was used to determine the association between AA density and COVID-19 prevalence (defined as the percentage of cases for the county population), and death rate (defined as number of deaths per 100,000 population). The models were adjusted for median age and poverty. Results: There was a direct association between AA density and COVID-19 prevalence; COVID-19 prevalence increased 5% for every 1% increase in county AA density (p<0.01). There was also an association between county AA density and COVID-19 deaths; the death rate increased 2 per 100,000 for every percentage increase in county AA density (p=0.02). Conclusion: These findings indicate that communities with a high AA density have been disproportionately burdened with COVID-19. To help develop effective interventions and programs that address this disparity, further study is needed to understand social determinants of health driving inequities for this community.

Sexually transmitted infections among high-risk populations that use treatment as prevention or pre-exposure prophylaxis: a protocol for a systematic review.

BACKGROUND: Among men who have sex with men, pre-exposure prophylaxis (PrEP) reduces the risk of HIV by 95%. Based on the documented benefits, the Centre for Disease Control and Prevention has recommended PrEP as a prevention method for high-risk groups. Moreover, for those HIV-infected individuals, antiretroviral therapy has been shown to serve as both as a treatment and prevention method for HIV. METHODS AND ANALYSIS: This systematic review protocol was reported according to the Preferred Reporting Items for Systematic reviews and Analyses (PRISMA) P framework. Medline (1980-present), Embase (1980-present), CINAHL (1980-present), Cochrane Central Register of Controlled Trials and clinicaltrials.gov will be used to identify relevant articles based on a piloted search strategy. Peer-reviewed observational and experimental studies will be included. A narrative style will be used to describe descriptive data. A meta-analysis will be conducted if heterogeneity is not significant. ETHICS AND DISSEMINATION: Recent evidence suggests that there is an increased risk of sexually transmitted infections (STIs) among high-risk persons that use PrEP. Furthermore, there is a paucity of data on the relationship of treatment as prevention and incidence of STIs. The findings of this review will assess this emerging public health phenomenon and serve to inform future public health policy. No formal ethical review is required for this protocol. All findings will be published in a peer reviewed journal. PROTOCOL REGISTRATION NUMBER: CRD42019128720.