Measuring the Prevalence of Mental Disorders in Adolescents in Kenya, Indonesia, and Vietnam: Study Protocol for the National Adolescent Mental Health Surveys.

PURPOSE: In low- and middle-income countries, there are limited data on mental disorders among adolescents. To address this gap, the National Adolescent Mental Health Surveys (NAMHS) will provide nationally representative prevalence data of mental disorders among adolescents in Kenya, Indonesia, and Vietnam. This paper details the NAMHS study protocol. METHODS: In each country, a multistage stratified cluster sampling design will be used. Participants will be eligible pairs of adolescents aged 10-17 years and their primary caregiver. Adolescents will be assessed for social phobia, generalized anxiety disorder, major depressive disorder, attention-deficit/hyperactivity disorder, conduct disorder, and post-traumatic stress disorder using the Diagnostic Interview Schedule for Children, version 5. Demographics, risk and protective factors, and service use information will also be collected. In the parallel clinical calibration study, diagnoses of major depressive disorder, social phobia, and generalized anxiety disorder made using the Diagnostic Interview Schedule for Children, version 5 will be calibrated against a diagnostic assessment by in-country clinicians in a separate sample. RESULTS: Data collection for the national survey and clinical calibration study will commence in 2021, with dissemination of findings and methodology due to occur in 2022. CONCLUSIONS: Accurately quantifying the prevalence of mental disorders in adolescents is essential for service planning. NAMHS will address this lack of prevalence data, both within the NAMHS countries and within their respective regions, while establishing a gold-standard methodology for data collection on adolescent mental health in low- and middle-income countries. More broadly, NAMHS will encourage capacity building within each country by establishing linkages between researcher, clinician, government, and other networks.

Gender differences in cigarette smoking and alcohol drinking among adolescents and young adults in Hanoi, Shanghai, and Taipei.

OBJECTIVE: This study aimed to examine gender differences in smoking and alcohol drinking behaviors in three Asian cities of Hanoi, Shanghai, and Taipei, and to assess the magnitude of gender differences across the three cities. METHODS: A total of 17,016 adolescents (age: 15-19 years) and young adults (age: 20-24 years) were selected using multi-stage sampling methods and surveyed in face-to-face interviews. A total of 16,554 unmarried respondents were included in this analysis. RESULTS: Gender differences were significant for smoking only, drinking only, and both behaviors in each city. Male respondents were 30.66 times more likely to report smoking only than female respondents in Hanoi, followed by Shanghai and Taipei. This pattern was similar for drinking only and both smoking and drinking behaviors. CONCLUSIONS: The magnitude of gender differences in smoking only, drinking only, and both behaviors widely varies across the three cities. Further research can examine how these differences may be used to prevent and reduce smoking and drinking in the adolescent and young adult population.

Postpartum Family Planning During Sociopolitical Transition: Findings from an Integrated Community-Based Program in Egypt.

CONTEXT: Limited information exists on postpartum family planning and implementation of integrated reproductive and maternal and child health programs in countries experiencing sociopolitical transition. METHODS: A quasi-experimental evaluation of an integrated reproductive and maternal and child health program implemented in selected sites in Upper and Lower Egypt was conducted between 2012 and 2014. Preintervention and postintervention household surveys were conducted among 12,454 women in intervention sites and nonintervention comparison sites who at survey had a child younger than 24 months. Bivariate and multivariate analyses estimated the intervention's effects on postpartum family planning-related outcomes, including contraceptive use, knowledge of optimal birthspacing, reproductive intentions and decision making about contraceptive use. RESULTS: In Upper Egypt, modern contraceptive use decreased over the study period in both intervention and comparison sites (by six and 15 percentage points, respectively), and in Lower Egypt, contraceptive use remained unchanged in intervention sites and decreased slightly (by three points) in comparison sites; in both regions, the intervention was positively associated with the difference in differences between groups (odds ratios, 1.5 for Upper Egypt and 1.3 for Lower Egypt). The intervention appears to have had a positive effect on knowledge of optimal birthspacing in Upper Egypt, on wanting to delay the next pregnancy in Lower Egypt, and on pregnancy risk and joint decision making in both regions. DISCUSSION: Study findings demonstrate the feasibility and effectiveness of an integrated reproductive and maternal and child health program implemented in a changing sociopolitical context. Revitalized efforts to bolster family planning within the country are needed to avert further losses and spark a return to positive trends.

Child Sexual Abuse and Its Relationship With Health Risk Behaviors Among Adolescents and Young Adults in Taipei.

This study explores the association of child sexual abuse (CSA) with subsequent health risk behaviors among a cross-section of 4354 adolescents and young adults surveyed in urban and rural Taipei. Descriptive analysis and logistic regressions were employed. The overall proportion of CSA was 5.15%, with more females (6.14%) than males (4.16%) likely to experience CSA. CSA was differently associated with multiple adverse health outcomes, after adjusting other factors, such as age, residence, economic status, education, employment status, and household instability. Both males and females with CSA experience were more likely to report drinking, gambling, and suicidal ideation compared with those who had no history of CSA. However, the significant association between CSA and smoking, fighting, and suicidal attempt was not observed among females. Effective interventions are needed to reduce CSA and its adverse effects on adolescent well-being.

Drunkenness and its association with health risk behaviors among adolescents and young adults in three Asian cities: Hanoi, Shanghai, Taipei.

PURPOSE: To assess the prevalence of drunkenness among adolescents in Hanoi, Shanghai, and Taipei and explore the association between heavy drinking and other health risk behaviors. METHODS: The data are drawn from the Three-city Collaborative Study of Adolescent Health, conducted in Hanoi, Shanghai, and Taipei in 2006. A sample of 17,016 adolescents and young adults, aged 15-24 years, was selected by multistage sampling. Descriptive analysis was used to estimate the proportion of drunkenness and other health risk behaviors. Multivariate logistic regression was used to investigate relationships between drunkenness and risky health behaviors. RESULTS: The proportions of the sample getting drunk during the past month were 6.36%, 4.53%, and 8.47% in Hanoi, Shanghai, and Taipei, respectively. More males than females reported drunkenness in all three cities, with the difference highest in Hanoi (11.08% vs. 1.14%) and lowest in Taipei (9.69% vs. 7.18%). Different levels of relationship between drunkenness and health risk behaviors, such as anxiety, suicidal ideation, smoking, gambling, fighting, drinking and driving, and having sexual intercourse, were found across the three cities; an exception was nonuse of contraception. CONCLUSION: Drunkenness was positively associated with many health risk behaviors. It may serve as an indicator of other risky behaviors. Interventions to reduce drinking and drunkenness may contribute considerably to the prevention of other risk behaviors and to adolescent safety and well-being.

Factors Affecting Turnover Intention among Nurses in Ethiopia.

BACKGROUND: Reducing turnover is essential to address health worker shortages in the public sector and improve the quality of services. This study examines factors associated with Ethiopian nurses' intention to leave their jobs. METHODS: Survey respondents (a sample of 425 nurses at 122 facilities) rated the importance of 20 items in decisions to leave their jobs and reported whether they intended to leave their jobs in the next year. Descriptive and inferential statistical analyses were used to identify predictors of nurses' intentions to leave their jobs. RESULTS: Half (50.2%) the nurses said they intended to leave their jobs in the next year. A multivariate analysis identified three significant predictors of nurses' intention to leave their jobs: holding a university degree rather than a diploma (adjusted odds ratio (OR)=2.246, 95% confidence interval (CI)=1.212, 4.163; p<0.01), having worked fewer years in the public health system (adjusted OR=0.948, 95% CI=0.914, 0.982; p<0.01) and rating the importance of limited opportunities for professional development more highly (adjusted OR=1.398, 95% CI=1.056, 1.850; p<0.02). CONCLUSION: Interventions to increase the retention of nurses at public health facilities in Ethiopia should target young nurses who are completing their compulsory service obligation and nurses with a university degree. They should include both non-financial and financial incentives.

Media's contribution to sexual knowledge, attitudes, and behaviors for adolescents and young adults in three Asian cities.

PURPOSE: Evidence in western countries indicates that the media have associations with adolescents' and young people's sexual behavior that may be as important as family, school, and peers. In this new study of Asian adolescents and young adults in the three cities of Hanoi, Shanghai, and Taipei, the associations between exposure to sexual content in the media and adolescents' and young adults' sex-related knowledge, attitudes, and behaviors are explored in societies with traditional Confucian culture, but at different stages in the process of modernization. METHODS: The data are from a questionnaire-based cross-sectional study conducted from 2006 to 2007, where a sample of 17,016 adolescents and young adults aged 15-24 years from Shanghai, Hanoi, and Taipei completed face-to-face interviews coupled with computer-assisted self-interviews for sensitive questions. For the objectives of this article, analysis was restricted to the 16,554 unmarried respondents. Exposure to sexual content in the mass media (including the Internet and traditional media), pornographic videos, and a preference for western/Asian movies/videos were the main media influence measures. Sex-related knowledge, premarital sexual permissiveness (PSP), and sex-related behaviors were the main outcome measures. The impact of each of four contexts including family, peer, school, and media on sex-related knowledge, attitudes, and behaviors were assessed using multiple linear regression stratified by gender and city, controlling for age, urban/rural residence, education, and economic status. The change in adjusted R(2) from the multiple linear regression analysis was adopted to indicate the contribution of family, peer, school, and media variables to respondents' sex-related knowledge, attitudes, and behaviors. RESULTS: The contextual factors, including family, peer, school, and media, explained 30%-50% of the variance in sex-related knowledge, 8%-22% of the variance in PSP, and 32%-41% of the variance in sex-related behaviors. Media variables explained 13%-24% of the variance in sexual knowledge, 3%-13% in PSP, and 3%-13% in sex-related behaviors, which was comparable with that of family, peer, and school variables. These associations differed by city and gender. CONCLUSIONS: Access to and use of mass media and the messages they present are influential factors on sex-related knowledge, attitudes, and behaviors of unmarried Asian adolescents and young adults, and should be considered in future research and intervention programs attempting to improve reproductive health outcomes.

Youth at risk: suicidal thoughts and attempts in Vietnam, China, and Taiwan.

PURPOSE: Despite increasing rates of suicide among youth in Asian cultures, there is a lack of suicide data among 15-24 year-olds, and little is known about the risk and protective factors for suicidality. This study examines the prevalence of suicidal ideation and attempts among 15-24 year-olds and identifies the sociodemographic correlates of suicidality in Hanoi, Shanghai, and Taipei. METHODS: A cross-sectional survey of 17,016 youth aged 15-24 years was conducted in rural and urban areas of Hanoi, Vietnam; Shanghai, China; and Taipei, Taiwan in 2006. Logistic regression was used to analyze correlates of suicidal ideation and attempt across cities. RESULTS: The 12-month prevalence of suicidal ideation and attempt was 8.4% and 2.5% across all three cities, respectively. Suicidal ideation was highest in Taipei (17.0%), Shanghai (8.1%), and lowest in Hanoi (2.3%); similar trends were found for suicidal attempts. Younger age cohorts (15-19 year-olds) and females were more likely to report suicidal ideation and suicidal attempts compared with 20-24 year-olds and males. In multivariate logistic regression results, across the three cities, female gender, younger age, family structure, parental support, family history of suicide, migration status, and substance use were associated with suicidal ideation. Factors associated with suicidal attempt included female gender, family history of suicide, parental support, and substance use. DISCUSSION: Suicidality is common among Asian youth, with highest levels reported in more industrialized cities.

The relationship between external contact and unmarried adolescents' and young adults' traditional beliefs in three East Asian cities: a cross-sectional analysis.

PURPOSE: There is growing contact with the outside world among adolescents and young adults in the three Asian cities of Hanoi, Vietnam, Shanghai, mainland China, and Taipei, Taiwan because of the open policies implemented by the national governments of each of these cities. Because these policies were enacted at different points in time, their concomitant social impact has not been simultaneous, with the result that these societies are at different stages of change. The goal of this current analysis is to examine the dimensions of external contact and respondents' departures from Confucian values-for example, embracing individualism, a woman's taking the initiative in expressing affection to a man, and permissiveness toward premarital sex-among unmarried adolescents and young adults in these three cities and the potential relationship between them. This will contribute to our understanding of contemporary Asian adolescents' and young adults' attitudes during different social transition periods, attitudes that are frequently contrary to traditional Confucian principles. METHODS: This is a cross-sectional study. The multicenter survey of 17,016 male and female adolescents and young adults aged 15-24 years from three cities with Confucian-influenced cultures-Shanghai, Hanoi, and Taipei-was conducted from May 2006 to January 2007 through face-to-face interviews coupled with computer-assisted self-interviews for sensitive questions; 16,554 unmarried respondents were included in this analysis. Binary logistic regression and general linear models were used to explore the associations between respondents' external contact and their nontraditional attitudes. All the analyses were done through SAS 9.1. RESULTS: There were significant differences in the positive association between respondents' external contact and non-Confucian values among adolescents in the three cities. More respondents in Taipei and Shanghai had external contact and identified with nontraditional values than those in Hanoi. The percentages of respondents reporting non-Confucian values were the highest in Taipei and the lowest in Hanoi. The analysis presented significant associations between respondents' exposure to Western culture and their adoption of nontraditional values across the three cities. Respondents who spoke Western languages and who preferred Western videos/actors/singers were more likely to exhibit Western individualism, concurrence with women taking the initiative in a romantic relationship with a man, and permissiveness toward premarital sexual behavior. CONCLUSIONS: Although these Asian cities are at different stages of social transition, exposure to Western culture is associated with unmarried adolescents' and young adults' departure from traditional Confucian social rules in all three.

Adolescents' and young adults' perception of homosexuality and related factors in three Asian cities.

PURPOSE: Adolescents' and young adults' perception of homosexuality plays an important role in the marginalization and stigmatization of the homosexual, thereby influencing his or her health. This article aims to study that perception and to examine its predictors in three Asian cities that are culturally dominated by Confucianism. METHODS: From May 2006 to January 2007, a cross-sectional survey of 17,016 adolescents and young adults, aged 15-24 years old, in both urban and rural sites of three Asian cities (Hanoi in Vietnam, Shanghai in the mainland of China, and Taipei in Taiwan) was conducted through interview and computer-assisted self-interview for sensitive questions. Chi-square tests and multivariate logistic regression were performed to identify the predictors for their perception of homosexuality. RESULTS: The percentage of adolescents and young adults who hold a positive view of homosexuality (i.e., thought it was normal and/or acceptable) was low, especially in Hanoi and Shanghai; these figures increased from Hanoi to Shanghai to Taipei for both males and females. Overall, those factors significantly associated with adolescents' and young adults' perception of homosexuality included individuals' demographic characteristics (urban/rural, age, economic status, student status, and educational level), preferred origin of movies/videos, self-identified sexual orientation, sexual and reproductive health knowledge, family values, gender role values, and attitudes toward premarital sex. CONCLUSIONS: In these three Asian cities composed of populations whose views are largely influenced by Confucianism, adolescents and young adults mainly hold a negative perception of homosexuality. The most common and important predictors for a respondent's perception of homosexuality were his or her knowledge of sexual and reproductive health and how traditional his/her values may be. Greater attention needs to be paid to the popularization of knowledge about sexual and reproductive health including homosexuality-and to efforts aimed at instilling more liberal attitudes to improve adolescents' and young adults' perception of homosexuality. This could then reduce the marginalization and stigmatization of the homosexual, and thus improve his/her health.

Cigarette smoking and drinking behavior of migrant adolescents and young adults in Hanoi, Vietnam.

PURPOSE: There has been a large migration from rural to urban areas in much of the developing world. In the past, this was less true in Vietnam, which remains largely agricultural; however, since the 1990s, economic reforms and loosening of government policies that had previously limited movement have led to a large increase in this rural to urban population movement. Risky health behaviors have been found among migrants in many other settings. The purpose of this research was to determine whether migrant adolescents and young adults in the city of Hanoi are more or less likely than local ones to engage in cigarette smoking and alcohol drinking health risk behaviors, to identify factors associated with these behaviors, and to suggest interventions to reduce these health risk behaviors among the study population. METHODS: A cross-sectional survey of 4,550 adolescents and young adults aged 15-24 years was conducted in urban Hanoi in 2006. This study examines current use of cigarettes and alcohol by migration status using multivariate logistic regressions. RESULTS: Cigarette smoking and drinking alcohol are male phenomena. The prevalence of cigarette smoking and alcohol drinking is high among adolescents and young adults in Hanoi and is more common among migrants who came from rural areas of other provinces than nonmigrants in the city. However, multivariate analysis revealed that migrants were neither more likely to smoke cigarettes nor drink alcohol than nonmigrants after controlling for other factors, such as age, full-time worker status, depression, and having close friends who smoke and/or drink. CONCLUSIONS: The results suggest that interventions aiming at smoking and/or drinking reduction should pay more attention to adolescents, especially males, changing health risk behaviors at school and at work, and peer influence than their migration status.

Association of secondhand smoke exposure with nicotine dependence among Black smokers.

INTRODUCTION: Exposure to secondhand smoke (SHS) is influenced by norms and regulations, socioeconomic status and immediate personal interactions. SHS exposure may occur in various settings, including the living space, workplace, and other social environments. This study examines the association between exposure to SHS and nicotine dependence among current smokers. METHODS: A cross-sectional sample of 246 Black (60% male and 40% female) current smokers age 40 and older, from Baltimore, Maryland and Washington, D.C, responded to an interviewer-administered questionnaire. We examined nicotine dependence using clinical guidelines based on the Diagnostic and Statistical Manual of Mental Disorders, Text Revision (2000). We performed multivariate logistic regression to assess the association between SHS and nicotine dependence. RESULTS: SHS exposure in the current home environment and exposure in settings outside the home, as well as difficulty to quit smoking and heaviness of smoking, were associated with nicotine dependence. After adjustment for age, gender, education, income, employment status, current alcohol consumption, history of marijuana use, and number of cigarettes smoked per day; exposure to SHS at home only, and in both current home environment and other settings, continued to be associated with clinically-defined nicotine dependence (OR=2.25; 95% CI 1.05, 4.86 vs. OR=2.31; 95% CI 1.03, 5.18), respectively. DISCUSSION: These findings highlight the relative importance of examining SHS exposure in personal (residential and automobile) and public (workplace and outdoor) settings by current smokers. Promotion of smoke-free environments may reduce the prevalence of nicotine dependence among current smokers.

Association between lifestyle factors and CpG island methylation in a cancer-free population.

BACKGROUND: Many risk factors have been associated with cancer, such as age, family history, race, smoking, high-fat diet, and poor nutrition. It is important to reveal the molecular changes related to risk factors that could facilitate early detection, prevention, and overall control of cancer. METHODS: We selected six cancer-specific methylated genes that have previously been reported in primary tumors and have also been detected in different bodily fluids of cancer patients. Here, we used quantitative fluorogenic real-time methylation-specific PCR in plasma DNA samples for the detection of methylation changes from an asymptomatic population who do not have any known cancer. RESULTS: The promoter methylation frequencies of the studied genes were as follows: APC (7%), CCND2 (22%), GSTP1 (2%), MGMT (9%), RARbeta2 (29%), and P16 (3%). Promoter methylation of at least one of the genes analyzed was observed in approximately 46% (72 of 157) of the samples by binary dichotomization. Promoter hypermethylation of at least two genes was detected in 17% (26 of 157) of the samples. RARbeta2 methylation was observed in 45% of subjects who had a high-fat diet in contrast with those who had a low-fat diet (23%; P = 0.007). DISCUSSION: Our findings may help to elucidate early methylation changes that may lead to cancer development. These methylation changes could be due to exposure to risk factors and may be useful for cancer prevention measures such as changes in lifestyle. Longitudinal follow-up of a high-risk population is needed to understand the association of methylation of candidate genes in cancer development.

Levels of change in adolescent sexual behavior in three Asian cities.

Considerable change in the romantic and sexual behaviors of Asian young people may be occurring as traditionally Confucian societies modernize and increase outside contacts. This study explores the dimensions and context of this change in three sites at different stages in the process of modernization: Hanoi (early), Shanghai (intermediate), and Taipei (later stage). A survey was conducted of 17,016 males and females aged 15-24 in urban and rural settings in three large metropolitan areas. Survival analysis and Cox regressions were performed to explore ages of respondents at key transitions and the significance of differences between two age cohorts: 15-19 and 20-24. Significant differences are found in levels of sexual and other transitions, even within the narrow time span reflected by the age cohorts. The findings highlight the differential impact of modernization on adolescent sexual behavior as traditional societies undergo social change, and they underline the importance of context in exploring youthful transitions.

Childhood sexual abuse and early menarche: the direction of their relationship and its implications.

PURPOSE: A relationship between childhood sexual abuse (CSA) and early menarche previously has been proposed and psychobiological mechanisms for the association have been suggested. Because it has serious implications for many disciplines, we attempted to confirm that association and explore its direction, first with hypothesis 1: the negative relationship between pubertal age and CSA is based on victims' increased target gratifiability at ages of high target vulnerability, and then with hypothesis 2: CSA and circumstances surrounding it are related causally to early menarche. METHODS: African-American and multi-ethnic Caucasian women (N = 323) were interviewed at several women's clinics at Johns Hopkins Bayview Medical Center; 64 women reported premenarcheal abuse. We assessed (1) ages of CSA and menarche to determine their relationships, (2) household characteristics and their relationships with CSA, (3) variables associated with CSA, to determine the independent effect of CSA and explore potential dose response (i.e., effects of increased stress). RESULTS: CSA and menarcheal age are related negatively (p < .05). Hypothesis 1 need not be rejected totally, but with most CSA events occurring long before puberty, hypothesis 2 is supported. Theoretically, stressful CSA characteristics increase victim/nonvictim differences in menarcheal age. Stress may derive from household characteristics often related to CSA but, even controlling for them, CSA has independent effects on menarcheal age. CONCLUSIONS: Hypothesis 1 may apply when CSA occurs within 2 years premenarche but, because hypothesis 2 is supported, continuing psychobiological effects and stress engendered by CSA are underscored. Mechanisms through which they impact the developing child require further exploration, and medical and psychological attention.