Association between history of hookah use and symptoms of postpartum depression: A population-based study.

OBJECTIVE: Although several biologic, psychosocial, and behavioral factors have been linked to postpartum depressive symptoms, studies examining the association between non-cigarette tobacco products and symptoms of postpartum depression are currently lacking. This study examined the association between hookah use and postpartum depressive symptoms. METHODS: A cross-sectional study was conducted using data from the US Centers for Disease Control and Prevention's Pregnancy Risk Assessment Monitoring System 2016-2020. Self-reported data on hookah use in the last 2 years and maternal mental health were captured using a structured questionnaire. Descriptive and inferential statistics were performed. RESULTS: The final study sample consisted of 106 894 participants. Approximately 8.2% of the participants reported postpartum depressive symptoms and 4.1% reported hookah use in the past 2 years. Compared with those without postpartum depressive symptoms, participants with postpartum depressive symptoms were more likely to be hookah users (5.5% vs 4.0%, P < 0.001). After adjustment for confounders, the odds of having postpartum depressive symptoms were significantly higher among participants who used a hookah in the past 2 years compared with non-users; adjusted odds ratio (95% confidence interval) 1.20 (1.03-1.40); P = 0.022. CONCLUSION: In a large, population-based sample of US women, hookah use in the past 2 years significantly increased the odds of having postpartum depressive symptoms, independent of potential confounders. This finding underscores the need for healthcare providers to communicate effectively about the health risks of hookah use.

Secondary distribution of HIV self-test kits by HIV index and antenatal care clients: implementation and costing results from the STAR Initiative in South Africa.

BACKGROUND: Partner-delivered HIV self-testing kits has previously been highlighted as a safe, acceptable and effective approach to reach men. However, less is known about its real-world implementation in reaching partners of people living with HIV. We evaluated programmatic implementation of partner-delivered self-testing through antenatal care (ANC) attendees and people newly diagnosed with HIV by assessing use, positivity, linkage and cost per kit distributed. METHODS: Between April 2018 and December 2019, antenatal care (ANC) clinic attendees and people or those newly diagnosed with HIV clients across twelve clinics in three cities in South Africa were given HIVST kits (OraQuick Rapid HIV-1/2 Antibody Test, OraSure Technologies) to distribute to their sexual partners. A follow-up telephonic survey was administered to all prior consenting clients who were successfully reached by telephone to assess primary outcomes. Incremental economic costs of the implementation were estimated from the provider's perspective. RESULTS: Fourteen thousand four hundred seventy-three HIVST kits were distributed - 10,319 (71%) to ANC clients for their male partner and 29% to people newly diagnosed with HIV for their partners. Of the 4,235 ANC clients successfully followed-up, 82.1% (3,475) reportedly offered HIVST kits to their male partner with 98.1% (3,409) accepting and 97.6% (3,328) using the kit. Among ANC partners self-testing, 159 (4.8%) reported reactive HIVST results, of which 127 (79.9%) received further testing; 116 (91.3%) were diagnosed with HIV and 114 (98.3%) initiated antiretroviral therapy (ART). Of the 1,649 people newly diagnosed with HIV successfully followed-up; 1,312 (79.6%) reportedly offered HIVST kits to their partners with 95.8% (1,257) of the partners accepting and 95.9% (1,206) reported that their partners used the kit. Among these index partners, 297 (24.6%) reported reactive HIVST results of which 261 (87.9%) received further testing; 260 (99.6%) were diagnosed with HIV and 258 (99.2%) initiated ART. The average cost per HIVST distributed in the three cities was US$7.90, US$11.98, and US$14.81, respectively. CONCLUSIONS: Partner-delivered HIVST in real world implementation was able to affordably reach many male partners of ANC attendees and index partners of people newly diagnosed with HIV in South Africa. Given recent COVID-19 related restrictions, partner-delivered HIVST provides an important strategy to maintain essential testing services.

The Impact of Receipt of Information on Prostate-Specific Antigen Testing on Screening with the Prostate-Specific Antigen Test.

There is controversy on prostate cancer screening with the prostate-specific antigen (PSA) test in the USA, and as a result, there has been an increased push for physicians to have a thorough discussion with patients on the advantages and disadvantages of prostate cancer screening with the PSA blood test. Prior studies showed that pre-screening discussions increased the likelihood of PSA testing. This study is aimed at examining the impact of discussions of the advantages and disadvantages of the PSA test among men that fit the prostate cancer screening guidelines determined by the American Urological Association (AUA). This cross-sectional study used secondary data from the 2018 Behavior Risk Factor Surveillance System (BRFSS) in the USA. The analytic sample was determined based on the American Urological Association (AUA) guidelines for prostate cancer screening (n = 54,607). Approximately, 89.5% of men underwent PSA testing. The odds of PSA testing were higher for men who received information on only the advantages of PSA testing (OR = 3.40, 95% CI = 2.80, 4.13), only the disadvantages of PSA testing (OR = 1.52, 95% CI = 1.02, 2.28), and both advantages and disadvantages of PSA testing (OR = 2.99, 95% CI = 2.46, 3.63) compared to men who received no information. Discussions with men, that meet the requirements for prostate cancer screening, about the advantages and disadvantages of PSA testing increased the likelihood that men would undergo PSA testing.

Association Between a History of Hookah Use and Breastfeeding Duration.

Background: There is limited evidence on the relationship between hookah use and breastfeeding. This study examines the association between a history of hookah use and breastfeeding duration among women in the United States. Materials and Methods: This cross-sectional study examined 96,392 women from the Pregnancy Risk Assessment and Monitoring System (PRAMS) 2016-2019 data. The main outcome of interest was any breastfeeding for at least 3 months. Descriptive statistics, chi-square test, and multivariable regression analyses were performed. Results: Overall, 68.3% of women breastfed for at least 3 months and 4.6% reported using hookah in the last 2 years. Women who reported using hookah in the last 2 years were significantly less likely to breastfeed for at least 3 months compared with women who did not report using hookah in the last 2 years (56.0% versus 68.9%; p < 0.001). In the multivariable model, the odds of breastfeeding for at least 3 months were significantly lower in women who used hookah in the last 2 years compared with those who did not use hookah; odds ratio (95% confidence interval) 0.82 (0.74-0.92; p < 0.001). Additionally, the odds of breastfeeding for at least 3 months were significantly lower for dual users of hookah and cigarettes 0.48 (0.33-0.68; p < 0.001). Conclusion: A history of hookah use is associated with early weaning, independent of potential confounders. This finding suggests the need for educating women about the negative consequences of hookah use on breastfeeding during preconception, prenatal, and postpartum care encounters.

Prevalence of Glucose Metabolic Disorders and Associated Inflammatory Markers Among People Living with HIV in Sub-Saharan Africa.

Background: Glucose metabolic disorder (GMD) is closely related to inflammation among those living with HIV. However, there are extant studies regarding this phenomenon in sub-Saharan Africa (SSA) that bears the burden of HIV infection. Therefore, we assessed the associations between inflammation biomarkers and GMD on a cohort of HIV+ individuals in SSA. Methods: We conducted a cross sectional study at the largest (patient volume) HIV clinic in Tanzania from March to May 2018. Purposive sampling was used to identify 407 HIV+ patients on treatment. Data were collected using the World Health Organization (WHO) STEPwise approach for noncommunicable disease surveillance. Clinical and demographic variables were extracted from the medical chart. Fasting blood glucose and inflammatory markers [C-reactive protein (CRP), interleukin (IL)-6, IL-18, and soluble tumor necrosis factor receptor (sTNFR)-1, sTNFR-2] were measured. Bivariate and multivariate analysis was conducted to examine the association between the biomarkers and GMD. Results: GMD was present in 67.6% (n = 271). Among those with GMD, 44.5%, 38.4%, and 17.1% presented with impaired fasting glucose, impaired glucose tolerance, and diabetes mellitus, respectively. Being older (>55 years) and initiating smoking at an age >28 years was associated with GMD (P = 0.05). Engaging in moderate activity significantly reduced the risk of GMD (P = 0.04). Having a current CD4 count between 351 and 500 reduced the odds of GMD by 66.7% in comparison to clients with CD4 counts ≤350. Comparing the highest to the lowest quartile at the multivariate level, only CRP showed an independent significant association with GMD (adjusted odds ratio: 1.9; 95% confidence interval: 1.03-3.57). Despite a linear relationship, none of the other biomarkers showed a significant association with GMD. Conclusion: Our study shows that high CRP and low CD4 are important contributors to the prevalence of GMD. Even when controlling for confounding variables did not diminish the associations between GMD and CRP. These findings point to the importance of creating awareness, education, and screening for GMD in high-epidemic countries. More rigorous studies are needed to identify the manifestation of inflammation in HIV patients.

Association Between Electronic Nicotine Delivery Systems Use and Breastfeeding Duration.

Background: Breastfeeding is beneficial for both mothers and infants. Unfortunately, some infants are not breastfed for the recommended duration of time. Previous studies have identified several demographic, socioeconomic, biological, and behavioral factors that impact breastfeeding practices. Studies examining the influence of electronic nicotine delivery systems (ENDS) on breastfeeding practices are currently lacking. Materials and Methods: This population-based, cross-sectional study used data from the 2016-2018 Pregnancy Risk Assessment and Monitoring System (n = 42,827). Chi-squared tests and multivariable logistic regression analyses were performed. Results: The prevalence of prenatal ENDS use was 0.9%. Only 40.8% of women who used ENDS during pregnancy breastfed for at least 3 months compared with 68.5% of women who did not use ENDS during pregnancy. In the multivariable model, the odds of breastfeeding for at least 3 months were significantly lower in women who used ENDS during pregnancy compared with those who did not use ENDS; odds ratio (95% confidence interval) 0.63 (0.44-0.89; p = 0.010). Conclusion: Prenatal exposure to ENDS is negatively associated with breastfeeding duration, independent of potential confounders. This finding suggests that screening for ENDS use during pregnancy can play a vital role in identifying women at-risk for suboptimal breastfeeding and offering ongoing support to improve breastfeeding practices.

Mental health symptoms and inflammatory markers among HIV infected patients in Tanzania.

BACKGROUND: HIV and mental disorders are predicted to be the leading causes of illness worldwide by the year 2030. HIV-infected patients are at increased risk of developing mental disorders which are significantly associated with negative clinical outcomes and propagation of new HIV infections. There is little evidence that links inflammation to development of mental disorders among HIV patients. Therefore, the main objective of this study was to evaluate if mental health symptoms were associated with biomarkers of inflammation in HIV infected subjects. METHODS: A cross-sectional study was conducted in Dar es Salam, Tanzania from March to May 2018. Standardized tools were used to collect data based on the World Health Organisation's (WHO) stepwise approach for non-communicable diseases (NCD) surveillance. A total of 407 HIV+ patients on antiretroviral therapy were recruited. The WHO stepwise approach for NCD surveillance was used to collect data together with anthropometric measurements. Mental health symptoms were determined based on self-reported thoughts of helplessness, suicide ideation, depression, despair, discouragement, and feelings of isolation. Enzyme-linked immunosorbent assay was used to test for inflammatory markers:- C-reactive protein (CRP), Iinterleukin-6 (IL-6), interleukin-18 (IL-18), soluble tumour necrosis factor receptor-I (sTNFR-I), and soluble tumour necrosis factor receptor-II (sTNFR-II). Bivariate and multi-variate analysis was conducted to examine the association between biomarkers and mental health symptoms. RESULTS: The prevalence of self-reported mental health symptoms was 42% (n = 169). Participants with self-reported symptoms of mental health had elevated CRP, were less likely to walk or use a bicycle for at least 10 minutes, were less likely to participate in moderate-intensity sports or fitness activities, and had poor adherence to HIV treatment (p < 0.005). CRP remained significant in the sex adjusted, age-sex adjusted, and age-sex-moderate exercise adjusted models. In the fully adjusted logistic regression model, self-reported mental health symptoms were significantly associated with a higher quartile of elevated CRP (OR 4.4; 95% CI 1.3-5.9) and sTNFR-II (OR 2.6; 95% CI 1.4-6.6) and the third quartile of IL-18 (OR 5.1;95% CI 1.5-17.5) as compared with those reporting no mental health symptoms. The significance of sTNFR-II and IL-18 in the fully adjusted model is confounded by viral load suppression rates at the sixth month. CONCLUSION: High CRP and sTNFR II were important contributors to the prevalence of mental health symptoms. This study is among the minimal studies that have examined mental health issues in HIV, and therefore, the findings may offer significant knowledge despite the potential reverse causality. Regardless of the nature of these associations, efforts should be directed toward screening, referral, and follow-up of HIV patients who are at-risk for mental health disorders.

Implementation of different HIV self-testing models with implications for HIV testing services during the COVID-19 pandemic: study protocol for secondary data analysis of the STAR Initiative in South Africa.

INTRODUCTION: HIV self-testing (HIVST) presents a convenient, private approach that removes barriers to providing HIV testing services. The Self-Testing Africa (STAR) Initiative aims to scale up HIVST among priority and undertested populations. HIVST has the potential to help maintain testing services during the social distancing restrictions implemented to prevent the spread of COVID-19. This project evaluates linkage to confirmatory testing and treatment for HIV-positive clients for the STAR South Africa site. METHODS AND ANALYSIS: This secondary data analysis protocol aims to evaluate different HIVST distribution models from a prospective study implemented during November 2017 and December 2020 by Ezintsha, a subdivision of Wits Reproductive Health and HIV Institute. Routinely collected distribution and self-reported HIVST outcomes data will be deidentified and analysed. The main outcomes of interest are linkage to care and treatment among HIVST users who report a reactive HIVST result. Additionally, we plan to determine sociodemographic factors associated with linkage to care and treatment among HIVST users. Descriptive statistics will be used to describe the variables of interest, and modified Poisson regression with robust variance estimation will be performed to identify factors associated with linkage to care and treatment among HIVST users who report a reactive HIVST result. Risk ratios and 95% CIs for the risk ratios will be reported. ETHICS AND DISSEMINATION: The study protocol has been approved by the University of Witwatersrand Human Research Ethics Committee. The dissemination plan for the study findings will include presentations to local and international health authorities, international conferences and publications in open access journals.

Association between Antiretroviral Treatment and Markers of Systemic Inflammation among HIV Patients in Ghana.

BACKGROUND: Studies from high-income countries have reported that even after receiving antiretroviral treatment (ART), HIV-infected adults may not achieve normal levels of certain inflammatory markers that are known to be associated with the onset and development of non-communicable diseases. OBJECTIVE: The aim of this study is to examine the relationship between ART and markers of systemic inflammation in HIV/AIDS patients at an urban antiretroviral clinic in Ghana. METHODS: We examined serum levels of high sensitivity CRP (hsCRP), interleukin-6 (IL-6), interleukin- 18(IL-18), and tumor necrosis factor-α (sTNFR1 and sTNFR2) from 40 HIV infected patients. Kruskal-Wallis Test was used to examine the differences in markers of systemic inflammation according to the types of ART medication taken. We then utilized generalized additive models (GAM) with non-linear function to examine the association between ART and markers of systemic inflammation after adjusting for potential confounders. RESULTS: Overall, 30 (75.0%) of the participants received ART and 35 (85%) were female. Kruskal- Wallis Test revealed no significant differences in the markers of systemic inflammation among the three categories of ART (none, AZT, 3TC, EFV/NVP, and TDF, 3TC/FTC, EFV/NVP). In the multivariable- adjusted GAM model, we found a significant but non-linear association between time since diagnosis and CRP levels (p=0.006). CONCLUSION: Although the relatively small sample size limits the scope of the study's findings, these results suggest that individuals on ART need to be screened periodically for the development of chronic conditions. This line of investigation has the potential to influence treatment and clinical guidelines that will improve the quality of care for HIV-infected patients.

Association Between E-cigarette Use and Depression in US Adults.

OBJECTIVES: Electronic cigarette (e-cigarette) use has recently increased among adults in the United States. Previous studies have identified physical health outcomes associated with e-cigarettes. Few studies have examined the relationship between e-cigarette use and mental health outcomes. This study aimed to investigate the relationship between e-cigarette use and depression. METHODS: The present cross-sectional study analyzed data from the 2017 Behavioral Risk Factor Surveillance System (BRFSS) in the United States (n = 11918). RESULTS: Overall, 3.7% and 11.2% of the participants were current and former e-cigarette users, respectively. A significantly higher proportion of current e-cigarette users reported having depression (32.4%) than former users (27.3%) and non-users (16.0%). In the multivariable model, we found significant interactions between marital status, employment status, marijuana use and e-cigarette use on depression. Compared to people who do not use e-cigarettes, the odds of self-reported depression were higher among unemployed current e-cigarette users (OR = 2.85, 95% CI = 1.63, 4.97) and unemployed former e-cigarette users (OR = 1.89, 95% CI = 1.26, 2.84). Compared to people who do not use marijuana, the odds of self-reported depression were higher among marijuana users who were also current e-cigarette users (OR = 1.68, 95% CI = 1.08, 2.61) and former e-cigarette users (OR = 1.35, 95% CI = 1.07, 1.71). Compared to people who do not use e-cigarettes, the odds of self-reported depression were higher among widowed/divorced/separated participants who were current e-cigarette users (OR = 3.42, 95% CI = 1.60, 7.29) and former e-cigarette users (OR = 1.55, 95% CI = 1.03, 2.34). CONCLUSION: In a representative sample of adults in the United States e-cigarette use is associated with depression, predominantly in widowed/divorced/separated, unemployed and people who use marijuana. This association was independent of potential cofounders.

Association Between Prenatal Smoking and Gestational Diabetes Mellitus.

OBJECTIVE: To evaluate whether there is an association between prenatal smoking and gestational diabetes mellitus (GDM). METHODS: We conducted a secondary data analysis using data from the Pregnancy Risk Assessment Monitoring System from 2009 to 2015. Outcome measures included self-reported GDM and change in smoking status during pregnancy (nonsmoker, quit smoking, reduced the amount smoked, smoked the same or more). Multivariable logistic regression analyses were performed to estimate the association between prenatal smoking and GDM status, adjusted for maternal age, race-ethnicity, prepregnancy body mass index (BMI) categories (underweight, normal [referent group], overweight, and obese), and gestational weight gain (inadequate, normal [referent group], and excessive), overall and stratified by prepregnancy BMI and gestational weight gain subgroups. RESULTS: A total of 222,408 women were included; 5.3% (n=12,897) had GDM. Most (48.1%) women had normal prepregnancy BMI, and 43.1% had excessive gestational weight gain. Mothers who continued to smoke the same or greater number of cigarettes or reduced the number of cigarettes smoked had higher odds of GDM (adjusted odds ratio [OR] 1.46, 95% CI 1.25-1.71 and OR 1.22, 95% CI 1.08-1.38, respectively). Smoking the same or more cigarettes was associated with higher odds of GDM in all subgroups of prepregnancy BMI or gestational weight gain. CONCLUSION: Prenatal smoking is associated with higher odds of GDM, after adjusting for known risk factors, and stratifying by prepregnancy BMI and gestational weight gain. Reducing smoking during pregnancy might reduce the risk of GDM and could be an additional reason for promoting smoking cessation among pregnant women.

Association between HIV/AIDS knowledge and stigma towards people living with HIV/AIDS in Botswana.

In Botswana, an estimated 350 000 people live with HIV/AIDS. HIV/AIDS testing rates are low, suggesting that many other people remain undiagnosed. Stigma related to HIV/AIDS is prevalent and contributes to low testing rates and under-diagnosis of the virus. Identifying factors that contribute to stigma, such as insufficient or inaccurate knowledge of HIV/AIDS, may be critical in increasing early identification and treatment. This cross-sectional study used nationally representative data from the 2013 Botswana AIDS Impact Survey (BAIS) IV to examine the relationship between HIV/AIDS knowledge and stigmatising attitudes toward people living with HIV/AIDS (PLWHA). The mean (standard error) for stigma towards PLWHA score and HIV/AIDS knowledge score were 0.99 (0.02) and 5.90 (0.03) respectively. HIV/AIDS knowledge score and stigma towards PLWHA score were strongly positively correlated r (4,4045) = 0.415, p < 0.001). After adjusting for potential confounders, HIV/AIDS knowledge score significantly predicted stigma towards PLWHA score [coefficient ß (95% CI)] [-0.25 (-0.29, -0.20), p < 0.001]. These findings imply that programmes and interventions that increase HIV/AIDS knowledge may reduce the pervasive apprehension, blame, and stigmatising attitude held towards PLWHA in Botswana.

The moderating role of race/ethnicity on associations between insurance status and HPV vaccination among women in the USA.

OBJECTIVE: To evaluate associations between insurance status and HPV vaccination. METHODS: The present cross-sectional study analyzed data from women aged 18-26 years who participated in the National Health and Nutritional Examination Surveys 2009-2012 in the USA. RESULTS: The study included 621 women; 424 (68.3%) had some type of insurance and 198 (30.6%) had received the HPV vaccine. In the multivariable model, we found significant interactions between race/ethnicity and insurance status on receiving HPV vaccination. Compared with individuals with no insurance, non-Hispanic black women with any type of insurance demonstrated increased likelihood of HPV vaccination (adjusted odds ratio [aOR] 3.63, 95% confidence interval [CI] 1.60-8.21; P=0.002). Among Mexican Americans, there was a negative association between having some insurance and HPV vaccination (aOR 0.35, 95% CI 0.15-0.81; P=0.007). For non-Hispanic black women, the association remained significant across all insurance types (private [aOR 4.29, 95% CI 1.67-11.00; P=0.003], Medicaid [aOR 2.86, 95% CI 1.15-7.13; P=0.025], and other [aOR 4.74, 95% CI 1.06-21.15; P=0.042]). Non-Hispanic white women with insurance other than private or Medicaid had a higher likelihood of HPV vaccination compared with uninsured individuals (aOR 8.36, 95% CI 2.79-25.05; P<0.001). CONCLUSION: The present findings help to identify at-risk populations less likely to receive the HPV vaccine.

Factors That Modify the Association of Maternal Postpartum Smoking and Exclusive Breastfeeding Rates.

BACKGROUND AND OBJECTIVE: Maternal postpartum smoking increases the risk for poor infant health outcomes, while exclusive breastfeeding has been shown to support infant health. Limited population-based research has been published on the interaction between maternal smoking and exclusive breastfeeding. The objective of this study was to examine factors modifying the association between maternal postpartum smoking and exclusive breastfeeding among women in the United States. METHODS: Secondary data analysis was conducted using the 2009-2011 Pregnancy Risk Assessment Monitoring System. Stratified analyses were used to examine the associations between maternal postpartum smoking and exclusive breastfeeding by sociodemographic factors. RESULTS: The postpartum smoking rate was 17.1%. The relationship between postpartum smoking and exclusive breastfeeding at 12 weeks varied by maternal education level, race/ethnicity, Medicaid use, and pregestational or gestational diabetes. The magnitude of reduction in the odds of exclusive breastfeeding at 12 weeks postpartum among the women who smoked in the postpartum period ranges from odds ratio (95% confidence interval) 0.52 (0.37-0.74) for non-Hispanic blacks to 0.31 (0.22-0.43) for women who had <12 years of education. CONCLUSIONS: Women who smoked in the postpartum period, who also suffered from socioeconomic disadvantages, had a higher likelihood of not continuing exclusive breastfeeding. Identification of women at high risk for not exclusively breastfeeding is important for targeting populations in need of appropriate and timely support for prenatal and postpartum smoking cessation and breastfeeding promotion.

Association of Youth Characteristics and Recent Utilization of Dental Services in the United States.

Background: Oral health is important for overall health of youth, although dental service utilization is lower than national goals. The purpose of the study was to identify sociodemographic and health behavioral characteristics of youth in the United States who reported having at least one dental visit in the past 12 months. Methods: Secondary data analysis was conducted using the 2015 Youth Risk Behavior Survey (YRBS) to examine factors associated with dental care utilization using Andersen's theory-based Behavioral Model of Health Care Utilization. Results: Among 5,814 youth, nearly 78 percent reported visiting a dentist in the past 12 months. After adjusting for potential confounders, characteristics significantly associated with higher likelihood of dental care utilization were: predisposing factors of non-Hispanic white ethnicity and health behavior characteristics of not using tobacco, not using illegal substances, not drinking soda, and wearing a seat belt; enabling factor of speaking English well; and perceived health of not being overweight. Discussion: Use of the Healthcare Utilization Model identified significant factors classified as predisposing, enabling, and need-related factors associated with youth's utilization of dental care services. Findings from the theory-based population-based study informs healthcare providers of factors to consider when promoting dental care among youth.

Association Between Risky Sexual Behavior and Cervical Cancer Screening Among Women in Kenya: A Population-Based Study.

Women residing in Eastern Africa are disproportionately affected by cervical cancer. Previous studies have identified risky sexual behavior as a major risk factor for cervical cancer. However, population-based studies examining the relationship between sexual behavior and cervical cancer screening are currently lacking. This descriptive cross-sectional study utilized nationally representative secondary data from the 2014 Kenya Demographic and Health Survey (n = 6104) to examine the association between risky sexual behavior and cervical cancer screening among sexually active women. Both descriptive and inferential statistical methods were utilized. Overall, 20.2% of the study sample reported having cervical cancer examination. Approximately 13.1% of the participants reported involvement in risky sexual behavior. Significantly lower proportion of women engaged in risky sexual behavior reported having cervical cancer examination (14.5 vs. 21.0%; p = 0.001). In the multivariable model, we found a significant interaction between risky sexual behavior and marital status on cervical cancer examination. Among women who were married/living together, risky sexual behavior was negatively associated with cervical cancer examination after adjusting for potential confounders (Prevalence Ratio, 95% CI) (0.42; 0.24-0.74; p = 0.002). The prevalence of having visual inspection with VIA or VILI were lower among women who were involved in risky sexual behavior (0.39; 0.18-0.87; p = 0.022). However, we were unable to detect any significant association between risky sexual behavior and having Papanicolaou test. With increasing incidence of cervical cancer in resource-limited settings, it is critical to identify populations at increased risk of infection and provide effective screening and follow-up services.

The relationship between history of hormonal contraceptive use and iron status among women in Tanzania: A population-based study.

OBJECTIVES: Approximately 30% of the Tanzanian women in the reproductive age group are iron deficient. At population-level, there is a dearth of research on the relationship between hormonal contraceptive use and iron deficiency. The study objective was to examine the relationship between history of hormonal contraceptive use and iron status among women in Tanzania. STUDY DESIGN: We conducted a cross-sectional study analysis including 4186 women who participated in the population-based 2010 Tanzania Demographic and Health Survey. MAIN OUTCOME MEASURE: Iron status determined by iron deficiency, anemia, and iron deficiency anemia. RESULTS: Almost 19.0% women reported history of hormonal contraceptive use. Nearly, 30.0%, 39.5%, and 14.3% women had iron deficiency, anemia and iron deficiency anemia respectively. History of hormonal contraceptive use was negatively associated with iron deficiency, anemia and iron deficiency anemia, independent of potential confounders. Compared to non-users, the multivariable-adjusted odds ratio OR (95% CI) among hormonal contraceptive users was 0.73 (0.56-0.94, p<0.05) for iron deficiency, 0.58 (0.46-0.72, p<0.001) for anemia, and 0.53 (0.37-0.74; p<0.001) for iron deficiency anemia. Longer duration of hormonal contraceptive use (>2years) had lesser odds of iron deficiency 0.63 (0.43-0.91, p for trend 0.005), anemia 0.51 (0.36-0.73, p for trend <0.001) and iron deficiency anemia 0.35 (0.19-0.65, p for trend <0.001). CONCLUSION: Our finding has important implications for educating healthcare providers and women about additional nutritional benefits of the use of hormonal contraceptives.

Trends in Modification of Smoking Behaviors Among Pregnant Women in West Virginia.

Background Rates of smoking among pregnant women in West Virginia are higher than national prenatal smoking rates. Recent research has pointed to the benefit of smoking reduction among a sample of pregnant women who participated in a clinical study in West Virginia. The purpose of the current study is to examine trends associated with reduced smoking exposure among a representative sample of pregnant women in the state. Method Secondary data analysis was conducted using de-identified weighted PRAMS 2005-2010 data from West Virginia examining factors associated with favorable change in prenatal smoking behavior, either quitting or reducing smoking in pregnancy. Results Multivariable analyses results demonstrate that pregnant women are more likely to engage in a favorable smoking behavior change if they were younger (<35 years of age), were primiparous, and had a higher level of education. Discussion Findings from the study identified factors that contribute to women's likelihood of quitting or reducing smoking in pregnancy in West Virginia. Health care providers and policy makers should consider these factors in implementing approaches that will be effective in promoting smoking cessation and reduction among pregnant women in the state thereby reducing prenatal smoking exposure. Conclusion Population-based research has been used to identify factors associated with smoking cessation or reduction that can be used to develop appropriate and effective approaches to modifying health behaviors in specific populations.

Association between oral contraceptive use and markers of iron deficiency in a cross-sectional study of Tanzanian women.

OBJECTIVE: To analyze the associations between oral contraceptive (OC) use and markers of iron deficiency, objectively measured using hemoglobin and soluble transferrin receptor. METHODS: A secondary data analysis was performed of a population-based cross-sectional study using data from the 2010 Tanzania Demographic and Health Survey. Weighted percentages were calculated. Multivariable logistic regression was used to examine the associations between OC use and iron deficiency, anemia, and iron deficiency anemia. RESULTS: Of the 4336 participants, only 7.3% reported a history of OC use. The prevalence rates of iron deficiency, anemia, and iron deficiency anemia were 30.3%, 40.9%, and 15.1%, respectively. Use of OCs was negatively associated with anemia and iron deficiency anemia, independent of potential confounders. Compared with OC nonusers, the multivariable-adjusted odds ratio among OC users was 0.44 (95% confidence interval 0.32-0.59; P<0.001) for anemia and 0.43 (95% confidence interval 0.27-0.68; P<0.001) for iron deficiency anemia. A longer duration of OC use was negatively associated with iron deficiency (P=0.003 for trend), anemia (P<0.001 for trend), and iron deficiency anemia (P<0.001 for trend). CONCLUSION: The significant association between OC use and iron status has important implications for educating healthcare providers and women about additional nutritional benefits of the use of OCs.