The role of health systems and policy in producing behavior and social change to enhance child survival and development in low- and middle-income countries: an examination of the evidence.

Evidence-based behavior change interventions addressing health systems must be identified and disseminated to improve child health outcomes. Studies of the efficacy of such interventions were identified from systematic searches of the published literature. Two hundred twenty-nine of the initially identified references were judged to be relevant and were further reviewed for the quality and strength of the evidence. Studies were eligible if an intervention addressed policy or health systems interventions, measured relevant behavioral or health outcomes (e.g., nutrition, childhood immunization, malaria prevention and treatment), used at least a moderate quality research design, and were implemented in low- or middle-income countries. Policy or systems interventions able to produce behavior change reviewed included media (e.g., mass media, social media), community mobilization, educational programs (for caregivers, communities, or providers), social marketing, opinion leadership, economic incentives (for both caregiver and provider), health systems strengthening/policy/legislation, and others. Recommendations for policy, practice, and research are given based on fairly strong data across the areas of health service delivery, health workforce, health financing, governance and leadership, and research.

From Stand to Forest: Woody Plant Recruitment in an Andean Restoration Project.

The growing deforestation of tropical forests requires the implementation of restoration actions capable of assisting the recovery of biodiversity and the functioning of these ecosystems. This research aimed to identify the environmental factors that influence the abundance and diversity of woody plant recruitment in an Andean forest restoration project in Medellin (Colombia). Data from woody plant individuals taller than 80 cm were collected in 22 plots of 200·m-2. The environmental factors selected were edaphic variables, plantation structure, slope, elevation, prior land use, and landscape forest cover. Generalized linear models (GLM) were used to analyze recruitment densit and Linear Mixed Models (LMM) to assess recruited species richness, diversity, and dominance. Woody plant recruitment attributes in our study area were similar to those of secondary succession in an Andean forest, but planted trees contributed little to recruitment density and diversity. While recruitment density was affected by slope, canopy closure, and landscape forest cover, recruitment diversity was influenced by physical (bulk density) and chemical (pH, aluminum, Cation Exchange Capacity) edaphic factors, planted tree diversity (species richness and composition), canopy closure, and the mortality rate of planted trees. We conclude that sites with lower mortality rates of planted trees and denser canopies enhance both recruitment density and diversity, indicating a synergy between active restoration and passive regeneration processes.

Developing diagnostic skills from preclinical dental education: Caries detection and assessment using e-learning assisted practice.

PURPOSE: To evaluate the feasibility of developing visual diagnostic skills for detecting and assessing dental caries using e-learning assisted practice in preclinical dental education. METHODS: A one-group before and after the study was conducted. After a theoretical lesson on cariology, 53 inexperienced second-year preclinical students assessed 78 clinical photographs using the Nyvad criteria; they received automated feedback upon completion of the test. After a week, all students reassessed the same set of photographs, which were randomly reordered. Differential diagnostic accuracy was analyzed category-pairwise, and overall accuracy measures were based on the receiver operator curve. Diagnostic accuracy in both attempts was evaluated and compared through estimation and pooling of individual student accuracies. RESULTS: Pooled category-pairwise accuracy was lower for discriminating Sound surface from Non-cavitated-active caries, and for discriminating inactive caries (surface discontinuity) from intact surface inactive caries and Cavitated-active caries. Pooled overall accuracy, after the theoretical lesson, was 0.79 (95% confidence interval [CI] 0.77-0.81), and it increased to 0.99 (95% CI 0.98-0.99) after feedback. Between-student variability in accuracy was reduced from I2  = 0.66 to 0.55. CONCLUSION: E-learning assisted practice is a feasible alternative to start developing visual diagnostic skills for detecting and assessing dental caries using the Nyvad criteria from preclinical dental education in cariology. However, further studies are required to evaluate its effectiveness in improving real-world practice knowledge and skills.

Public health issues related to HPV vaccination.

The human papillomavirus (HPV) is clearly established as the cause of cervical cancer, and vaccines targeting oncogenic forms of the virus are important as a primary method of prevention. However, barriers to cervical screening and vaccination such as a lack of knowledge of HPV, access to healthcare, and poor follow-up prevent the acceptance and utilization of HPV vaccines. Strategies for prevention of disease and implementation of vaccination are in development, but the importance of primary prevention of HPV infection needs to be stressed. This review assesses the potential impact of vaccination for cervical cancer, barriers to vaccination, and the methods used to increase coverage. With the advent of prophylactic vaccines, HPV, a common infection in the United States, can be prevented in most women.

The impact of education and literacy levels on cancer screening among older Latin American and Caribbean adults.

BACKGROUND: There is limited information related to the effects of education and literacy on cancer screening practices among older adults in Latin American and Caribbean countries. METHODS: To determine the association between education and cancer screening use, we developed a cross-sectional study using data from the Health, Well-Being and Aging in Latin America and the Caribbean Study. The sample included 4,183 men and 6,708 women aged 60 years and older from seven cities. The outcomes are mammogram and Pap smear use in women and prostate examination use in men within the last 2 years. RESULTS: In general, illiterate or lower-educated older men and women have the lowest rates of cancer screening use compared with higher-educated counterparts. Multivariate logistic models, by city and in a combined sample of six cities showed that high education is associated with higher odds of having a mammogram or a Pap smear in women and a prostate examination in men. CONCLUSIONS: Older adults with low educational or literacy levels should be targeted for screening programs in these populations.

The reliability and validity of the Brief Sensation Seeking Scale (BSSS-8) with young adult Latino workers: implications for tobacco and alcohol disparity research.

AIM: This study investigated the reliability and validity of the Brief Sensation Seeking Scale (BSSS-8) in both English and Spanish with Latinos, the fastest-growing minority group in the United States, and the correlation between sensation seeking and tobacco and alcohol use. DESIGN: Cross-sectional survey, computer-assisted telephone interviews (CATI). SETTING: Dallas and Houston, Texas. PARTICIPANTS: A total of 789 Latinos participated in this study. Participants were currently in the work-force, not enrolled in college, and between the ages of 18 and 30 years. MEASUREMENTS: Participants completed a self-report questionnaire (in either English or Spanish) consisting of items measuring tobacco and alcohol use as well as the eight-item Brief Sensation Seeking Scale. FINDINGS AND CONCLUSIONS: For English-speaking Latino participants, the BSSS factor structure was second-order unidimensional and correlated positively with life-time cigarette use, intention to smoke in the future and amount and frequency of alcohol consumption. For Spanish-speaking Latino participants, a four-subfactor solution for the BSSS provided the best fit to the data although correlations between the four subscales and cigarette use were small.

Energy balance feasibility study for Latinas in Texas: a qualitative assessment.

INTRODUCTION: Obesity has reached epidemic levels, with nearly two-thirds of the U.S. population considered overweight or obese. Latinos have some of the highest rates of overweight, obesity, and sedentary lifestyle. Research from scientifically sound evidence-based interventions to reduce the disproportionate burden of obesity and its associated morbidity and mortality among Latinas is greatly needed. The purpose of this study was to assess knowledge, attitudes, and behaviors about nutrition and exercise among Latinas aged 40 years and older residing in a low-income community in Houston, Texas, and the applicability of an evidence-based church program to promote healthy energy balance. METHODS: Qualitative assessment was conducted through 10 focus groups with 75 women recruited through three Catholic churches, community groups, and leaders. RESULTS: Participants identified barriers and enabling factors to healthy nutrition and physical activity. Barriers included lack of awareness about nutrition and physical activity, cultural beliefs, and socioeconomic and environmental factors. Preferred strategies were group activities with direct guidance from qualified individuals and interpersonal contact among participants, social support with positive reinforcement for behavior change or maintenance, and a friendly environment for learning and achieving suitable goals. The church was considered a powerful resource to influence Latinas to improve their health, exercise, and nutrition practices. CONCLUSION: Our findings suggest that using the church environment to reach Latina women aged 40 years and older is a feasible and culturally appropriate strategy. The church environment provides a safe, comfortable, and familiar atmosphere for women and addresses specific cultural barriers and safety concerns of family members.

Social influences, and attitudes and beliefs associated with smoking among border Latino youth.

BACKGROUND: Adolescent smoking rates have declined among all ethnic groups since the late 1990s. However, despite the recent declines and intervention efforts, today smoking remains a serious problem among youth, with a quarter of adolescents being current smokers by the time they complete 12th grade. This problem is particularly prevalent among Latino youth, who have among the highest rates of lifetime and past-30-day use. The purpose of this study was to examine the association between psychosocial factors and the smoking behavior of Latino youth living along the Mexico-US border. METHODS: A convenient sample of 2471 middle and high school Latino students was surveyed in fall 2000. Logistic regression analysis was used to examine the association between study risk factors and youth smoking behavior. RESULTS: The strongest predictor of lifetime and past-30-day smoking was peer influence; however, the strength of the association was greater with recent use. There were also differences in the influence of family and attitudes and beliefs between the 2 groups. CONCLUSIONS: These differences need to be taken into consideration to guide development of tailored prevention and control interventions aimed at this specific group. These efforts should address social influences to smoke, particularly those from peers; promote changes in attitudes and beliefs toward smoking; increase understanding of the addictive nature of nicotine; and provide development of skills young people need to resist social and environmental pressures to smoke. Strict control and enforcement measures are needed to completely eliminate the sale of cigarettes to minors.

Tobacco control policy advocacy attitudes and self-efficacy among ethnically diverse high school students.

This study applied self-efficacy theory to assess empowerment to advocate on behalf of tobacco control policies. The Youth Tobacco Survey with added policy advocacy self-efficacy, attitudes, and outcome expectations scales was given to 9,177 high school students in Texas. Asians showed the lowest prevalence of experimentation and current smoking, followed by African Americans. Anglo-Europeans had higher rates of current smoking. Latino male students had the highest experimentation and current smoking rates. Policy advocacy self-efficacy was higher among African Americans. Latinos scored lowest. Asians had the highest level of approval for tobacco control policies. African Americans had the highest scores in policy advocacy outcome expectations, followed by Asians and Latinos. Anglo-Europeans scored lowest. Students who had never tried smoking had the highest scores in all three scales, with a decreasing trend as the frequency of smoking increased. Associations with smoking status remained significant when controlling by gender and ethnicity.

Health insurance and cervical cancer screening among older women in Latin American and Caribbean cities.

BACKGROUND: The purpose of this study is to describe the prevalence of Papanicolaou (Pap) smear use for cervical cancer screening and to estimate its association with type of health care insurance. METHODS: A cross-sectional study using data from the Health, Well-Being and Aging in Latin America and the Caribbean Study (SABE). The sample includes 6357 women aged 60 and older from seven cities. The outcome was reporting a Pap smear for cervical cancer screening during the previous 2 years. Main independent variable was health care insurance. Covariates were demographic or socioeconomic variables, medical conditions and functional status. RESULTS: Prevalence of Pap smear use across the seven cities ranged from 21% in Bridgetown to 45% in Mexico City. In a multivariate analysis of the combined sample, without Havana that has universal health care insurance, women with public insurance (OR 0.55, 95% CI 0.43-0.71) or with no insurance (OR 0.23, 95% CI 0.15-0.34) were less likely to have a Pap smear compared with women with private insurance. Also, women with no insurance were less likely to have a Pap smear (OR 0.40, 95% CI 0.30-0.54) compared with women with any health insurance. CONCLUSIONS: In general, the prevalence of Pap smear use was lower than that reported for Hispanic populations in the United States. Overall, lack of health insurance or having public health insurance determined lower odds for having a Pap smear for cervical cancer screening.

Behavioral sciences concepts in research on the prevention of violence / Conceptos de las ciencias conductuales en las investigaciones sobre la prevención de la violencia

El propósito de este artículo es examinar los factores que pudieran explicar las variaciones de la violencia en el nivel poblacional e introducir conceptos de las ciencias conductuales en el campo de las investigaciones efectuadas por encuesta. La violencia y su prevención son temas que competen cada vez más a los especialistas de la salud pública. Conceptos propios de las ciencias del comportamiento se han aplicado al desarrollo de técnicas para prevenir diversas enfermedades mediante actividades de promoción de la salud, entre las cuales figuran el adiestramiento para la adquisición de destrezas, la persuasión, el uso de incentivos y los cambios ambientales de carácter facilitador. Este enfoque arraigado en la salud pública también puede aplicarse a la violencia. El análisis que parte de la salud pública puede ir más allá de las conductas individuales para enfocar las fuentes sociales y ambientales de la violencia individual y colectiva. Los factores ambientales pueden determinar la magnitud de los conflictos, así como los medios disponibles para resolverlos. Las actitudes, normas y habilidades pueden ejercer influencia en las decisiones individuales y colectivas sobre la manera de responder a situaciones capaces de suscitar violencia, y estos factores sociales y congnoscitivos pueden variar notablemente entre distintas culturas e incluso dentro de una misma. Si se desea llegar a un conocimiento más profundo de la violencia, las metodologías de entrevista propias de las ciencias sociales pueden aplicarse para medir variables cuantitativas, pero es necesario seleccionar estratégicamente los conceptos particulares que se han de evaluar. Estas variables pueden abarcar la aprobación de la sociedad, las actitudes valorativas, las normas e intenciones percibidas en relación con la violencia, las actitudes hacia opciones contrarias a la violencia, las habilidades y la autoeficacia que confieren, las interpretaciones de los conflictos y sucesos desencadenantes, el control de sí mismo y la capacidad para usar métodos no violentos para resolver los conflictos sociales. A fin de crear un enfoque de salud pública aplicable al control de la violencia en las Américas, la Organización Panamericana de la Salud organizó el proyecto ACTIVA, que es un programa multinacional de investigación colaborativa destinado a medir la victimización y los comportamientos agresivos y a identificar actitudes asociadas con los actos de violencia públicos y privados. Estos nuevos conocimientos podrían aplicarse a fin de aminorar la carga de violencia que enfrentarán las generaciones futuras en la Región de las Américas

El propósito de este artículo es examinar los factores que pudieran explicar las variaciones de la violencia en el nivel poblacional e introducir conceptos de las ciencias conductuales en el campo de las investigaciones efectuadas por encuesta. La violencia y su prevención son temas que competen cada vez más a los especialistas de la salud pública. Conceptos propios de las ciencias del comportamiento se han aplicado al desarrollo de técnicas para prevenir diversas enfermedades mediante actividades de promoción de la salud, entre las cuales figuran el adiestramiento para la adquisición de destrezas, la persuasión, el uso de incentivos y los cambios ambientales de carácter facilitador. Este enfoque arraigado en la salud pública también puede aplicarse a la violencia. El análisis que parte de la salud pública puede ir más allá de las conductas individuales para enfocar las fuentes sociales y ambientales de la violencia individual y colectiva. Los factores ambientales pueden determinar la magnitud de los conflictos, así como los medios disponibles para resolverlos. Las actitudes, normas y habilidades pueden ejercer influencia en las decisiones individuales y colectivas sobre la manera de responder a situaciones capaces de suscitar violencia, y estos factores sociales y cognoscitivos pueden variar notablemente entre distintas culturas e incluso dentro de una misma. Si se desea llegar a un conocimiento más profundo de la violencia, las metodologías de entrevista propias de las ciencias sociales pueden aplicarse para medir variables cuantitativas, pero es necesario seleccionar estratégicamente los conceptos particulares que se han de evaluar. Estas variables pueden abarcar la aprobación de la sociedad, las actitudes valorativas, las normas e intenciones percibidas en relación con la violencia, las actitudes hacia opciones contrarias a la violencia, las habilidades y la autoeficacia que confieren, las interpretaciones de los conflictos y sucesos desencadenantes, el control de sí mismo y la capacidad para usar métodos no violentos para resolver los conflictos sociales. A fin de crear un enfoque de salud pública aplicable al control de la violencia en las Américas, la Organización Panamericana de la Salud organizó el proyecto ACTIVA, que es un programa multinacional de investigación colaborativa destinado a medir la victimización y los comportamientos agresivos y a identificar actitudes asociadas con los actos de violencia públicos y privados. Estos nuevos conocimientos podrían aplicarse a fin de aminorar la carga de violencia que enfrentarán las generaciones futuras en la Región de las Américas