Cervical Cancer and Human Papillomavirus Vaccine Awareness Among Married Bhutanese Refugee and Nepali Women in Eastern Nepal.

This study examined the sexually transmitted infections (STIs), cervical cancer, and human papillomavirus virus (HPV) vaccine-related awareness and knowledge among married Bhutanese refugee and Nepali women living in eastern Nepal. Participants were recruited from a women's health camp in Jhapa District in eastern Nepal. A demographic and health survey with questions on STIs, cervical cancer and HPV vaccine was administered to consenting participants. Women who were born in Bhutan or living in the United Nations administered refugee camps were classified as Bhutanese. Of the 630 participants, 14.3% of participants were Bhutanese and the mean age was 38.8 ± 8.2 years. A higher proportion of Bhutanese than Nepali women reported a lack of cervical cancer awareness (42.0% vs. 30.7%; p = 0.036). Only 21.5% of the participants knew HPV as the cause of cervical cancer; 13.9% were aware of an HPV vaccine; and 96% reported that they would have their children vaccinated against HPV if the vaccine was available free of cost to them. In multivariable analyses, the lack of awareness about STIs was directly associated with the lack of cervical cancer awareness [odds ratio (OR) 4.50; 95% confidence interval (CI) 2.99-6.77] and inversely associated with HPV-vaccine awareness [OR 0.53; 95% CI 0.29-0.97]. Low cervical cancer and HPV vaccine awareness and knowledge among Nepali and Bhutanese women in eastern Nepal highlight the need for increasing awareness and knowledge in the context of STIs and reproductive health education. Increasing awareness and knowledge of HPV, its role in cervical cancer, and prevention modalities is a first critical step for implementing successful targeted primary cervical cancer prevention measures focused on behavior modification and vaccine administration.

Elevated Blood Lead Levels Among Resettled Refugee Children in Ohio, 2009-2016.

Objectives. To assess the prevalence of and the demographic factors for elevated blood lead level (EBLL; ≥ 5 µg/dL) at resettlement among newly admitted refugee children. Methods. This cross-sectional study used data from the postresettlement refugee medical screening of 5661 children resettled in Ohio from 2009 to 2016. We computed prevalence of EBLL and adjusted prevalence ratio with modified Poisson regression modeling. Results. Overall, 22.3% of children younger than 18 years and 27.1% of those younger than 6 years had an EBLL. Children resettled from a South Asia region including Afghanistan (EBLL prevalence = 56.2%; 95% confidence interval [95% CI] = 48.1%, 64.3%), Nepal (44.0%; 95% CI = 33.7%, 54.1%), Bhutan (32.8%; 95% CI = 30.4%, 35.9%), and Burma (31.8%; 95% CI = 27.5%, 35.9%) had the highest prevalence of EBLLs. In addition, those younger than 6 years (prevalence ratio [PR] = 2.0; 95% CI = 1.6, 2.6), male (PR = 1.3; 95% CI = 1.1, 1.4), and screened within 30 days of arrival (PR = 1.7; 95% CI = 1.1, 2.5) had significantly higher EBLL prevalence than did children aged 13 years and older, female, and screened 90 days after arrival. Conclusions. The overall high proportion of EBLL and variation in EBLL by country of origin among resettled refugee children in the United States warrant comprehensive, yet tailored, guidelines for health professionals and resettlement and government agencies for better prevention and awareness programs targeting these high-risk children.

High-risk human papillomavirus infection and abnormal cervical cytology among Nepali and Bhutanese refugee women living in eastern Nepal.

BACKGROUND: Cervical cancer is the leading cause of cancer morbidity and mortality among women in Nepal and Bhutan. Data on high-risk human papillomavirus (HR-HPV) infection and cervical abnormalities among Nepali and Bhutanese women are sparse. The objectives of this study were to assess and compare the prevalence of HR-HPV infection and cervical abnormalities among Nepali and Bhutanese women living in Jhapa District in eastern Nepal; and examine the risk factors for HR-HPV infection and cervical abnormalities in those women. METHODS: Study participants were recruited from a women's health camp organized by NFCC-International, a Nepal-based non-governmental organization, in 2014. Consenting participants were administered a demographic and health questionnaire and cervico-vaginal specimens collected. Both self-collected and clinician-collected cervico-vaginal specimens were tested for HR-HPV infection. Cytologic exam was performed on clinician-collected samples and cervical cytology results were categorized according to the Bethesda classification. A participant was classified as a Bhutanese if they were either born in Bhutan or currently lived in one of the United Nations administered Bhutanese refugee camps in Jhapa; otherwise, the participant was classified as a Nepali. RESULTS: Of the 647 study participants, 15.9% were Bhutanese women living in refugee camps and the overall age (± standard deviation) was 38.8 ± 8.2 years. The prevalence of HR-HPV infection was 8.9% and abnormal cervical cytology was 7.1% respectively, with no significant difference in HR-HPV positivity (p = 0.399) or abnormal cervical cytology (p = 0.698) between Nepali and Bhutanese women. Compared to women whose husbands had not migrated for employment, women whose husbands had migrated outside of the district had 3.30 times (95% Confidence Interval [CI]: 1.13-9.64) the odds of being HR-HPV positive and women whose husbands had migrated outside the country had 2.92 times (95% CI: 1.32-6.49) the odds of having abnormal cervical cytology. CONCLUSIONS: HR-HPV positivity and abnormal cervical cytology were similar among Nepali and Bhutanese women. Husbands migrating for employment within or outside the country was a significant risk factor for high-risk HPV infection and cervical cytology, indicating the important role spousal behavior may play in HR-HPV acquisition and cervical abnormalities among these women.

Factors associated with parental reasons for "no-intent" to vaccinate female adolescents with human papillomavirus vaccine: National Immunization Survey - Teen 2008-2012.

BACKGROUND: 1) To identify socio-demographic factors associated with parental "no-intent" for their 13-17 year old unvaccinated daughter to receive the human papillomavirus (HPV) vaccine series within the next twelve months, 2) to describe patterns in "no-intent" by socio-demographic factors, and 3) to identify socio-demographic factors associated with parental reasons for "no-intent". METHODS: Data from 2008-2012 National Immunization Survey - Teen (NIS - Teen) were examined in this study. Parents with "no-intent" to vaccinate their daughters were asked to identify reasons for their decision. All responses were categorized into five domains identified as barriers to receive the HPV vaccine series: 1) Safety and Effectiveness Concerns; 2) Systemic Barriers; 3) Vaccine Misinformation; 4) Lack of Knowledge about the Vaccine; and 5) Socio-cultural Barriers. Multivariable logistic regression models were performed to address the study objectives. RESULTS: Number of people in the household, household income, mother's age, education, health insurance, recommendation of a health care provider, and the survey year were significantly associated with parental "no-intent". Race/ethnicity, mother's education, marital status, recommendation of a health care provider, household income, age of the unvaccinated daughter, and the survey year, were significantly associated with one or more domains identified as barriers to receive the HPV vaccine. CONCLUSIONS: This study identified sub-groups of parents across different socio-demographic factors with "no-intent" for their adolescent daughters to receive the HPV vaccine. Developing strategies that target educational tools towards the identified sub-groups of parents about the purpose, safety, and efficacy of the HPV vaccine, and HPV infection, may help increase HPV vaccine acceptance, initiation and completion rates.

Influence of a husband's healthcare decision making role on a woman's intention to use contraceptives among Mozambican women.

BACKGROUND: Previous studies in developing countries suggest that a husband plays an influential role in a woman's contraceptive use. The influence of a husband/partner's healthcare decision making power on a woman's intention to use contraceptives in Mozambique has not been studied. The present study examined this relationship using data from the 2011 Mozambique Demographic and Health Survey (DHS), which included a nationally representative sample of 7,022 women aged 15-49 years. METHODS: The primary outcome of interest in the study was a woman's intention to use contraceptives. The primary exposure of interest was the person making decisions about a woman's healthcare, dichotomized as the husband/partner alone vs. the woman herself or jointly with her husband/partner. Several potential socio-demographic confounders were adjusted for in overall and stratified multivariable logistic regression models. Adjusted odds ratio (AOR) and the associated 95% confidence interval (CI) are reported. RESULTS: The mean age of the sample was 30.4 (95% CI: 30.1 - 30.7) years. Overall, a woman who reported her husband/partner usually made the decision about her healthcare was 19% less likely to report an intention to use contraceptives than a woman who reported that she herself or jointly with her husband/partner made the decision (AOR = 0.81, 95% CI 0.71- 0.92). In stratified analyses, the association remained statistically significant among rural women (AOR = 0.75, 95% CI: 0.65 - 0.87); among women with knowledge of modern contraceptive methods (AOR = 0.83, 95% CI: 0.73 - 0.95); and among women with three or more (AOR = 0.81, 95% CI: 0.68 - 0.97) and two or fewer (AOR = 0.79, 95% CI: 0.65 - 0.96) living children. CONCLUSIONS: A husband/partner's healthcare decision making power in the relationship had a significant negative effect on a Mozambican woman's intention to use contraceptives. These findings have implications for addressing the role of men in the design and implementation of successful family planning programs to improve the contraceptive uptake rate among women in Mozambique.

Knowledge, Attitudes, Practices, and Prevention Barriers Related to Childhood Lead Poisoning Among Nepali-Speaking Bhutanese Parents in Northeast Ohio, United States.

The study objectives were: (i) to develop and administer a survey to assess childhood lead poisoning (CLP) knowledge, attitudes, practices and prevention barriers (KAP-B) among the Nepali-Speaking Bhutanese (NSB) community in Northeast Ohio; and (ii) to examine the association between socio-demographic characteristics of NSB parents and their understanding of CLP as measured by the constructs of knowledge and attitudes. A Nepali language KAP-B questionnaire was developed and 200 NSB parents with at least one child ≤ 7 years of age from the Akron Metropolitan Area, Ohio were interviewed. NSB parents demonstrated a low level of knowledge about CLP prevention measures. While 82% lived in pre-1978 houses, only 27.5% perceived their house/neighborhood to be potentially lead contaminated. Only 33% of the parents reported understanding lead-related information provided by their child's healthcare provider. Low-level CLP awareness among NSB community emphasizes a need for culturally tailored and linguistically appropriate community-level CLP educational intervention programs in this vulnerable community.

Relationship Between Primary Language Spoken at Home and Blood Lead Levels in Children from Northeast Ohio, United States: A Retrospective Cohort Study.

To estimate the prevalence and incidence of blood lead levels (BLL) ≥ 5 and ≥ 3.5 µg/dl and assess their association with primary language spoken at home in Northeast Ohio, U.S. children, a retrospective cohort study was conducted among 19,753 children aged < 6 years. Primary language spoken at home was used to define children from resettled refugee families (RRFs) and non-RRFs. The overall BLL ≥ 5 and ≥ 3.5 µg/dl prevalence were 3.22 and 6.10%, and incidence rates were 2.25 and 3.64 cases per 100 person-years, respectively. Compared to children from non-RRFs children from RRFs were 3.62-times [95% confidence interval (CI): 1.84, 7.13] as likely to have BLL ≥ 5 µg/dl prevalence, and 6.72-times [95% CI 2.60, 17.40] as likely to have BLL ≥ 5 µg/dl incidence during the follow-up period. The higher prevalence and incidence of BLL acquired in the United States among children from RRFs warrant further research to identify specific environmental and sociocultural lead sources for these children.

Determinants of obstetric fistula in Afghanistan: An analysis of the Demographic and Health Survey 2015.

OBJECTIVE: To examine the reproductive, sociodemographic, and geographic factors associated with obstetric fistula, which is a significant but neglected health problem faced by women in low-income countries, in women in Afghanistan, where epidemiologic studies examining the determinants of obstetric fistula are currently lacking. METHODS: This cross-sectional study used data from a nationally representative sample of women collected through the Afghanistan Demographic and Health Survey 2015. Descriptive and binary and multivariable logistic regression analyses were performed to estimate the prevalence of obstetric fistula and describe and assess the risk factors associated with the condition. RESULTS: Among the weighted sample of 29 374 women aged 15-49 years, 3% reported having an obstetric fistula. In a multivariable logistic regression analysis, factors associated with women reporting a history of an obstetric fistula included parity, ethnicity, geography, income level, educational attainment, employment outside the home, decider on medical care, and their husband's education level. CONCLUSION: Our findings highlight the multifactorial nature of the determinants of obstetric fistula in Afghan women and underscore the need for multidisciplinary integrative interventions to address the reproductive, socio-economic, cultural, and healthcare-related factors in reducing the burden of obstetric fistula in women in Afghanistan.

Long-Acting Injectable Antipsychotic Use in Patients with Schizophrenia and Criminal Justice System Encounters.

Background: Nonadherence to medication is prevalent in persons diagnosed with schizophrenia, thus increasing the likelihood of relapse, poor health outcomes, hospitalization, high treatment costs, and high rates of both violent and non-violent offenses. Objective: To assess the association between long-acting injectable (LAI) antipsychotic use and criminal justice system encounters in patients with schizophrenia or schizoaffective disorder. Methods: This retrospective follow-up study was conducted among patients aged ≥18 years treated for schizophrenia or schizoaffective disorder at a community mental health center in Akron, Ohio, between January 1, 2010, and June 15, 2016. The incidence of criminal justice system encounters at 6 months, 1 year, and 2 years pre- versus post-LAI antipsychotic initiation was assessed. A subanalysis was conducted for individuals with a history of prior arrest. Results: Overall, the risk ratio (RR) of having an encounter with the criminal justice system was significantly lower for patients treated with LAI antipsychotics 1 year after initiation of treatment compared with a similar time period prior to initiation (RR [95% confidence interval (CI)]: 0.74 [0.59-0.93]; P<0.01) and 2 years (0.74 [0.62-0.88]; P<0.0001). Statistically significant reductions in criminal justice system encounters after treatment than before treatment were observed in the once-monthly paliperidone palmitate (PP1M) cohort. The incidence of arrests was lower in the 6-month (27 vs 85 arrests), 1-year (46 vs 132 arrests) and 2-year (88 vs 196 arrests) periods post-index LAI medication than in the corresponding periods pre-index LAI medication among individuals with a history of prior arrest. Conclusions: Patients with schizophrenia or schizoaffective disorder who were initiated on a LAI antipsychotic medication, specifically PP1M, were less likely to have an encounter with the criminal justice system compared with a similar time period before the initiation of LAI treatment.

Factors Associated with the Presence of Strong Social Supports in Bhutanese Refugee Women During Pregnancy.

Social support may mitigate stress related to the refugee experience, including during resettlement. For refugee women, social support can play an important role during pregnancy. In-depth interviews were conducted within a sample of 45 Bhutanese refugee women. Perceived social support was measured using the Norbeck Social Support Questionnaire. Averaged social support scores are reported to account for personal network size. Participants were identified as "low support" and "high support" based on their reported score. The mean social support score reported was 18.9. Participants experiencing a secondary resettlement within the U.S. were 4.52 (95% CI 1.19-17.15) times as likely to report a "high support" network compared to participants who resettled directly from Nepal. Personal social networks are an important source of support for resettled refugee women during pregnancy in the U.S.. Refugee women who experience secondary resettlement may perceive stronger support from their personal connections.

Neighborhood Violence Impacts Disease Control and Surveillance: Case Study of Cali, Colombia from 2014 to 2016.

Arboviruses are responsible for a large burden of disease globally and are thus subject to intense epidemiological scrutiny. However, a variable notably absent from most epidemiological analyses has been the impact of violence on arboviral transmission and surveillance. Violence impedes surveillance and delivery of health and preventative services and affects an individual's health-related behaviors when survival takes priority. Moreover, low and middle-income countries bear a disproportionately high burden of violence and related health outcomes, including vector borne diseases. To better understand the epidemiology of arboviral outbreaks in Cali, Colombia, we georeferenced chikungunya (CHIKV), dengue (DENV), and Zika (ZIKV) viral cases from The National System of Surveillance in Public Health between October 2014 and April 2016. We extracted homicide data from the municipal monthly reports and kernel density of homicide distribution from IdeasPaz. Crucially, an overall higher risk of homicide is associated with increased risk of reported DENV, lower rates of acute testing, and higher rates of lab versus clinical discordance. In the context of high violence as a potential barrier to access to preventive health services, a community approach to improve health and peace should be considered.

Community context and sub-neighborhood scale detail to explain dengue, chikungunya and Zika patterns in Cali, Colombia.

BACKGROUND: Cali, Colombia has experienced chikungunya and Zika outbreaks and hypoendemic dengue. Studies have explained Cali's dengue patterns but lack the sub-neighborhood-scale detail investigated here. METHODS: Spatial-video geonarratives (SVG) with Ministry of Health officials and Community Health Workers were collected in hotspots, providing perspective on perceptions of why dengue, chikungunya and Zika hotspots exist, impediments to control, and social outcomes. Using spatial video and Google Street View, sub-neighborhood features possibly contributing to incidence were mapped to create risk surfaces, later compared with dengue, chikungunya and Zika case data. RESULTS: SVG captured insights in 24 neighborhoods. Trash and water risks in Calipso were mapped using SVG results. Perceived risk factors included proximity to standing water, canals, poverty, invasions, localized violence and military migration. These risks overlapped case density maps and identified areas that are suitable for transmission but are possibly underreporting to the surveillance system. CONCLUSION: Resulting risk maps with local context could be leveraged to increase vector-control efficiency- targeting key areas of environmental risk.

Spousal migration and human papillomavirus infection among women in rural western Nepal.

BACKGROUND: In April 2014 we investigated the association of migration of a woman's husband with her high-risk human papillomavirus (HR-HPV) infection status and her abnormal cervical cytology status in the Achham district of rural Far-Western Nepal. METHODS: Women were surveyed and screened for HR-HPV during a health camp conducted by the Nepal Fertility Care Center. Univariate and multivariable statistical tests were performed to determine the association of a husband's migration status with HR-HPV infection and cervical cytology status. RESULTS: In 265 women, the prevalence of HR-HPV was 7.5% (20/265), while the prevalence of abnormal cervical cytology, defined using the Bethesda system as atypical glandular cells of undetermined significance or worse, was 7.6% (19/251). Half of the study participants (50.8%, 130/256) had husbands who had reported migrating for work at least once. Women aged ≤34 years were significantly less likely to test positive for HR-HPV than women aged >34 years (OR 0.22, 95% CI 0.07 to 0.71). HR-HPV infection and abnormal cervical cytology status were not directly associated with a husband's migration. CONCLUSION: Older women were found to have a higher prevalence of HPV than younger women. It is possible that a husband's migration for work could be delaying HR-HPV infections in married women until an older age.

Genomic diversity and phylogenetic relationships of human papillomavirus 16 (HPV16) in Nepal.

OBJECTIVES/BACKGROUND: Sequence variants in HPV16 confer differences in oncogenic potential; however, to date there have not been any HPV sequence studies performed in Nepal. The objective of this study was to characterize HPV16 viral genome sequences from Nepal compared to a reference sequence in order to determine their lineages. Additionally, we sought to determine if five High-grade Squamous Intraepithelial Lesion (HSIL) subjects were genetically distinct from the non-HSIL subjects. METHODS: DNA was isolated from exfoliated cervical cells from 17 individuals in Nepal who were previously identified to be HPV16-positive. A custom HPV16 Ion Ampliseq panel of multiplexed degenerate primers was designed that generated 47 overlapping amplicons and covered 99% of the viral genome for all known HPV16 variant lineages. All sequence data were processed through a custom quality control and analysis pipeline of sequence comparisons and phylogenetic analysis. RESULTS: There were high similarities across the genomes, with two major indels observed in the non-coding region between E5 and L2. Compared to the PAVE reference HPV16 genome, there were up to 9, 4, 38, 27, 8, 7, 52, and 32 nucleotide variants in the E6, E7, E1, E2, E4, E5, L2, and L1 genes in the Nepalese samples, respectively. Based on sequence variation, HPV16 from Nepal falls across the A, C, and D lineages in this study. We found no evidence of genetic distinctness between HSIL and non-HSIL subjects. CONCLUSIONS: The evolutionary and pathological characteristics of the representative HPV16 genomes from Nepal seem similar to results from other parts of the world and provide the basis for further studies.

Human papillomavirus vaccine awareness, uptake, and parental and health care provider communication among 11- to 18-year-old adolescents in a rural Appalachian Ohio county in the United States.

PURPOSE: This study examined human papillomavirus (HPV) vaccine awareness and uptake, and communication with a parent and/or a health care provider among 11- to 18-year-old male and female adolescents in an Appalachian Ohio county. METHODS: Five questions regarding the HPV vaccine were added to the 2012 Youth Risk Behavior Surveillance System (YRBSS) surveys administered to middle and high school students in the county. The YRBSS surveys are school-based, anonymous, and voluntary. The questions added were about vaccine awareness and uptake, and communication with a parent or health care provider about the vaccine. RESULTS: Of the 1,299 participants, 51.9% were male and 90.3% were white. Overall, 49.2%, 23.5%, 19.2%, and 24.6%, respectively, reported vaccine awareness, uptake of at least 1 dose of the HPV vaccine, communication with a parent, and communication with a health care provider. Females and adolescents ≥ 15 years were significantly more likely to report awareness, uptake, and parental and provider communication than males and adolescents ≤ 14 years. Adolescents receiving any dose of the vaccine were significantly more likely to have had a parent (OR: 3.74; 95% CI: 2.30-6.06) or a health care provider (OR: 10.91; 95% CI: 6.42-18.6) discuss the vaccine than those who had not received any dose. CONCLUSIONS: Despite the strong link between parental and health care provider communication and HPV vaccine uptake, the levels of communication remain low in this Appalachian population. These findings suggest the need for public health education programs targeting the health care providers, the parents, and the adolescents to improve awareness, knowledge, and HPV vaccine uptake.

Chronic Disease Burden Among Bhutanese Refugee Women Aged 18-65 Years Resettled in Northeast Ohio, United States, 2008-2011.

The purpose of this community-based study was to assess the prevalence of chronic diseases among 18-65 year old Bhutanese refugee women resettled in Northeast Ohio, United States (US). A Nepali-language questionnaire was administered in a face-to-face mode. Anthropometric measurements included height, weight, and hip and waist circumferences. The overall prevalence (95 % confidence interval) of self-reported hypertension, diabetes, asthma, heart disease, and cancer were 15.3 % (9.2-23.4), 6.4 % (2.3-10.9), 5.5 % (2.0-11.5), 2.7 % (0.6-7.8), and 1.8 % (0.2-6.4), respectively. Overweight/obesity was observed in 64.8 % of the women; 69.5 and 74.1 % had waist circumference >80 cm and waist-to-hip ratio ≥85, respectively. Length of time in the US was not associated with the prevalence of the chronic conditions. This study suggests chronic conditions may be significant health issues among US resettled Bhutanese refugees and a larger population-based study to confirm the findings is warranted.

Poly-traumatization and harmful behaviors in a sample of emergency department Psychiatric Intake Response Center youth.

The purpose of this study is to examine risk factors for poly-traumatization, and the impact of poly-traumatization on harmful behaviors (suicidal, self-harm, and violent), among a group of pediatric patients presenting at an emergency department's psychiatric intake response center. We employed a retrospective medical chart review in a children's hospital for a 2-year span (N=260). The study employed 2 statistical analyses. The first analysis used multinomial logistic regression to model the odds of harmful behaviors comparing increasing numbers of co-occurring traumatization types. The second analysis employed latent class modeling techniques in three ways to (a) define different poly-traumatization populations, (b) examine the relationship between predictors and class assignment, and (c) examine the relationship between class assignment and harmful behavioral outcomes. About 62% of the sample presented with at least 1 traumatization type and about 50% one harmful behavior type. Compared to those with 1, 2, or 3 traumatization types, patients with 4 or more traumatization types have higher odds of harmful behaviors. The latent class analysis revealed 2 populations: High serious victimization and minimal traumatization. History of family mental health issues was the only significant predictor of class membership. Class membership was associated with all of the harmful behavioral outcome categories. These findings support consideration of poly-traumatization as a risk factor for the high occurrence of harmful behaviors in this sample of pediatric psychiatric patients and that history of family mental health issues may contribute to the high co-occurrence of poly-traumatization.

Prenatal HIV counseling, testing, and antiretroviral prophylaxis by obstetric and family medicine providers in Alabama.

BACKGROUND: The study reported here assessed the implementation of recommendations for routine universal prenatal counseling and voluntary HIV testing among Alabama physicians who provide prenatal care and determined factors associated with noncompliance. METHODS: Voluntary, confidential mailed survey of obstetrics and family medicine practitioners. RESULTS: Of the 138 physicians who responded to a mailed survey in Alabama, 17 (12.3%) indicated that they did not offer universal HIV counseling and testing to pregnant women. Factors associated with failure to offer universal HIV counseling and testing included having more than 50% of patients refuse HIV counseling and testing when offered and never knowingly having given prenatal/perinatal care to women with HIV. Low/medium familiarity with the US Public Health Service recommendations for perinatal zidovudine use to reduce HIV transmission and physician specialty are also suggested as predictors of not offering universal testing. CONCLUSIONS: Despite the well-established benefits of antiretroviral prophylaxis to prevent vertical transmission of HIV, some physicians in Alabama have been slow to adopt universal testing of their pregnant patients for HIV in the prenatal period. Practitioner education is as important as patient education in eliminating pediatric HIV in the Deep South.

Socio-demographic and dietary factors associated with excess body weight and abdominal obesity among resettled Bhutanese refugee women in Northeast Ohio, United States.

Studies of obesity and related health conditions among the Bhutanese, one of the largest refugee groups resettled in the United States in the past five years, are limited. This study examined the factors associated with excess body weight (body mass index ≥ 23 kg/m2) and abdominal obesity (waist circumference > 80 cm) in a community-based sample of 18-65 year old Bhutanese refugee women in Northeast Ohio. A Nepali-language questionnaire was used to measure socio-demographic and dietary factors. Height, weight, and waist circumference were measured to define excess body weight and abdominal obesity. The mean (±standard deviation) age of the 108 participants was 36.5 (±12.2) years and length of time in the U.S. was 19.4 (±11.9) months. Overall, 64.8% and 69.4% of the women had excess body weight and abdominal obesity, respectively. Age was significantly associated with both excess body weight (odds ratio: 1.10; 95% confidence interval: 1.05-1.16) and abdominal obesity (1.09; 1.04-1.14). Consuming meat (4.01; 1.14-14.60) was significantly associated with excess body weight but not abdominal obesity. These findings suggest the need for lifestyle and dietary change education programs among this new and vulnerable group to reduce the prevalence of excess body weight and abdominal obesity and their health consequences.

Association of being bullied in school with suicide ideation and planning among rural middle school adolescents.

BACKGROUND: This study examined the association of ever being bullied in school with suicide ideation (ever thinking about killing oneself) and ever seriously making a plan to kill oneself (suicide planning) among rural middle school adolescents. METHODS: Using the US Centers for Disease Control and Prevention's Middle School Youth Risk Behavior Survey instrument, 2 cross-sectional surveys were conducted among middle school adolescents (N = 1082) in a rural Appalachian county in Ohio in 2009 and 2012. Multivariable logistic regression models assessed the relationship of ever being bullied in school with suicide ideation and planning. RESULTS: Overall, a total of 468 participants (43.1%) reported ever being bullied in school, and 22.3% and 13.2% of the adolescents surveyed reported suicide ideation and planning, respectively. In the multivariable analyses, ever being bullied in school was significantly associated with both suicide ideation (odds ratio [OR] = 2.4; 95% confidence interval [CI]: 1.7-3.5) and planning (OR = 2.5; 95% CI: 1.6-3.8). CONCLUSIONS: The results show a strong association between being bullied in school and suicide ideation and planning among rural middle school adolescents. Prevention of bullying in school as early as in middle school should be a strategy for reducing suicide ideation and planning among adolescents.