Alcohol Use and HIV Prevention Among Personnel in the Belize Defence Force.

To evaluate the effect of a peer-based risk reduction project on alcohol use and sexual behavior within Belize Defence Force personnel. We used a quasi-experimental, mixed quantitative and qualitative methods design to evaluate project outcomes. Two serial cross-sectional surveys were conducted [baseline (n = 126) and 6-month follow-up (n = 128)] using computer assisted self-interview. Semistructured interviews were collected from 12 peer counselors 3 months after the beginning of the project. The proportion of respondents screening positive for alcohol dependence decreased significantly from 80 % at preintervention to 66 % at postintervention (p = 0.045), and the percentage of respondents reporting that they normally drink alcohol before work decreased from 11 to 3 % (p = 0.013). Alcohol abuse and dependency scores correlated positively with the overall number of sexual partners in both male and female respondents. There was a slight decrease in the percentage of female respondents' reporting inconsistent condom use for vaginal sex (baseline 100 %, follow-up 83 %, p = 0.088), but there was no appreciable change reported in condom use among male respondents. Qualitative findings suggest that techniques to reduce the quantity of alcohol consumed were a salient focus of peer counselors, and administrative barriers can readily mitigate implementation of such interventions. In this evaluation of a risk reduction program with the BDF, we found evidence of a reduction in types of alcohol use from baseline to follow-up. Alcohol-related risk reductions carry implications for reducing sexual risk behavior in military personnel. Future research with stronger experimental design strategies may better elucidate how substance use reduction is linked with sexual risk reduction in military personnel.

Marine protected areas and children's dietary diversity in the Philippines.

Fish living around the coral reefs in the Philippines provide livelihoods for more than a million local fishers and are an important source of protein for coastal communities. However, this rich resource is at risk from myriad threats, which consequently threaten human livelihoods, nutrition, and health. In this paper, we examine the degree to which marine protected areas (MPAs), which aim to conserve marine biodiversity, are associated with improved nutritional outcomes in children under age 5. This analysis, which uses data from the 2008 Philippines Demographic and Health Survey and MPA data from the Coastal Conservation and Education Fund, found a positive association between MPAs and children's dietary diversity when the MPAs were located closer than 2 km to a child's community. MPA characteristics such as age or type of management were not consistently associated with dietary diversity. These results suggest a positive association of proximity to MPAs with certain aspects of children's diet.

Community violence perpetration and victimization among adults with mental illnesses.

OBJECTIVES: In a large heterogeneous sample of adults with mental illnesses, we examined the 6-month prevalence and nature of community violence perpetration and victimization, as well as associations between these outcomes. METHODS: Baseline data were pooled from 5 studies of adults with mental illnesses from across the United States (n = 4480); the studies took place from 1992 to 2007. The MacArthur Community Violence Screening Instrument was administered to all participants. RESULTS: Prevalence of perpetration ranged from 11.0% to 43.4% across studies, with approximately one quarter (23.9%) of participants reporting violence. Prevalence of victimization was higher overall (30.9%), ranging from 17.0% to 56.6% across studies. Most violence (63.5%) was perpetrated in residential settings. The prevalence of violence-related physical injury was approximately 1 in 10 overall and 1 in 3 for those involved in violent incidents. There were strong associations between perpetration and victimization. CONCLUSIONS: Results provided further evidence that adults with mental illnesses experienced violent outcomes at high rates, and that they were more likely to be victims than perpetrators of community violence. There is a critical need for public health interventions designed to reduce violence in this vulnerable population.

Using satellite remote sensing and household survey data to assess human health and nutrition response to environmental change.

Climate change and degradation of ecosystem services functioning may threaten the ability of current agricultural systems to keep up with demand for adequate and inexpensive food and for clean water, waste disposal and other broader ecosystem services. Human health is likely to be affected by changes occurring across multiple geographic and time scales. Impacts range from increasing transmissibility and the range of vectorborne diseases, such as malaria and yellow fever, to undermining nutrition through deleterious impacts on food production and concomitant increases in food prices. This paper uses case studies to describe methods that make use of satellite remote sensing and Demographic and Health Survey data to better understand individual-level human health and nutrition outcomes. By bringing these diverse datasets together, the connection between environmental change and human health outcomes can be described through new research and analysis.

Community-based conservation reduces sexual risk factors for HIV among men.

BACKGROUND: Despite numerous programs to combat the global HIV and AIDS pandemic, infection rates remain high, especially in sub-Saharan Africa, where two-thirds of all people living with HIV reside. Here, we describe how we used rigorous program evaluation methods to assess the effectiveness of a community-based natural resource management program that "mainstreamed" HIV awareness and prevention activities within rural communities in Namibia. FINDINGS: We used data from two rounds of the Namibia Demographic and Health Surveys (2000 and 2006/2007) and quasi-experimental statistical methods to evaluate changes in critical health-related outcomes in men and women living in communal conservancies, relative to several non-conservancy comparison groups. Our final dataset included 117 men and 318 women in 2000, and 170 men and 357 women in 2006/2007. We evaluated the statistical significance of the main effects of survey year and conservancy residence, and a conservancy-year interaction term, using generalized linear models. Our analyses show that community-based conservation in Namibia has significantly reduced multiple sexual partnerships, the main behavioural determinant of HIV/AIDS infection in Africa. CONCLUSIONS: Our results demonstrate the effectiveness of holistic community-based approaches centered on the preservation of lives and livelihoods, and highlight the potential benefits of integrating conservation and HIV prevention programming in other areas of communal land tenure in Africa.

Assessing impact of agroecological interventions in Niger through remotely sensed changes in vegetation.

Water scarcity is a major challenge in the Sahel region of West Africa. Water scarcity in combination with prevalent soil degradation has severely reduced the land productivity in the region. The decrease in resiliency of food security systems of marginalized population has huge societal implications which often leads to mass migrations and conflicts. The U.S. Agency for International Development (USAID) and development organizations have made major investments in the Sahel to improve resilience through land rehabilitation activities in recent years. To help restore degraded lands at the farm level, the World Food Programme (WFP) with assistance from USAID's Bureau for Humanitarian Assistance supported the construction of water and soil retention structures called half-moons. The vegetation growing in the half-moons is vitally important to increase agricultural productivity and feed animals, a critical element of sustainable food security in the region. This paper investigates the effectiveness of interventions at 18 WFP sites in southern Niger using vegetative greenness observations from the Landsat 7 satellite. The pre - and post-intervention analysis shows that vegetation greenness after the half-moon intervention was nearly 50% higher than in the pre-intervention years. The vegetation in the intervened area was more than 25% greener than the nearby control area. Together, the results indicate that the half-moons are effective adaptations to the traditional land management systems to increase agricultural production in arid ecosystems, which is evident through improved vegetation conditions in southern Niger. The analysis shows that the improvement brought by the interventions continue to provide the benefits. Continued application of these adaptation techniques on a larger scale will increase agricultural production and build resilience to drought for subsistence farmers in West Africa. Quantifiable increase in efficacy of local-scale land and water management techniques, and the resulting jump in large-scale investments to scale similar efforts will help farmers enhance their resiliency in a sustainable manner will lead to a reduction in food security shortages.

Lifetime Suicide-Related Behavior, Violent Victimization, and Behavioral Health Outcomes: Results From a Vulnerable Population Needs Assessment.

This study is concerned with two risk factors that have been independently associated with poor behavioral health: (a) lifetime suicide-related behavior (SRB) and (b) interpersonal violence victimization experiences. The purpose of this article was to assess whether the combination of SRB (ideation, attempt) and violent victimization exacerbates behavioral health symptom risk. This pattern is examined across three vulnerable population samples: community-based adults, college students, and bondage and sadomasochism (BDSM) community members. Data from a community health and sexuality survey (n = 2,175) were collected as a health needs assessment in partnership with the National Coalition for Sexual Freedom; latent class analysis (LCA) was then employed to identify intersectionality. This paper builds on prior findings yielding two distinct violence-related classes: (a) SRB only and (b) violent victimization + SRB. Controlling for demographic covariates, analyses revealed a consistent pattern in which the violent victimization + SRB subgroup displayed significantly worse behavioral health outcomes, including symptoms of depression, anxiety, general distress, and posttraumatic stress. Membership in any of the three available samples did not moderate the latent class-behavioral health associations, suggesting the additive impact of lifetime victimization + SRB is equitable across samples. Results are consistent with social-ecological framing of shared suicide-interpersonal violence falling under the same category of public health concerns sharing risk factors and health outcomes.

Who is the vulnerable child? Using survey data to identify children at risk in the era of HIV and AIDS.

Over the past decade, there has been increasing global attention to mitigating the impacts of the HIV/AIDS epidemic on children's lives. Within this context, developing and tracking global child vulnerability indicators in relation to HIV and AIDS has been critical in terms of assessing need and monitoring progress. Although orphanhood and adult household illness (co-residence with a chronically ill or HIV-positive adult) are frequently used as markers, or definitions, of vulnerability for children affected by HIV and AIDS, evidence supporting their effectiveness has been equivocal. Data from 60 nationally representative household surveys (36 countries) were analyzed using bivariate and multivariate methods to establish if these markers consistently identified children with worse outcomes and also to identify other factors associated with adverse outcomes for children. Outcome measures utilized were wasting among children aged 0-4 years, school attendance among children aged 10-14 years, and early sexual debut among adolescent boys and girls aged 15-17 years. Results indicate that orphanhood and co-residence with a chronically ill or HIV-positive adult are not universally robust measures of child vulnerability across national and epidemic contexts. For wasting, early sexual debut, and to a lesser extent, school attendance, in the majority of surveys analyzed, there were few significant differences between orphans and non-orphans or children living with chronically ill or HIV-positive adults and children not living with chronically ill or HIV-positive adults. Of other factors analyzed, children living in households where the household head or eldest female had a primary education or higher were significantly more likely to be attending school, better household health and sanitation was significantly associated with less wasting, and greater household wealth was significantly associated both with less wasting and better school attendance. Of all marker of child vulnerability analyzed, only household wealth consistently showed power to differentiate across age-disaggregated outcomes. Overall, the findings indicate the need for a multivalent approach to defining child vulnerability, one which incorporates household wealth as a key predictor of child vulnerability.

Incontinence and trauma: sexual violence, female genital cutting and proxy measures of gynecological fistula.

Obstetric fistula, characterized by urinary or fecal incontinence via the vagina, has begun to receive attention on the international public health agenda, however less attention has been given to traumatic fistula. Field reports indicate that trauma contributes to the burden of vaginal fistula, especially in regions wrought by civil unrest, however evidence is largely anecdotal or facility-based. This paper specifically examines the co-occurrence of incontinence and two potential sources of trauma: sexual violence and female genital cutting using the most recent Demographic and Health Surveys in Malawi, Rwanda, Uganda and Ethiopia. Multivariate selection models are used to control for sampling differences by country. Results indicate that sexual violence is a significant determinant of incontinence in Rwanda and Malawi, however not in Uganda. Simulations predict that elimination of sexual violence would result in from a 7 to a 40% reduction of the total burden of incontinence. In contrast, no evidence is found that female genital cutting contributes to incontinence and this finding is robust for types of cutting and high risk samples. Results point to the importance of reinforcing prevention programs which seek to address prevention of sexual violence and for the integration of services to better serve women experiencing both sexual violence and incontinence.

Spousal violence in Bangladesh as reported by men: prevalence and risk factors.

To study risk factors for perpetration of spousal violence among men in Bangladesh, self-reported Demographic and Health Surveys data from 2,780 married men using bivariate and multivariate techniques are analyzed. Of the respondents, 74% report having ever been violent toward their wives; 37% report violence in the past year. Nonnormative behaviors increase the risk for violence: Men who marry more than once, men who use drugs, and men who are unfaithful to their wives are all significantly more likely to report violence against their spouses. Egalitarian attitudes toward women do not decrease the risk for violence. However, attitudes explicitly about wife-beating are the strongest predictor of violence: Men who believe wife-beating is acceptable are more than 4 times as likely to report recent violence against their wives. While men's self-reports of spousal violence indicate that wife-beating is prevalent in Bangladesh, the results indicate opportunities for programmatic intervention.

Methodological limitations in the measurement and statistical modeling of violence among adults with mental illness.

OBJECTIVES: Methodological limitations of extant research hinder the development of effective violence risk screening, assessment, and management strategies for adults with mental illness. This study quantifies the effects of three common limitations: (a) insensitive measurement of violence that results in violence classification with high levels of information bias, (b) use of cross-sectional data, and (c) use of data lacking spatiotemporal contiguity. METHODS: We utilize secondary data (N = 3,000 participants; N = 10,017 observations) and parametric and nonparametric bootstrap simulation methodologies. RESULTS: Not utilizing self-reported violence data increases information bias. Furthermore, cross-sectional data that exclude self-reported violence produce biased associations between substance use and psychiatric symptoms and violence. Associations between baseline variables and subsequent violence attenuate over longer time lags and, when paired with high levels of violence information bias, result in fewer significant effects than should be present. Moreover, the true direction of the simulated relationship of some significant effects is reversed. CONCLUSIONS: Our findings suggest that the validity of conclusions from some extant research on violence among adults with mental illness should be questioned. Efforts are needed to improve both the measurement of violence, through inclusion of self-report, and the statistical modeling of violence, using lagged rather than nonlagged models with improved spatiotemporal contiguity.

Reliability and Validity of START and LSI-R Assessments in Mental Health Jail Diversion Clients.

Risk assessment instruments are increasingly used in mental health jail diversion programs. This study examined the reliability and validity of Short-Term Assessment of Risk and Treatability (START) and Level of Service Inventory-Revised (LSI-R) assessments overall and by client race. Research assistants completed START and LSI-R assessments for 95 diversion clients. Arrests and jail days were collected via official records and self-report 3, 6, 9, 12, and 18 months after baseline. Assessments demonstrated good interrater reliability and convergent validity. START strength total scores and LSI-R risk estimates were the strongest predictors of recidivism. Total scores and risk estimates did not differ as a function of client race, but there were some differences in accuracy of START vulnerability and LSI-R total scores and risk estimates in predicting jail days (but not arrests), over shorter follow-ups. No such differences were found for START strength total scores across any follow-up period or recidivism measure.

Benefits of biodiverse marine resources to child nutrition in differing developmental contexts in Hispaniola.

There is an urgent need for an improved empirical understanding of the relationship among biodiverse marine resources, human health and development outcomes. Coral reefs are often at this intersection for developing nations in the tropics-an ecosystem targeted for biodiversity conservation and one that provides sustenance and livelihoods for many coastal communities. To explore these relationships, we use the comparative development contexts of Haiti and the Dominican Republic on the island of Hispaniola. We combine child nutrition data from the Demographic Health Survey with coastal proximity and coral reef habitat diversity, and condition to empirically test human benefits of marine natural resources in differing development contexts. Our results indicate that coastal children have a reduced likelihood of severe stunting in Haiti but have increased likelihoods of stunting and reduced dietary diversity in the Dominican Republic. These contrasting results are likely due to the differential in developed infrastructure and market access. Our analyses did not demonstrate an association between more diverse and less degraded coral reefs and better childhood nutrition. The results highlight the complexities of modelling interactions between the health of humans and natural systems, and indicate the next steps needed to support integrated development programming.

Performance and clinical utility of a short violence risk screening tool in U.S. adults with mental illness.

Risk assessment instruments are typically long, costly, and resource-intensive. Thus, a short, easily administered preliminary screening tool can increase the efficiency of the subsequent violence risk assessment process. A preliminary tool can identify those at low risk of violence so that they can be screened out of the process of further violence risk assessment. Recently, Singh, Grann, Lichtenstein, Långström, and Fazel (2012) used data drawn from national registries to develop a short screening tool for a sample of Swedish adults diagnosed with schizophrenia. The screening tool included 5 items: male sex, previous criminal conviction, under 32 years of age, alcohol abuse, and drug abuse. The current study examines the predictive validity and clinical utility of the screening tool developed by Singh et al. (2012) in predicting community-based violence over 6-month and 12-month durations in U.S. adults with schizophrenia (n = 3,471) and the generalizability of those findings to the assessment of violence risk in adults with other primary diagnoses. Results demonstrated that the screening tool performed reasonably well at screening out individuals who did not commit violence during follow-up; however, the screening tool did not perform as well at identifying individuals who did commit violence during follow-up. Although those who screened positive were about twice as likely to engage in violence in the 6-month follow-up period, by the 12-month follow-up there was little difference in likelihood of engaging in violence between participants who were screened in and those who were screened out. Overall, findings of the present study do not provide compelling support for the clinical utility of the screening tool in its current form. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Effects of sample size and distributional assumptions on competing models of the factor structure of the PANSS and BPRS.

Factor analytic work on the Positive and Negative Syndrome Scale (PANSS) and Brief Psychiatric Rating Scale (BPRS) has yielded varied and conflicting results. The current study explored potential causes of these discrepancies. Prior research has been limited by small sample sizes and an incorrect assumption that the items are normally distributed when in practice responses are highly skewed ordinal variables. Using simulation methodology, we examined the effects of sample size, (in)correctly specifying item distributions, collapsing rarely endorsed response categories, and four factor analytic models. The first is the model of Van Dorn et al., developed using a large integrated data set, specified the item distributions as multinomial, and used cross-validation. The remaining models were developed specifying item distributions as normal: the commonly used pentagonal model of White et al.; the model of Van der Gaag et al. developed using extensive cross-validation methods; and the model of Shafer developed through meta-analysis. Our simulation results indicated that incorrectly assuming normality led to biases in model fit and factor structure, especially for small sample size. Collapsing rarely used response options had negligible effects.

Jail-to-community treatment continuum for adults with co-occurring substance use and mental disorders: study protocol for a pilot randomized controlled trial.

BACKGROUND: Adults with co-occurring mental and substance use disorders (CODs) are overrepresented in jails. In-custody barriers to treatment, including a lack of evidence-based treatment options and the often short periods of incarceration, and limited communication between jails and community-based treatment agencies that can hinder immediate enrollment into community care once released have contributed to a cycle of limited treatment engagement, unaddressed criminogenic risks, and (re)arrest among this vulnerable and high-risk population. This paper describes a study that will develop research and communication protocols and adapt two evidence-based treatments, dual-diagnosis motivational interviewing (DDMI) and integrated group therapy (IGT), for delivery to adults with CODs across a jail-to-community treatment continuum. METHODS/DESIGN: Adaptations to DDMI and IGT were guided by the Risk-Need-Responsivity model and the National Institute of Corrections' implementation competencies; the development of the implementation framework and communication protocols were guided by the Evidence-Based Interagency Implementation Model for community corrections and the Inter-organizational Relationship model, respectively. Implementation and evaluation of the protocols and adapted interventions will occur via an open trial and a pilot randomized trial. The clinical intervention consists of two in-jail DDMI sessions and 12 in-community IGT sessions. Twelve adults with CODs and four clinicians will participate in the open trial to evaluate the acceptability and feasibility of, and fidelity to, the interventions and research and communication protocols. The pilot controlled trial will be conducted with 60 inmates who will be randomized to either DDMI-IGT or treatment as usual. A baseline assessment will be conducted in jail, and four community-based assessments will be conducted during a 6-month follow-up period. Implementation, clinical, public health, and treatment preference outcomes will be evaluated. DISCUSSION: Findings have the potential to improve both jail- and community-based treatment services for adults with CODs as well as inform methods for conducting rigorous pilot implementation and evaluation research in correctional settings and as inmates re-enter the community. Findings will contribute to a growing area of work focused on interrupting the cycle of limited treatment engagement, unaddressed criminogenic risks, and (re)arrest among adults with CODs. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02214667 . Registered on 10 August 2014.

The intersection of interpersonal and self-directed violence among general adult, college student and sexually diverse samples.

BACKGROUND: Suicide and interpersonal violence (i.e. victimization and perpetration) represent pressing public health problems, and yet remain mostly addressed as separate topics. AIMS: To identify the (1) frequency and overlap of suicide and interpersonal violence and (2) characteristics differentiating subgroups of violence-related experiences. METHODS: A health survey was completed by 2,175 respondents comprised of three groups: college students ( n = 702), adult members of a sexuality special interest organization ( n = 816) and a community adult sample ( n = 657). Latent class analysis was used to identify subgroups characterized by violence experiences; logistic regression was used to identify respondent characteristics differentiating subgroups. RESULTS: Overall rates of violence perpetration were low; perpetration, victimization and self-directed violence all varied by sample. Adults with alternative sexual interests reported high rates of victimization and self-directed violence. Analyses indicated two subgroups: (1) victimization + self-directed violence and (2) self-directed violence only. The victimization + self-directed violence subgroup was characterized by older, White, female and sexual orientation minority persons. The self-directed violence subgroup was characterized by younger, non-White, male and straight counterparts engaging with more sexual partners and more frequent drug use. CONCLUSION: Findings support the Centers for Disease Control and Prevention (CDC) definition of suicide as self-directed violence. Suicide intervention and prevention should further account for the role of violent victimization by focusing on the joint conceptualization of self-directed and interpersonal violence. Additional prevention implications are discussed.

Upstream watershed condition predicts rural children's health across 35 developing countries.

Diarrheal disease (DD) due to contaminated water is a major cause of child mortality globally. Forests and wetlands can provide ecosystem services that help maintain water quality. To understand the connections between land cover and childhood DD, we compiled a database of 293,362 children in 35 countries with information on health, socioeconomic factors, climate, and watershed condition. Using hierarchical models, here we find that higher upstream tree cover is associated with lower probability of DD downstream. This effect is significant for rural households but not for urban households, suggesting differing dependence on watershed conditions. In rural areas, the effect of a 30% increase in upstream tree cover is similar to the effect of improved sanitation, but smaller than the effect of improved water source, wealth or education. We conclude that maintaining natural capital within watersheds can be an important public health investment, especially for populations with low levels of built capital.Globally diarrheal disease through contaminated water sources is a major cause of child mortality. Here, the authors compile a database of 293,362 children in 35 countries and find that upstream tree cover is linked to a lower probability of diarrheal disease and that increasing tree cover may lower mortality.

Performance of recidivism risk assessment instruments in U.S. correctional settings.

With the population of adults under correctional supervision in the United States at an all-time high, psychologists and other professionals working in U.S. correctional agencies face mounting pressures to identify offenders at greater risk of recidivism and to guide treatment and supervision recommendations. Risk assessment instruments are increasingly being used to assist with these tasks; however, relatively little is known regarding the performance of these tools in U.S. correctional settings. In this review, we synthesize the findings of studies examining the predictive validity of assessments completed using instruments designed to predict general recidivism risk, including committing a new crime and violating conditions of probation or parole, among adult offenders in the United States. We searched for studies conducted in the United States and published between January 1970 and December 2012 in peer-reviewed journals, government reports, master's theses, and doctoral dissertations using PsycINFO, the U.S. National Criminal Justice Reference Service Abstracts, and Google. We identified 53 studies (72 samples) conducted in U.S. correctional settings examining the predictive validity of 19 risk assessment instruments. The instruments varied widely in the number, type, and content of their items. For most instruments, predictive validity had been examined in 1 or 2 studies conducted in the United States that were published during the reference period. Only 2 studies reported on interrater reliability. No instrument emerged as producing the "most" reliable and valid risk assessments. Findings suggest the need for continued evaluation of the performance of instruments used to predict recidivism risk in U.S. correctional agencies. (PsycINFO Database Record