Digital Personal Health Coaching Platform for Promoting Human Papillomavirus Infection Vaccinations and Cancer Prevention: Knowledge Graph-Based Recommendation System.

BACKGROUND: Health promotion can empower populations to gain more control over their well-being by using digital interventions that focus on preventing the root causes of diseases. Digital platforms for personalized health coaching can improve health literacy and information-seeking behavior, leading to better health outcomes. Personal health records have been designed to enhance patients' self-management of a disease or condition. Existing personal health records have been mostly designed and deployed as a supplementary service that acts as views into electronic health records. OBJECTIVE: We aim to overcome some of the limitations of electronic health records. This study aims to design and develop a personal health library (PHL) that generates personalized recommendations for human papillomavirus (HPV) vaccine promotion and cancer prevention. METHODS: We have designed a proof-of-concept prototype of the Digital Personal Health Librarian, which leverages machine learning; natural language processing; and several innovative technological infrastructures, including the Semantic Web, social linked data, web application programming interfaces, and hypermedia-based discovery, to generate a personal health knowledge graph. RESULTS: We have designed and implemented a proof-of-the-concept prototype to showcase and demonstrate how the PHL can be used to store an individual's health data, for example, a personal health knowledge graph. This is integrated with web-scale knowledge to support HPV vaccine promotion and prevent HPV-associated cancers among adolescents and their caregivers. We also demonstrated how the Digital Personal Health Librarian uses the PHL to provide evidence-based insights and knowledge-driven explanations that are personalized and inform health decision-making. CONCLUSIONS: Digital platforms such as the PHL can be instrumental in improving precision health promotion and education strategies that address population-specific needs (ie, health literacy, digital competency, and language barriers) and empower individuals by facilitating knowledge acquisition to make healthy choices.

Application of the theoretical domains framework to identify factors influencing catch-up HPV vaccinations among male college students in the United States: A review of evidence and recommendations.

BACKGROUND: Genital human papillomavirus (HPV) infection is the most prevalent sexually transmitted infection among young adults ages 15-25 years in the United States (US). Although HPV vaccines are recommended for individuals ages through 26 years, vaccine completion rates remain substantially low. METHODS: Accordingly, our study utilized a comprehensive - Theoretical Domains Framework (TDF) of behavior change to systematically identify facilitators and barriers to catch-up HPV vaccinations. Five databases - Medline, Embase, CINAHL, ERIC, and PsycINFO were searched from January 2009 to July 2019 for empirical studies using quantitative and qualitative methods to assess HPV vaccine uptake among males ages 18-26 years within US college and university settings. The TDF analytic process included a content analysis using the mixed deductive-inductive approach to extract, analyze and categorize data into TDF domains/themes and sub-themes. RESULTS: Overall, 17 studies were selected for data extraction. We identified eleven key TDF domains that influenced HPV vaccination behavior among college male students: 'knowledge' (82% of included studies), 'environmental context and resources' (53%), 'beliefs about consequences' (53%), 'unrealistic optimism' (50%) and 'pessimism' (6%), 'emotion' (50%), 'social influences' (50%), 'beliefs about capabilities' (41%), 'intention' (24%), 'reinforcement' (18%), 'social professional role and identity'(12%), and 'behavioral regulation' (12%). Barriers influencing HPV vaccine uptake included lack of knowledge and awareness regarding HPV infections, HPV vaccine safety, effectiveness, side effects, and costs; absence of health providers' recommendations; lack of healthcare and health insurance; low levels of perceived susceptibility and severity for HPV infections; HPV vaccine misinformation; as well as social stigma and peer influences regarding HPV vaccinations. Enablers for HPV vaccine uptake included high levels of perceived benefits for HPV vaccines. DISCUSSION: Our study theoretically identified factors influencing HPV vaccinations. This could inform the efficient planning, support, and implementation of interventions that facilitate catch-up HPV vaccination practices among high-risk males within college/university settings.

Midwives' knowledge and perceived barriers to screening alcohol use among pregnant women in a southwestern US state.

INTRODUCTION: Alcohol consumption during pregnancy can produce multiple damaging outcomes to the foetus, commonly referred to as fetal alcohol spectrum disorders (FASD). FASD represents the leading non-genetic cause of preventable birth defects in the United States where alcohol guidelines recommend pregnant woman abstain from alcohol use. This study examined: (i) midwives' knowledge, attitude and intent to screen for prenatal alcohol use; and (ii) assessed perceived barriers to communicating alcohol-related information. METHODS: Using an online questionnaire, data were obtained from midwives (n = 61) in a southwestern US state between March and May 2018. Descriptive statistics were used to describe midwives' knowledge, attitude, intent and perceived barriers. RESULTS: Several midwives considered one alcoholic beverage per occasion to be safe for the foetus (20.3%), some thought alcohol was safe during the 3rd trimester (14.8%) only and few thought it was safe in all trimesters. Many midwives (63.3%) were unaware that the TWEAK and T-ACE were validated alcohol screening tools for pregnant women. Furthermore, most midwives (>50%) agreed that limited time with patients, a need for additional training and lack of information on referral resources interfered with their sharing of alcohol abstinence guidelines. Midwives reported highly favourable attitudes and intentions toward sharing alcohol abstinence messages with their pregnant patients. DISCUSSION AND CONCLUSIONS: More in-depth research and larger samples are needed to explore barriers (knowledge gaps, limited time with patients, need for additional training) that hinder midwives' dissemination of abstinence messages to pregnant women and limit the uptake of validated alcohol screening tools.

Healthcare professionals' perceptions and recommendations regarding adolescent vaccinations in Georgia and Tennessee during the COVID-19 pandemic: A qualitative research.

INTRODUCTION: Despite its benefits, HPV vaccine uptake has been historically lower than other recommended adolescent vaccines in the United States (US). While hesitancy and misinformation have threatened vaccinations for many years, the adverse impacts from COVID-19 pandemic on preventive services have been far-reaching. OBJECTIVES: To explore the perceptions and experiences of adolescent healthcare providers regarding routine vaccination services during the COVID-19 pandemic. METHODOLOGY: Between December 2020 and May 2021, in-depth qualitative interviews were conducted via Zoom video conferencing among a purposively selected, diverse group of adolescent healthcare providers (n = 16) within 5 healthcare practices in the US southeastern states of Georgia and Tennessee. Audio recordings were transcribed verbatim and analyzed using a rapid qualitative analysis framework. Our analysis was guided by the grounded theory and inductive approach. RESULTS: Participants reported that patient-provider communications; effective use of presumptive languaging; provider's continuing education/training; periodic reminders/recall messages; provider's personal conviction on vaccine safety/efficacy; early initiation of HPV vaccination series at 9 years; community partnerships with community health navigators/vaccine champions/vaccine advocates; use of standardized forms/prewritten scripts/standard operating protocols for patient-provider interactions; and vaccine promotion through social media, brochures/posters/pamphlets as well as outreaches to schools and churches served as facilitators to adolescent HPV vaccine uptake. Preventive adolescent services were adversely impacted by the COVID-19 pandemic at all practices. Participants highlighted an initial decrease in patients due to the pandemic, while some practices avoided the distribution of vaccine informational materials due to sanitary concerns. CONCLUSION: As part of a larger study, we provided contextual information to refine an intervention package currently being developed to improve adolescent preventive care provision in healthcare practices. Our results could inform the implementation of comprehensive intervention strategies that improve HPV vaccination rates. Additionally, lessons learned (e.g. optimizing patient- provider interactions) could be adopted to expand COVID-19 vaccine acceptance on a sizable scale.

Association Between Neighborhood Factors and Adult Obesity in Shelby County, Tennessee: Geospatial Machine Learning Approach.

BACKGROUND: Obesity is a global epidemic causing at least 2.8 million deaths per year. This complex disease is associated with significant socioeconomic burden, reduced work productivity, unemployment, and other social determinants of health (SDOH) disparities. OBJECTIVE: The objective of this study was to investigate the effects of SDOH on obesity prevalence among adults in Shelby County, Tennessee, the United States, using a geospatial machine learning approach. METHODS: Obesity prevalence was obtained from the publicly available 500 Cities database of Centers for Disease Control and Prevention, and SDOH indicators were extracted from the US census and the US Department of Agriculture. We examined the geographic distributions of obesity prevalence patterns, using Getis-Ord Gi* statistics and calibrated multiple models to study the association between SDOH and adult obesity. Unsupervised machine learning was used to conduct grouping analysis to investigate the distribution of obesity prevalence and associated SDOH indicators. RESULTS: Results depicted a high percentage of neighborhoods experiencing high adult obesity prevalence within Shelby County. In the census tract, the median household income, as well as the percentage of individuals who were Black, home renters, living below the poverty level, 55 years or older, unmarried, and uninsured, had a significant association with adult obesity prevalence. The grouping analysis revealed disparities in obesity prevalence among disadvantaged neighborhoods. CONCLUSIONS: More research is needed to examine links between geographical location, SDOH, and chronic diseases. The findings of this study, which depict a significantly higher prevalence of obesity within disadvantaged neighborhoods, and other geospatial information can be leveraged to offer valuable insights, informing health decision-making and interventions that mitigate risk factors of increasing obesity prevalence.

Examining the Implementation of Digital Health to Strengthen the COVID-19 Pandemic Response and Recovery and Scale up Equitable Vaccine Access in African Countries.

The COVID-19 pandemic has profoundly impacted the world, having taken the lives of over 6 million individuals. Accordingly, this pandemic has caused a shift in conversations surrounding the burden of diseases worldwide, welcoming insights from multidisciplinary fields including digital health and artificial intelligence. Africa faces a heavy disease burden that exacerbates the current COVID-19 pandemic and limits the scope of public health preparedness, response, containment, and case management. Herein, we examined the potential impact of transformative digital health technologies in mitigating the global health crisis with reference to African countries. Furthermore, we proposed recommendations for scaling up digital health technologies and artificial intelligence-based platforms to tackle the transmission of the SARS-CoV-2 and enable equitable vaccine access. Challenges related to the pandemic are numerous. Rapid response and management strategies-that is, contract tracing, case surveillance, diagnostic testing intensity, and most recently vaccine distribution mapping-can overwhelm the health care delivery system that is fragile. Although challenges are vast, digital health technologies can play an essential role in achieving sustainable resilient recovery and building back better. It is plausible that African nations are better equipped to rapidly identify, diagnose, and manage infected individuals for COVID-19, other diseases, future outbreaks, and pandemics.

Sentiment Analysis of the Covid-19 Vaccines on Social Media.

The COVID-19 pandemic fueled one of the quickest vaccine developments in history. Misinformation on online social media often leads to negative vaccine sentiment. We conducted a sentiment analysis and Latent Dirichlet Allocation topic modeling from Reddit communities focusing on the COVID-19 vaccine. Polarity analysis suggested these communities expressed positive sentiment regarding the vaccine. However, topic modeling revealed community members mainly focused on the side effects and vaccination experience.

Social Determinants and Indicators of COVID-19 Among Marginalized Communities: A Scientific Review and Call to Action for Pandemic Response and Recovery.

Coronavirus disease 2019 (COVID-19) has placed massive socio-psychological, health, and economic burdens including deaths on countless lives; however, it has disproportionally impacted certain populations. Co-occurring Social Determinants of Health (SDoH) disparities and other underlying determinants have exacerbated the COVID-19 pandemic. This literature review sought to (1) examine literature focused on SDoH and COVID-19 outcomes ie, infectivity, hospitalization, and death rates among marginalized communities; and (2) identify SDoH disparities associated with COVID-19 outcomes. We searched electronic databases for studies published from October 2019 to October 2021. Studies that were selected were those intersecting SDoH indicators and COVID-19 outcomes and were conducted in the United States. Our review underscored the disproportionate vulnerabilities and adverse outcomes from COVID-19 that have impacted racial/ethnic minority communities and other disadvantaged groups (ie, senior citizens, and displaced/homeless individuals). COVID-19 outcomes were associated with SDoH indicators, ie, race/ethnicity, poverty, median income level, housing density, housing insecurity, health-care access, occupation, transportation/commuting patterns, education, air quality, food insecurity, old age, etc. Our review concluded with recommendations and a call to action to integrate SDoH indicators along with relevant health data when implementing intelligent solutions and intervention strategies to pandemic response/recovery among vulnerable populations.

Examining the Implementation of Digital Health to Strengthen the COVID-19 Pandemic Response and Recovery and Scale up Equitable Vaccine Access in African Countries.

The COVID-19 pandemic has profoundly impacted the world, having taken the lives of over 6 million individuals. Accordingly, this pandemic has caused a shift in conversations surrounding the burden of diseases worldwide, welcoming insights from multidisciplinary fields including digital health and artificial intelligence. Africa faces a heavy disease burden that exacerbates the current COVID-19 pandemic and limits the scope of public health preparedness, response, containment, and case management. Herein, we examined the potential impact of transformative digital health technologies in mitigating the global health crisis with reference to African countries. Furthermore, we proposed recommendations for scaling up digital health technologies and artificial intelligence-based platforms to tackle the transmission of the SARS-CoV-2 and enable equitable vaccine access. Challenges related to the pandemic are numerous. Rapid response and management strategies-that is, contract tracing, case surveillance, diagnostic testing intensity, and most recently vaccine distribution mapping-can overwhelm the health care delivery system that is fragile. Although challenges are vast, digital health technologies can play an essential role in achieving sustainable resilient recovery and building back better. It is plausible that African nations are better equipped to rapidly identify, diagnose, and manage infected individuals for COVID-19, other diseases, future outbreaks, and pandemics.

HPV-Associated Anal Cancer Knowledge, Attitudes, and Health Communication Behaviors Among Non-clinical Providers at HIV/AIDS Service Organizations in Southern United States Region.

Co-infection with HIV/HPV and bio-behavioral risk factors (e.g., immunodeficiency, un-protected sex) increase likelihood for developing anal and other HPV-associated cancers among people living with HIV/AIDS (PLWHA). We explored knowledge, attitudes, and health communication regarding HPV-associated anal cancers among HIV/AIDS service organization (ASO) employees/volunteers delivering non-clinical services to PLWHA. Participants (n=59) were recruited from six ASOs located in the South United States Census region and completed a 118-item self-administered survey. For current analyses, outcome measures were knowledge, attitudes, and health communication regarding anal cancer. Descriptive statistics assessed outcome measures which were subsequently dichotomized into binary variables (i.e., high/favorable or low/unfavorable). Fisher's exact test examined associations between outcome measures and ASO employees/volunteers' sex/sexual orientation (i.e., heterosexual female, heterosexual male, LGBTI female, LGBTI male). Mean age for ASO employees/volunteers was 45.5 years (±13.5 SD). Participants were heterosexual females (45.7%), LGBTI males (27.3%), heterosexual males (13.5%), and LGBTI females (13.5%). Almost half (44.8%) had not heard about anal Pap screening and 39.0% did not think HPV can cause anal cancer. Overall, 73.9% had low knowledge scores. Participants (47.4%) were unsure or believed HPV vaccinations were non-protective against anal cancer while 94.9% had favorable health communication behaviors. Knowledge regarding anal cancer being linked to HPV (p=0.006) and health information seeking on anal cancer (p=0.000) were statistically significantly different by sex/sexual orientation. Fostering increased knowledge, favorable attitudes, and improved health communication behaviors among ASO employees/volunteers could facilitate dissemination and promotion of anal cancer prevention strategies (anal Pap screenings, HPV vaccinations) among PLWHA.

A 10-year systematic review of theory-driven approaches to increasing catch-up HPV vaccination rates among young adult males in colleges/university settings.

OBJECTIVE: To describe rates and identify factors associated with human papillomavirus (HPV) vaccination among young adult males in college/university settings. METHODS: Study was reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Five electronic databases were searched for empirical studies published between 2009 and 2019 and focused on predictors for HPV vaccine uptake. Studies' methodological quality scores ranged between 12 and 23 points. RESULTS: Five hundred and ninety eight titles/abstracts and 154 full-text articles were screened. Eighteen studies were included for final analysis. Results depicted participants' attitude, perceived susceptibility, severity, benefits, and barriers in receiving HPV vaccine. Many participants did not perceive themselves to be susceptible to HPV infection, and barriers to receiving HPV vaccine outweighed benefits. HPV knowledge and vaccination rates were relatively low among respondents. CONCLUSION: Prevention campaigns that increase knowledge, promote positive attitudes, change perception of susceptibility, and address barriers may result in higher HPV vaccination rates among males in college/university settings.

Network Analysis of COVID-19 Vaccine Misinformation on Social Media.

Almost half of the world population has received at least one dose of vaccine against the COVID-19 virus. However, vaccine hesitancy amongst certain populations is driving new waves of infections at alarming rates. The popularity of online social media platforms attracts supporters of the anti-vaccination movement who spread misinformation about vaccine safety and effectiveness. We conducted a semantic network analysis to explore and analyze COVID-19 vaccine misinformation on the Reddit social media platform.

A Digital Personal Health Library for Enabling Precision Health Promotion to Prevent Human Papilloma Virus-Associated Cancers.

Human papillomavirus (HPV) causes the most prevalent sexually transmitted infection (STI) in the United States. Sexually active young adults are susceptible to HPV, accounting for approximately 50% of new STIs. Oncogenic HPV subtypes 16 and 18 are associated with squamous intraepithelial lesions and cancers and are mostly preventable through prophylactic HPV vaccination. Accordingly, this study's objectives are to (1) summarize SDoH barriers and implication for low HPV vaccination rates among young adults (18-26 years), (2) propose a digital health solution that utilizes the PHL to collect, integrate, and manage personalized sexual and health information, and (3) describe the features of the PHL-based app. Through the application of novel techniques from artificial intelligence, specifically knowledge representation, semantic web, and natural language processing, this proposed PHL-based application will compile clinical, biomedical, and SDoH data from multi-dimensional sources. Therefore, this application will provide digital health interventions that are customized to individuals' specific needs and capacities. The PHL-based application could promote management and usage of personalized digital health information to facilitate precision health promotion thereby, informing health decision-making regarding HPV vaccinations, routine HPV/STI testing, cancer screenings, vaccine safety/efficacy/side effects, and safe sexual practices. In addition to detecting vaccine hesitancy, disparities and perceived barriers, this application could address participants' specific needs/challenges with navigating health literacy, technical skills, peer influence, education, language, cultural and spiritual beliefs. Precision health promotion focused on improving knowledge acquisition and information-seeking behaviors, promoting safe sexual practices, increasing HPV vaccinations, and facilitating cancer screenings could be effective in preventing HPV-associated cancers.

Public sentiment analysis and topic modeling regarding COVID-19 vaccines on the Reddit social media platform: A call to action for strengthening vaccine confidence.

BACKGROUND: The COVID-19 pandemic fueled one of the most rapid vaccine developments in history. However, misinformation spread through online social media often leads to negative vaccine sentiment and hesitancy. METHODS: To investigate COVID-19 vaccine-related discussion in social media, we conducted a sentiment analysis and Latent Dirichlet Allocation topic modeling on textual data collected from 13 Reddit communities focusing on the COVID-19 vaccine from Dec 1, 2020, to May 15, 2021. Data were aggregated and analyzed by month to detect changes in any sentiment and latent topics. RESULTS: Polarity analysis suggested these communities expressed more positive sentiment than negative regarding the vaccine-related discussions and has remained static over time. Topic modeling revealed community members mainly focused on side effects rather than outlandish conspiracy theories. CONCLUSION: Covid-19 vaccine-related content from 13 subreddits show that the sentiments expressed in these communities are overall more positive than negative and have not meaningfully changed since December 2020. Keywords indicating vaccine hesitancy were detected throughout the LDA topic modeling. Public sentiment and topic modeling analysis regarding vaccines could facilitate the implementation of appropriate messaging, digital interventions, and new policies to promote vaccine confidence.

An Urban Population Health Observatory System to Support COVID-19 Pandemic Preparedness, Response, and Management: Design and Development Study.

BACKGROUND: COVID-19 is impacting people worldwide and is currently a leading cause of death in many countries. Underlying factors, including Social Determinants of Health (SDoH), could contribute to these statistics. Our prior work has explored associations between SDoH and several adverse health outcomes (eg, asthma and obesity). Our findings reinforce the emerging consensus that SDoH factors should be considered when implementing intelligent public health surveillance solutions to inform public health policies and interventions. OBJECTIVE: This study sought to redefine the Healthy People 2030's SDoH taxonomy to accommodate the COVID-19 pandemic. Furthermore, we aim to provide a blueprint and implement a prototype for the Urban Population Health Observatory (UPHO), a web-based platform that integrates classified group-level SDoH indicators to individual- and aggregate-level population health data. METHODS: The process of building the UPHO involves collecting and integrating data from several sources, classifying the collected data into drivers and outcomes, incorporating data science techniques for calculating measurable indicators from the raw variables, and studying the extent to which interventions are identified or developed to mitigate drivers that lead to the undesired outcomes. RESULTS: We generated and classified the indicators of social determinants of health, which are linked to COVID-19. To display the functionalities of the UPHO platform, we presented a prototype design to demonstrate its features. We provided a use case scenario for 4 different users. CONCLUSIONS: UPHO serves as an apparatus for implementing effective interventions and can be adopted as a global platform for chronic and infectious diseases. The UPHO surveillance platform provides a novel approach and novel insights into immediate and long-term health policy responses to the COVID-19 pandemic and other future public health crises. The UPHO assists public health organizations and policymakers in their efforts in reducing health disparities, achieving health equity, and improving urban population health.

HemPHL: A Personal Health Library and mHealth Recommender to Promote Self-Management of Hemophilia.

Hemophilia is a rare inherited bleeding disorder characterized by the blood's inability to clot and could result in potentially life-threatening spontaneous bleeding into joints, organs, and tissues. Moreover, long-term management of this chronic disease is complex and costly. Current scientific evidence demonstrates that personalized digital health technologies could promote and facilitate the self-management of chronic diseases. This study introduces HemPHL a Personal Health Library and mHealth Recommender platform to gather, manage, and exchange tailored health information and recommendations to facilitate self-management and home therapy among individuals with hemophilia. The proposed digital health solution will adopt novel data science, artificial intelligence tools and techniques to manage and use information, as well as promote best practices for health education to enable patients to make informed decisions about their health. To accomplish this, an array of complex health and non-health information will be obtained from multi-dimensional sources to develop a secure, single access point of information for patient use. Patient's access to personalized health information could harness their engagement and independence as well as empower them to remotely monitor their health progress and improve compliance with treatment plans. This hemophilia-focused, user-centered app can markedly improve patients' clinical outcomes and overall quality of life.

Addressing Parental Vaccine Hesitancy and Other Barriers to Childhood/Adolescent Vaccination Uptake During the Coronavirus (COVID-19) Pandemic.

Routine childhood immunizations are proven to be one of the most effective public health interventions at controlling numerous deadly diseases. Therefore, the CDC recommends routine immunizations for children and adolescent populations against vaccine-preventable diseases e.g., tetanus, pertussis, diphtheria, etc. This current review sought to examine barriers to pediatric vaccine uptake behaviors during the COVID-19 pandemic. We also explored the implications for parental vaccine hesitancy/delay during an ongoing health crisis and proposed recommendations for increasing vaccine confidence and compliance. Our review determined that the receipt for vaccinations steadily improved in the last decade for both the United States and Tennessee. However, this incremental progress has been forestalled by the COVID-19 pandemic and other barriers i.e. parental vaccine hesitancy, social determinants of health (SDoH) inequalities, etc. which further exacerbate vaccination disparities. Moreover, non-compliance to routine vaccinations could cause an outbreak of diseases, thereby, worsening the ongoing health crisis and already strained health care system. Healthcare providers are uniquely positioned to offer effective recommendations with presumptive languaging to increase vaccination rates, as well as, address parental vaccine hesitancy. Best practices that incorporate healthcare providers' quality improvement coaching, vaccination reminder recall systems, adherence to standardized safety protocols (physical distancing, hand hygiene practices, etc.), as well as, offer telehealth and outdoor/drive-through/curbside vaccination services, etc. are warranted. Additionally, a concerted effort should be made to utilize public health surveillance systems to collect, analyze, and interpret data, thereby, ensuring the dissemination of timely, accurate health information for effective health policy decision-making e.g., vaccine distribution, etc.

Alcohol messages disseminated to pregnant women by midwives.

BACKGROUND: Pregnant women frequently report inconsistent messages regarding alcohol consumption from their healthcare providers. Midwives play a major role in prenatal care. However, little research has examined alcohol-related information provided by midwives. OBJECTIVE: To examine alcohol-related messages disseminated to pregnant women by midwives. METHODS: In 2018, 61 certified professional midwives (CPMs) and certified nurse-midwives (CNMs) were recruited from professional organizations in a southwestern state. Midwives responded to an online cross-sectional survey containing the prompt: "A pregnant patient confides in you that she drinks alcohol. She then asks you to tell her a "safe" level of alcohol consumption that won't cause harm to her unborn fetus. How would you respond?" Open-ended responses were analyzed through content analysis and categorized using an inductive approach. RESULTS: Responses were grouped into five non-exclusive themes: "harmful effects and unknown safe limits" (77.0%); "abstaining is best" (50.8%); "light drinking is acceptable" (16.4%); "describe your drinking" (21.3%); "I will refer you" (16.4%). The most frequently shared messages were "safe levels of prenatal alcohol use are unknown" (68.9%) and "discontinue alcohol during pregnancy" (45.9%). However, some messages contradicted US dietary guidelines, including "a little bit of alcohol unlikely to cause harm" (11.5%); "cut-down if having more than 1-2 drinks per occasion" (4.9%); and "if you must drink, wine is best" (1.6%). CPMs were less likely to share abstinence messages (p = .003) and more likely to suggest referrals (p = .024), compared to CNMs. CONCLUSION: Concerted efforts are needed to ensure information disseminated aligns with health guidelines and encourages abstinence during pregnancy.

Dissemination of Prenatal Drinking Guidelines: A Preliminary Study Examining Personal Alcohol Use Among Midwives in a Southwestern US State.

INTRODUCTION: The constellation of birth defects seen in fetuses exposed to alcohol in utero have been described as fetal alcohol spectrum disorders. Evidence suggests that health care providers' communication practices regarding prenatal alcohol use could have beneficial outcomes. There is a paucity of investigations, however, that have examined the health professionals' personal alcohol use and prenatal alcohol recommendations they provide. METHODS: This study sought to examine and compare midwives' personal alcohol use and communication practices regarding prenatal alcohol consumption. Certified nurse-midwives (CNMs) and certified professional midwives (CPMs) in a southwestern US state participated. Inclusion criteria included training in prenatal care, labor, birth, and membership in a midwife professional organization. Personal drinking behaviors were assessed with Alcohol Use Disorder Identification Test-Consumption (AUDIT-C). RESULTS: All midwives (N = 61; 100%) reported they typically screened a patient for alcohol use during an initial prenatal visit. However, 5 (8.2%) respondents opted for recommendations that advised patients to drink once in a while. Similarly, 4 (6.6%) midwives counseled no more than one drink per day. In the cohort of participants (n = 40) with AUDIT-C scores, 25 (62.5%) engaged in nonrisky drinking (AUDIT-C scores <3). Most respondents (n = 39 of 40; 97.5%) typically consumed 1 to 2 standard drinks on the day they drank. There was no statistically significant difference in mean overall AUDIT-C scores between CNMs and CPMs (P = .42). When examining midwives' (1) responses on the AUDIT-C questionnaire, (2) nonrisky or risky drinking behaviors, and 3) communication practices regarding prenatal alcohol use, Fisher's exact test showed no statistically significant differences between CNMs and CPMs. DISCUSSION: Results of this study highlight the importance of advocating healthy lifestyles among health care professionals while also promoting communication practices that align with national alcohol guidelines. Future investigations that examine associations between health care professionals' personal alcohol use and type or effectiveness of services offered to patients may be beneficial.

Socio-Ecological Factors of Adolescent Substance Use in Nigeria: A Systematic Review of Literature.

Adolescent substance use is influenced by a multitude of socio-ecological factors ranging from intrapersonal to policy-related. We systematically searched electronic databases using variations and Boolean connections of substance use terms to identify literature on Nigerian adolescent substance use (alcohol, drugs, and tobacco). Using the social ecological model to organize findings from the review, we present the intrapersonal, interpersonal, institutional, community, and/or policy factors of substance use identified in the studies. Of the 13 studies reviewed, most examined only intrapersonal and interpersonal factors affecting Nigerian adolescent substance use, while none clearly examined the impact of other ecological levels (community and policy) on adolescent substance use. All the studies reviewed were cross-sectional, and none employed a sound theoretical framework to guide their inquiry. This review underscores the need for future theory-driven, longitudinal research that captures the dynamic nature of Nigerian adolescent substance use behaviors and other associated health-related behaviors, such as sexual behaviors and intentional/unintentional injuries.