Parenting a High and Growing Population of Youth in the Arab Region: A Scoping Review for an Evidence-Informed Research Agenda.

The Arab region is experiencing the largest youth cohort in its history. Parental influence is a clear factor in the well-being of this demographic. This scoping review serves as the first consolidated synthesis of existing research on parenting in the Arab world, aimed at identifying research gaps and informing future research agendas. Searches of 18 databases resulted in 4,758 records (1995-2018) in all languages. Using Arksey and O'Malley's methodological framework, eligible studies (n = 152) underwent duplicate data abstraction. An evidence gap map was developed using 3i.e.'s platform. Studies were mostly published in English (88%), and lead authors' affiliations were mostly from Arab institutions. Included studies were mostly cross-sectional (89%), quantitative (96%), conducted in a school/university (83%), and surveyed children and adolescents (70%). Most studies (79%) examined parenting influences on youth outcomes. Fewer examined parenting measurement (30%) or evaluated interventions (1%). Mental health and school performance were the most commonly investigated outcomes. The evidence gap map allows researchers who study youth in the Arab world to efficiently and visually delineate the gaps and strategically prioritize research needs. Future studies should employ robust mixed methods study designs, focus on evaluation and psychometric research, engage youth in the research process and explore a more diverse set of outcomes.

The "dirty work" of last responders: Occupational stigma risk and protective factors.

Last responders constitute an occupational category that includes all those who are involved in the postmortem care of deceased persons and their families. The work of last responders is often considered "dirty work" and, as a result, stigmatized. Last responders are aware of this stigma, and stigma consciousness has been associated with negative health outcomes. Despite the wide acknowledgment of stigma among last responders, specific risk, or protective factors for experiencing stigma have not been investigated. This paper aims to identify determinants of stigma among last responders in the United States. The data for this study were obtained from a national cross-sectional survey of last responders. The survey included a measure of stigma and multiple sociodemographic characteristics. A hurdle model was used to assess the association between the characteristics of last responders and their perceived stigma. Respondents were predominantly male (55.1%), White non-Hispanic (90.2%), and employed full-time (96%). Seventy-seven percent reported having experienced at least one form of occupation-related stigma. There was no significant association between the experience of stigma and any socio-demographic variables. The experience of stigma is nearly ubiquitous among last responders->75% of last responders in the sample experienced at least one form of stigma. Another aspect of its ubiquitous nature is the lack of evidence that stigma was experienced differentially across sex, race/ethnicity, employment type, and length of years as a last responder. Interventions are needed to decrease stigma among last responders and to support last responders in managing the consequences of the stigma they experience.

The Association Between State Characteristics and Latinx People's Treated Hypertension in Established and New Latinx Destination States: A Multilevel Analysis.

This study sought to quantify the contributions of state-level factors including income inequality, state's legislature political control, and Medicaid expansion in new and established Latinx destination states on Latinx individuals' treated hypertension. Mixed-effects logistic regression analyses were conducted to analyze 2017 Behavioral Risk Factor Surveillance System data from 7524 Latinx adults nested within 39 states. Overall, 70% reported being pharmacologically treated for hypertension, and 66% resided in established destination states. Compared with Latinx people in established destination states, Latinx people in new destinations had lower odds of having treated hypertension (odds ratio [OR] = 0.72, 95% CI = 0.54-0.95). Within established Latinx destinations, the odds of treated hypertension were lower in states where legislatures expanded Medicaid than in states that did not expand Medicaid (OR = 0.84, 95% CI = 0.79-0.89). However, after controlling for the effects of individual-level factors, this association was no longer statistically significant. In new Latinx destination states, Medicaid expansion, legislatures' political control, and income inequality were not associated with treated hypertension. The study results highlight the importance of considering both individual- and state-level factors, as the interplay of such factors could hinder the successful implementation of cardiovascular risk reduction interventions.

Community and Organizational Readiness to Adopt a Physical Activity Intervention in Micropolitan Settings.

BACKGROUND: Assessing community and organizational readiness is key to successfully implementing programs. The purpose of this study was to assess the baseline readiness of micropolitan communities to adopt an evidence-based physical activity (PA) intervention by exploring three dimensions: (1) attitudes and current efforts toward prevention, (2) community and organizational climate that facilitates (or impedes) change, and (3) capacity to implement change. METHOD: Data were collected from community leaders in 14 communities through an online survey in June 2021 (n = 149). Data were analyzed in aggregate using descriptive statistics for multiple-choice responses and content analysis for open ended responses. One-way repeated analyses of variance were used to compare mean score differences. RESULTS: In reference to their attitudes prior to the pandemic, respondents said that addressing PA was "somewhat a priority" in their professional positions (M = 2.01, SD = 0.94), their organizations (M = 2.08, SD = 0.91), and their communities (M = 2.28, SD = 0.88). Current PA efforts included statewide initiatives, community sponsored events/clubs, and youth sports leagues. The community climate included both PA facilitators (mainly outdoor PA resources) and barriers (cost, lack of social services, and an unsupportive PA environment). Individual-level capacity (M = 2.94; SD = 1.21) to adopt a PA program was regarded lower than the community's capacity (M = 3.95; SD = 0.82), and perceptions of capacity at the community level improved even more if technical assistance (M = 3.96; SD = 0.84) or financial support (M = 4.12; SD = 0.80) were provided. CONCLUSION: Readiness varied by dimension, suggesting the need for tailored implementation supports including technical assistance and financial support.

Multidisciplinary approach to community engagement in global public health research.

  Recently, there has been a renewed interest in the role of community engagement in knowledge production and ethical issues such as 'helicopter research', indicating exploitative research activities of some researchers as well as short-term relationships with research communities especially in low- and middle-income countries. This approach is detrimental to both communities and the larger scientific community as this may breed mistrust. Major institutions such as the National Institute of Health and Care Research in the United Kingdom have highlighted the importance of community engagement as a tool to improve the reach, quality, and impact of the research by incorporating the voices and concerns of marginalized communities. Similarly, in its 2022 guidance, the American Society for Human Genetics (ASGH) highlights the need to address underrepresentation in genomics research through community engagement. Establishing ethical and meaningful long-term relationships can be challenging especially for researchers who are not members of the community or those from other countries. This article describes how 'community-engaged research' can address some ethical challenges in global public health in different cultural settings.

Ignored and distressed: a cross-sectional study of the impact of COVID-19 on last responders.

BACKGROUND: Last responders constitute an occupational category that includes all those that are involved in the postmortem care of deceased persons and their families. Last responders are exposed to several categories of work-related stressors that affect their health and well-being. COVID-19 exacerbated these stressors. Research to understand the consequences of COVID-19 on the health and wellbeing of last responders is nascent. This study aimed to assess COVID-19 related stress, coping and wellbeing among last responders in the United States. METHODS: We conducted a national cross-sectional survey of last responders in July through September of 2020. The survey measured wellbeing, stress, coping, and stigma; COVID-19 experiences, and socio-demographics. A ridge regression model was fit for the outcome variables. RESULTS: Analysis was conducted on 366 respondents from 43 states. Respondents were male (55.4%), age 50 + (57.4%), and White non-Hispanic (90.3%); 54% reported moderate-high stress and 41% endorsed mild-severe anxiety. Seventy-seven percent had experienced at least one form of stigma related to their occupation. Variables associated with higher perceived stress and anxiety included gender (female), shorter length of employment, perceiving a higher impact from COVID-19 on everyday life, and increased perceived stigma. CONCLUSIONS: Last responders are a critical part of the health care system. Throughout this pandemic, last responders have been frequently ignored and not prioritized for protection and support. Interventions to support last responders cope with stress, and to decrease anxiety are urgently needed. There is also a critical need to challenge community stigma towards last responders.

Students supporting students: evaluating the impact of the COVID-19 pandemic on resident assistant mental health.

OBJECTIVE: To examine the impact of the novel coronavirus SARS-CoV2 (COVID-19) pandemic on Residents Assistants (RA) at a public university in the Midwest. PARTICIPANTS: Sixty-seven RAs that had been offered an RA position for the '20-'21 academic year. METHODS: An online cross-sectional survey measuring socio-demographics, stress, and well-being was fielded. MANCOVA models evaluated the impact of COVID-19 on well-being of Current RAs and compared to the non-current RA groups. RESULTS: Sixty-seven RAs provided valid data. Overall, 47% of RAs had moderate-severe anxiety and 86.3% had moderate-high level of stress. Current RAs perceiving a great impact of COVID on life had significantly more stress, anxiety, burnout, and secondary traumatic stress than those who did not. RAs who started then quit experienced significantly higher secondary trauma compared to Current RAs. CONCLUSIONS: Further research is needed to better understand the experiences and of RAs and to develop policies and programs to support RAs.

Identifying the Social Determinants of Treated Hypertension in New and Established Latino Destination States.

Little is known about the influence of social and environmental contexts on Latino hypertension-related disparities. This study examined the influence of social determinants of cardiovascular health on medically treated hypertension, contrasting established vs. new Latino destination states. Logistic regression models were fitted to analyze 2017 Behavioral Risk Factors Surveillance Survey data from 8,999 Latinos. Overall, 70.4% indicated having treated hypertension. History of diabetes (OR = 2.60) and access to healthcare (OR = 2.38) were associated with treated hypertension, regardless of destination state. In established destinations, Latinos who graduated high school (OR = 1.19) or attended college (OR = 1.32) had higher odds of treated hypertension; whereas those who completed college were less likely to have treated hypertension (OR = 0.80). In contrast, in both new and non-destination states, the odds of treated hypertension were consistently lower across levels of educational attainment. Results highlight the need for cardiovascular-risk reduction interventions to incorporate the social and environmental context in the development process.

Conceptual framework for systemic capacity strengthening for health policy and systems research.

Health policy and systems research (HPSR) is critical in developing health systems to better meet the health needs of their populations. The highly contextualised nature of health systems point to the value of local knowledge and the need for context-embedded HPSR. Despite such need, relatively few individuals, groups or organisations carry out HPSR, particularly in low-income and middle-income countries. Greater effort is required to strengthen capacity for, and build the field of, HPSR by capturing the multilevel and nuanced representation of HPSR across contexts. No comprehensive frameworks were found that inform systemic HPSR capacity strengthening. Existing literature on capacity strengthening for health research and development tends to focus on individual-level capacity with less attention to collective, organisational and network levels. This paper proposes a comprehensive framework for systemic capacity strengthening for HPSR, uniquely drawing attention to the blurred boundaries and amplification potential for synergistic capacity strengthening efforts across the individual, organisational and network levels. Further, it identifies guiding values and principles that consciously acknowledge and manage the power dynamics inherent to capacity strengthening work. The framework was developed drawing on available literature and was peer-reviewed by the Board and Thematic Working Groups of Health Systems Global. While the framework focuses on HPSR, it may provide a useful heuristic for systemic approaches to capacity strengthening more generally; facilitate its mainstreaming within organisations and networks and help maintain a focused approach to, and structure repositories of resources on, capacity strengthening.

Waterpipe tobacco smoking (WTS) control policies: global analysis of available legislation and equity considerations.

INTRODUCTION: The Framework Convention on Tobacco Control (FCTC) offers guidance on evidence-based policies to reduce tobacco consumption and its burden of disease. Recently, it has provided guidance for alternative tobacco products, such as the waterpipe. Waterpipe tobacco smoking (WTS) is prevalent worldwide and policies to address it need to take into consideration its specificities as a mode of smoking. In parallel, a growing body of literature points to the potential of evidence-based tobacco control policies to increase health inequities. This paper updates a previous global review of waterpipe tobacco policies and adds an equity lens to assess their impact on health inequities. METHODS: We reviewed policies that address WTS in 90 countries, including 10 with state-owned tobacco companies; 47 were included in our final analysis. We relied primarily on the Tobacco-Free Kids organisation's Tobacco Control Laws website, providing access to tobacco control laws globally. We categorised country tobacco policies by the clarity with which they defined and addressed waterpipe tobacco in relation to nine FCTC articles. We used the PROGRESS (Place of residence, Race/ethnicity/culture/language, Occupation, Gender/sex, Religion, Education, Socioeconomic status and Social capital) framework for the equity analysis, by reviewing equity considerations referenced in the policies of each country and including prevalence data disaggregated by equity axis and country where available. RESULTS: Our results revealed very limited attention to waterpipe policies overall, and to equity in such policies, and highlight the complexity of regulating WTS. We recommend that WTS policies and surveillance centre equity as a goal. CONCLUSIONS: Our recommendations can inform global policies to reduce WTS and its health consequences equitably across population groups.

Integrating user experience evaluation in the development of a web-based Community Engagement Toolkit.

Current advances in technology have allowed programs to become more innovative and provide web-based services and products for their participants. This requires evaluators to expand their evaluation repertoire to continue to provide useful and actionable information. Our study illustrates the application of user experience evaluation as part of the formative evaluation of the Community Engagement Toolkit (CETK), developed by the Network of the National Library of Medicine. The CETK is a website containing resources that help library staff deliver health-literacy programming more effectively. The overarching objective of the evaluation was to obtain in-depth feedback from potential users about the website design and content in order to make the toolkit user friendly and useful. We used an online video conferencing software to conduct contextual observations and interviews with geographically dispersed participants. Findings from the evaluation study indicated an overall favorable review of the toolkit's interface and navigation, but relatively less favorable review of content relevance and broad appeal for the participants. Feedback from the participants was used to inform the development of the toolkit to increase the likelihood of its use and value for intended users.

Does knowing about the long-term health effects of alcohol matter? Evidence from a university sample in Lebanon.

BACKGROUND: Research linking awareness of health effects of alcohol and harmful alcohol drinking status is limited. AIMS: To investigate the association between awareness of long-term alcohol effects and alcohol use disorders. METHODS: University students aged 18-25 years (n = 1155) completed a self-filled survey. Participants were asked if they knew that alcohol causes: (1) problems in the liver; (2) cancers of the mouth, throat, oesophagus and breast; (3) damage to the heart; and (4) weakening of the immune system. Multinomial regression analyses were conducted to assess the association between awareness of long-term alcohol effects and alcohol drinking status, including Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) alcohol use disorders. RESULTS: One third (32.8%) were past-year drinkers and 18% screened positive for DSM-5 alcohol use disorders. Compared to past-year drinkers with no alcohol use disorders, non-past-year ever drinkers were twice as likely to know about the link between alcohol and cancers of the mouth, throat, oesophagus and breast. Past-year drinkers with an alcohol use disorders were less likely to know about this association. Non-past-year ever drinkers (vs past-year drinkers with no alcohol use disorders) were also 2.6 times more likely to know the alcohol liver risks. CONCLUSIONS: There is a strong inverse relationship between awareness of the effects of alcohol and harmful consumption among young people, providing preliminary support for the protective nature of knowledge on alcohol drinking status. Efforts to increase public awareness of the long-term health effects of alcohol may be useful in reducing alcohol-related harm.

A call to advance and translate research into policy on governance, ethics, and conflicts of interest in public health: the GECI-PH network.

Efforts to adopt public health policies that would limit the consumption of unhealthy commodities, such as tobacco, alcohol and ultra-processed food products, are often undermined by private sector actors whose profits depend on the sales of such products. There is ample evidence showing that these corporations not only try to influence public health policy; they also shape research, practice and public opinion. Globalization, trade and investment agreements, and privatization, amongst other factors, have facilitated the growing influence of private sector actors on public health at both national and global levels. Protecting and promoting public health from the undue influence of private sector actors is thus an urgent task. With this backdrop in mind, we launched the "Governance, Ethics, and Conflicts of Interest in Public Health" Network (GECI-PH Network) in 2018. Our network seeks to share, collate, promote and foster knowledge on governance, ethical, and conflicts of interest that arise in the interactions between private sectors actors and those in public health, and within multi-stakeholder mechanisms where dividing lines between different actors are often blurred. We call for strong guidance to address and manage the influence of private sector actors on public health policy, research and practice, and for dialogue on this important topic. Our network recently reached 119 members. Membership is diverse in composition and expertise, location, and institutions. We invite colleagues with a common interest to join our network.

High-School Students Rarely Use E-Cigarettes Alone: A Sociodemographic Analysis of Polysubstance Use Among Adolescents in the United States.

INTRODUCTION: Most adolescents reporting e-cigarette use have also used combustible tobacco; however, the extent to which they use other substances is less clear. This study assessed e-cigarette use with tobacco, alcohol, or cannabis and quantified the risk of polysubstance use among adolescents overall and by sociodemographic characteristics. AIMS AND METHODS: Using 2017 Youth Behavioral Risk Factor Surveillance System data from adolescents (grades 9-12) with complete substance use information (n = 11 244), we examined e-cigarette poly-use status (none [referent], e-cigarettes only, or e-cigarettes + other substances). We estimated the prevalence of substance use and modeled odds of e-cigarette use, alone or with other substances, by several sociodemographic characteristics. Analyses were completed in Stata version 15.1 using survey procedures to account for the complex survey design. RESULTS: Approximately 12% of adolescents reported past 30-day e-cigarette use. Almost all (93%) e-cigarette users also reported other substance use; alcohol appeared most frequently in combinations. Odds of e-cigarette single use and e-cigarette poly-use (vs. no use) were higher for males and adolescents with lower grades (odds ratios [ORs] = 1.44-2.31). Racial/ethnic minorities had lower odds of e-cigarette poly-use than White peers (ORs = 0.18-0.61), and bisexual (vs. straight) adolescents were more likely to be e-cigarette poly-users (OR = 1.62). E-cigarette use increased from 9th grade (7%) to 12th grade (16%). CONCLUSIONS: Polysubstance use is highly prevalent among adolescents who use e-cigarettes. Therefore, e-cigarette screening should include the assessment of other substances, especially alcohol. Early and comprehensive prevention efforts to reduce e-cigarette and other substance use could have a substantial beneficial impact on population health over time. IMPLICATIONS: This study extends knowledge about e-cigarette use among adolescents by exploring its use with alcohol, cannabis, and other tobacco products. We found that e-cigarettes were very rarely used alone, and our analysis identified several sociodemographic factors associated with greater odds of e-cigarette polysubstance use. In response, we recommend that prevention interventions address multiple substances concurrently, screen repeatedly to detect new initiation as age increases, focus on e-cigarette use as a less stigmatized entry point to discussions of substance use, and target priority population subgroups.

'When I smoked it, it was like a slap in the face but it felt really good': exploring determinants of midwakh use among young adults in Lebanon.

BACKGROUND: Dokha ('dizziness' in English) is a type of alternative tobacco product (ATP) increasing in popularity in the Arab world; and smoked in a pipe called a midwakh. Midwakh use is common among nationals in the United Arab Emirates (UAE); yet, evidence indicates its spread among expats in the UAE as well as beyond the UAE. Research on midwakh use is nascent, and no qualitative research has been published. This paper explored the context and determinants of midwakh use among young adults in Lebanon using qualitative methods. METHODS: We conducted four focus group discussions with 18 midwakh ever smokers aged 18-25 years in Lebanon. Discussions were recorded, transcribed and thematically analysed using the Pragmatics, Attraction, Communication, Expectations framework. RESULTS: 'Pragmatics' was evident in participants' comments about availability of a supply of dokha. For 'attraction', participants described why they prefer midwakh smoking and compared it to other ATPs. Regarding communication, participants shared terms used to describe their use of midwakh (eg, 'buzz'/taking a hit). Participants also described expectations from smoking midwakh, including stress relief. CONCLUSION: Midwakh smoking is appealing to young adults due to factors such as the 'buzz', perceived harm reduction, stress relief and its ability to satisfy nicotine craving with small amounts of tobacco. As a result, despite experiencing negative effects on first use, young adults choose to continue to use midwakh, and find it hard to quit. These results have implications for prevention and control of midwakh smoking among young adults. Framework Convention on Tobacco Control guidance documents to address ATPs are critically needed to prevent the global spread of yet another tobacco product.

"Taking Up a New Problem": Context and Determinants of Pod-Mod Electronic Cigarette Use Among College Students.

In this article, we explore the context and determinants of pod-mod electronic cigarette (ECIG) use among college students aged 18 to 24 in the United States. We conducted semi-structured interviews with 55 students (M age = 20 years, 56% female, 65% White) on three campuses in the Northwest, Midwest, and Southeast. We performed a thematic analysis. Students described ECIG use by peers, increased ECIG exposure and prevalence in college, and school-related stress as reasons for vaping. Pod-mod features such as convenience, design, easy concealment, and flavors made vaping more appealing. Negative aspects of vaping included addiction, cost, and possible health consequences. Most viewed vaping as a college behavior and intended to quit after graduation. Our results show that the college environment plays a major role in young adult ECIG use. These findings can inform the development of targeted interventions to prevent and control uptake of ECIGs by young adults.

"I Like to Try My Hardest to Keep My Small Family Together": Housing as a Key Resource for Academic Success of Pregnant and Parenting College-Aged Students.

Pregnant and/or parenting students (PPS) face unique challenges to attending college. The prevalence of housing insecurity may be higher among college PPS. Adding to the limited research in this area, our study explores how housing could be a barrier to attending and maintaining academic success in college for PPS. We partnered with a Midwestern community college (CC) to conduct the study, which consisted of (1) an environmental scan of in-state collegiate housing programs available to PPS, (2) an online survey among PPS attending the partner CC, and (3) key informant interviews with providers at agencies serving PPS and high school PPS planning to attend college. Eight of the 18 institutions we identified from our environmental scan offered family housing. Populations most often addressed were married students (56%), families (39%), and single parents (28%). Out of 22 responses from our online survey, about a third of PPS disagreed or strongly disagreed that they felt satisfied with housing support provided by the partnering CC and that housing options offered were family friendly. PPS perceived affordability, proximity to campus and to their children's school, on-site day care, and amenities as important aspects of housing. Key informant participants (n = 9 interviews) described social support, PPS-specific housing, and access to services as important to college attendance. Community college efforts to meet the needs of PPS must consider the unique barriers PPS face to finding affordable and stable housing. Collaborating with local agencies that offer services for PPS is one approach to ensuring their academic success.