Hispanic Men and Women's Knowledge, Beliefs, Perceived Susceptibility, and Barriers to Clinical Breast Examination and Mammography Practices in South Texas Colonias.

Breast cancer is the second leading cause of cancer death among women of all ethnicities. Though the disease is not a primary concern within male populations male perceptions and beliefs of breast cancer screening may contribute to a partner's or loved one's decision to engage in regular mammograms or clinical breast examinations. The current study seeks to explore a comparative analysis of breast cancer knowledge, beliefs, susceptibility, and barriers to female breast cancer and breast cancer screening among Hispanic men and women residing in the Colonias of South Texas. Using a multistage systematic sampling design, 2,812 men and women were surveyed from the two South Texas Counties; Maverick and Val Verde. Individuals between the ages of 20 and 75 (n = 2360) were included in the analysis. T-tests and linear regression models were used to examine gender differences in, knowledge, beliefs, susceptibility, and barriers to breast cancer and breast cancer screening. Significant differences were found between males and females across all measures. Regression analysis demonstrates Hispanic women hold more favorable beliefs about breast cancer and early detection, display higher perceived barriers to clinical breast examinations and mammography, and view themselves more susceptible to the development of breast cancer than their male counterparts. Results framed within a cultural context suggest outreach efforts within South Texas Colonias should consider inclusion of male family members in efforts to increase favorable views toward and engagement in regular breast cancer screening.

Association between quantitative varicella-zoster virus antibody levels and zoster reactivation in HIV-infected persons.

BACKGROUND: Varicella-zoster virus (VZV) reactivation is common but difficult to predict in HIV-infected persons. OBJECTIVE: Since qualitative VZV antibodies can determine past VZV disease or vaccination, we evaluated whether quantitative VZV antibody levels over time can predict future zoster. STUDY DESIGN: US Military HIV Natural History (NHS) participants with a zoster diagnosis at least 5 years after HIV diagnosis (n = 100) were included. Zoster-negative controls (n = 200) were matched by age, race, gender, and CD4 count at HIV diagnosis. Repository plasma specimens collected at baseline and prior to zoster diagnosis were evaluated using a quantitative anti-VZV ELISA assay. Differences in quantitative VZV levels were analyzed by Wilcoxon Mann-Whitney and Fisher's exact tests. RESULTS: Median CD4 count at HIV diagnosis was similar for cases and controls (535 [IQR 384-666] vs. 523 [IQR 377-690] cells/µL; p = 0.940), but lower for cases at zoster diagnosis (436 [IQR 277-631] vs. 527 [IQR 367-744] cells/µL; p = 0.007). Antiretroviral therapy (ART) use prior to zoster diagnosis was lower for cases (52.0%) compared to controls (64.5%; p = 0.025). Cases had similar mean VZV antibody levels prior to zoster diagnosis compared to controls [2.25 ± 0.85 vs. 2.44 ± 0.96 index value/optical density (OD) ratio; p = 0.151] with no difference in the change in antibody levels over time (0.08 ± 0.71 vs. 0.01 ± 0.94 index value/OD per year; p = 0.276). CONCLUSION: Quantitative VZV antibody levels are stable in HIV-infected persons and do not predict zoster reactivation. Low CD4 count and lack of ART use appear to be better predictors of future zoster diagnosis.

Live versus attenuated influenza vaccine uptake and post-vaccination influenza-like illness outcomes in HIV-infected US Air Force members.

BACKGROUND: Although clinical data is limited, guidelines recommend avoiding live attenuated intranasal influenza vaccine (LAIV) in HIV-infected persons. OBJECTIVES: To evaluate non-guideline LAIV use and resulting adverse effects in an HIV-infected population. STUDY DESIGN: A retrospective analysis of influenza vaccination in US Air Force (USAF) members with HIV infection immunized between 2005 and 2015 was performed. Influenza vaccination history after HIV diagnosis was evaluated, including receipt of LAIV or inactivated influenza vaccine (IIV). The proportion with influenza-like illness (ILI) diagnoses within 30days after vaccination with IIV or LAIV was assessed by ICD-9 codes. RESULTS: 437 patients met inclusion criteria, with 121 (27.7%) receiving at least one dose of LAIV and 316 (72.3%) receiving only IIV during follow-up. The mean number of LAIV doses received was 1.5±0.89 (range, 1-4) and the majority (n=50, 82%) received their first LAIV vaccination within the first year after HIV diagnosis. Patients were predominantly males and the LAIV group had a lower mean age at HIV diagnosis (27.5±6.6) compared to the IIV group (30±7.8; p <0.001). Overall, IIV was associated with ILI diagnosis within 30days of vaccination (X2 4.58; p=0.032), with 16 cases (94.1%) occurring in those who received IIV compared to 1 case (5.9%) in those who received LAIV. CONCLUSION: Although over a quarter of USAF members received LAIV after HIV diagnosis, LAIV administration did not show an increased frequency of post-vaccine ILI diagnoses. Further education is needed to ensure that USAF members with HIV infection are vaccinated according to guideline recommendations, particularly newly diagnosed patients.

Stress, Pregnancy, and Motherhood: Implications for Birth Weights in the Borderlands of Texas.

We argue that changes over time in how ideas of stress are incorporated into understandings of pregnancy and motherhood among Mexican immigrant women living in the United States may affect the documented increase of low birth weight infants born to those women. Stress has consistently been linked to low birth weight, and pregnant Mexican American and Mexican immigrant women differ in levels of perceived social stress. What is lacking is an explanation for these differences. We utilize a subset of 36 ethnographic interviews with pregnant immigrant women from northern Mexico and Mexican Americans living in south Texas to demonstrate how meanings of pregnancy and motherhood increasingly integrate notions of stress the longer immigrant Mexican women live in the United States. We situate our results within anthropological and sociological research on motherhood in the United States and Mexico, anthropological research in the U.S.-Mexico borderlands, and interdisciplinary research on Hispanic rates of low birth weight.

Herpes simplex virus seroprevalence and seroconversion among active duty US air force members with HIV infection.

BACKGROUND: Herpes simplex virus (HSV) infection is associated with an increased risk of both HIV transmission and acquisition. We evaluated longitudinal HSV serology and sexually transmitted infections (STIs) among active duty US Air Force (USAF) members with HIV infection. METHODS: USAF members diagnosed with HIV between 1996 and 2012 were included and divided into 2 groups: 1996-2004 (n=131) and 2005-2012 (n=266). HSV-1 and -2 serology was evaluated at HIV diagnosis. Longitudinal HSV-1 and -2 serology and ICD-9 codes for HSV and non-HSV STIs were also examined for those with ≥ 1 year of follow-up. RESULTS: Patients were most commonly Caucasian (44.2%) or African American (43.4%) men with a median age of 28 years at HIV diagnosis. HSV-2 seroprevalence at HIV diagnosis decreased from the period of 1996-2004 (48.8%) to 2005-2012 (30.1%; P<0.01). Odds of HSV-2 seropositivity was significantly greater for non-Caucasians (OR 2.19, 95% CI 1.33-3.60) and for HIV diagnosis between 1996 and 2004 (OR 2.06, 95% CI 1.29-3.27), with a trend observed for those age >30 years at HIV diagnosis (OR 1.73, 95% CI 0.94-3.18). A total of 81 (20.4%) patients developed STIs by ICD-9 codes, including 24 (6.1%) new genital herpes diagnoses, during a median follow-up of 4.6 years. HSV-2 seroconversion occurred in 33 of 253 (13.0%) with an incidence rate of 5.07 per 100 person-years (95% CI 4.76-5.37). CONCLUSION: Although HSV-2 seroprevalence at HIV diagnosis decreased over time, high-risk sexual behaviors were ongoing as evidenced by the high proportion of new STI diagnoses and HSV-2 seroconversions. Continued education to reduce risk behaviors is warranted to prevent acquisition and transmission of STIs in HIV-infected persons.

Reproductive habitus, psychosocial health, and birth weight variation in Mexican immigrant and Mexican American women in south Texas.

The Latina Paradox, or persistent, unexplained variation in low birth weight rates in recently immigrated Mexican women and the trend toward higher rates in subsequent generations of Mexican American women, is most often attributed to unidentified sociocultural causes. We suggest herein that different disciplinary approaches can be synthesized under the constructs of reproductive habitus and subjective social status to identify influences of sociocultural processes on birth weight. Reproductive habitus are "modes of living the reproductive body, bodily practices, and the creation of new subjects through interactions between people and structures" (Smith-Oka, 2012: 2276). Subjective social status infers comparison of self to others based on community definitions of status or socioeconomic status (Adler 2007). We present results from a prospective study of low-income Mexican immigrant and Mexican American women from south Texas that tested the ability of reproductive habitus and subjective social status to elucidate the Latina Paradox. We hypothesized that reproductive habitus between Mexican immigrant women and Mexican American women inform different subjective social statuses during pregnancy, and different subjective social statuses mediate responses to psychosocial stressors known to correlate with low birth weight. Six hundred thirty-one women were surveyed for psychosocial health, subjective social status, and reproductive histories between 2011 and 2013. Eighty-three women were interviewed between 2012 and 2013 for status during pregnancy, prenatal care practices, and pregnancy narratives and associations. Birth weight was extracted from medical records. Results were mixed. Subjective social status and pregnancy-related anxiety predicted low birth weight in Mexican immigrant but not Mexican American women. Mexican immigrant women had significantly lower subjective social status scores but a distinct reproductive habitus that could explain improved psychosocial health during pregnancy. Results underscore the importance of a biopsychosocial, mixed methods approach that integrates anthropology, psychology, and epidemiology in the effort to understand the complex dynamic between sociocultural processes and birth weight.

Subjective Social Status, Mental and Psychosocial Health, and Birth Weight Differences in Mexican-American and Mexican Immigrant Women.

Recent Mexican immigrant women on average have an unexpectedly low incidence of low birth weight (LBW). Birth weights decline and LBW incidence increases in post-immigrant generations. This pilot project tested the hypothesis that subjective social status (SSS) of pregnant women predicts variation in birth weight between Mexican immigrant and Mexican-American women. 300 low-income pregnant Mexican immigrant and Mexican-American women in South Texas were surveyed for SSS, depression, pregnancy-related anxiety, perceived social stress and self-esteem and subsequent birth weight. No significant difference in SSS levels between pregnant Mexican immigrant and Mexican-American women were found. However, SSS better predicted variation in birth weight across both groups than mental and psychosocial health variables. Results suggest distinct relationships among SSS, mental and psychosocial health that could impact birth weight. They underscore the relevance of a multilevel, biopsychosocial analytical framework to studying LBW.

Evaluation of extragenital screening for gonorrhea and chlamydia in HIV-infected active duty Air Force members.

This study evaluated the hypothesis that detection of Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) infections among HIV-infected active duty members of the U.S. Air Force would increase after expanding screening to include extragenital infections. Before and after the start of extragenital screening, urethral screening was positive for GC/CT in 2.9% and 1.9% of HIV-infected service members. Much higher proportions of rectal (11.1%) and pharyngeal (21.9%) specimens were found to be positive for GC or CT after starting extragenital screening. Only 5.9% of the extragenital positive specimens were associated with positive urethra specimens. Circumstances that warrant routine extragenital screening and the potential benefits are discussed.

Perceived social stress, pregnancy-related anxiety, depression and subjective social status among pregnant Mexican and Mexican American women in south Texas.

PURPOSE: The purpose of this study was to determine differences in subjective social status, perceived social stress, depressive symptoms, and pregnancy-related anxiety between pregnant Mexican American and Mexican immigrant women. METHODS: Three hundred pregnant Mexican immigrant and Mexican American women in South Texas were surveyed for pregnancy-related anxiety, perceived social stress, depressive symptoms, and subjective social status. RESULTS: Pregnant Mexican immigrant women had higher levels of pregnancy-related anxiety and lower levels of depression and perceived social stress than pregnant Mexican American women. Change in these variables among Mexican immigrant women was relatively linear as time of residence in the United States increased. Mexican immigrant and Mexican American women had significantly different correlations between subjective social status, self-esteem and perceived social stress. CONCLUSIONS: Results indicate that subjective social status is an important psychosocial variable among pregnant Hispanic women. Results contribute to ongoing efforts to provide culturally responsive prenatal psychosocial support services.

Breast cancer knowledge, attitude and screening behaviors among Hispanics in South Texas colonias.

This study examines breast cancer knowledge, attitudes and screening behaviors of Hispanic women living in the South Texas colonias of Maverick and Val Verde Counties. We used the Health Belief Model to analyze the effects of HBM constructs on clinical breast exam (CBE) and mammogram screening. Using a multistage systematic sampling approach we interviewed women living within these colonias. Logistic regression analysis was used to predict CBE and mammography screening behaviors. The results indicate that knowledge, susceptibility, barriers and source of health information were statistically significant in predicting CBE among these women. In addition, background variables such as marital status and health insurance were also significant in predicting CBE. Findings further indicate that source of health information, barriers, and health insurance significantly predicts mammography screening behaviors. Results suggest that for women living in colonias along the South Texas Border socio-demographic variables play a significant role in CBE and mammography utilization.

Disparities of food availability and affordability within convenience stores in Bexar County, Texas.

The American Diabetes Association (ADA) recommends healthful food choices; however, some geographic areas are limited in the types of foods they offer. Little is known about the role of convenience stores as viable channels to provide healthier foods in our "grab and go" society. The purposes of this study were to (1) identify foods offered within convenience stores located in two Bexar County, Texas, ZIP Codes and (2) compare the availability and cost of ADA-recommended foods including beverages, produce, grains, and oils/fats. Data were analyzed from 28 convenience store audits performed in two sociodemographically diverse ZIP Codes in Bexar County, Texas. Chi-squared tests were used to compare food availability, and t-tests were used to compare food cost in convenience stores between ZIP Codes. A significantly larger proportion of convenience stores in more affluent areas offered bananas (χ (2) = 4.17, P = 0.003), whole grain bread (χ (2) = 8.33, P = 0.004), and baked potato chips (χ (2) = 13.68, P < 0.001). On average, the price of diet cola (t = -2.12, P = 0.044) and certain produce items (e.g., bananas, oranges, tomatoes, broccoli, and cucumber) was significantly higher within convenience stores in more affluent areas. Convenience stores can play an important role to positively shape a community's food environment by stocking healthier foods at affordable prices.

College student adoption of non-pharmaceutical interventions during the 2009 H1N1 influenza pandemic: a study of two Texas universities in Fall 2009.

OBJECTIVE: College students were at high risk for contracting the 2009 H1N1 virus. Many universities implemented campaigns to encourage use of non-pharmaceutical interventions (NPIs) to reduce the spread of the virus. The purpose of this study was to determine factors related to student adoption of NPIs. METHODS: Online surveys were conducted at two universities prior to the availability of the H1N1 vaccine. In total, 909 students participated. RESULTS: More than 80% of students adopted at least one action to reduce the likelihood of contracting the flu. Perception of the public health threat was associated with use of each of the NPIs. Perceived susceptibility, previous seasonal flu vaccination, and symptom knowledge were associated with four of the five NPIs. CONCLUSION: Increasing college student understanding of the threat posed by a pandemic, as well as their susceptibility to that threat, could encourage the use of NPIs prior to availability of a vaccine.

Effects of individual and neighborhood factors on maternal care in Cambodia.

This study analyzed data from the 2005 Cambodia Demographic and Health Survey to examine the effects of individual- and community-level factors on the receipt of four or more antenatal care visits, receipt of antenatal care within the first trimester of pregnancy, delivery in a health facility and delivery by trained medical professional. The findings demonstrate that age at birth, parity level, educational attainment, household wealth, occupation, media exposure and counseling about pregnancy complications are significant determinants of pregnancy care. There is also a strong evidence of the impact of community-level factors on the utilization of maternal health services. Programs to improve maternal health outcomes must take into account covariates at multiple levels of influence to better address the needs of women of reproductive age in Cambodia.

Student utilization of a university 2009 H1N1 vaccination clinic.

The 2009 H1N1 influenza resulted in widespread outbreaks on college campuses. Once sufficient quantity of vaccine became available, many universities held vaccination clinics for students. We sought to examine factors associated with participation in an on-campus vaccination effort. A self-administered questionnaire was completed by students in January 2010. Our results suggest a high degree of awareness of the 2009 H1N1 virus among students. The odds of being vaccinated were higher for students who believed the H1N1 virus was a greater public health threat and for students who had friends and family that were vaccinated after controlling for sex, ethnicity, age, and living conditions.

Initiation of and barriers to prenatal care use among low-income women in San Antonio, Texas.

Healthy People 2010 goals set a target of 90% of mothers starting prenatal care in the first trimester of pregnancy. While there are questions about the value of prenatal care (PNC), there is much observational evidence of the benefits of PNC including reduction in maternal, fetal, perinatal, and infant deaths. The objective of this study was to understand barriers to PNC as well as factors that impact early initiation of care among low-income women in San Antonio, Texas. A survey study was conducted among low-income women seeking care at selected public health clinics in San Antonio. Interviews were conducted with 444 women. Study results show that women with social barriers, those who were less educated, who were living alone (i.e. without an adult partner or spouse), or who had not planned their pregnancies were more likely to initiate PNC late in their pregnancies. It was also observed that women who enrolled in the WIC program were more likely to initiate PNC early in their pregnancies. Women who initiated PNC late in pregnancy had the highest odds of reporting service-related barriers to receiving care. However, financial and personal barriers created no significant obstacles to women initiating PNC. The majority of women in this study reported that they were aware of the importance of PNC, knew where to go for care during pregnancy, and were able to pay for care through financial assistance, yet some did not initiate early prenatal care. This clearly establishes that the decision making process regarding PNC is complex. It is important that programs consider the complexity of the decision-making process and the priorities women set during pregnancy in planning interventions, particularly those that target low-income women. This could increase the likelihood that these women will seek PNC early in their pregnancies.

Effects of socio-economic and behavioural factors on childhood malnutrition in Yemen.

This study examined the effects of socio-economic and behavioural factors on childhood malnutrition in Yemen. The three anthropometric indicators such as height-for-age, weight-for-height and weight-for-age are used to examine the nutritional status of children aged less 5 years in Yemen. The independent variables include background characteristics, behavioural risk factors and illness characteristics. Data for the study come the most recent Yemen Demographic and Health Survey, a nationally representative sample, conducted in Yemen in 1997. Logistic regression analysis is used to estimate the odds of being malnourished. The three anthropometric indicators show high to very high levels of child malnutrition in Yemen. The prevalence of stunting and underweight is so widespread that almost every other child under the age of 5 is either stunted or underweight. Social, economic and behavioural factors show very significant association with childhood malnutrition. The study results indicate the importance of social and behavioural factors in describing childhood malnutrition in Yemen. The study results will help develop nutritional and health promotion policies in order to improve childhood malnutrition in this country.

An assessment of fetal loss among currently married women in India.

The present paper assesses fetal loss among currently married women in India. In addition, the effects of social, economic, demographic and health factors on fetal loss are studied. The study uses data from the second National Family Health Survey conducted in India during 1998-2000. The results show wide variations in fetal loss (induced abortion, spontaneous abortion and still-birth) measures across the country. The importance of mother's nutritional status, birth spacing, risky behaviours such as smoking, drinking and chewing tobacco and age at marriage for pregnancy outcomes in India is also discussed. The study results imply a broad understanding of reproductive health in India, and emphasize the importance of widening the scope of community-based reproductive health education programmes to improve the reproductive health of women.

Individual, household, programme and community effects on childhood malnutrition in rural India.

The children living in rural areas of India disproportionately suffer from malnutrition compared with their urban counterparts. The present article analyses the individual, household, community and programme factors on nutritional status of children in rural India. Additionally, we consider the random variances at village and state levels after introducing various observed individual-, household- and programme-level characteristics in the model. A multilevel model is conducted using data from the National Family and Health Survey 2. The results show that maternal characteristics, such as socio-economic and behavioural factors, are more influential in determining childhood nutritional status than the prevalence of programme factors. Also, it was found that individual factors show evidence of state- and village-level clustering of malnutrition.

Contraceptive use in Yemen: a component analysis.

The objective of this paper is to examine the role of modernization on current use of modern contraception in the Republic of Yemen. We used modernization theory as well as Ryder's cohort-historical model to investigate the change in fertility variables across cohorts. Data from Demographic and Health Surveys conducted in 1991 and 1997 in Yemen are used. It has been argued that in Islamic societies such as Yemen, the extent of contraceptive use is more likely to be determined by religious values than by external forces of change. However, our findings suggest that the social context of contraceptive use in Yemen is similar to the preconditions attained in societies that have experienced improvements in contraceptive use during the stage of fertility decline. We have discussed in detail the policy implications of our findings.

Influence of parental and socioeconomic factors on stunting in children under 5 years in Egypt.

We assessed the relationship between parental and socioeconomic characteristics and nutritional status of children under 5 years in Egypt. Data from the 2000 Egypt Demographic and Health Survey were used. A logistic regression technique was used to estimate the odds of being malnourished. Children whose mothers had a higher level of education and were >150 cm had a lower risk of stunting than those of mothers with no education and shorter height (<150 cm). Parental consanguinity, rural residence, high birth order and short birth interval significantly increased the odds of stunting. Children aged > 12 months had greater odds of stunting than those <12 months.