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1.
BMC Public Health ; 20(1): 203, 2020 Feb 07.
Artigo em Inglês | MEDLINE | ID: mdl-32033546

RESUMO

BACKGROUND: More than half of women in India are anemic. Anemia can result in fatigue, poor work productivity, higher risk of pre-term delivery, and maternal mortality. The Indian government has promoted the use of iron-folic acid supplements (IFA) for the prevention and treatment of anemia for the past five decades, but uptake remains low and anemia prevalence high. Current programs target individual-level barriers among pregnant women and adolescents, but a more comprehensive approach that targets multiple levels among all women of reproductive age is needed to increase uptake of IFA and iron-rich foods. METHODS: The Reduction in Anemia through Normative Innovations (RANI) project is a norms-based intervention to reduce anemia among women of reproductive age. We will evaluate the intervention through a clustered randomized controlled trial in Odisha, India. We will collect data at three time points (baseline, midline, and end line). For the study, we selected 89 clusters of villages, which we randomized into treatment and control on a 1:1 basis. The treatment arm will receive the RANI project components while the control arm will receive usual care. Fifteen clusters (40-41 villages) were selected and 4000 women (2000 in each arm) living in the selected clusters will be randomly selected to take part in data collection. Women in both study arms will have their hemoglobin concentrations measured. They will also complete in-person surveys about their knowledge, attitudes, perceptions of iron folic acid supplements, and nutritional intake. We will also select a smaller cohort of 300 non-pregnant women (150 in each arm) from this cohort for additional physical activity and cognitive testing. We will conduct both within- and between-group comparisons (treatment and control) at baseline, midline and end line using t-tests. We will also conduct structural equation modeling to examine how much each factor accounts for IFA use and hemoglobin levels. DISCUSSION: This RCT will enable us to examine whether a social norms-based intervention can increase uptake of iron folic acid supplements and iron rich foods to reduce anemia. TRIAL REGISTRATION: This trial was registered with Clinical Trial Registry- India (CTRI) (CTRI/2018/10/016186) on 29 October 2018.

2.
Subst Use Misuse ; 55(4): 546-556, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31718377

RESUMO

Background: Many risk factors for tobacco use among the general young adult population, such as tobacco advertising receptivity, have gone unexamined among those with internalizing problems, despite disproportionately high rates of tobacco use. Objective: The objective of this study was to examine the interrelationship of internalizing problems, tobacco advertising receptivity, and tobacco use among young adults using data from Wave 1 of the Population Assessment for Tobacco and Health Study. Methods: The sample included 9,110 young adults (ages 18-24). Multivariable logistic regression models examined the association between internalizing problems and advertising receptivity and tobacco use. Separate models were run for cigarettes, cigars, e-cigarettes, smokeless tobacco and any tobacco use. An interaction term (receptivity × internalizing problems) was added to each model. Results: Except for smokeless tobacco, individuals with high internalizing problems reported greater odds of product use compared to those with low internalizing problems. There was no association between internalizing problems and use of smokeless tobacco. For all products, receptivity was positively associated with tobacco use. A borderline significant interaction was detected between cigarette advertising receptivity and internalizing problems, such that the magnitude of the relationship between receptivity to cigarette advertising and cigarette use was stronger for those with high internalizing problems compared those with low internalizing problems. Conclusions/Importance: The relationship between cigarette advertising receptivity and cigarette use may differ for those with and without internalizing problems. Disproportionate receptivity to risk-promoting messages among young adults with internalizing problems could exacerbate disparities in cigarette use.

3.
Drug Alcohol Depend ; 205: 107686, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31706253

RESUMO

BACKGROUND: Cigarette smoking is disproportionately high among adults with two or more psychiatric disorders (psychiatric comorbidities), yet research on non-cigarette tobacco use among this population is scant. Additionally, most studies on tobacco use this among this population rely on psychiatric diagnoses rather than individual symptoms, potentially excluding individuals with symptom-specific issues that increase their risk for tobacco use but do not meet the criteria for diagnosis. The objectives of this study were to identify unique classes of individuals based on symptoms of psychiatric disorders and to assess differences in demographic characteristics and tobacco use behaviors between classes. METHODS: This study used data from Wave 2 of the Population Assessment of Tobacco and Health Study adult dataset. Latent class analysis was used to classify individuals based on internalizing, externalizing and substance use problems. Bivariate and multivariable models examined the association between latent class membership and current use of cigarettes, cigar products, electronic nicotine delivery systems, pipe, hookah and smokeless tobacco products. Poly tobacco use was also examined. RESULTS: Three latent classes were identified. The "normative" class reported low prevalence of all symptoms, the "severe internalizing and non-violent externalizing" class reported severe internalizing problems and non-violent externalizing problems and the "severe" class reported high prevalence of all symptoms. Tobacco use was highest for the "severe" class and lowest for the "normative" class across products. CONCLUSIONS: Individuals in the "severe" class may be at elevated risk of tobacco-related morbidity and mortality and would likely benefit from targeted tobacco control interventions.

4.
Am J Med Genet A ; 179(5): 762-769, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30821068

RESUMO

This study explored patients' experiences and perceptions of living with thalassemia (an inherited hematologic disorder), perceptions of social stigma, and impact on disclosure decision-making. Semistructured, in-person interviews were conducted in Singapore with 30 individuals: 16 thalassemia major patients and 14 parents of children with thalassemia. Findings were indicative of felt or enacted stigma that may have influenced disclosure decisions. Although affected individuals commonly disclosed their thalassemia diagnosis to family members, they either downplayed the condition with or avoided disclosure to unrelated individuals. Disclosure outside the family occurred only in response to triggers, such as questions about absences due to medical care. Health professionals should provide anticipatory guidance about disclosure strategies when managing individuals with thalassemia.

5.
J Adolesc Health ; 64(4S): S31-S36, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30914165

RESUMO

PURPOSE: The role of mass media in promoting social norms surrounding contraceptive use among adolescents in developing countries has not received much attention. Hence, program planners have little guidance on how to design media messages that take advantage of existing social norms in promoting contraceptive use. METHODS: We analyzed data from the Demographic and Health Surveys in Ethiopia and Tanzania, restricting our sample to 15- to 24 year-old adolescents (N = 6,230 and N = 5,138, respectively). We proposed and tested the hypotheses that collective norms around contraception use would be associated with individual contraception use in that area and that this relationship would be stronger when media use is low, than when media use is high. Logistic regressions were run to predict individual-level contraception use from collective norms for contraception use, media use, and their interaction, controlling for age, urban versus rural location, marital status, wealth, and education, taking into account intraclass correlations within clusters. RESULTS: Collective norms were associated with individual contraception use in both samples. Media use attenuated the association between collective norms and contraception use in Ethiopia but not in Tanzania. (ß = -.22, p = < .01 in Ethiopia and ß = -.08, p = .10 in Tanzania). CONCLUSIONS: Mass media can serve as external agents of change to attenuate the impact of collective norms on individual behavior. A deeper examination of how and why media use attenuates the relationship between collective norms and individual contraception use in some subpopulations more than others is warranted.

6.
Accid Anal Prev ; 122: 172-180, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30384087

RESUMO

Globally, more adolescents die from road traffic fatalities than from any other cause, and males are significantly more vulnerable than females. Driver education interventions directed at males are less likely to succeed than those directed at females, and stronger optimistic bias and overconfidence bias have been implicated as likely reasons. We report results from a quasi-experiment conducted in Serbia, targeting male and female adolescents. Stratified by size, forty schools were randomly assigned to either a personal-narrative intervention or a no-intervention control arm. Data were collected before the intervention (N = 1449) and again six months later (N = 1072). Risk perceptions improved for both males and females, and injunctive norms improved for females. Improvements in overconfidence bias and descriptive norms were predictive of improvements in high-risk driving behaviors. A significant interaction between improvements in injunctive norms and the intervention revealed that males whose injunctive norms improved were significantly more likely to be affected by the intervention, compared to the other groups. Implications for interventions are discussed.


Assuntos
Comportamento do Adolescente/psicologia , Condução de Veículo/psicologia , Acidentes de Trânsito/prevenção & controle , Adolescente , Feminino , Humanos , Masculino , Ensaios Clínicos Controlados não Aleatórios como Assunto , Assunção de Riscos , Sérvia , Fatores Sexuais
7.
Stud Fam Plann ; 49(4): 345-365, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30411794

RESUMO

A common reason for nonuse of modern contraceptives is concern about side effects and health complications. This article provides a detailed characterization of the belief that modern contraceptives cause infertility, and an examination of how this belief arises and spreads, and why it is so salient. We conducted focus group discussions and key informant interviews in three rural communities along Kenya's eastern coast, and identified the following themes: (1) the belief that using modern contraception at a young age or before childbirth can make women infertile is widespread; (2) according to this belief, the most commonly used methods in the community were linked to infertility; (3) when women observe other women who cannot get pregnant after using modern contraceptives, they attribute the infertility to the use of contraception; (4) within the communities, the primary goal of marriage is childbirth and thus community approval is rigidly tied to childbearing; and, therefore (5) the social consequences of infertility are devastating. These findings may help inform the design of programs to address this belief and reduce unmet need.


Assuntos
Anticoncepção/efeitos adversos , Anticoncepção/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Infertilidade/induzido quimicamente , Adolescente , Adulto , Idoso , Serviços de Planejamento Familiar , Feminino , Humanos , Entrevistas como Assunto , Quênia , Masculino , Pessoa de Meia-Idade , População Rural , Normas Sociais , Adulto Jovem
8.
Reprod Health ; 15(1): 111, 2018 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-29925395

RESUMO

BACKGROUND: In the last decade, the proportion of Ethiopian women using contraceptive methods has increased substantially (from 14% in 2005 to 35% in 2016 among married women). Numerous factors have contributed to the increased uptake. An important one is the implementation of the Health Extension Program, a government-led health service delivery strategy that has deployed more than 38,000 health extension workers (HEWs) throughout the country. Key mechanisms underlying the success of this program are not well understood. Using a case study approach, the goal of this study is to describe how key features of local contexts, community perceptions, and messaging by HEWs have contributed to the increased use of modern contraception in one community in Ethiopia. METHODS: We conducted focus groups and individual interviews with men, women, adolescents, and key informants, including (HEWs), in Oromia, Ethiopia. We used a random sampling protocol to recruit all participants except key informants, with whom purposive sampling was used to ensure participants were knowledgeable on family planning in the village. Interviews were audio recorded, translated, transcribed, and then analyzed using applied thematic analysis and NVivo v.11 qualitative research software. RESULTS: We identified four themes that may explain uptake of contraception: (1) HEWs are seen as trusted and valued community members who raised awareness about family planning; (2) the HEW messaging that contraception is useful to space pregnancies among married women was effective; (3) the message that spacing is healthy for mother and child was also effective; and (4) communicating to the entire community (including men, women, adolescents, and religious leaders), contributed to changing attitudes around contraception. CONCLUSION: The four aspects of the Health Extension Program approach increased uptake of contraception in our sample. In contexts where community health workers are valued by the health systems and local communities they serve, this type of approach to widening modern contraception use could help increase uptake and address unmet need. Understanding these granular aspects of the program in one local context may help explain how use of contraception increased in the country as a whole.


Assuntos
Agentes Comunitários de Saúde , Comportamento Contraceptivo/etnologia , Anticoncepção/estatística & dados numéricos , Adolescente , Adulto , Criança , Etiópia , Serviços de Planejamento Familiar , Feminino , Grupos Focais , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Adulto Jovem
9.
J Public Health Res ; 7(1): 1269, 2018 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-29780765

RESUMO

Background: Youth exposure to alcohol marketing has been shown to be an important contributor to the problem of underage drinking in the U.S. More work is needed on identifying and minimizing content with particular appeal to youth. Design and Methods: We tested the association between the youth-appeal of marketing content of televised alcohol advertisements and the brand-specific alcohol consumption of both underage youth and adults. We used existing data from three sources: a brand-specific alcohol consumption survey among underage youth (N=1032), a brand-specific alcohol consumption survey among adults (N ~13,000), and an analysis of content appealing to youth (CAY) in a sample of televised alcohol advertisements (n=96) aired during the youth survey. The association between CAY scores for the 96 alcohol ads and youth (age 13-20) versus adult (age 21+) consumption of those ads' brands was tested through bivariate and multivariate models. Results: Brand CAY scores were (a) positively associated with brand-specific youth consumption after controlling for adult brand consumption; (b) positively associated with a ratio of youth-toadult brand-specific consumption; and (c) not associated with adult brand consumption. Conclusions: Alcohol brands with youth-appealing advertising are consumed more often by youth than adults, indicating that these ads may be more persuasive to relatively younger audiences, and that youth are not simply mirroring adult consumption patterns in their choice of brands. Future research should consider the content of alcohol advertising when testing marketing effects on youth drinking, and surveillance efforts might focus on brands popular among youth.

10.
Health Commun ; 33(2): 164-173, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-27982709

RESUMO

Underage drinking is a serious public health problem in the United States, and youth exposure to alcohol advertising has been indicated as a possible contributing factor. Although a number of studies have identified advertising content features that youth find appealing, a key limitation of this research is the absence of a broader tool to examine those features, especially those used by alcohol brands that are popular with underage drinkers. We created an index of content elements found in the research literature to be appealing to youth, and then used this index in a content analysis to identify the degree to which youth-appealing content appeared in a sample of alcohol ads that aired on television shows popular among youth. Finally, using bivariate analysis, we tested the relationship between alcohol brands' use of this content and the popularity of those brands among youth. We found that many of the ads featured youth-appealing content, and that the ads for the alcohol brands most popular among youth had more youth-appealing content than the less popular brands.


Assuntos
/tendências , Publicidade Direta ao Consumidor/tendências , Televisão , Consumo de Álcool por Menores/prevenção & controle , Adolescente , Fatores Etários , Bebidas Alcoólicas , Criança , Comportamento do Consumidor , Feminino , Humanos , Masculino , Consumo de Álcool por Menores/psicologia , Estados Unidos , Adulto Jovem
11.
Gates Open Res ; 2: 15, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29683135

RESUMO

Background: More than half of women of reproductive age in India are anemic. Anemia is associated with increased risk of preterm delivery, higher maternal mortality and contributes to fatigue, which affects women's work productivity. The World Health Organization (WHO) recommends daily oral iron and folic acid (IFA) supplements during pregnancy and weekly supplements for women of reproductive age. Government programs and global donors have distributed and promoted IFA supplements in India for over four decades. However, initial intake and compliance remain inadequate. Objectives: This protocol describes the formative research phase of a larger study, called the Reduction in Anemia through Normative Innovations (RANI) Project, which will test, through a randomized controlled trial, the hypothesis that a social norms-based behavioral intervention in Odisha, India will improve uptake of IFA supplements and reduce anemia among reproductive age women as compared to usual care. The focus of this paper is on the formative research required to develop a sound intervention. We will examine socio-normative barriers to and facilitators of IFA supplement uptake. Methods and analysis: Based on the Theory of Normative Social Behavior, we will adopt a mixed-method, multilevel approach. We will collect data using focus groups, in-depth interviews, observations, Rapid Participatory Ethnographic Evaluation and Research (PEER) techniques, and perceptual mapping methods. Our sample includes reproductive age women (pregnant and not pregnant), their husbands, their mothers/in law and key stakeholders. Before collecting the data, and after analyzing the results, we will hold convenings in India to engage key stakeholders in collaborative design. Following the intervention design, we will test components of the intervention, gather user feedback and fine-tune as necessary. Impact: This study will contribute to the social norms and behavioral intervention research and inform policymakers about the value of adopting a socio-normative approach.

13.
J Health Commun ; 22(12): 981-989, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29173103

RESUMO

Individuals' behaviors are influenced by those of others in their social environment (i.e., descriptive norms), as well as by how individuals perceive they should behave in that environment (e.g., injunctive norms). Although social norms are thought to play an important role in hepatitis B virus (HBV) screening, limited theoretical or empirical guidance exists on how the underlying process works. In addition, norms are social phenomena that are spread through family discussion about the importance of getting HBV screening. Using the theory of normative social behavior (TNSB), this study examined the roles of injunctive norms (IN), descriptive norms (DN), and family discussion in HBV screening behavior among Asian Americans. Data from a survey of Asian Americans in the Baltimore Washington metropolitan area (N = 877) were used to test underlying theoretical propositions. DN and family discussion emerged as key factors in HBV screening behavior among all Asian Americans. IN were associated with HBV screening among Chinese and Korean Americans, but not for Vietnamese Americans. Family discussion moderated the influence of DN on behavior among Chinese and Vietnamese Americans. However, the main effect of DN on screening behavior was not modified by IN (no interactions between DN and IN). The results indicate that family discussion and social norms are integral in enabling Asian Americans to undergo HBV screening and warrant sensitivity in the design and implementation of a liver cancer prevention program in this high-risk group of Asian Americans.


Assuntos
Americanos Asiáticos/psicologia , Comunicação , Família/etnologia , Hepatite B/etnologia , Programas de Rastreamento/estatística & dados numéricos , Normas Sociais/etnologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Americanos Asiáticos/estatística & dados numéricos , Família/psicologia , Feminino , Hepatite B/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
14.
J Health Commun ; 22(8): 672-681, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28753075

RESUMO

Traffic road accidents are one of the leading causes of mortality in Nepal and around the world. Drivers in Nepal are not adequately educated about road safety rules. Road conditions are chaotic as traffic regulations are also not strictly enforced. Public safety campaigns may be able to alter drivers' attitudes and behaviors; however, little is known about which persuasive strategies may be most effective. Drawing on self-determination theory and the Health Belief Model, the current study used a post-only experimental design to test the impact of a short video message. The video included collective vs. individual appeals, and messages emphasizing one's ability to make the right choice (autonomy support) vs. directive language. Participants were Nepali college students (mean age 20, N = 199). Using structural equation modeling, the study found that directive messages rather than autonomy support influenced an individual seeing value in the recommended behavior (identified regulation), which in turn influenced perceived susceptibility, perceived severity, and behavioral intention. The study also proposed a behavior change model by incorporating the stage of identification with the message upon exposure. This model aims to expand the model proposed by the Health Belief Model, to include a stage of value identification before cues to action influence perception of threat. Further implications are discussed.


Assuntos
Condução de Veículo/psicologia , Autonomia Pessoal , Teoria Psicológica , Assunção de Riscos , Segurança , Acidentes de Trânsito/prevenção & controle , Comportamento de Escolha , Feminino , Humanos , Masculino , Modelos Psicológicos , Nepal , Comunicação Persuasiva , Estudantes/psicologia , Estudantes/estatística & dados numéricos , Universidades , População Urbana/estatística & dados numéricos , Adulto Jovem
15.
Prev Sci ; 18(2): 245-252, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27981447

RESUMO

Individual factors associated with HIV testing have been studied across multiple populations; however, testing is not just an individual-level phenomenon. This secondary analysis of 2005 and 2011 Ethiopia Demographic and Health Survey data was conducted to determine the extent to which the 2007 institution of an opt-out policy of HIV testing during antenatal care increased testing among women, and whether effects differed by women's stigmatizing beliefs about HIV. A logit model with interaction between pre-/post-policy year and policy exposure (birth in the past year) was used to estimate the increased probability of past-year testing, which may be attributable to the policy. Results suggested the policy contributed to a nine-point increase in the probability of testing (95% CI 0.06-0.13, p < 0.0001). A three-way interaction was used to compare the effects of exposure to the policy among women holding higher and lower HIV stigmatizing beliefs. The increase in the probability of past-year testing was 16 percentage points greater among women with lower stigmatizing beliefs (95% CI 0.06-0.27, p = 0.002). Women with higher stigmatizing beliefs were less likely to report attending antenatal care (ANC), testing at their last ANC visit, or being offered a test at their last ANC visit. We encourage researchers and practitioners to explore interventions that operate at multiple levels of socio-ecological spheres of influence, addressing both stigma and structural barriers to testing, in order to achieve the greatest results in preventing HIV.


Assuntos
Participação da Comunidade , Infecções por HIV/diagnóstico , Política de Saúde , Cuidado Pré-Natal , Estigma Social , Adolescente , Adulto , Testes Diagnósticos de Rotina/estatística & dados numéricos , Etiópia , Feminino , Humanos , Gravidez , Estatística como Assunto , Adulto Jovem
16.
J Health Commun ; 21(10): 1079-87, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27668832

RESUMO

Social norms affect human behavior, and underage drinking is no exception. Using the theory of normative social behavior, this study tested the proposition that the association between perceptions about the prevalence of drinking (descriptive norms) and underage drinking is strengthened when perceived pressures to conform (injunctive norms) and beliefs about the benefits of drinking (outcome expectations) are high. This proposition was tested on a nationally representative sample of underage drinkers ages 13-20 (N = 1,031) in relation to their alcohol consumption, expanding on research with college-age youth. On average, males and females reported drinking 23 and 18 drinks per month, respectively. The main effect of descriptive norms (ß = .10, p < .01) on alcohol consumption was modified by interactions with injunctive norms (ß = .11, p < .01), benefit to self (ß = .12, p < .001), and benefit to others (ß = .10, p < .01). Underage drinkers are most vulnerable to excessive drinking if they believe that most others drink, that they themselves are expected to drink, and that drinking confers several benefits. Norms-based interventions to reduce youth alcohol use need to focus on changing not only descriptive norms but also injunctive norms and outcome expectations.


Assuntos
Motivação , Normas Sociais , Consumo de Álcool por Menores/psicologia , Adolescente , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Conformidade Social , Percepção Social , Inquéritos e Questionários , Estados Unidos , Adulto Jovem
17.
Violence Vict ; 31(2): 215-34, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26822267

RESUMO

Bystander behavior interventions aim to reduce violence by encouraging individuals to intervene in a safe and effective manner when they hear or see circumstances that could lead to violence. This study used a participatory-based approach to develop a 9-item scale to measure bystander behaviors to prevent dating violence among friends. Predominantly, female students (N = 37) on a college campus in the Mid-Atlantic region of the United States were asked to define bystander behaviors. Responses were thematically sorted and ranked according to importance in preventing dating violence and feasibility by 12 participants. Psychometric testing of intentions to perform the behavior was done based on responses from an additional 288 respondents. Exploratory factor analysis was used to examine whether bystander behaviors directed at friends to prevent dating violence was a uni- or multidimensional construct, which has not been done to date in the available literature. Results demonstrated a unidimensional factor structure with strong factor loadings (above .71) and internal consistency (Cronbach's alpha .92); items focused on primary and secondary prevention behaviors toward friends. These findings provide a reliable and single construct scale to assess college-age women's response to witnessing the victimization of a friend. These findings can facilitate future program evaluations.


Assuntos
Corte/psicologia , Comportamento de Ajuda , Violência por Parceiro Íntimo/psicologia , Delitos Sexuais/prevenção & controle , Estudantes/psicologia , Feminino , Humanos , Relações Interpessoais , Masculino , Grupo Associado , Autoeficácia , Apoio Social , Fatores Socioeconômicos , Estudantes/estatística & dados numéricos , Estados Unidos , Adulto Jovem
18.
Nicotine Tob Res ; 18(5): 1363-70, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26610937

RESUMO

INTRODUCTION: The Indian Cigarettes and Other Tobacco Products Act prohibits youths' access to tobacco products at points-of-sale and near educational institutions, requires signage stating these restrictions in these venues, and bans outdoor advertisements. This observational study examined compliance with these provisions, changes in compliance over 1 year, and factors associated with compliance. METHODS: Data were collected in 2012 and 2013 from points-of-sale (n = 555 in 2012, n = 718 in 2013), educational institutions (n = 277 in 2012, n = 276 in 2013), and neighborhoods (n = 104 in 2012, n = 125 in 2013) in 25 urban and rural towns in five states. Compliance across years was compared using chi-square tests. Multilevel regression equations assessed factors associated with compliance at Wave 2 and change in compliance from Wave 1 to Wave 2. RESULTS: Most points-of-sale had no/low compliance, with little change over time (58% to 63%, P = .108). The proportion of educational institutions observing just 1-2 provisions increased (39% to 52%, P = .002). Most neighborhoods complied with the advertisement ban at both waves (91% to 96%, P = .172). In the multilevel analysis, point-of-sale compliance increased in small cities; compliance decreased at points-of-sale and increased at institutions in mid-sized cities. Changes in point-of-sale compliance were due to compliance with access restrictions and signage requirements; changes in educational institution compliance were due to compliance with the sales ban. CONCLUSIONS: Compliance with provisions regarding the sale and display of tobacco products is moderate, while compliance with the advertisement ban remains high in these five Indian states. Greater enforcement will further reduce youths' exposure to tobacco products. IMPLICATIONS: The study adds to the literature on compliance and changes in compliance with policy to prohibit youth access to tobacco products in India, a country that has large geographic disparities in youth smoking prevalence. The findings highlight several important areas on which efforts can focus to improve compliance among points-of-sale, educations institutions, and neighborhoods to limit youths' exposure and access to tobacco products. Rural areas and large cities in particular need more concerted efforts.


Assuntos
/legislação & jurisprudência , Comércio/legislação & jurisprudência , Fidelidade a Diretrizes , Prevenção do Hábito de Fumar , Indústria do Tabaco/legislação & jurisprudência , Produtos do Tabaco/legislação & jurisprudência , Adolescente , Cidades , Humanos , Índia , Análise Multinível , Análise de Regressão , Características de Residência , Instituições Acadêmicas , Tabaco , Tabagismo
19.
Afr J Reprod Health ; 20(2): 53-61, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29553164

RESUMO

Youth report embarrassment, cost, and poor access as barriers to sexual and reproductive health (SRH) services. Interventions to address barriers like youth friendly services have yet to conclusively demonstrate impact on protective behaviours like condom or contraceptive use. SRH encompasses a range of services so we aimed to assess how perceived barriers differed depending on the service being sought between common services accessed by young people: HIV/STI testing, abortion, and contraception. 1203 Ghanaian youth were interviewed. Data was analysed to identify barriers by service type, demographics, and between high and low HIV prevalence communities. Being embarrassed or shy was the most commonly reported barrier across services. Overall being embarrassed or shy, fear of safety, fear of family finding out and cost were the most reported barriers across all services. Further analysis by service indicated that being embarrassed was a significantly greater barrier for HIV/STI testing and contraception when compared with abortion (p<0.001) and safety concerns and cost were significantly greater barriers for abortion and contraception compared with HIV/STI testing (p<0.001). Efforts to develop interventions that consider the service being sought may help address the range of barriers faced by youth with diverse SRH needs.

20.
Int Q Community Health Educ ; 36(1): 53-70, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26608074

RESUMO

Young girls in Malawi must be able to acquire sexual health information and skills to protect themselves from HIV/AIDS and prevent unintended pregnancies. The purpose of this study was to evaluate a pilot training program that sought to enhance the skills of grandmothers (Agogos) to discuss issues related to sex and sexuality with young girls. Data from eight focus group discussions were analyzed, comparing trained Agogos and the girls they counseled to untrained Agogos and the girls they counseled. Trained Agogos and the girls they counseled, compared with untrained Agogos and the girls they counseled, reported being more comfortable in communicating sexual issues with young girls at earlier ages, were more likely to have interactive discussions, and were more likely to stress the importance of finishing school as reasons to delay sexual activity. More research is needed to determine if such an approach is effective and sustainable.


Assuntos
Cultura , Avós , Infecções por HIV/prevenção & controle , Gravidez não Planejada , Adolescente , Idoso , Criança , Redes Comunitárias , Feminino , Grupos Focais , Humanos , Malaui , Masculino , Pessoa de Meia-Idade , Gravidez , Pesquisa Qualitativa
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