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Adolescents living with HIV (ALHIV) have poorer adherence to antiretroviral treatment (ART). This study investigates the interconnectivity of stressors induced by the COVID-19 pandemic, anxiety and family dynamics on adolescents' adherence to ART. A telephone survey was conducted among 196 South African ALHIV previously enrolled in support groups. Generalized structural equations modeling was used to understand how pandemic-related stressors affected ART adherence. Respondents reported experiencing life stressors since the implementation of COVID-19 restrictions, including doing worse at school (32%), loss of household income (44%) and less food available (38%). Forty-two percent reported greater verbal aggression from adults at home and 60% experienced anxiety. The structural equations model demonstrated a direct path from experiencing life stressors to increased verbal aggression from caregivers, which led to anxiety and ultimately, poorer ART adherence. Each stressor experienced increased the odds of experiencing verbal aggression by 51% (OR=1.51, 95%CI=1.14-2.00) which, in turn, increased the odds of having anxiety four-fold (OR=4.1, 95%C =2.16-7.76). Anxiety was associated with a 74% reduction in the odds of being fully ART adherent (OR=0.26, 95%CI=0.08-0.81). COVID-19-induced stressors exacerbated the mental and physical vulnerability of ALHIV. Findings elucidate how both discord at home and anxiety can result in poorer ART adherence.
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Ansiedade , COVID-19 , Infecções por HIV , Adesão à Medicação , SARS-CoV-2 , Estresse Psicológico , Humanos , COVID-19/psicologia , COVID-19/epidemiologia , África do Sul/epidemiologia , Adolescente , Masculino , Feminino , Infecções por HIV/psicologia , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Ansiedade/psicologia , Ansiedade/epidemiologia , Estresse Psicológico/epidemiologia , Estresse Psicológico/psicologia , Adesão à Medicação/psicologia , Adesão à Medicação/estatística & dados numéricos , Pandemias , Inquéritos e Questionários , Fármacos Anti-HIV/uso terapêutico , Cuidadores/psicologia , Agressão/psicologia , Adulto JovemRESUMO
Let's Talk is a structured, family-centered adolescent HIV prevention program developed for use in South Africa using key components adapted from programs successfully implemented in the US and South Africa. It is designed to address individual HIV transmission risk factors common among orphaned and vulnerable adolescents, including elevated risk for poor psychological health and sexual risk behavior. These efforts are accentuated through parallel programing to support caregivers' mental health and parenting skills. Twelve Let's Talk groups, each serving approximately 10 families, were piloted by two local community-based organizations in Gauteng and Kwa-Zulu Natal provinces, South Africa. Face-to-face interviews were conducted among participating caregivers and adolescents at baseline and three months post-intervention to explore the potential effects of the program on intermediate outcomes that may support HIV preventive behavior. Specifically, generalized estimation equations were used to estimate average change on HIV prevention knowledge and self-efficacy, caregiver and adolescent mental health, and family dynamics. Among the 105 adolescents and their 95 caregivers who participated in Let's Talk and completed both surveys, statistically significant improvements were found for adolescents' HIV and condom use knowledge as well as condom negotiation self-efficacy, but not sexual refusal self-efficacy. Both caregivers and adolescents demonstrated significantly better mental health at post-test. Adolescent/caregiver connection and communication about healthy sexuality also improved. These preliminary results highlight the potential of HIV prevention interventions that engage caregivers alongside the vulnerable adolescents in their care to mitigate adolescent HIV risk factors. A more rigorous evaluation is warranted to substantiate these effects and identify their impact on adolescents' risk behavior and HIV incidence.
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Saúde do Adolescente , Crianças Órfãs/psicologia , Família , Infecções por HIV/epidemiologia , Populações Vulneráveis , Adolescente , Comportamento do Adolescente , Cuidadores/psicologia , Comunicação , Preservativos , Feminino , Infecções por HIV/psicologia , Humanos , Masculino , Projetos Piloto , Fatores de Risco , Autoeficácia , Comportamento Sexual/psicologia , Saúde Sexual , África do Sul/epidemiologia , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Child and youth care workers (CYCWs) are a crucial and growing component of South Africa's national response to HIV and AIDS and other issues affecting children and families. CYCWs use the community-centred Isibindi model of care to reach the most vulnerable with key services including psychosocial, health, economic and education support. Like others in similar professions, they may be at risk for occupational challenges affecting retention. METHODS: This study uses data from the first nationally representative survey of CYCWs in South Africa to identify factors associated with workers' retention intentions. Data were collected in 2015 as part of a formative evaluation conducted around the mid-point of a nationwide Isibindi programme expansion. A total of 1158 CYCWs from 78 sites participated. The response rate for the sample was 87%. Questions addressed demographics, work history, retention intentions, training, mentorship and supervision experiences, workload and remuneration. Mixed effects regression models with random intercepts for project site and mentor were used to estimate factors associated with retention intentions. RESULTS: High-quality mentorship and frequent supervision support retention intentions among CYCWs. Respondents who indicated that wanting to help children or the community was their primary motivator for seeking work as a CYCW were also more likely to report intending to continue working as a CYCW. High perceived workloads and feeling threatened or unsafe on the job were negatively associated with retention intentions. As CYCWs gained experience, they were also less likely to intend to stay. CONCLUSIONS: Understanding the factors affecting retention in the CYCW workforce is vital to helping vulnerable children and families across South Africa access key social and health services. Findings highlight the importance of mentoring and supervision as part of the Isibindi model and the value of support for manageable workloads, workplace safety, and career advancement opportunities for promoting worker retention.
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Serviços de Saúde do Adolescente/organização & administração , Serviços de Saúde da Criança/organização & administração , Centros Comunitários de Saúde/organização & administração , Pessoal de Saúde/psicologia , Satisfação no Emprego , Cuidados de Enfermagem/psicologia , Reorganização de Recursos Humanos/estatística & dados numéricos , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Pessoal de Saúde/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Cuidados de Enfermagem/estatística & dados numéricos , África do Sul , Inquéritos e QuestionáriosRESUMO
To our knowledge, this is the first study to document correlates of complicated grief among bereaved adolescents in sub-Saharan Africa. Participants included 339 female adolescents in South Africa who experienced the loss of a loved one at least six months prior to the survey; their primary caregivers were also surveyed. One-fifth of adolescents were classified as having complicated grief using the Inventory of Complicated Grief Revised for Children in conjunction with grief-induced functional impairment. The loss of a biological parent, the primary caregiver's level of grief, and economic stressors since the loss were associated with increased odds of complicated grief among adolescents. Adolescents' age, residential changes, time since the loss, multiple losses, bereavement due to death by illness, and caregiver depression did not affect the odds. Findings signal the potential of family-centered interventions and economic support services for bereaved adolescents.
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Comportamento do Adolescente/psicologia , Atitude Frente a Morte , Luto , Cuidadores/psicologia , Pesar , Adolescente , Criança , Feminino , Humanos , Pessoa de Meia-Idade , África do Sul , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Children and adolescents affected by HIV are at elevated risk of depression, yet research on related interventions in this population is scarce in sub-Saharan Africa. This study sought to examine the effects of interpersonal psychotherapy for groups (IPTG) on depressive symptomology among orphaned and vulnerable adolescents in South Africa. METHOD: A cluster randomized controlled trial wherein adolescents ages 14-17 enrolled in community-based programming for HIV-affected and vulnerable families were randomly assigned by geographic cluster to participate in a 16-session IPTG intervention or the standard of care (n = 489). Baseline and postintervention surveys conducted with enrollees included standardized depression screening. Utilizing an intent-to-treat design, mixed effects models were performed to examine treatment effects for all participants and potential moderators including gender and baseline depression level (Clinical Trials registration: ClinicalTrials.gov NCT02386878). RESULTS: While 23% of adolescents in the intervention group did not attend any IPTG sessions, average attendance was 12 out of 16 possible sessions among participants. The intervention was not associated with changes in depression symptomology. CONCLUSIONS: Results underscore the importance of mitigating participation barriers prior to intervention roll-out and the need for increased evidence for psychological health interventions to mitigate depression among orphaned and vulnerable adolescents. This intervention and the study selectively targeted at-risk adolescents versus using diagnostic mental health criteria for enrollment; more research is needed to identify the potential benefits and disadvantages of these approaches.
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HIV counseling and testing (HCT) is critical for children in generalized epidemic settings, but significant shortfalls in coverage persist, notably among orphans and others at disproportionate risk of infection. This study investigates the impact of a home visiting program in South Africa on orphaned and vulnerable children's uptake of HCT. Using propensity score matching, survey data for children receiving home visits from trained community-based care workers were compared to data from children living in similar households that had not yet received home visits (n = 1324). Home visits by community-based care workers increased the odds of a child being tested by 97% (OR = 1.97, 95% CI = 1.34-2.92). The home visitation program had an especially pronounced effect on orphans, more than doubling their odds of being tested (OR = 2.12, 95% CI = 1.00-4.47) compared to orphans living in similar households that did not receive home visits. Orphan status alone had no effect on HCT independent of program exposure, suggesting that the program was uniquely able to increase testing in this subgroup. Results highlight the potential for increasing HCT access among children at high risk through targeted community-based initiatives.
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Serviços de Saúde da Criança/organização & administração , Crianças Órfãs , Aconselhamento , Infecções por HIV/diagnóstico , Promoção da Saúde/métodos , Serviços de Assistência Domiciliar/organização & administração , Visita Domiciliar , Adulto , Criança , Crianças Órfãs/estatística & dados numéricos , Pré-Escolar , Serviços de Saúde Comunitária/organização & administração , Participação da Comunidade , Feminino , Infecções por HIV/psicologia , Humanos , Masculino , Aceitação pelo Paciente de Cuidados de Saúde , Avaliação de Programas e Projetos de Saúde , Características de Residência , África do SulRESUMO
OBJECTIVE: Dietary diversity is associated with nutrient adequacy and positive health outcomes but indicators to measure diversity have focused primarily on consumption, rather than sustainable provisioning of food. The Nutritional Functional Diversity score was developed by ecologists to describe the contribution of biodiversity to sustainable diets. We have employed this tool to estimate the relative contribution of home production and market purchases in providing nutritional diversity to agricultural households in Malawi and examine how food system provisioning varies by time, space and socio-economic conditions. DESIGN: A secondary analysis of nationally representative household consumption data to test the applicability of the Nutritional Functional Diversity score. SETTING: The data were collected between 2010 and 2011 across the country of Malawi. SUBJECTS: Households (n 11 814) from predominantly rural areas of Malawi. RESULTS: Nutritional Functional Diversity varied demographically, geographically and temporally. Nationally, purchased foods contributed more to household nutritional diversity than home produced foods (mean score=17·5 and 7·8, respectively). Households further from roads and population centres had lower overall diversity (P<0·01) and accessed relatively more of their diversity from home production than households closer to market centres (P<0·01). Nutritional diversity was lowest during the growing season when farmers plant and tend crops (P<0·01). CONCLUSIONS: The present analysis demonstrates that the Nutritional Functional Diversity score is an effective indicator for identifying populations with low nutritional diversity and the relative roles that markets, agricultural extension and home production play in achieving nutritional diversity. This information may be used by policy makers to plan agricultural and market-based interventions that support sustainable diets and local food systems.
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Conservação dos Recursos Naturais , Dieta/efeitos adversos , Política Ambiental , Abastecimento de Alimentos , Modelos Biológicos , Política Nutricional , Cooperação do Paciente , Biodiversidade , Comportamento do Consumidor , Produtos Agrícolas/química , Produtos Agrícolas/crescimento & desenvolvimento , Dieta/economia , Dieta/etnologia , Características da Família , Feminino , Abastecimento de Alimentos/economia , Humanos , Malaui , Masculino , Inquéritos Nutricionais , Cooperação do Paciente/etnologia , Avaliação de Programas e Projetos de Saúde , Saúde da População Rural/economia , Saúde da População Rural/etnologia , Estações do AnoRESUMO
OBJECTIVE: Changes to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) occurred in 2009 when supplemental foods offered through the programme were updated to align with current dietary recommendations. The present study reports on a new index developed to monitor the retail environment's adoption of these new food supply requirements in New Orleans. DESIGN: A 100-point WIC Availability Index (WIC-AI) was derived from new minimum state stocking requirements for WIC vendors. A sample of supermarkets, medium and small food stores was assessed in 2009 before changes were implemented and in 2010 after revisions had gone into effect. WIC-AI scores were utilized to compare differences in meeting requirements by store type, WIC vendor status and year of measurement. SETTING: Supermarkets, medium and small WIC and non-WIC food stores in New Orleans, Louisiana, USA. RESULTS: At baseline supermarkets had the highest median WIC-AI score (93·3) followed by medium (69·8) and small food stores (48·0). Small WIC stores had a higher median WIC-AI score at baseline than small non-WIC stores (66·9 v. 38·0). Both medium and small WIC stores significantly increased their median WIC-AI scores between 2009 and 2010 (P<0·01). The increased median WIC-AI score in small food stores was largely attributed to increased availability of cereals and grains, juices and fruit, and infant fruit and vegetables. CONCLUSIONS: The WIC-AI is a simple tool useful in summarizing complex food store environment data and may be adapted for use in other states or a national level to inform food policy decisions and direction.
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Assistência Alimentar , Rotulagem de Alimentos , Abastecimento de Alimentos , Política Nutricional , Adulto , Pré-Escolar , Grão Comestível/economia , Grão Comestível/provisão & distribuição , Feminino , Abastecimento de Alimentos/economia , Frutas/economia , Frutas/provisão & distribuição , Sucos de Frutas e Vegetais/economia , Sucos de Frutas e Vegetais/provisão & distribuição , Humanos , Lactente , Recém-Nascido , Masculino , Nova Orleans , Gravidez , Características de Residência , Inquéritos e Questionários , Verduras/economia , Verduras/provisão & distribuiçãoRESUMO
Adolescents and young adults living with HIV (AYLHIV) in sub-Saharan Africa experience poorer HIV outcomes than adults, including lower ART adherence and virologic suppression. They also have high rates of unprotected sex, increasing the risk of adverse sexual health outcomes and onward transmission. This one-arm, pre-post study investigates a structured 14-session support group aiming to boost treatment adherence and sexual protective behavior for AYLHIV in South Africa. Logistic and Poisson regression analyses were performed on self-reported pre- and post-intervention survey data collected approximately 7.5 months apart from a cohort of 548 AYLHIV. Participants were significantly more likely to report at least 95% adherence at follow-up and rate their health as "good;" they also demonstrated greater treatment knowledge and had fewer absences from school overall and due to illness. Among sexually active AYLHIV, contraception use at last sex increased significantly, while condom use did not. Effects were small, and greater programmatic emphasis on adherence and multifaceted service packages is likely necessary to promote viral suppression. Nonetheless, the intervention addresses an important gap in service provision for AYLHIV in South Africa. Findings denote the potential for incorporating care and treatment components into sexual and reproductive health interventions tailored for AYLHIV.
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In order to quantify the risk of pancreatic cancer associated with history of any allergy and specific allergies, to investigate differences in the association with risk according to age, gender, smoking status, or body mass index, and to study the influence of age at onset, we pooled data from 10 case-control studies. In total, there were 3,567 cases and 9,145 controls. Study-specific odds ratios and 95% confidence intervals were calculated by using unconditional logistic regression adjusted for age, gender, smoking status, and body mass index. Between-study heterogeneity was assessed by using the Cochran Q statistic. Study-specific odds ratios were pooled by using a random-effects model. The odds ratio for any allergy was 0.79 (95% confidence interval (CI): 0.62, 1.00) with heterogeneity among studies (P < 0.001). Heterogeneity was attributable to one study; with that study excluded, the pooled odds ratio was 0.73 (95% CI: 0.64, 0.84) (Pheterogeneity = 0.23). Hay fever (odds ratio = 0.74, 95% CI: 0.56, 0.96) and allergy to animals (odds ratio = 0.62, 95% CI: 0.41, 0.94) were related to lower risk, while there was no statistically significant association with other allergies or asthma. There were no major differences among subgroups defined by age, gender, smoking status, or body mass index. Older age at onset of allergies was slightly more protective than earlier age.
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Hipersensibilidade/epidemiologia , Neoplasias Pancreáticas/epidemiologia , Fumar/epidemiologia , Distribuição por Idade , Idoso , Asma/epidemiologia , Índice de Massa Corporal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Distribuição por Sexo , Fatores SocioeconômicosRESUMO
RATIONALE: Interventions that promote sexual health communication between adolescents and their parents or other primary caregivers are an important tool for reducing female adolescents' behavioral risk. Understanding the mechanisms by which interventions effectively foster communication can inform future programs. OBJECTIVE: An initial evaluation of Let's Talk, a structured, family-centered HIV prevention intervention for vulnerable adolescents in South Africa, found an increase in caregiver-adolescent sexual communication. This analysis expands upon initial findings to explore the role of parental knowledge, the quality of the parent-adolescent relationship, and the mental health of both parties on caregiver-adolescent sexual health communication. METHOD: Using mixed methods data collected in 2015 and 2016, structural equation modeling of differenced pre- and postintervention survey data from 64 female Let's Talk participants ages 13-17 and their caregivers was used to explore the pathway to increased frequency of caregiver-adolescent sexual health communication. Focus group discussions (FGDs) were held with intervention participants (n = 25) and facilitators (n = 6). RESULTS: The path analysis indicates that caregivers' mental health indirectly affected caregiver-adolescent relationship quality, and adolescents' mental health exerted a direct effect. Relationship quality, in turn, directly affected the level of parental sexual communication reported by the adolescent. FGDs suggested that cultural norms inhibit frank discussions between caregivers and adolescents about sexual health, but that thoughtfully designed interventions such as Let's Talk can mitigate this barrier. Qualitative findings also echoed quantitative findings about the role of caregiver-adolescent relationship quality and mental health on communication frequency and highlighted the importance of enhancing participants' technical knowledge and particularly their skills related to expression, listening, and anger management to help enable sensitive conversations. CONCLUSIONS: Findings overall suggest that a holistic intervention approach emphasizing caregiver-adolescent relationship development and designed to support the mental health of both parties may hold significant promise for enhancing sexual health communication.
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Comportamento do Adolescente , Infecções por HIV , Comunicação em Saúde , Saúde Sexual , Adolescente , Cuidadores , Comunicação , Feminino , Infecções por HIV/prevenção & controle , Humanos , Comportamento Sexual , África do SulRESUMO
Human papillomavirus-16 (HPV-16) is a risk factor for head and neck squamous cell carcinoma (HNSCC). HPV-positive cancers have distinct disease cofactors and improved survival following treatment. There is conflicting evidence of a protective association of fruit consumption with HNSCC. As HPV-related disease is clinically distinct, we investigated whether the association between fruit consumption and HNSCC risk was modified by exposure to HPV-16. We studied 270 cases and 493 controls with fruit intake information and known HPV-16 antibody status. Cases were identified at nine Boston-area medical facilities between 1999 and 2003. Controls were randomly selected from the greater population and frequency matched to cases by age, gender, and town of residence. Controlling for age, gender, race, smoking, alcohol, total energy intake, body mass index, and education, the seronegative individuals had a significantly lower risk of HNSCC with increasing total fruit consumption [odds ratio (OR)(tertile 2), 0.60; 95% confidence interval (95% CI), 0.38-0.95; OR(tertile 3), 0.57; 95% CI, 0.35-0.95] and specifically increasing citrus fruit consumption (OR(tertile 2), 0.61; 95% CI, 0.39-0.97; OR(tertile 3), 0.59; 95% CI, 0.37-0.96). However, among the seropositive, risk increased with greater fruit consumption (OR(tertile 2), 2.27; 95% CI, 0.92-5.58; OR(tertile 3), 1.40; 95% CI, 0.55-3.59) and citrus fruit consumption (OR(tertile 2), 3.35; 95% CI, 1.36, 8.24; OR(tertile 3), 3.15; 95% CI, 1.23-8.08). This interaction was statistically significant (P < 0.05), showing that fruit consumption was associated with a reduced HNSCC risk among HPV-16-seronegative individuals but an increased HNSCC risk among the HPV-16-seropositive individuals. These findings suggest that dietary factors dramatically alter the pattern of occurrence of HPV-associated HNSCC and show that viral-related disease is clinically and etiologically distinct.
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Carcinoma de Células Escamosas/virologia , Dieta , Frutas , Neoplasias de Cabeça e Pescoço/virologia , Papillomavirus Humano 16/patogenicidade , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Modelos Logísticos , Masculino , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Bereavement increases children's risk for psychological disorders, highlighting the need for effective interventions, especially in areas where orphanhood is common. We aimed to assess the effects of an eight-session support group intervention on the psychological health of bereaved female adolescents in South Africa. METHODS: This randomised controlled trial enrolled female adolescents at 11 schools in three peri-urban towns of Free State province, South Africa. 453 bereaved ninth-grade students aged 13-17 years who had expressed interest in taking part in the group were randomly assigned (1:1) to receive the intervention or to be waitlisted for programme enrolment after the study period and serve as the control group. The intervention, Abangane ("friends" in isiZulu), is a locally derived, curriculum-based support group focused on coping with loss incorporating indigenous stories and cognitive behavioural therapy components. Weekly group sessions were facilitated by trained social workers or social auxiliary workers from a local non-profit organisation. The primary outcomes included indicators of grief and depression as reported by adolescents and behavioural problems reported by their caregivers. Grief was measured with three scales: the grief subscale of the Core Bereavement Items to assess normative grief; and the Intrusive Grief Thoughts Scale and the Inventory of Complicated Grief-Revised for Children to assess maladaptive grief symptoms in the past 4 weeks. Depression symptoms in the past 7 days were measured with the Center for Epidemiological Studies-Depression Scale for Children. Caregivers completed the Brief Problem Monitor-Parent Form to report on adolescent's behaviour in the previous 4 weeks. Analysis was intention to treat. This study is registered with ClinicalTrials.gov, number NCT02368808. FINDINGS: Between Sept 30, 2014, and Feb 5, 2015, eligible female participants were identified, of whom 226 were assigned to the intervention, Abangane, and 227 were assigned to the waitlisted control group. Analysis included 382 adolescents who completed both surveys (193 participants assigned to Abangane and 189 assigned to waitlist). At follow up, the intervention group had significantly lower scores for primary outcomes, including intrusive grief (p=0·000, Cohen's d=-0·21), complicated grief (p=0·015, d=-0·14), and depression (p=0·009, d=-0·21) relative to the waitlisted group, while core bereavement scores were similar between groups (p=0·269). Caregivers in the intervention group reported lower levels of behavioural problems among adolescents (p=0·017, d=-0·31). INTERPRETATION: Short-term, structured, theory-based support groups with contextually relevant content show promise in mitigating psychological and behavioural problems among bereaved adolescents. Abangane is replicable in resource limited settings, using freely available curriculum materials, existing programme structures, and appropriately trained personnel to implement it. FUNDING: US Agency for International Development Southern Africa.
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Luto , Transtornos Mentais/prevenção & controle , Grupos de Autoajuda , Adolescente , Feminino , Humanos , África do SulRESUMO
This study examines how the consumption of fruits and vegetables is affected by home cooking habits and shopping patterns, including distance to patronized stores and frequency of shopping, in two low-income predominantly African American urban neighborhoods in New Orleans, Louisiana. In-person interviews were conducted in 2013 with 901 adult residents who identified themselves as the primary household shopper. Respondents were asked where and how often they shopped and answered a food frequency questionnaire. Addresses were geocoded and distances to the stores where respondents shopped were calculated. Multivariable logistic regression was used to examine the relationship between food consumption and personal factors, neighborhood factors and shopping habits. Consumption of daily servings of fresh produce increased by 3% for each additional trip to a grocery store, by 76% for shopping at a farmer's market, and by 38% for preparing food at home. Each additional trip to a convenience store increased the frequency of consumption of chips, candy and pastries by 3%. The distance from residence to the type of store patronized was not associated with consumption of produce or chips, candy or pastries. Shopping at full-service grocery stores, farmer's markets and cooking at home were positively associated with the consumption of fresh produce while shopping at convenience stores was associated with increased consumption of chips, candy and pastries. These findings are useful for designing programmatic interventions to increase fresh fruit and vegetable consumption among residents in low-income urban communities.
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Investigations of the ability of polymorphisms in the GSTM1, GSTT1, and GSTP1 genes to alter susceptibility to head and neck squamous cell carcinoma (HNSCC) have examined gene-environment interaction in their detoxification of tobacco-associated carcinogens. Little work has been done to ask if these variant genes also modify the interaction of tobacco and alcohol in the development of HNSCC. To test this hypothesis, we conducted a case-control study, enrolling 692 incident cases of HNSCC and 753 population controls. Information about lifetime tobacco and alcohol use was ascertained through questionnaires, and genotypes for GSTM1, GSTT1, and GSTP1 were determined from constitutional DNA. Genotype frequencies were compared among cases and controls, and the association between genotypes and tobacco use was evaluated on cancer risk through logistic regression. Deletion of GSTM1 was associated with an increased risk for HNSCC [odds ratio (OR), 1.3; 95% confidence interval (95% CI), 1.0-1.6]. GSTT1 deletion was associated with a slight decreased HNSCC risk (OR, 0.8; 95% CI, 0.6-1.0). Among those with GSTM1 present, the OR of cancer for heavy smoking was 2.6 (95% CI, 1.6-4.3) compared with 4.2 for those with the GSTM1 deleted (95% CI, 2.6-6.7). The combination of consuming 10 to 20 alcohol drinks weekly and smoking >45 pack-years was associated with a 13-fold elevated risk (OR, 12.6; 95% CI, 4.0-40.2) among the GSTM1 deleted subjects compared with an OR of 3.6 (95% CI, 1.5-8.7) among the GSTM1 present individuals. These data (showing that the GSTM1 deletion affects on the tobacco and alcohol synergy) suggest that the interaction of these carcinogens is, at least in part, driven by alcohol, enhancing the carcinogenic action of tobacco smoke.
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Consumo de Bebidas Alcoólicas/efeitos adversos , Glutationa Transferase/genética , Glutationa Transferase/fisiologia , Neoplasias Laríngeas/genética , Neoplasias Bucais/genética , Neoplasias Faríngeas/genética , Polimorfismo Genético , Fumar/efeitos adversos , Carcinoma de Células Escamosas/genética , Estudos de Casos e Controles , Predisposição Genética para Doença , Genótipo , Neoplasias de Cabeça e Pescoço/genética , Humanos , Análise de Regressão , Inquéritos e QuestionáriosRESUMO
OBJECTIVES: While pancreatic cancer (PC) most often affects older adults, to date, there has been no comprehensive assessment of risk factors among PC patients younger than 60 years. METHODS: We defined early-onset PC (EOPC) and very-early-onset PC (VEOPC) as diagnosis of PC in patients younger than 60 and 45 years, respectively. We pooled data from 8 case-control studies, including 1954 patients with EOPC and 3278 age- and sex-matched control subjects. Logistic regression analysis was performed to identify associations with EOPC and VEOPC. RESULTS: Family history of PC, diabetes mellitus, smoking, obesity, and pancreatitis were associated with EOPC. Alcohol use equal to or greater than 26 g daily also was associated with increased risk of EOPC (odds ratio, 1.49; 95% confidence interval, 1.21-1.84), and there appeared to be a dose- and age-dependent effect of alcohol on risk. The point estimate for risk of VEOPC was an odds ratio of 2.18 (95% confidence interval, 1.17-4.09). CONCLUSIONS: The established risk factors for PC, including smoking, diabetes, family history of PC, and obesity, also apply to EOPC. Alcohol intake appeared to have an age-dependent effect; the strongest association was with VEOPC.
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Adenocarcinoma/diagnóstico , Neoplasias Pancreáticas/diagnóstico , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , Adenocarcinoma/etiologia , Adenocarcinoma/fisiopatologia , Fatores Etários , Idade de Início , Consumo de Bebidas Alcoólicas/efeitos adversos , Estudos de Casos e Controles , Diabetes Mellitus/fisiopatologia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Obesidade/complicações , Razão de Chances , Neoplasias Pancreáticas/etiologia , Neoplasias Pancreáticas/fisiopatologia , Pancreatite/complicações , Fatores de Risco , Fumar/efeitos adversosRESUMO
BACKGROUND: Fresh fruit and vegetables are important components of a healthy diet. Distance to a supermarket has been associated with the ability to access fresh produce. METHODS: A randomly sampled telephone survey was conducted with the main shopper for 3000 households in New Orleans, Louisiana in 2011. Individuals were asked where and how often they shopped for groceries, frequency of consumption of a variety of foods, and whether they had access to a car. Bivariate models assessed the relationship between four outcomes: car access, distance to the store patronized by the respondent, number of monthly shopping trips, and daily servings of produce. Structural equation modeling (SEM) was used to distinguish direct and indirect effects. RESULTS: In bivariate models, car access was positively associated with number of shopping trips and produce consumption while distance was inversely associated with shopping trips. In SEM models, produce consumption was not associated with car access or distance, but to the number of monthly shopping trips. CONCLUSION: The frequency of shopping is associated with car access but a further distance deters it. Access to stores closer to the shopper may promote more frequent shopping and consumption of produce.
RESUMO
Elevated mortality rates of lung cancer in the Mississippi River corridor in Louisiana have been clearly documented for the past half-century and rank among the highest in the nation. A population-based case-control study of lung cancer termed Lower Mississippi River Interagency Cancer Study was conducted in southern Louisiana. Lung tumor specimens were collected, isolated by laser capture microdissection, subjected to PCR to amplify KRAS, and sequenced to confirm mutation status and specificity. Of the 116 lung tumors analyzed to date, 32 (27.6%) contained mutations in either codon 12 or 13 of KRAS. This frequency is comparable to that reported in the literature; however, the mutation spectrum was strikingly different. Of the 32 mutations observed, 21 (65.6%) resulted in the inappropriate insertion of cysteine, 6 (18.8%) resulted in the insertion of serine, 3 (9.4%) resulted in the insertion of valine, and 1 (3.1%) each resulted in the insertion of aspartate and alanine. These data indicate that an abnormally high proportion of cysteine (P = 0.010) and serine (P = 0.002) mutations was observed in our sample group versus lung cancers reported in the literature. KRAS mutations were more common in African Americans with an odds ratio of 2.4 (P = 0.048), as were serine mutations, although the latter did not reach statistical significance (odds ratio, 2.6; P = 0.373). No association was found between the observed mutation spectrum and known lung cancer risk factors.
Assuntos
População Negra , Carcinógenos/toxicidade , Exposição Ambiental/efeitos adversos , Neoplasias Pulmonares/induzido quimicamente , Neoplasias Pulmonares/etnologia , Exposição Ocupacional/efeitos adversos , Mutação Puntual/efeitos dos fármacos , Proteínas Proto-Oncogênicas/efeitos dos fármacos , População Branca , Adulto , Idoso , Biomarcadores Tumorais/análise , Biomarcadores Tumorais/genética , Estudos de Casos e Controles , Códon/efeitos dos fármacos , Códon/genética , Medicina Baseada em Evidências , Feminino , Humanos , Louisiana/etnologia , Neoplasias Pulmonares/genética , Masculino , Pessoa de Meia-Idade , Mutação Puntual/genética , Reação em Cadeia da Polimerase , Polimorfismo Genético/efeitos dos fármacos , Polimorfismo Genético/genética , Proteínas Proto-Oncogênicas/genética , Proteínas Proto-Oncogênicas p21(ras) , Análise de Sequência de DNA , Análise Espectral , Proteínas rasRESUMO
OBJECTIVE: This study determined the variation in hospital breastfeeding support for African-American women in Louisiana. STUDY DESIGN: Data from the 2007-2008 Louisiana Pregnancy Risk Assessment Monitoring System (n=2,534) were used to determine the odds of African-American women's hospital experiences with breastfeeding-related services following delivery relative to women of all other races. SAS-callable SUDDAN software was used for analyses. RESULTS: African-American women were 60% less likely than women of other races to initiate breastfeeding or pump milk (odds ratio=0.40, 95% confidence interval=0.31-0.52). Compared with women of other races, African-American mothers were less likely to receive breastfeeding instruction and support from healthcare professionals while in the hospital, including being less likely to receive phone numbers for support and less likely to have their baby remain in the hospital room with them. African-American mothers were also less likely to report that they breastfed while in-hospital or breastfed exclusively while in-hospital. CONCLUSION: This study shows significant racial differences in initiation of breastfeeding and hospital experiences following delivery in Louisiana.
Assuntos
Negro ou Afro-Americano , Aleitamento Materno/etnologia , Promoção da Saúde , Disparidades em Assistência à Saúde , Apoio Social , Adolescente , Adulto , Aleitamento Materno/psicologia , Aconselhamento , Feminino , Pesquisas sobre Atenção à Saúde , Promoção da Saúde/métodos , Humanos , Modelos Logísticos , Louisiana , Gravidez , Cuidado Pré-Natal , Medição de RiscoRESUMO
Cadmium has been hypothesized to be a pancreatic carcinogen. We test the hypothesis that cadmium exposure is a risk factor for pancreatic cancer with a population-based case-control study sampled from a population with persistently high rates of pancreatic cancer (south Louisiana). We tested potential dietary and nondietary sources of cadmium for their association with urinary cadmium concentrations which reflect long-term exposure to cadmium due to the accumulation of cadmium in the kidney cortex. Increasing urinary cadmium concentrations were significantly associated with an increasing risk of pancreatic cancer (2nd quartile OR = 3.34, 3rd = 5.58, 4th = 7.70; test for trend P ≤ 0.0001). Potential sources of cadmium exposure, as documented in the scientific literature, found to be statistically significantly associated with increased risk of pancreatic cancer included working as a plumber, pipefitter or welder (OR = 5.88) and high consumption levels of red meat (4th quartile OR = 6.18) and grains (4th quartile OR = 3.38). Current cigarette smoking, at least 80 pack years of smoking, occupational exposure to cadmium and paints, working in a shipyard, and high consumption of grains were found to be statistically significantly associated with increased concentrations of urinary cadmium. This study provides epidemiologic evidence that cadmium is a potential human pancreatic carcinogen.