Prevalence, trends, and determinants of contraception use among women in Nigeria: An analysis of Nigeria demographic and health surveys 2008 to 2018.

Within Africa, maternal mortality remains a concern that can be prevented and addressed. Among the various African countries, Nigeria has one of the highest mortality rates, particularly in a context where the population continues to rise. The relationship between contraceptive usage among married Nigerian women and low socioeconomic development contributes to another concerning public health issue- performing unskilled abortions. This cross-sectional study examines how seven (7) key social determinants of health impact the usage of contraceptive methods among Nigerian women ages 15-24. Data were analyzed and acquired from the Nigerian Demographic and Health Survey (NDHS) and the National Population Commission (NPC) in 2008, 2013, and 2018. Bivariate and multivariable logistic regression analyses illustrate social determinants have a deep effect on access and usage of contraceptives in Nigeria. Results yielded that as factors such as age, education, and socioeconomic status increase, the use of contraceptives increases as well. While autonomy has little to no significance, religion and urbanity present challenges to Nigerian women who are interested in using contraceptives. More so, this study suggests a stronger need for education for Nigerian women at an early age and deepening the understanding of the barriers to contraception use with the help of the community and religious leaders.

En Afrique, la mortalité maternelle reste une préoccupation qui peut être évitée et traitée. Parmi les différents pays africains, le Nigeria présente l'un des taux de mortalité les plus élevés, notamment dans un contexte où la population ne cesse d'augmenter. La relation entre l'utilisation de contraceptifs chez les femmes nigérianes mariées et le faible développement socio-économique contribue à un autre problème de santé publique préoccupant : la pratique d'avortements non qualifiés. Cette étude transversale examine l'impact de sept (7) déterminants sociaux clés de la santé sur l'utilisation des méthodes contraceptives chez les femmes nigérianes âgées de 15 à 24 ans. Les données ont été analysées et acquises à partir de l'Enquête démographique et de santé nigériane (NDHS) et de la Commission nationale de la population (NPC) en 2008, 2013 et 2018. Les analyses de régression logistique bivariées et multivariées illustrent que les déterminants sociaux ont un effet profond sur l'accès et l'utilisation des contraceptifs. au Nigéria. Les résultats ont montré qu'à mesure que des facteurs tels que l'âge, l'éducation et le statut socio-économique augmentent, l'utilisation de contraceptifs augmente également. Même si l'autonomie n'a que peu ou pas de signification, la religion et l'urbanité présentent des défis pour les femmes nigérianes qui souhaitent utiliser des contraceptifs. Plus encore, cette étude suggère un besoin plus fort d'éducation des femmes nigérianes dès leur plus jeune âge et d'approfondir la compréhension des obstacles à l'utilisation de la contraception avec l'aide de la communauté et des chefs religieux.

Hispanic mothers' accounts of vaccinating their adolescent children against HPV: features of the clinic visit.

ABSTRACTObjective: Despite the widespread availability of the human papillomavirus (HPV) vaccine in the US, rates of vaccination among Hispanic adolescents lag behind those of other recommended vaccines. Understanding what happens during the HPV vaccination visit should provide important insight into communication between health care providers and Hispanic mothers and identifies areas where communication can be improved. As such, this qualitative study explored Hispanic mothers' experiences during their adolescent child's HPV vaccination visit.Design: Fifty-one participants completed individual interviews. Transcripts were analyzed using a conventional content analysis approach to identify emergent categories or themes.Results: We identified three features of the HPV vaccination visit including: the primary reason for the visit, the type of counseling the mother received about the vaccine and the type of HPV vaccine recommendation received. Most mothers reported that their child was vaccinated against HPV at a routine well-child visit. Some mothers reported that they received in-depth counseling about the vaccine, while others received brief or no counseling from the provider. Mothers also reported receiving either a strong recommendation to vaccinate, a recommendation to vaccinate that emphasized her choice, or no recommendation to vaccinate.Conclusion: Most Hispanic mothers report that they received counseling and a recommendation from their adolescent child's health care provider before vaccinating. However, most of the mothers first heard about the HPV vaccine at the vaccination visit. Mothers who had previously heard about the vaccine outside of the clinic, reported making an appointment specifically for their child to be vaccinated against HPV. Together, these findings indicate a need to raise awareness of the vaccine and to promote HPV vaccination more strongly in this population. Education efforts should target mothers in community settings, in addition to clinic settings in order to increase awareness and vaccination in this population.

Perceived partner beliefs about condoms and self-efficacy communication within the context of the theory of gender and power.

The theory of gender and power provides a unique framework for understanding condom use by accounting for distinct challenges faced by minority women in particular. This study examined whether self-efficacy about condom use communication (SECC) and perceived partner's beliefs about condom (PPBC) use had an influence on condom use frequency; and whether these associations varied by gender. A sample of 252 African-American college students (101 males and 151 females) completed a confidential online survey assessing SECC, PPBC, and condom use behavior. SECC and PPBC showed significant associations with condom use behavior. Furthermore, there was a gender interaction effect with PPBC on condom use behavior. As PPBC increases toward positive associations about condom use, condom use behavior increased significantly more for females (B = 0.42; p = .02) as compared to males (B = 0.26; p = .19). This study supports the need to teach young women effective communication skills in order for them to accurately assess what their partner thinks about condom-related behaviors; and ultimately not allow partner discouragement to influence their decisions to use condoms. Interventions aimed at reducing risky sexual behavior on predominantly Black college campuses, in particular, may benefit from directly addressing relationship power and focusing on building self-efficacy in communicating condom use.

Toward a Model of HPV Vaccine Series Completion in Adolescent Hispanic Males: Identifying Mothers' Salient Behavioral, Normative, and Control Beliefs.

Human papillomavirus (HPV) vaccine series completion among adolescent Hispanic males (35%) is lower than the Healthy People 2020 80% goal. This directed qualitative content analysis identified mothers' beliefs about their sons completing the series. We found that mothers (N = 19) (1) express positive feelings; (2) believe the vaccine has positive effects; (3) identify the father and doctors as supporters and friends as nonsupporters; (4) list health insurance, transportation, and clinic reminders as facilitators; and (5) mention affordability as a barrier to vaccine completion. Results provide guidance for interventions. Increasing HPV vaccination among boys will decrease the overall incidence of HPV in this population.

Latent Classes of Sexual Positioning Practices and Sexual Risk Among Men Who Have Sex with Men in Paris, France.

HIV/STI risk varies by sexual positioning practices; however, limited data have characterized the behavioral profiles of men who have sex with men (MSM) in France. This study used latent class analysis (LCA) to explore sexual risk profiles among MSM in Paris, France. LCA was used to classify sexual positioning and serosorting profiles among MSM in Paris (n = 496). Age, HIV status, relationship status, substance use, group sex, and PrEP history were used in a multinomial regression model predicting class membership. Three latent classes were identified: majority top/serosorters, versatile/low partners, and majority bottom/some serosorters. Majority top/serosorters had the highest probability of condomless serosorting; majority bottom/some serosorters had the highest mean number of partners (~ 12 partners) for condomless receptive anal intercourse. HIV-positive MSM were more likely to be classified as majority bottom/some serosorters than versatile/low partners (AOR 7.61; 95% CI 2.28, 25.3). Findings support the need for tailored and targeted interventions for highest-risk individuals.

Using Social Marketing Theory as a Framework for Understanding and Increasing HPV Vaccine Series Completion Among Hispanic Adolescents: A Qualitative Study.

HPV vaccine series completion rates among adolescent Hispanic females and males (~39 and 21 %, respectively) are far below the Healthy People 80 % coverage goal. Completion of the 3-dose vaccine series is critical to reducing the incidence of HPV-associated cancers. This formative study applies social marketing theory to assess the needs and preferences of Hispanic mothers in order to guide the development of interventions to increase HPV vaccine completion. We conducted 51 in-depth interviews with Hispanic mothers of adolescents to identify the key concepts of social marketing theory (i.e., the four P's: product, price, place and promotion). Results suggest that a desire complete the vaccine series, vaccine reminders and preventing illnesses and protecting their children against illnesses and HPV all influence vaccination (product). The majority of Completed mothers did not experience barriers that prevented vaccine series completion and Initiated mothers perceived a lack of health insurance and the cost of the vaccine as potential barriers. Informational barriers were prevalent across both market segments (price). Clinics are important locations for deciding to complete the vaccine series (place). They are the preferred sources to obtain information about the HPV vaccine thus making them ideal locations to deliver intervention messages, followed by television, the child's school and brochures (promotion). Increasing HPV vaccine coverage among Hispanic adolescents will reduce the rates of HPV-associated cancers and the cervical cancer health disparity among Hispanic women. This research can inform the development of an intervention to increase HPV vaccine series completion in this population.

Assessing Whether Religious Behaviors and Positive and Negative Affect are Associated with Alcohol Use and Abuse Among a Sample of College Students Living in the Midwest.

Alcohol use and abuse are a problem on college campuses. Religious behaviors (religious attendance, prayer, and importance) have been shown to be a protective factor against alcohol use among college students. This study examined the role religious behaviors and positive and negative affect had on drinking (alcohol use and alcohol to intoxication). College students (765) completed an online survey. The results showed that college students who attended religious services were less likely to use alcohol than those who did not attend religious services. The results have important implications for college administrators and policy makers. Limitations and future research will be discussed.

A randomized controlled trial of two interventions to increase colorectal cancer screening among Hispanics on the Texas-Mexico border.

BACKGROUND: Colorectal cancer (CRC) is the second and third leading cause of cancer death for Hispanic men and women, respectively. CRC can be prevented if precursors are detected early and removed and can be successfully treated if discovered early. While one-on-one interventions for increasing CRC screening (CRCS) are recommended, few studies specifically assess the effectiveness of lay health worker (LHW) approaches using different educational materials. PURPOSE: To develop and evaluate the effectiveness of two LHW-delivered CRCS interventions known as Vale la Pena (VLP; "It's Worth It!") on increasing CRCS among Hispanics. DESIGN: The study design was a cluster randomized controlled trial with two treatment arms. SETTING/PARTICIPANTS: Six hundred and sixty five Hispanics 50 years and older were recruited from 24 colonias (neighborhoods) in the Lower Rio Grande Valley of the Texas-Mexico border. INTERVENTION: The interventions were a small media print intervention (SMPI) (including DVD and flipchart), and a tailored interactive multimedia intervention (TIMI) delivered on tablet computers. A no intervention group served as the comparison group. Data were collected between 2007 and 2009 and analyzed between 2009 and 2013. MAIN OUTCOME MEASURES: Measures assessed CRCS behavior, self-efficacy, knowledge, and other psychosocial constructs related to CRCS and targeted through VLP. RESULTS: Among participants reached for follow-up, 18.9 % in the SMPI group, 13.3 % in the TIMI group, and 11.9 % in the comparison group completed CRCS. Intent-to-treat analysis showed that 13.6 % in the SMPI group, 10.2 % in the TIMI group, and 10.8 % in the comparison group completed CRCS. These differences were not statistically significant. CONCLUSION: Results indicated that there are no significant differences in CRCS uptake between groups.

Get the message: targeting beliefs to develop risk reduction intervention messages for African American adolescents.

Risk reduction interventions that promote condom use, a vital component of most HIV prevention interventions, have been successful in increasing condom use among African American adolescents. Understanding theoretical components that lead to behavior change and selecting relevant risk reduction messages remain important considerations for targeting new interventions and tailoring existing interventions. The present study sought to (1) identify the most important theoretical determinants of condom use intention in African American adolescent males and females, separately, using the integrative model of behavior prediction, and (2) identify underlying beliefs within the determinants that were good candidates for message development in similar interventions. Using 446 African American adolescents, multi-group SEM indicated that the gender-specific IM exhibited a better fit than the overall model. Specifically, the IM had a stronger capacity for predicting condom use intention and condom use behavior for adolescent boys. Using a specific criteria for message selection, specific condom use beliefs were discussed as potential candidate messages for both African American males and females.

Concept Mapping STI/HIV Prevention and Condom Use among Young African American Adults.

Theory-based HIV prevention programs have resulted in increased condom use, which remains the best method for the prevention of sexually transmitted infections (STIs) among sexually active heterosexual individuals. Particularly, the integrative model of behavior prediction theorizes that attitudes, norms, self-efficacy, and socioenvironmental factors influence intention and behavior and has been useful in understanding STI risk among adolescents. However, more research is needed regarding young African American adults. Given the increased freedom and decision-making independence afforded to young adults compared to adolescents, it is important to consider the STI/human immunodeficiency virus (HIV) prevention messages that would resonate with them, particularly regarding condom use. The present study sought to explore how attitudes, subjective norms, self-efficacies, and socioenvironmental factors may influence condom use and STI/HIV prevention, as conceptualized by the participants. We conducted a group-based concept map, a systems-thinking mixed methodology that resulted in a geospatial map reflecting the conceptualizations of the participants. Self-identified young heterosexual African American adults (N = 43) aged 20-26 engaged in an interactive concept mapping procedure in order to "map out" their overarching concepts about STI/HIV risk and condom use. Seven overall conceptual domains emerged: self-efficacy for partner communication, condom use self-efficacy, social media/sociocultural influences, condom use/STI knowledge, condom use cons, condom use pros, and subjective and social norms about condom use. We presented the concept map and discussed the conceptual interpretations and the relationships among the overarching concepts. We also discussed how the social environment, including the social media environment, was conceptualized regarding STI/HIV risk and prevention among young African American adults. Concept mapping can be viewed as a way to determine worthwhile messages for intervention development. The findings may provide information for prevention programs aimed at reducing the incidence of STIs among young adult heterosexual persons within African American communities.

Concept mapping sociocultural aspects of cervical cancer prevention among African American women.

Introduction: For African American women in Houston, cervical cancer mortality is disproportionate to their racial and ethnic counterparts. Most notably, lack of human papillomavirus (HPV) screening and vaccination as well as late diagnosis increase cervical cancer mortality. However, cervical cancer is largely preventable. While previous research has identified a few social determinants that are specifically related to cervical cancer (e.g., education, income, neighborhood), there may be a host of additional social and cultural factors that contribute to a lack of preventative behavior. Methods: The present study used concept mapping to explore sociocultural determinants of cervical cancer prevention beliefs among young African American women. N = 15 African American women, ages 18-25, participated in a group concept mapping session focused on cervical cancer knowledge, beliefs about women's health, and how their social environment and culture play a role in their conceptualization of cervical cancer prevention. Discussion: Five overarching concepts emerged: (1) Screening, (2) Support System, (3) Cervical Cancer 101 (knowledge), (4) Fatalism, and (5) Ease of Prevention. Conclusion: The present study highlights the use of concept mapping for prevention science, particularly in exploratory studies for understanding cervical cancer screening barriers, avenues for intervention, and public health messaging. We discuss the findings and implications for public health research in cervical cancer prevention tailored for African American women.

Using the interactive systems framework in understanding the relation between general program capacity and implementation in afterschool settings.

The present study uses the Interactive Systems Framework (ISF) to understand how general capacity influences the implementation of prevention programs in afterschool settings. Eight afterschool sites received the Good Behavior Game (GBG) intervention, a program designed to foster supportive behavioral management and positive youth behavior. In line with the Prevention Support System component of ISF, the intervention afterschool staff were trained and received weekly on-site support from coaches in implementing the GBG. It was found that GBG implementation scores were greatest in afterschool programs that rated high on both organizational- and community-levels of general capacity; high scores on only one level of general capacity resulted in lower implementation scores. Thus, afterschool sites that were more organized, maintained adequate facilities, and developed strong linkages to individuals or organizations in the community scored highest in implementation fidelity and quality. This study highlights the importance of considering interactions among multiple levels of general capacity in efforts to promote evidence-based practices in afterschool settings. Caution should be taken in generalizing findings due to the small sample in this study.

Examining the theory of planned behavior applied to condom use: the effect-indicator vs. causal-indicator models.

The authors investigated whether a causal-indicator model or an effect-indicator model of the theory of planned behavior (TPB) is more suitable for predicting behavioral intention and for which behaviors. No previous studies have evaluated this question using the same sample and same behavior. In this study, African American adolescents ages 12-17 participating in risk reduction classes were assessed on their initial attitudes, norms, perceived control, and intention regarding condom use. Second-order structural equation modeling indicated that the effect-indicator model exhibited superior fit above the causal-indicator model. Furthermore, modeling the behavioral antecedents in a causal way may not be as accurate due to the underlying uni-dimensional nature of attitudes, subjective norms, and control. The TPB was not disconfirmed as a suitable model for African American adolescents' regarding condom use. Prevention programs may benefit by focusing on adolescent behavior change with regard to the global components in order to influence more specific concepts of these social cognitions. Editors' Strategic Implications: Despite limitations including correlational data, this study yields implications for prevention programming and, more broadly, an important theoretical elaboration on effect-indicator and causal-indicator models of the TPB.

Hispanic Mothers' Beliefs About Having Their Adolescent Sons Initiate the HPV Vaccine Series.

Rates of HPV vaccination among adolescent Hispanic males lag far behind the Healthy People 2020 80% goal. This study identified Hispanic mothers' salient beliefs regarding having their sons initiate the HPV vaccine series. Twenty-seven Hispanic mothers completed in-depth interviews. They responded to questions that elicited the salient behavioral, normative and control beliefs associated with initiating the HPV vaccine series. We content analyzed their responses. We found that, regarding having their sons initiate the HPV vaccine, mothers: (1) express mostly positive feelings; (2) believe that the vaccine has positive effects, with side effects as the main negative effect; (3) believe that their sons' father and doctor support vaccination while some friends do not; and (4) believe that vaccine affordability, transportation and the support of their sons' father facilitate vaccine initiation. Overall, mothers held positive salient beliefs about the HPV vaccine including that it protects their son's health, has minimal side effects and is recommended by physicians. We are more likely to increase vaccination rates among adolescent Hispanic males if we address mothers' salient beliefs, including reinforcing their positive beliefs.

Identifying Hispanic mothers' salient beliefs about human papillomavirus vaccine initiation in their adolescent daughters.

Guided by the Integrative Model of Behavioral Prediction, we identify mothers' salient beliefs regarding their daughters' initiation of the human papillomavirus vaccine series. In all, 34 Hispanic mothers responded to elicitation questions. Salient beliefs included the following: (1) feeling secure, happy, relieved, concerned, and fear about vaccinating; (2) believing that vaccinating prevents and protects from human papillomavirus but may result in side effects and sexual disinhibition; (3) identifying the daughter, father, mother, aunt, friends, and grandmothers as supporters/non-supporters; and (4) affordability, transportation, clinic distance, and making appointments as facilitators/barriers. This study begins the process of building a model of human papillomavirus vaccine initiation for this population.

Gender Differences in the Association Between Alcohol Use and Sedentary Behavior Among Adults.

PURPOSE: We examined differences in the association between alcohol use and sedentary behavior by gender among adults. DESIGN: Cross-sectional study that employs a complex, multistage stratified probability cluster sample design. SETTING: National Health and Nutrition Examination Survey (NHANES) 2007 to 2014. PARTICIPANTS: NHANES participants aged ≥20 years and identifying as Hispanic, white, or black (N = 18 441). MEASURES: Demographic characteristics, sedentary behavior, and alcohol consumption. Sedentary behavior was measured based on the number of minutes of sedentary activity per week. Alcohol consumption in the last year was measured based on responses to items assessing whether the participant consumes alcoholic beverages and the number of alcoholic beverages consumed on average. ANALYSIS: Multinomial logistic regression analysis was used to estimate associations of alcohol use with categories of sedentary behavior by gender. RESULTS: Compared to women who reported not consuming alcohol, women who were heavy drinkers were significantly more likely to engage in high sedentary activity (odds ratio [OR]: 1.47; 95% confidence interval [CI]: 1.16-1.87), relative to low levels of sedentary activity. Similarly, women who were binge drinkers were more likely to engage in moderate levels of sedentary activity (OR: 1.39; 95% CI: 1.05-1.85). There were no significant associations between alcohol use and sedentary activity among men. CONCLUSION: Findings suggest that alcohol consumption should be considered in health promotion efforts targeting sedentary behavior among women.

Activity and Weight Misperception among Overweight and Obese US Adults.

OBJECTIVES: Engaging in some exercise is associated with weight misperception (ie, overweight and obese participants self-reporting being normal weight or underweight) among adults. Less is known about associations between various types of activity with weight misperception. We examined associations between activity (moderate-vigorous leisure-time, work- and transportation-related physical activity, and sedentary activity) and weight misperception. METHODS: We used cross-sectional data from 7992 National Health and Nutrition Examination Survey 2007-2010 participants aged 20+ years with a ≥ 25 body mass index. Logistic regression models were used to estimate activity-weight misperception associations. RESULTS: Individuals who performed some activity, versus none, were less likely to misperceive their weight (Odds Ratio [OR]: 0.78; 95% Confidence Interval [CI]: 0.66, 0.93). Those who engaged in high levels of transportation activity were more likely to misperceive their weight (OR: 1.29; 95% CI: 1.09, 1.54). Individuals who engaged in medium and high levels of sedentary activity, versus low, were less likely to misperceive their weight (OR: 0.65; 95% CI: 0.57, 0.75 and OR: 0.51; 95% CI: 0.43, 0.61, respectively). Associations varied by sex. CONCLUSIONS: Variation in associations of various types of activity with weight misperception should be considered when developing health promotion programs.

Human papillomavirus vaccine: 2-1-1 helplines and minority parent decision-making.

BACKGROUND: Research is needed to understand parental factors influencing human papillomavirus (HPV) vaccination, particularly in groups with a higher burden of cervical cancer. PURPOSE: To determine correlates of HPV vaccination among a sample of low-income parents of age-eligible daughters (aged 9-17 years) who called the 2-1-1 Helpline. Secondary analyses describe potential differences in HPV vaccination correlates by Hispanic and black parent groups, in particular. METHODS: This 2009 cross-sectional feasibility survey of cancer prevention needs was conducted in Houston at the 2-1-1 Texas/United Way Helpline. In 2012, to examine the association between parental psychosocial, cognitive, and decisional factors and HPV vaccination uptake (one or two doses), bivariate and multivariable logistic regression analyses were conducted for minority parents and for Hispanic and black parent groups, separately. RESULTS: Lower rates of HPV vaccination uptake were reported among minority daughters of 2-1-1 callers (29% overall) compared with national and Texas rates. In final adjusted analysis, factors positively associated with HPV vaccination uptake included being offered the vaccination by a doctor or nurse, belief that the vaccine would prevent cervical cancer, and Hispanic ethnicity. Secondary analyses detected differences in factors associated with vaccination in Hispanic and black groups. CONCLUSIONS: Findings indicate low levels of vaccination among 2-1-1 callers. Increased understanding of determinants of HPV vaccination in low-income minority groups can guide interventions to increase coverage. Because 2-1-1 informational and referral services networks reach populations considered medically underserved, 2-1-1 can serve as a community hub for informing development of and implementing approaches aimed at hard-to-reach groups.

Systems thinking tools as applied to community-based participatory research: a case study.

Community-based participatory research (CBPR) is being used increasingly to address health disparities and complex health issues. The authors propose that CBPR can benefit from a systems science framework to represent the complex and dynamic characteristics of a community and identify intervention points and potential "tipping points." Systems science refers to a field of study that posits a holistic framework that is focused on component parts of a system in the context of relationships with each other and with other systems. Systems thinking tools can assist in intervention planning by allowing all CBPR stakeholders to visualize how community factors are interrelated and by potentially identifying the most salient intervention points. To demonstrate the potential utility of systems science tools in CBPR, the authors show the use of causal loop diagrams by a community coalition engaged in CBPR activities regarding youth drinking reduction and prevention.