Revisiting the healthy immigrant effect with diabetes risk in Canada: why race/ethnicity matters.

Objective: Evidence shows that recent immigrants are healthier than the native-born population, a phenomenon known as the healthy immigrant effect. With increasing duration of stay, this health gap significantly narrows as immigrants' health deteriorates to either resemble or become worse than the host population. However, little is known about the category of immigrants for whom this decline is most pronounced since the extant research largely considers immigrants as a homogeneous group, thus overlooking important racial/ethnic differences.Design: Using data from the 2014 Canadian Community Health Survey (CCHS), we categorised immigrants by race/ethnicity and duration of stay in Canada and compared them to their native-born white Canadian counterparts on the likelihood of having a chronic health condition, using type 2 diabetes (T2D) as a case.Results: In the base model, recent visible minority (i.e. non-white or non-Caucasian) immigrants and recent white immigrants were less likely than the native-born white Canadian population to have T2D (recent visible minority immigrants OR = 0.46, CI = 0.27-0.79, p = 0.005; recent white immigrants OR = 0.26, CI = 0.11-0.64, p = 0.003). The odds of having T2D were significantly higher for long-term immigrants than the native-born white Canadian population (long-term visible minority immigrants OR = 1.59, CI = 1.27-2.00, p = 0.000; long-term white immigrants OR = 1.74, CI = 1.44-2.10, p = 0.000). In the multivariate model, long-term visible minority immigrants were about 2.3 times more likely than their white Canadian born counterparts to have T2D (CI = 1.86-2.96, p = 0.000). Long-term visible minority immigrants were about 2.1 times more likely than long-term white immigrants to have T2D (CI = 1.49-2.94, p = 0.000)Conclusion: Immigrants' health deterioration varies significantly across ethnic categories in Canada. Interventions for facilitating the integration of visible minority immigrants may help reduce these health inequities.

Local knowledge and practices towards malaria in an irrigated farming community in Ghana.

BACKGROUND: Although malaria is endemic across Ghana, the risk is generally elevated for residents living in and around stagnant water bodies such as dams and irrigated farming projects. What knowledge do these at-risk populations have about the aetiology and symptoms of malaria? What are their coping strategies? And what interventions are needed to help improve the health outcomes of people living in high-risk malaria communities? METHODS: This study addressed these research questions with primary data, comprising both qualitative interviews and quantitative surveys, collected in Asutsuare-a rural irrigated farming community located in the Greater Accra Region of Ghana. RESULTS: Results from the fieldwork showed that awareness of malaria as a major health concern in the community was universal. Respondents also displayed a high knowledge of some common clinical symptoms of malaria. Yet, only 3% out of the total survey respondents of 337 indicated they immediately visit a health facility for treatment whenever they suspected malaria. The overwhelming majority (about 97%) indicated they only visit a healthcare facility for treatment if they felt the suspected malaria illness was severe and/or other treatment options had failed. CONCLUSION: Malaria testing training for drug dispensing personnel as well as the provision of malaria testing kits in drug dispensing stores are necessary to facilitate early malaria screening and timely diagnosis particularly in rural endemic areas.

Substance Use among Sexual Minorities: Has it Actually Gotten Better?

BACKGROUND: Despite efforts to decrease substance use, rates among sexual minority youth (SMY) remain higher than among heterosexuals. Substance use is a leading contributor to morbidity and mortality in adulthood, and SMY's use of substances is related to poorer mental and emotional health. OBJECTIVES: We sought to document the trends in substance use for a large sample of youth over 14 years with special attention to SMY. In addition, we tested whether there were disparities in substance use behaviors between SMY and heterosexual youth. Last, we examined changes in disparities over time in substance use among SMY. METHODS: We analyzed data from 8 waves of the Massachusetts YRBS (N = 26,002, Mage = 16), from 1999 to 2013, to investigate trends and disparities in current tobacco, alcohol, and cannabis use for heterosexual youth and SMY. We used logistic regression interaction models to test whether these disparities have widened or narrowed for SMY, as compared to heterosexuals, over the span of 14 years. RESULTS: In absolute terms, substance use rates decreased for nearly all youth between 1999 and 2013. There were striking disparities in substance use between heterosexual youth and all sexual minority subgroups. These disparities in substance use narrowed among males but remained unchanged or worsened among females. Conclusions/Importance: Trends in substance use are changing over time, but not in the same ways for all sexual minority subgroups. Patterns are worsening for females. These findings suggest that we need to address the needs of LGB populations in novel ways.

Trends and disparities in disordered eating among heterosexual and sexual minority adolescents.

OBJECTIVE: Disordered eating has decreased for all youth over time, but studies have not focused specifically on lesbian, gay, and bisexual (LGB) youth. Research has found that LGB youth report disordered eating behaviors more often compared to their heterosexual counterparts, but no studies have documented trends over time for LGB youth and considered whether these disparities are narrowing or widening across sexual orientation groups. METHOD: We use pooled data from the 1999 to 2013 Massachusetts Youth Risk Behavior Surveys (N = 26,002) to investigate trends in purging, fasting, and using diet pills to lose or control weight for heterosexual and sexual minority youth. We used crosstabs, logistic regression, and interactions in regression models, stratified by sex. RESULTS: The prevalence of disordered eating has decreased on all three measures across nearly all groups of heterosexual and sexual minority youth. However, we found disparities in reported disordered eating behaviors for LGB youth persisted across all survey years, with LGB students reporting significantly higher prevalence of disordered eating than heterosexuals. The disparities in fasting to control weight widened between the first and last survey waves between lesbian adolescents and heterosexual females. DISCUSSION: The significant reductions over time in prevalence of disordered eating among some youth are encouraging, but the disparities remain. Indeed, the increasing prevalence of fasting, diet pill use, and purging to control weight among lesbians may warrant targeted prevention and intervention programs. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2017; 50:22-31).

Adolescent sexual risk-taking in the informal settlements of Nairobi, Kenya: understanding the contributions of religion.

Young people in sub-Saharan Africa are at the centre of the global HIV epidemic as they account for a disproportionate share of new infections. Their vulnerability to HIV has been attributed to a myriad of factors, in particular, risky sexual behaviours. While economic factors are important, increasing attention has been devoted to religion on the discourse on sexual decision-making because religious values provide a perspective on life that often conflicts with risky sexual behaviours. Given the centrality of religion in the African social fabric, this study assesses the relationship between adolescent religiousness and involvement in risky sexual behaviours using data from the informal settlements of Nairobi. Guided by social control theory, the paper explores if and how religion and religiosity affect sexual risk-taking among adolescents.

Religion, contraception, and method choice of married women in Ghana.

Using pooled data from the 1998 and 2003 Demographic and Health Surveys, this paper investigates the association between religion and contraceptive behavior of married women in Ghana. Guided by the particularized theology and characteristics hypotheses, multinomial logit and complementary log-log models are used to explore denominational differences in contraceptive adoption among currently married women and assess whether the differences could be explained through other characteristics. We found that while there were no differences between women of different Christian faiths, non-Christian women (Muslim and Traditional) were significantly more likely to have never used contraception compared with Christian women. Similar observations were made on current use of contraception, although the differences were greatly reduced in the multivariate models.

Superstition, witchcraft and HIV prevention in sub-Saharan Africa: the case of Ghana.

Belief in superstition and witchcraft is central to many African conceptions of illness, disease causation and etiology. While a number of anthropological studies have alluded to a theoretical link between such beliefs and HIV prevention in particular, there is limited empirical assessment of the association. Using data from the 2008 Ghana Demographic and Health Survey and applying random-effects logit models, we investigate whether the belief that AIDS can spread through witchcraft associates with the sexual decision making of never-married men and women. The results show that men who believed AIDS can spread through witchcraft and other supernatural means were less likely to have used condoms at last sexual intercourse, controlling for other socioeconomic and cultural variables. Women with similar beliefs were more likely to have experienced sexual intercourse but less likely to have used condoms at last sex. For women, however, the relationship between such superstitious beliefs and condom use was somewhat attenuated after controlling for ethnicity and region of residence. From a policy perspective, the findings suggest that local beliefs regarding AIDS causation must be considered in designing HIV/AIDS programmes and interventions.

Ideal versus actual: the contradiction in number of children born to Nigerian women.

Although desired family size is often different from actual family size, the dynamics of this difference are not well understood. This paper examines the patterns and determinants of the difference between desired and actual number of children (unmet fertility desires) among women aged 15-49 years using pooled data from the 1990, 1999 and 2003 Nigeria Demographic and Health Surveys (NDHSs). The results show that more than two-thirds of the sample have unmet fertility desires (18.1% have more while 52.4% have fewer than desired). It was found that early and late childbearing increased the odds of unmet fertility desires. Also, women with low levels of education, from poor households, rural residents as well as those who had experienced child death were at a higher risk of unmet fertility desires in the multivariate context. The study highlights the policy and programme implications of the findings.

Ten-Year Trends in Physical Dating Violence Victimization Among Adolescent Boys and Girls in British Columbia, Canada.

Physical dating violence (PDV) victimization among adolescents is a serious global problem. Although knowledge of trends in PDV victimization can help guide programming and health policies, little research has examined whether the prevalence of PDV victimization has increased, decreased, or remained stable over time among non-U.S.-based samples of youth. In addition, few studies have directly tested whether disparities in PDV victimization between boys and girls have narrowed, widened, or remained unchanged in recent years. To address these gaps, we used school-based data from the British Columbia Adolescent Health Survey (BC AHS) of 2003, 2008, and 2013 (n boys = 18,441 and n girls = 17,459) to examine 10-year trends in PDV victimization. We also tested whether trends differed across self-reported sex. Data from the 2003 to 2013 BC AHS revealed that recent PDV victimization rates had significantly decreased among youth overall (5.9%-5.0%) and boys (8.0%-5.8%), but not girls (5.3%-4.2%). Although boys had steeper declines than girls in PDV victimization rates, year-by-sex interactions indicate that the sex gap in PDV victimization had not significantly narrowed. Moreover, rates of PDV victimization over the 10-year period indicated significantly higher rates of PDV victimization among boys compared with girls. Despite positive declines in recent rates of PDV victimization among youth, important differences in rates of PDV victimization between boys and girls remain. These findings underscore the need for greater attention to sex differences in research and programming and health policies to reduce PDV victimization and the sex disparities therein.

Religion, HIV/AIDS and sexual risk-taking among men in Ghana.

Although a growing body of research has linked religious involvement with HIV/AIDS protective behaviour in Africa, the focus has mainly been on women. Given the patriarchal nature of African culture, this paper argues for the inclusion of men, a critical group whose sexual behaviours have increasingly been linked to the spread and sustenance of the virus in the region. Drawing on different theoretical discourses and using data from the 2003 Ghana Demographic and Health Survey, this paper examines how religious affiliation influences men's risky sexual behaviours. While the results from the bivariate analysis suggested that Muslims and Traditionalists were significantly less likely to engage in risky sexual behaviour compared with Christians, those differences disappeared once socioeconomic variables were controlled, rendering support for the selectivity thesis. This finding could benefit programmatic and policy formulation regarding AIDS prevention in Ghana.

Worsening Perceptions of Family Connectedness and Parent Support for Lesbian, Gay, and Bisexual Adolescents.

OBJECTIVES: Lesbian, gay, and bisexual (LGB) adolescents often report compromised relations with their families. Given the recent changes in societal attitudes toward LGB individuals, in respect to rights for marriage and other legal statuses, we explore whether or not there has been a change in how LGB and heterosexual adolescents perceive their family relations over time. METHODS: Using the British Columbia Adolescent Health Survey from British Columbia, Canada (N = 99,373; M age = 14.8), we investigated the trends and disparities in family connectedness and mother/father support in four data sets from 1998 to 2013. RESULTS: We found that while levels of perceived family connectedness and parent support have increased for heterosexual adolescents since 1998, the same increases were not found for LGB adolescents. Among LGB participants, levels of perceived connectedness/support generally decreased in each survey waves, especially among females. Alarmingly, significant disparities in these perceptions remained for LGB youth over time. CONCLUSIONS: Our findings have implications for supportive interventions focused on LGB adolescents and their families and in particular, the role of father support.

Investigating site-level longitudinal effects of population health interventions: Gay-Straight Alliances and school safety.

There is limited research on evaluating nonrandomized population health interventions. We aimed to introduce a new approach for assessing site-level longitudinal effects of population health interventions (SLEPHI) by innovatively applying multiple group multilevel (MG-ML) modeling to repeated cycles of cross-sectional data collected from different individuals of the same sites at different times, a design commonly employed in public health research. For illustration, we used this SLEPHI method to examine the influence of Gay-Straight Alliances (GSAs) on school-level perceived safety among lesbian, gay, and bisexual (LGB) and heterosexual (HET) adolescents. Individual-level data of perceived school safety came from 1625 LGB students (67.4% female; mean age, 15.7 years) and 37,597 HET students (50.2% female; mean age, 15.4 years) attending Grades 7-12 in 135 schools, which participated in 3 British Columbia Adolescent Health Surveys (BCAHS: 2003, 2008, 2013) in Canada. School-level data of GSA length since established were collected by telephone in 2008 and 2014. Nested MG-ML models suggested that after accounting for secular trend, cohort effects, measurement error, measurement equivalence, and student age, GSA length linearly related to increased school-level perceived safety among LGB students (b = 1.57, SE = 0.21, p < .001, ß = 0.32) and also among HET students (ß = 0.34 in 2003 & 2013, ß = 0.32 in 2008) although statistical differences between years for HET youth were likely due to the large sample size. By conducting MG-ML analysis on repeated cross-sectional surveys, this SLEPHI method accounted for many confounding factors and followed schools for a longer period than most longitudinal designs can follow individuals. Therefore, we drew a stronger conclusion than previous observational research about GSAs and LGB students' well-being. The SLEPHI method can be widely applied to other repeated cycles of cross-sectional data in public health research.

Modulation of antimicrobial efflux pumps of the major facilitator superfamily in Staphylococcus aureus.

Variants of the microorganism Staphylococcus aureus which are resistant to antimicrobial agents exist as causative agents of serious infectious disease and constitute a considerable public health concern. One of the main antimicrobial resistance mechanisms harbored by S. aureus pathogens is exemplified by integral membrane transport systems that actively remove antimicrobial agents from bacteria where the cytoplasmic drug targets reside, thus allowing the bacteria to survive and grow. An important class of solute transporter proteins, called the major facilitator superfamily, includes related and homologous passive and secondary active transport systems, many of which are antimicrobial efflux pumps. Transporters of the major facilitator superfamily, which confer antimicrobial efflux and bacterial resistance in S. aureus, are good targets for development of resistance-modifying agents, such as efflux pump inhibition. Such modulatory action upon these antimicrobial efflux systems of the major facilitator superfamily in S. aureus may circumvent resistance and restore the clinical efficacy of therapy towards S. aureus infection.

Boys are not exempt: Sexual exploitation of adolescents in sub-Saharan Africa.

Research on youth sexual exploitation in Africa has largely neglected the experiences of exploited boys. To date, much of the research in sub-Saharan Africa continues to consider boys mainly as exploiters but not as exploited. Using the only publicly available population-based surveys from the National Survey of Adolescents, conducted in four sub-Saharan African countries - Burkina Faso, Ghana, Malawi, and Uganda-we assessed factors associated with transactional sexual behaviour among never-married adolescent boys and girls. We also examined whether boys' reported sexual exploitation was linked to similar risky sexual behaviours as has been noted among girls in sub-Saharan Africa. Results from our analyses indicated that even though adolescent girls have a somewhat higher likelihood of reporting sexual abuse and exploitation, the odds of trading sex were significantly elevated for previously traumatized boys (that is those with a history of sexual and physical abuse) but not for their female counterparts. Just like adolescent girls, transactional sexual behaviour was associated with the risk of having concurrent multiple sexual partners for boys. These findings support the reality of boys' sexual exploitation within the African context, and further highlight the importance of including males in general and boys in particular in population-based studies on sexual health, risk, and protective factors in the sub-Saharan African region. Understanding the factors linked to sexual exploitation for both boys and girls will help in developing policies and programs that could improve the overall sexual and reproductive health outcomes among adolescents and youth in sub-Saharan Africa.

Trends in suicidality among sexual minority and heterosexual students in a Canadian population-based cohort study.

OBJECTIVES: Despite evidence from numerous studies that document disparities in suicidality for sexual minorities, few have investigated whether or not these trends have improved over time, which is the objective of the current study. METHODS: Using school-based population data over a 15-year period (1998 to 2013), multivariate logistic regressions were used to calculate age-adjusted odds ratios separately by gender. Interactions were included to test widening or narrowing disparities within orientation groups, which makes this one of the first studies to test whether gaps in disparities between heterosexual and sexual minorities have widened or narrowed over time. RESULTS: Results show that sexual minority youth are persistently at a greater risk for suicidal behaviour, a trend that has continued particularly for bisexual youth of both sexes. Results also suggest that the gap in suicidal behaviour is widening among some female sexual orientation groups, yet narrowing for other male sexual orientation groups. CONCLUSIONS: These findings have important public health implications, especially since we see decreases in suicidal behaviour for heterosexual adolescents, but not in the same way for many sexual minority youth, despite advances in social acceptance of gay, lesbian, and bisexual issues in North America.

Prevalence of Pregnancy Involvement Among Canadian Transgender Youth and its Relation to Mental Health, Sexual Health, and Gender Identity.

While little research has been conducted into the reproductive experiences of transgender people, available evidence suggests that like cisgender people, most transgender people endorse a desire for these experiences. This study explores the pregnancy experiences and related health factors among transgender and gender-diverse 14-25 year olds using a national Canadian sample (N = 923). Results indicated that 26 (5%) transgender youth reported a pregnancy experience in the past and the prevalence among 14-18 year olds was comparable to population-based estimates using the same question in the British Columbia Adolescent Health Survey. Transgender youth with a history of pregnancy involvement reported a diverse range of gender identities, and this group did not differ from the remainder of the sample on general mental health, social supports, and living in felt gender. This group did report over six times greater likelihood of having been diagnosed with a sexually transmitted infection by a doctor (19%), but did they not differ in reported contraception use during last sexual intercourse. These findings suggest that pregnancy involvement is an issue that should not be overlooked by health professionals working with transgender youth and that this group has particular sexual health needs.

Sexual Orientation Trends and Disparities in School Bullying and Violence-Related Experiences, 1999-2013.

Numerous recent studies have demonstrated that schools are often unsafe for lesbian, gay, and bisexual (LGB) adolescents, who are more likely than heterosexual peers to be bullied, harassed, or victimized in school contexts. Virtually all of these studies call for change, yet none investigate whether or not it has occurred. Using repeated waves of a population-based high school survey, we examine (1) the extent to which sexual orientation differences in school bullying and violence-related experiences are reported by lesbian/gay, bisexual, and heterosexual male and female adolescents; (2) trends in school bullying and violence-related experiences for each gender/orientation group, and (3) whether disparities have changed over time. Data were drawn from eight Massachusetts biennial Youth Risk Behavior Surveys from 1999 to 2013, grouped into 4 waves totaling 24,845 self-identified heterosexual, 270 lesbian/gay, and 857 bisexual youth. Disparities between LGB and heterosexual peers were found in all indicators. Heterosexual youth and gay males saw significant reductions in every outcome between the first and last waves. Among bisexual males, skipping school due to feeling unsafe, carrying weapons in school, and being bullied all decreased, but among lesbians and bisexual females only fighting in school declined significantly. Improvement trends in school safety were more consistent for heterosexual youth and gay males than for bisexual or lesbian females. Notably, despite these improvements, almost no reduction was seen in sexual orientation disparities. Future research should identify influences leading to reduced school victimization, especially focusing on ways of eliminating persistent sexual orientation disparities. Future research should identify influences leading to reduced school victimization, especially focusing on ways of eliminating persistent sexual orientation disparities.