Browsing by Subject "Prevention"

The prevalence of single combustible tobacco product use has decreased among adolescents and young adults (AYAs) in recent years, but the introduction of alternative tobacco products has led to increases in dual- or poly-use, especially among AYAs. Understanding susceptibility to multiple tobacco product (MTP) use is crucial, as it predicts initiation and subsequent use. Mental distress, including stress and mental health symptoms, may influence susceptibility and harm perceptions, yet this area remains underexplored in the literature. This dissertation aims to fill this gap by examining the influence of mental distress on susceptibility to MTP use among AYAs and whether it alters harm perceptions. By addressing these questions, this research aims to develop effective prevention techniques to prevent substance use initiation and reduce susceptibility among vulnerable populations, ultimately improving long-term health outcomes.Chapter 1 of this dissertation further introduces the background and context of this critical issue at the intersection of mental health and tobacco uptake among the AYA population in the United States, setting the stage for understanding the multifaceted relationship between mental health, stress, tobacco use, and susceptibility among AYAs, and laying a strong foundation for the subsequent chapters' detailed exploration and analysis. The theoretical framework guiding the dissertation is introduced to provide a structured lens through which to examine the complex interplay of factors influencing tobacco use behaviors among AYAs. This framework incorporates theories from psychology, public health, and dependence studies, offering a comprehensive approach to understanding the pathways and mechanisms that contribute to susceptibility and initiation of tobacco product use in this vulnerable population. Chapter 2 was a systematic scoping review which employed the Joanna Briggs Institute (JBI) method and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist to explore factors associated with multiple tobacco product (MTP) susceptibility, uptake, and use among U.S. adolescents and young adults. A comprehensive search strategy in PsycINFO and PubMed databases yielded 52 eligible articles published from 2013 onwards. Data extraction focused on demographic, individual, familial, social, environmental, and societal factors influencing MTP use. Key findings revealed higher susceptibility to MTP use among older adolescents and males, with Hispanic and Non-Hispanic Black adolescents also exhibiting elevated susceptibility to MTP use. Factors such as intentions to use tobacco, peer and parental tobacco use, and limited exposure to pro-smoking media were associated with susceptibility to MTP use. Additionally, e-cigarette use was linked to subsequent cigarette smoking initiation, while experimentation with MTP was influenced by parental use and tobacco marketing exposure. Progression to MTP use involved concurrent use of multiple products, with sociodemographic characteristics and environmental influences playing significant roles. These findings underscore the complex interplay of factors shaping tobacco use behaviors among adolescents and young adults, highlighting areas for further research and targeted interventions. Chapter 3 employed two pilot studies to examine the relationship between mental health factors (perceived stress, anxiety, and depression) and susceptibility to hookah tobacco smoking among adolescents and young adults; examining differences based on susceptibility status and exploring the predictive role of these factors while considering known risk factors and covariates. Statistical analyses using were conducted across two studies to explore demographic characteristics and predictor variables related to susceptibility and smoking status among young adults. Chi-square tests, t-tests (Study 1), and ANOVAs (Study 2) were utilized for comparisons, alongside bivariate logistic regression and proportional logistic regression for relationship exploration. Findings from Study 1 revealed that perceived stress was a significant predictor, with susceptible young adults reporting higher stress levels, indicating a potential link to susceptibility to hookah tobacco smoking (HTS). Peer acceptability and harm perceptions also emerged as influential factors. Study 2 showed differences in psychological distress levels between non-susceptible individuals and hookah users, highlighting the role of psychological factors in HTS behaviors. A positive linear trend in stress, anxiety, and depression levels from susceptibility status transitions (i.e., from non-susceptible, to susceptible, to use) underscored the need for comprehensive interventions targeting multiple risk factors. The consistent predictive power of perceived stress emphasizes its importance in addressing susceptibility to HTS among young adults. These findings advocate for tailored interventions addressing psychological, social, and demographic factors collectively to reduce susceptibility and prevent HTS initiation effectively. Chapter 4 utilized a national dataset (the Population Assessment on Tobacco and Health) to explore longitudinal links between multiple tobacco product (MTP) susceptibility, mental health symptoms, product harm perceptions and initiation of MTP use among AYAs in the US. We first examined whether increased externalizing and internalizing symptoms predicted changes in susceptibility to MTP use. Longitudinal parallel-process (LPP) modeling was used, involving multilevel modeling (MLM) and structural equations modeling (SEM) considering age group as the major predictor. We also examined whether harm perceptions mediated any relationships between mental distress and susceptibility, adjusting for covariates. We then examined if harm perceptions predicted MTP uptake. Cox-proportional hazard regression analyzed relationships between harm perceptions and MTP uptake. A linear regression model estimated longitudinal relationships between harm perceptions and susceptibility status. Mediation analysis determined if susceptibility status mediated the relationship between harm perceptions and MTP uptake. Lastly, as an exploratory analysis, we examined the interaction between mental distress and susceptibility on MTP uptake. We utilized intercepts and slopes for each variable in analyses to provide insights into how these factors evolve over time. Among a sample of AYAs who reported never smoking cigarettes, e-cigarettes, hookah tobacco, nor cigars (traditional, filtered, and cigarillos) at Wave 1, we found that non-susceptible individuals had higher perceived harm and lower mental health symptoms than susceptible individuals. Susceptibility was highest during the transition from ages 12-14 to 15-17, highlighting a critical period for intervention. Young adults showed higher initiation rates of MTP by Wave 6, emphasizing the need for targeted interventions during the transition to adulthood. Unexpectedly, higher initial levels of mental distress were associated with reduced susceptibility to MTP use, challenging conventional assumptions. Perceptions of harm mediated these relationships variably, indicating complex pathways influencing MTP use initiation. Further investigation using Cox-proportional hazard regression models confirmed that higher initial and increasing perceptions of harm over time were protective against MTP initiation. However, contrary to expectations, higher initial harm perceptions were associated with increased susceptibility initially. Initial susceptibility partially mediated the relationship between perceptions of harm and MTP initiation, highlighting nuanced interactions. The study suggests that while mental distress influences susceptibility and perceptions of harm, its direct moderation effect on MTP initiation was not significant. These findings underscore the importance of developmental stages and social contexts in shaping MTP use behaviors, advocating for tailored interventions during critical transitions to mitigate tobacco use among AYAs. Chapter 5 concludes the dissertation by synthesizing its findings from all chapters, discussing their implications and recommendations for future research.

Background: Cervical cancer is a preventable disease with a disproportionate burden in Sub-Saharan Africa. In Kenya, cervical cancer is the leading cause of cancer-related death in women. In line with WHO recommendations, Kenya is offering screening to women between the ages of 30 and 65 years old; however, rates of screening uptake are far below desired levels due to economic, logistical, and social barriers. This study is phase 2 of a two-part trial exploring implementation strategies for HPV-testing using self-collected specimens. Drawing on lessons from phase 1, we offered HPV-testing through community health campaigns (CHCs) in rural communities followed by linking HPV-positive women to facility-based treatment. Methods: Target communities were enumerated before the CHCs to identify women in the age range of 30-65 years old and who were not pregnant. Women were educated about cervical cancer by community health volunteers and told of when and where the CHC would be happening. At the CHC, participants were consented, given a brief demographics survey, and instructed on how to self-collect cervical specimens for HPV-testing. Participants were later contacted via SMS messaging, phone calls, or home visits with their results. Women who were enumerated but did not attend the fair were visited at home and offered testing. Those who tested as HPV-positive were linked to their nearest health center for preventative treatment. Descriptive statistics and logistic regression were used to analyze the demographic characteristics of women who came to the CHC and women who sought treatment compared with those who didn’t. Results: A total of 3299 women were screened for HPV, an estimated target population reach of 77%. The average HPV positivity rate was 16.7% across both the CHCs and the mop up. Of the 551 women who were HPV positive, 278 of them (50.5%) sought treatment. Characteristics associated with screening at the CHC included being encouraged to come by someone the woman knows, having completed primary school, some secondary school or attending college and above, working in the labor, professional, academic professions, having heard of cervical cancer before, working outside the home, and having missed work to attend screening. Women who came to the CHC had 25% greater odds of seeking treatment compared to women screened in home visits. Characteristics associated with seeking treatment included having tested for cervical cancer before and having missed work to attend screening. Having heard of cervical cancer before was also associated with seeking treatment, but with less precise estimates. Conclusion: Social support for seeking care and knowledge of cervical cancer are associated with women attending community health campaigns that offer self-collected HPV-testing. Other demographics have weak or null associations with care-seeking behavior in this context, suggesting the CHC model with enhanced linkage to care methods could be a way to overcome some of the social and logistical barriers women face for accessing preventative treatment. However, at a treatment linkage rate of only 50%, more work needs to be done to further understand the barriers to care in this context.

The HIV epidemic in the United States continues to be a significant public health problem, with approximately 50,000 new infections occurring each year. National public health priorities have shifted in recent years towards targeted HIV prevention efforts among people living with HIV/AIDS (PLWHA) that include: increasing engagement in and retention in care, improving HIV treatment adherence, and increasing screening for and treatment of substance use and psychological difficulties. This study evaluated the efficacy of Positive Choices (PC), a brief, care-based, theory-driven, 3-session counseling intervention for newly HIV-diagnosed men who have sex with men (MSM), in the context of current national HIV prevention priorities. The study involved secondary analysis of data from a preliminary efficacy trial of the PC intervention (n=102). Descriptive statistics examined baseline substance use, psychological characteristics and strategies, and care engagement and HIV-related biological outcomes. Generalized Estimating Equations (GEE) examined longitudinal changes in these variables by study condition. Results indicated that PC improved adherence to HIV treatment, but increased use of illicit drugs, specifically amyl nitrates and other stimulant drugs; additionally, moderation analyses indicated differences in patterns of change over time in viral load by baseline depression status. Implications of the findings and suggestions for future research are discussed.

Background: Limpopo Province has the highest rates of intimate partner violence (IPV) in South Africa, with data suggesting that over half of women experience IPV in their lifetimes. However, data among young, university-attending women in this province is lacking. This study aimed to estimate the prevalence of IPV victimization among university women and examine factors associated with IPV history. The study also aimed to explore how university women recognize IPV, suggest ways victims seek help, and identify a victim’s coping strategies using qualitative methods.

Methods: This study utilized a mixed methods approach and was conducted at the University of Venda (UNIVEN), a rural-based university in Vhembe district. Convenience sampling was used to recruit female participants who were currently enrolled at the university, aged 18 to 31 years, and currently in a relationship or in a relationship within the past year. 113 females were enrolled in the study. After obtaining written informed consent, we conducted a self-administered cross-sectional survey. IPV was measured using the Revised Conflict Tactics Scale (CTS2), which assessed for both past year and lifetime IPV experiences. To explore the association between IPV and other factors, other measures included an alcohol use screening tool (AUDIT-C) and a measure assessing attitudes toward gender roles. Descriptive statistics and Fisher’s exact tests were performed to assess the relationship between potential risk factors and IPV. Logistic regression analyses examined the associations between exposure variables and lifetime IPV victimization. Short explanatory model interviews (SEMI) examining women’s perceptions of IPV-related issues using a custom vignette were administered directly following the survey. The interviews were recorded and later analyzed using thematic analysis.

Results: 92.23% of participants reported being victims of any form of IPV in their lifetime. Psychological aggression (82.52%) was the most prevalent type of lifetime violence, followed by sexual coercion (73.79%), physical assault (37.86%), and injury (15.53%). The joint frequency distribution of IPV victimization by subscale reveals that 9.71% of participants reported being victims of all four forms of IPV at least once in their lifetime, while most respondents reported experiencing two types of IPV (35.9%). Compared to having no sexual partners in the past year, having two or more sexual partners was significantly associated with higher odds of being a lifetime victim of sexual coercion (p = 0.031; OR: 4.41; 95% CI 1.14 - 17.02). Study findings support an increased odds of lifetime IPV (p = 0.030; OR: 7.04; 95% CI 1.21 – 40.97) and physical assault (p = 0.010; OR: 3.77; 95% CI 1.37 – 10.40) for participants who personally knew an IPV victim at UNIVEN compared to women who did not personally know a victim. Participants who disagreed or strongly disagreed that IPV should be viewed as a crime were 11.37 times more likely to be victims of lifetime sexual coercion than those who agreed (p = 0.027; OR: 11.37; 95% CI 1.32 - 97.82). The SEMI revealed most women recognized IPV in the vignette, and the recommended help-seeking behaviors included seeking informal and formal help, leaving the relationship, and changing behavior.

Conclusions: IPV prevalence among the study sample was reported nearly universally. Number of sexual partners, personally knowing a victim of IPV at the university, and attitudes toward gender roles were significantly associated with having a history of IPV. University commitment and multi-sectoral collaboration at all levels are critical for the provision of resources, services, and violence prevention efforts. Future research is needed to inform evidence-based interventions that will reduce victimization by addressing risk factors, under-reporting, and barriers to seeking help.

Background: Despite increased use of insecticide-treated nets (ITNs) among children under 5 years in Malawi, use of ITNs alone is insufficient to eliminate malaria. Therefore, other prevention methods should be explored to achieve malaria elimination. Previous studies illustrated that mother’s knowledge of ITNs positively influenced her child’s ITN use. In other settings, mothers’ knowledge of ITNs led to increased ITN use and reduced parasitemia among children under 5 years. Therefore, it may be plausible that maternal knowledge of other malaria prevention methods is associated with under-five malaria parasitemia. This study examined whether maternal knowledge of other malaria prevention methods is associated with malaria parasitemia among children under five years in Malawi. I hypothesized that higher levels of maternal knowledge of malaria prevention methods would be associated with lower odds of malaria parasitemia in children under-five.

Methods: The analytic sample included 1,880 children under 5 years of age. Maternal knowledge of malaria prevention methods was assessed using 12 items from the 2017 Malawi Malaria Indicator Survey (MMIS). Each of the 12 items was given either a score of 1 for a correct response or a score of 0 for an incorrect response. All 12 items were added up to create a continuous composite score ranging from a minimum score of 0 (low knowledge) to a maximum score of 12 (high knowledge). I also classified the total score as a 3-level categorical variable: low (score: 0-3), intermediate (score: 4), and high (score: 5-12). For the binary variable, a total score of less than or equal to 4 was considered inadequate knowledge, while a total score of greater than or equal to 5 was considered adequate knowledge. Malaria parasitemia was assessed using positive and negative malaria microscopy test results. I examined the association between maternal knowledge of malaria prevention methods and under-5 parasitemia using weighted multivariable logistic regression models. I also adjusted for sociodemographic characteristics such as mother’s highest level of education, ethnicity, type and place of residence, region, child’s age, and wealth index.

Results: Maternal knowledge of malaria prevention methods was not found to be a significant predictor of under-5 malaria parasitemia. The survey items used to create the composite score had an alpha value of 0.43 which indicated poor reliability. Of the 1,880 children included in the analytic sample, 67.5% had mothers with only primary school education, 85.7% were from rural areas, and 22.8% were from the poorest wealth index bracket. After adjustment, maternal knowledge of malaria prevention methods as a composite score (adjusted odds ratio [AOR]=1.14, 95% confidence interval [CI]: 0.96, 1.35), as a three-level categorical variable (high knowledge AOR=2.28, 95% CI: 0.63-8.25), or as a binary variable (inadequate knowledge AOR=0.78, 95% CI 0.54-1.14) were not significantly associated with under-five malaria prevalence. Only maternal knowledge of burning leaves was significantly associated with a 5.44 higher odds of malaria parasitemia among children under five years.

Conclusions: In this study, I did not find evidence supporting the hypothesis that higher levels of maternal knowledge of malaria prevention methods is associated with a lower prevalence of under-5 malaria parasitemia in Malawi. This may be because maternal knowledge of malaria prevention methods is not a good indicator of actual practice. Therefore, future studies should explore the relationship between the preventative practices used by mothers and the prevalence of malaria among their children under five years. Future research identifying how alternative malaria prevention practices to ITNs impact under-five parasitemia may help Malawi progress toward malaria elimination.