Childhood adversity and adolescent motherhood: A cross-sectional study of trauma, partner age gaps, and parenting in the Dominican Republic.

School active commuting is a key behavior to promote physical activity in children, yet limited evidence exists in Chile. This study examined its prevalence and associated factors among Chilean schoolchildren. A cross-sectional study was conducted using data from the Chilean National Physical Activity and Sports Habits Survey, including a subsample of 1137 children aged 5-10 years derived from a nationally representative survey. School active commuting was defined as the dependent variable. Independent variables included sex, area of residence, socioeconomic status (SES), caregiver's education, self-rated health, leisure activities, and home-based physical or sedentary behaviors. About one in three children (35%) reported commuting actively to school. Boys showed higher participation than girls, and active commuting was more common among children from lower SES households and among those whose caregivers had lower educational attainment. Children who preferred physical activities during leisure time were also more likely to commute actively. No differences were observed by geographic area, self-rated health, or home-based activity levels. Schools and local communities should work together to ensure safe, equitable, and accessible environments that support active commuting. Active commuting remains low in Chilean children, emphasizing the need for multisectoral policies to promote physical activity and reduce inequalities.

Time trends and projections of binge drinking, tobacco use and their co-occurrence in Brazilian adults from 2006 to 2030.

Florida has the second-highest rate of acute hepatitis C virus (HCV) infection cases in the United States. However, HCV care cascade outcomes among individuals seeking care in Florida emergency departments (EDs) remain unknown. To assess HCV care cascade outcomes and identify HCV infection predictors among individuals tested for HCV in Florida EDs. This retrospective study used electronic health records (2016-2023) linked to the Agency for Healthcare Research and Quality on Social Determinants of Health regional data. Adults aged 18-79 years tested for HCV infection in Florida EDs. Outcomes included the proportions of individuals completing each HCV care cascade step: (1) HCV screening; (2) HCV diagnosis; (3) linkage to care; and (4) treatment initiation. A multivariable logistic regression model was used to identify predictors of HCV infection. Among individuals seeking care in EDs, 4.98% (n=18,444) were tested for HCV, of whom 4.97% were confirmed HCV-positive. Among HCV-positive individuals, 11.24% were linked to care, and 2.84% initiated treatment. Significant predictors of HCV infection included having Medicaid insurance (OR=1.53, 95% CI: 1.14-2.07) or being uninsured (OR=2.88, 95% CI: 2.02-4.12), coinfection with human immunodeficiency virus (OR=28.99, 95% CI: 22.31-37.67), opioid injection drug use (OR=3.62, 95% CI: 2.76-4.75), opioid overdose (OR=3.89, 95% CI: 2.32-6.52), and residing in communities characterized by lower educational attainment (fourth quartile OR=1.95, 95% CI: 1.27-2.98). Significant gaps persist across the HCV care cascade among individuals tested in Florida EDs. Innovative public health interventions are needed to support these vulnerable populations.

Perceived harmfulness of e-cigarettes and heated tobacco products compared to cigarettes: Findings from the 2020 ITC Malaysia survey.

Impact of soil lead on children's urinary levels and parent-reported learning disabilities in areas of diffuse contamination.

Despite decades of evidence demonstrating that cervical cancer screening prevents morbidity and mortality, approximately one in four eligible Americans remains overdue for screening. Screening gaps are unevenly distributed, disproportionately affecting uninsured individuals, those with lower income or educational attainment, rural residents, and racial and ethnic minority populations. In this commentary, we highlight that perceived out-of-pocket costs for cervical cancer screening-rather than actual costs-remain a salient and modifiable barrier to screening among low-income, underscreened women, even in the context of Affordable Care Act (ACA) provisions. Optimizing cervical cancer prevention requires attention not only to initial screening uptake but also to completion of the full screening continuum, including timely follow-up after abnormal results. Recent policy developments-including the US Supreme Court affirmation of the ACA preventive services mandate, elimination of cost-sharing for patient navigation beginning in 2026, expansion of coverage for diagnostic follow-up starting in 2027 for insured individuals, and endorsement of self-collected human papillomavirus testing-create an unprecedented opportunity to reduce financial and logistic barriers to completion of cervical cancer screening. However, realizing the population-level and equity benefits of these advances will require deliberate implementation strategies that emphasize transparent communication about patient out-of-pocket costs, integration of navigation services, and follow-up pathways. See related article by Isaacson et al., p. 1158.

The goal of this paper is to identify environmental, behavioral, and genetic predictors and early midlife correlates of problematic alcohol Use (PAU) patterns from adolescence to early midlife. The data are from 1463 twin individuals (60.5% female) in the population-based FinnTwin12 cohort born 1983-1987. PAU was assessed at ages 14, 22 and 37 using symptoms of alcohol use disorder (AUD) obtained from psychiatric interviews, mmMAST scores, and the AUDIT. Self-reported health and well-being were assessed at age 37. A behavioral and environmental risk index (BERI) was created by summing six risk factors: low socioeconomic status in childhood, family history of AUD, childhood externalizing and internalizing behaviors, adolescent substance use, peer substance use, and stressful life events in adolescence. The twins' genetic predispositions were indexed using polygenic scores for externalizing behavior (PGSEXT), PAU (PGSPAU), and depression (PGSMDD). Twins were classified into four PAU groups: Never (n = 599, reference), Remitted (n = 480), Persistent (n = 271), and Late-onset (n = 113). When included in the same model, both BERI and PGSEXT were significantly associated with Remitted PAU, while BERI scores and PGSPAU were significantly associated with Persistent PAU. Compared to the Never PAU group, individuals in the Persistent and Late-onset PAU groups reported lower educational attainment, poorer physical health, lower relationship satisfaction, lower life satisfaction, a worse financial situation, more depressive symptoms, recurrent pain, and sleep problems, and were less likely to be partnered or have children. Persistent PAU was associated with the most negative outcomes in early midlife, and childhood and adolescent risk factors and genetic risk as indexed by PGSPAU were strong predictors of group membership. Late-onset PAU may be the result of novel stressors in adulthood, given the lack of association with childhood and adolescent environmental risk or genetic risk.

Early Assessment of Risk Factors for Emergence Delirium in Adult Patients Undergoing General Anesthesia: A Cross-Sectional Correlational Study.

Attention-deficit/hyperactivity disorder (ADHD) symptoms and emotional problems frequently co-occur. Longitudinal data provide opportunities to understand how and why they co-develop. Data were drawn from the Twins Early Development Study, which included 27,890 participants. Emotional problems and ADHD symptoms were parent-reported using the Strengths and Difficulties Questionnaire and Conners' Parent Rating scales. We modeled the co-development of ADHD symptoms and emotional problems from ages 4 to 21 using joint trajectory analysis. The predictors included polygenic scores (PGSs) for multiple psychiatric symptoms, maternal depression, family chaos, and socioeconomic status (SES). The outcomes included SES, lifetime psychiatric diagnoses, undergraduate diploma attainment, and entry into parenthood at age 26. A four-class joint trajectory model was selected as best fitting and included: 'Low ADHD, Low emotional problems', 'High-decreasing ADHD, Low emotional problems', 'Mid-decreasing ADHD, Increasing emotional problems', and 'Increasing ADHD, Increasing emotional problems'. The consistently low-symptom group reported lower ADHD and had lower externalizing PGSs, lower maternal depression, higher SES, and less home chaos at baseline, and higher educational attainment and fewer lifetime depression/anxiety diagnoses at 26 than groups with higher symptom levels. Those with high ADHD symptoms in childhood or increasing ADHD symptoms from childhood to adulthood had the lowest educational attainment and SES in adulthood. Groups characterized by increasing ADHD symptoms also tended to show increases in emotional problems, whereas increases in emotional problems did not necessarily coincide with increases in ADHD symptoms. The trajectories had distinct early-life predictors and adult outcomes, highlighting potential intervention targets.

Lower maternal educational attainment is associated with adverse neonatal outcomes, including lower birthweight, low birthweight, and neonatal intensive care unit (NICU) admission. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is intended to improve nutritional and pregnancy outcomes among socioeconomically vulnerable mothers, but whether WIC participation attenuates education-related neonatal disparities remains uncertain. To examine whether WIC participation is associated with narrowing of the neonatal outcome gap between mothers with lower and higher educational attainment. We conducted a population-based retrospective cohort study using the 2024 United States Natality Public Use File. The analysis was restricted to singleton live births with maternal education and WIC status. Lower education was defined as high school/GED or less, and higher education as bachelor's degree or higher. Outcomes were birthweight, low birthweight (<2500 g), and NICU admission. Crude outcomes were compared across four education-WIC groups. Multivariable generalized linear models adjusted for maternal age, race and Hispanic origin, marital status, prenatal care timing, prepregnancy body mass index, smoking, maternal medical risk factors, live-birth order, and infant sex. The primary parameter was the education-by-WIC interaction. The analytic cohort included 2,570,707 births. In crude analyses, the low-vs-high education gap in low birthweight was 3.56 percentage points among non-WIC births and 1.78 percentage points among WIC births; corresponding NICU admission gaps were 2.03 and 0.77 percentage points. In adjusted models, lower education was associated with lower birthweight and higher risks of low birthweight and NICU admission. WIC participation attenuated these disparities: the education-by-WIC interaction was +21.3 g for birthweight, -0.9 percentage points for low birthweight, and -0.7 percentage points for NICU admission (all p<.001). WIC participation was associated with smaller education-related disparities in birthweight, low birthweight, and NICU admission. These findings support WIC as a populationlevel mechanism for reducing neonatal outcome disparities.

Children with special healthcare needs (CSHCN) live with long-term physical, developmental, behavioural, or mental conditions that affect everyday functioning and require specialized care. According to the International Classification of Functioning, Disability and Health (ICF), such conditions may cause impairments in body functions and structures, limitations in activities, and restrictions in participation, shaped by environmental factors. Evidence on social participation and its correlates in CSHCN remains limited. Therefore, we aimed to identify which correlates are associated with social participation across different conditions and indications in a multi-site sample of CSHCN in Social Paediatric Centres (SPCs) in Germany. This study analysed parent-reported data of CSHCN (3-18 years) from the baseline of the PART-CHILD cohort collected in routine care in 15 SPCs in Germany (2019-2020). Social participation (outcome) in home, community, school, and living activity domains was assessed using the German Child and Adolescent Scale of Participation (CASP). In the regression analysis, independent variables included environmental factors (parental educational attainment, German native language) and health-related factors (impairment type and complexity reported as reason for referral to the SPCs, health-related quality of life (HRQoL)), as well as age (operationalised in groups [3-6; 7-10; 11-18 years]) and sex as covariates. Linear complete case regression models were performed, and β-coefficients and 95% confidence intervals were reported. Five hundred fifty-one families of CSHCN (68.24% female; 44.46% aged three to six and 34.66% from seven to ten years old) were available for analysis (10.99% missing outcome). CASP total mean score was 75.99 (± 20.03; range: 25-100), the lowest in living activities subscale (68.07 ± 24.81), including household activities, shopping, transportation. In the complete case regression analysis (n = 350), older child age and higher HRQoL were associated with higher social participation score across all domains. Children with both physical and cognitive impairments had lower CASP scores in the total, home, and school models, with a trend to association in the community model. Lower parental educational attainment was significantly associated with reduced social participation in the living activities subscale. In this study, we confirmed previous findings on factors determining social participation in CSHCN, such as age and higher HRQoL. Impairment complexity (combined physical and cognitive impairments) decreased participation in home and school. The lower participation in daily living activities for lower educated parents confirms, that social environment significantly influences social participation. This highlights that to improve social participation, strategies are needed that address family-level and broader environmental barriers to lessen social and functional disadvantages in particularly vulnerable subgroups. PART-CHILD cohort, German Clinical Trials Register - Deutsches Register Klinischer Studien (DRKS), DRKS00015054, registered on 16 November 2018.

Premature mortality in young adulthood has become a growing public health concern in the United States, yet it remains unclear whether vulnerability to early death originates as early as adolescence. Although depressive symptoms are highly prevalent during adolescence and linked to long-term health and socioeconomic disadvantages, their prospective association with premature mortality remains poorly understood. This study examined whether depressive symptoms experienced during adolescence predict premature mortality in young adulthood and whether health behaviors and socioeconomic status in early adulthood help explain this association. Data were drawn from Waves I and III of the National Longitudinal Study of Adolescent to Adult Health, along with the Mortality Outcomes Surveillance System established in Wave V (N = 14,320). Cox proportional hazards models estimated the association between adolescent depressive symptoms and premature mortality, and cause-specific Cox proportional hazards models evaluated deaths due to disease, suicide, and external causes. Mediation analyses tested health behaviors and socioeconomic factors as mechanisms. Higher adolescent depressive symptoms were associated with increased risk of all-cause premature mortality in young adulthood. Cause-specific models showed that this association was concentrated in deaths due to external causes, with no significant associations for disease-related deaths or suicide. Cigarette smoking, marijuana use, lower educational attainment, and reduced employment in early adulthood accounted for part of the association for all-cause mortality. For external-cause mortality, however, health behaviors-specifically cigarette smoking and marijuana use-emerged as the prominent mediating pathways. Findings suggest that adolescent depressive symptoms may be associated with an increased vulnerability to premature mortality, in part through behavioral and socioeconomic pathways that emerge in early adulthood. Strengthening early mental health identification and support could reduce long-term disparities in survival.

Traumatic brain injury (TBI) is a major global public health problem, with a high burden of long-term sequelae that extend beyond acute survival and physical recovery. Sleep disturbances are increasingly recognised as a common and clinically significant consequence of TBI, yet they remain under-recognised and inadequately addressed, particularly in low- and middle-income countries such as Vietnam. This study aimed to assess sleep quality and to identify factors associated with sleep disturbances among patients with TBI in Vietnam. A cross-sectional study was conducted in 2020 through phone interviews among 212 TBI patients in Vietnam. Data on demographics and socioeconomic status, health risk behavior, mental health issues, social support, and sleep quality were collected. Multivariate Tobit regression and Multivariate Logistic Regression models were used to determine factors related to the PSQI score and sleep disturbances among TBI patients. A total of 212 adults with TBI were enrolled (mean age 47.1 ± 17.6 years, and 67.5% were male), nearly half of the participants (47.2%) reported sleep disturbances. The majority experienced mild TBI (93.9%), and road traffic accidents were the leading cause of injury (65.6%). Individuals with sleep disturbances indicated a significantly higher prevalence of depressive symptoms compared with those without sleep disturbances (38.0% vs. 7.1%, p < 0.001). In addition, perceived social support was significantly lower among participants with sleep disturbances than normal sleep quality (p < 0.001). Multivariable regression analysis indicated that being female, hazardous drinking, and higher depressive symptom scores were associated with poorer sleep quality, whereas higher educational levels and stronger perceived social support were associated with better sleep outcomes. This is one of the first studies in Vietnam to examine sleep disturbances and their associated factors among patients with TBI. The findings indicate a high prevalence of sleep disturbances and highlight significant associations between sleep quality and sociodemographic characteristics, depressive symptoms, perceived social support, and health behaviors. This study underscores the importance of recognizing sleep disturbance as a key outcome in TBI care and highlights the need for integrated, multidisciplinary rehabilitation interventions that address sleep, mental health, and social functioning, with particular attention to vulnerable groups such as women, individuals with lower educational attainment, and those with substance use.

The COVID-19 pandemic substantially disrupted healthcare utilization across clinical conditions, populations, and care settings. Consistent and equitable access to care is essential to mitigate the long-term consequences of COVID-19, particularly among individuals with pre-existing conditions. While prior studies have documented broad patterns in healthcare use during the pandemic, limited evidence exists on how utilization shifts before and after a COVID-19 diagnosis, particularly across specific diseases, encounter types, and sociodemographic subgroups. We conducted a matched retrospective cohort study using electronic health record data from MedStar Health between March 25, 2019, and June 30, 2021. A difference-in-differences design was used to compare changes in health care utilization between adult patients who tested positive for COVID-19 (exposure group) and those who tested negative (comparison group), across the 6-month periods before and after testing. Outcomes included encounters across outpatient, inpatient, emergency department, and virtual settings, overall and stratified by pre-existing conditions (heart failure, diabetes mellitus, kidney disease, malignant neoplasm, hypothyroidism, hyperthyroidism, anxiety disorder, depressive disorder, and drug poisoning/overdose), while accounting for demographic characteristics (sex, age, race/ethnicity, insurance type, state of residence) and census tract-level socioeconomic indicators (median household income, educational attainment, and poverty/food access). To estimate the absolute burden of health care utilization associated with COVID-19, we converted DiD rate ratios into excess encounters per 1,000 individuals in the exposed group. COVID-19 exposure was associated with a 4% overall reduction in health care utilization during the post-COVID period (RR = 0.96, p < 0.001, 262 fewer visits per 1,000 patients), primarily driven by decreased outpatient visits (RR = 0.96, p < 0.001). Significant declines were observed among adults aged ≥ 65 years (RR = 0.92, p < 0.001), males (RR = 0.90, p < 0.001), Black individuals (RR = 0.96, p < 0.001), and Medicare beneficiaries (RR = 0.91, p < 0.001). Geographically, encounter rates declined significantly in DC (RR = 0.93, p < 0.001) and Maryland (RR = 0.98, p = 0.023), but not in Virginia. Socioeconomic indicators also correlated with healthcare utilization: patients residing in areas with lower income (RR = 0.94, p = 0.003), lower educational attainment (RR = 0.95, p = 0.011), or higher rates of food stamp/SNAP participation (RR = 0.93, p < 0.001) experienced greater declines in utilization. Among clinical conditions, the largest reductions in healthcare visits were seen for patients with kidney disease (RR = 0.88, p < 0.001), drug poisoning/overdose (RR = 0.88, p < 0.001), hypothyroidism (RR = 0.91, p < 0.001), diabetes mellitus (RR = 0.94, p < 0.001), and heart failure (RR = 0.94, p = 0.002). In contrast, encounters for patient cohorts with hyperthyroidism (RR = 1.14, p = 0.004) increased notably, while those for depressive disorders (RR = 1.03, p = 0.072) showed a modest increase. No significant changes were observed in patient cohorts with anxiety (RR = 1.00, p = 0.83) and cancer (RR = 1.00, p = 0.81). COVID-19 exposure was associated with broad but varied changes in healthcare utilization during the post-COVID period. Several chronic conditions showed notable declines in encounter rates, although these patterns were not consistent across all conditions. The heterogeneity in utilization patterns suggests potential gaps in ongoing care and highlights the need for targeted efforts to support continued management of health conditions after COVID-19.

ABSTRACT Background The Latine population is at least two times more likely to be food insecure compared to the non-Hispanic white population. Challenges in accessing sufficient, culturally preferred, and healthy foods, particularly for those in rural areas, include limited financial resources and transportation difficulties. Additionally, this population commonly has low enrollment in food assistance programs, an effective method in reducing food insecurity (FI). Obesity, diabetes, cardiovascular diseases (CVD), and depression are frequently associated with FI; the Latine population carries a disproportionately high burden or risk of these diseases. Objectives We aimed to understand the prevalence of FI, FI as a predictor and outcome variable, and health conditions associated with FI among the Latine population in rural, western North Carolina. Methods We conducted a cross-sectional survey in community settings using purposive sampling. Data were analyzed using descriptive statistics, bivariate analysis, and multivariable binary logistic regressions. Results Among 193 participants, 47% reported FI. Those identifying as food insecure were more likely to report a household income under $35,000 (OR 5.49, 95% CI: 1.37, 22.06), low educational attainment (OR 3.85, 95% CI: 1.23, 12.04), and being unmarried (OR 3.53, 95% CI: 1.01, 12.20). When modeled as a predictor, FI was associated with higher odds of reporting symptoms of CVD (OR 3.95, 95% CI: 1.43, 12.14) and depression (OR 5.01, 95% CI: 1.45, 21.52). Conclusion Our study demonstrates a high prevalence of FI and significant relationships between FI and a myriad of variables in a region of rural, western NC and contributes to a dearth of literature about the experience of FI among the Latine population. Understanding the predictors of FI in this context can better support efforts to increase food security among this population.

Dental sealants are an important preventive service for reducing occlusal caries in children and adolescents. As digital health information-seeking behaviors have become increasingly prevalent, online search activities may serve as indicators of population-level interest in preventive healthcare services. Understanding how online search trends relate to actual dental sealant utilization may provide valuable insights for public health planning. This study aimed to examine longitudinal trends in dental sealant utilization and online search activity in South Korea from 2016 to 2023 and to assess the association between sealant utilization and online search trends. Monthly data on patients receiving dental sealants under the National Health Insurance program were analyzed alongside relative search volume (RSV) data for "dental sealant" obtained from NAVER Data Lab. Subgroup differences in online search activity according to sex, age group, and search device were assessed. Multivariate ordinary least squares regression was performed to examine the association between RSV and sealant utilization, with adjustment for key influencing factors. Sealant utilization exhibited pronounced seasonal variation, with higher utilization during school oral examination and vacation season. Significant differences in online search activity were observed across sex, age groups, and search devices, with the highest search interest observed among individuals aged 19-39 years. Over time, mobile-based searches steadily increased and surpassed desktop-based searches. RSV was positively and significantly associated with sealant utilization after adjustment for covariates (P=.036). Larger population size and higher household income were associated with greater sealant utilization, whereas a higher proportion of individuals with lower educational attainment was associated with reduced utilization. Online search activity was significantly associated with dental sealant utilization, suggesting that digital search trends may reflect information-seeking behavior at the population level. The increasing predominance of mobile-based searches highlights the importance of mobile-centered digital strategies for disseminating evidence-based oral health information. Integrating online search indicators with traditional utilization data may support the timing, targeting, and design of preventive dental health policies and outreach programs.

Survivors of oesophageal and gastric cancer frequently experience persistent symptoms and functional limitations that affect their health-related quality of life (HRQL). Although self-care is increasingly recognised as a central component of survivorship care, little is known about what determines self-care engagement or whether engagement is associated with better HRQL. This study examined the sociodemographic and healthcare-related variables associated with self-care engagement and explored its association with global quality of life (QOL) in a nationwide cohort. A cross-sectional survey was conducted among individuals diagnosed with oesophageal or gastric cancer in Sweden between 2021 and 2023. Participants completed the EORTC QLQ-C30 and a study-specific questionnaire assessing symptoms and self-care. Self-care engagement was operationalised as the ratio of self-care strategies used to the number of symptoms experienced and categorised into no, moderate, and high. Factors associated with self-care engagement were analysed using multinomial logistic regression, and the association between self-care engagement and global QOL was assessed using linear regression, adjusting for sociodemographic and clinical confounders. Of the 432 respondents, 422 reported at least one symptom and were included in the self-care analysis. One-third of the participants reported no self-care engagement, whereas two-thirds reported moderate or high engagement. Across all models, university education was the strongest and only consistent variable associated with self-care engagement (high vs. no self-care engagement: odds ratio 2.83, 95% confidence interval 1.48-5.42). Neither assignment of a designated contact nurse nor proximity to the treating hospital was associated with self-care engagement. Participants with high self-care engagement had substantially better global QOL than those with moderate or no self-care engagement, with mean differences exceeding 10 points on a 0-100 scale. Global QOL did not differ between the moderate and no self-care groups. Self-care engagement varies widely among oesophageal and gastric cancer survivors and appears to be influenced by educational level. High self-care engagement is associated with clinically meaningful improvements in global QOL, whereas no or moderate self-care appears insufficient to confer benefits. These findings suggest an equity gap in survivorship care, and future research should explore the development of structured and accessible interventions to enhance self-care capabilities among patients with lower educational attainment.

Patient-reported outcome measures (PROMs) are increasingly integrated into routine clinical care and value-based accountability frameworks, yet systematic non-response may exclude structurally marginalized populations, including transgender and gender diverse (TGD) individuals. This study examined individual- and neighborhood-level predictors of non-response to the PROMIS Global Health (PROMIS-10) questionnaire among TGD individuals using an intersectional multilevel framework. We conducted an observational cohort study used electronic health record data from 2015 to 2023 within a large U.S. healthcare system. TGD adults (≥18 years) assigned the PROMIS-10 during clinical encounters were included. PROM non-response was defined as a questionnaire assigned but not completed. Multivariable regression evaluated sociodemographic predictors, and multilevel analysis of individual heterogeneity and discriminatory accuracy quantified variance across intersectional strata. Structural predictors included segregation (Delta Index) and Social Vulnerability Index (SVI). Non-response at encounter level was high among 7528 TGD patients (85.8%; 95% CI 84.2-87.4). Older age (≥ 36 years; β = 3.3; 95% CI 1.12-5.50) and lower educational attainment (β = 3.23; 95% CI 1.05-5.41) were associated with increased non-response, while insurance type was not associated and ethno-racial identity showed a small, non-significant increase after adjustment. Intersectional strata explained only 1% of variance in non-response, decreasing to 0.3% after adjustment. Higher segregation (Delta Index; β = 10; 95% CI 4.0-17.0) and residence in the highest vulnerability areas (SVI > 0.75; β = 7.9; 95% CI 0.6-15.0) predicted greater non-response. PROM non-response among TGD individuals reflects individual and structural inequities. Equity-centered PROM implementation strategies are needed to prevent systematic exclusion from outcome-based evaluation.

IntroductionLittle is known about the burden of sexually transmitted infections (STIs) among adolescent girls and young women (AGYW) employed as domestic workers in Ugandan households.MethodsWe conducted a community-based cross-sectional study from November 2023 to March 2024 to determine the prevalence and correlates of STIs among Ugandan AGYW aged 14–24 in the Kampala Metropolitan Area. Self-collected vaginal swabs were tested for Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) using GeneXpert. HIV and syphilis testing were performed using the Bioline HIV/syphilis Duo test. Correlates of STI prevalence were determined using modified Poisson regression.ResultsAmong 262 AGYW, median age was 20 years (IQR 18–23) and 87 (33%) had an STI: CT (27.5%), syphilis (5.7%), HIV (4.6%) and NG (1.5%). Overall, 14.9% had >1 STI. Of 12 AGYW with HIV, 3 (25%) were newly diagnosed and 6/9 had detectable viral loads (≥1000 copies/mL). In the prior 12 months, 126 (48%) had received syndromic STI treatment, but only 35 (28%) notified their partners. Additionally, 102 (39%) had used emergency contraception and 54% believed it was protective against STIs, including HIV. Factors associated with STI prevalence included non-cash compensation for domestic work (adjusted prevalence ratio (aPR) 2.26; 95% CI 1.04 to 4.92; p=0.040), lower educational attainment (aPR 1.73; 95% CI 1.16 to 2.57; p=0.007), alcohol consumption in the past 6 months (aPR 1.72; 95% CI 1.12 to 2.64; p=0.013) and transactional sex during the past 6 months (aPR 1.43; 95% CI 1.01 to 2.04; p=0.045). Conversely, self-reported sexual abuse was negatively associated with STIs (aPR 0.48; 95% CI 0.28 to 0.83; p=0.008).ConclusionThe high prevalence of undiagnosed STIs and unsuppressed HIV among AGYW domestic workers in Central Uganda highlights the urgent need to increase STI/HIV prevention, testing and treatment coverage for these underserved and vulnerable young women. Targeted interventions are needed to mitigate STI/HIV acquisition in this population.