Need For Public Health Initiatives Research Articles

Impact of prenatal maternal depression on gestational length: post hoc analysis of a randomized clinical trial

Shortened gestation is a leading cause of childhood morbidity and mortality with lifelong consequences for health. There is a need for public health initiatives on increasing gestational age at birth. Prenatal maternal depression is a pervasive health problem robustly linked via correlational and epidemiological studies to shortened gestational length. This proof-of-concept study tests the impact of reducing prenatal maternal depression on gestational length with analysis of a randomized clinical trial (RCT). Participants included 226 pregnant individuals enrolled into an RCT and assigned to receive either interpersonal psychotherapy (IPT) or enhanced usual care (EUC). Recruitment began in July 2017 and participants were enrolled August 10, 2017 to September, 8 2021. Depression diagnosis (Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; DSM 5) and symptoms (Edinburgh Postnatal Depression Scale and Symptom Checklist) were evaluated at baseline and longitudinally throughout gestation to characterize depression trajectories. Gestational dating was collected based on current guidelines via medical records. The primary outcome was gestational age at birth measured dichotomously (≥39 gestational weeks) and the secondary outcome was gestational age at birth measured continuously. Posthoc analyses were performed to test the effect of reducing prenatal maternal depression on gestational length. This trial is registered with ClinicalTrials.gov (NCT03011801). Steeper decreases in depression trajectories across gestation predicted later gestational age at birth, specifically an increase in the number of full-term babies born ≥39 gestational weeks (EPDS linear slopes: OR=1.54, 95% CI 1.10-2.16; and SCL-20 linear slopes: OR=1.67, 95% CI 1.16-2.42). Causal mediation analyses supported the hypothesis that participants assigned to IPT experienced greater reductions in depression symptom trajectories, which in turn, contributed to longer gestation. Supporting mediation, the natural indirect effect (NIE) showed that reduced depression trajectories resulting from intervention were associated with birth ≥39 gestational weeks (EPDS, OR=1.65, 95% CI 1.02-2.66; SCL-20, OR=1.85, 95% CI 1.16-2.97). We used a RCT design and found that reducing maternal depression across pregnancy was associated with lengthened gestation. This research was supported by the NIH (R01 HL155744, R01 MH109662, R21 MH124026, P50 MH096889).

Ultraprocessed Food Consumption and Cardiometabolic Risk Factors in Children

High intake of ultraprocessed foods (UPFs) has been associated with higher cardiometabolic risk in adults; however, the evidence in children is limited. To investigate the association between UPF consumption and cardiometabolic risk factors in the Childhood Obesity Risk Assessment Longitudinal Study (CORALS). This baseline cross-sectional analysis was conducted using the data of CORALS participants recruited between March 22, 2019, and June 30, 2022. Preschool children (aged 3-6 years) were recruited from schools and centers in 7 cities in Spain. Inclusion criteria included informed consent signed by parents or caregivers and having a completed a set of questionnaires about the child's prenatal history at home. Exclusion criteria included low command of Spanish or unstable residence. Energy-adjusted UPF consumption (in grams per day) from food frequency questionnaires and based on the NOVA food classification system. Age- and sex-specific z scores of adiposity parameters (body mass index [BMI], fat mass index, waist-to-height ratio, and waist circumference) and cardiometabolic parameters (diastolic and systolic blood pressure, fasting plasma glucose, homeostasis model assessment for insulin resistance, high-density and low-density lipoprotein cholesterol, and triglycerides) were estimated using linear regression models. Of 1509 enrolled CORALS participants, 1426 (mean [SD] age, 5.8 [1.1] years; 698 boys [49.0%]) were included in this study. Mothers of children with high UPF consumption were younger, had a higher BMI, were more likely to have overweight or obesity, and had lower education levels and employment rates. Compared with participants in the lowest tertile of energy-adjusted UPF consumption, those in the highest tertile showed higher z scores of BMI (β coefficient, 0.20; 95% CI, 0.05-0.35), waist circumference (β coefficient, 0.20; 95% CI, 0.05-0.35), fat mass index (β coefficient, 0.17; 95% CI, 0.00-0.32), and fasting plasma glucose (β coefficient, 0.22; 95% CI, 0.06-0.37) and lower z scores for HDL cholesterol (β coefficient, -0.19; 95% CI, -0.36 to -0.02). One-SD increments in energy-adjusted UPF consumption were associated with higher z scores for BMI (β coefficient, 0.11; 95% CI, 0.05-0.17), waist circumference (β coefficient, 0.09; 95% CI, 0.02-0.15), fat mass index (β coefficient, 0.11; 95% CI, 0.04-1.18), and fasting plasma glucose (β coefficient, 0.10; 95% CI, 0.03-0.17) and lower HDL cholesterol (β coefficient, -0.07; 95% CI, -0.15 to -0.00). Substituting 100 g of UPFs with 100 g of unprocessed or minimally processed foods was associated with lower z scores of BMI (β coefficient, -0.03; 95% CI, -0.06 to -0.01), fat mass index (β coefficient, -0.03; 95% CI, -0.06 to 0.00), and fasting plasma glucose (β coefficient, -0.04; 95% CI, -0.07 to -0.01). These findings suggest that high UPF consumption in young children is associated with adiposity and other cardiometabolic risk factors, highlighting the need for public health initiatives to promote the replacement of UPFs with unprocessed or minimally processed foods.

Burden of the Fruity: Family Support and Suicide Ideation as Mediators Between Discrimination and Suicide Behavior in LGBTQ+ Malaysians

ABSTRACT Malaysian pervasive climate places its LGBTQ+ residents at heightened risk for suicidal behaviors (SB). This cross-sectional study aimed to elucidate connections between minority stressors (discrimination), types of social supports, and suicidality in this marginalized population. Utilizing online surveys, 317 LGBTQ+ Malaysians aged 18–49 provided data regarding experienced discrimination, perceived social support from family, friends, and significant others, suicidal ideation (SI), and SB. Quantitative analyses illuminated several key findings. First, discrimination is positively associated with SB, while all support types are inversely related to SB, with family support demonstrating the strongest correlation. Regression modeling revealed family support as the sole unique predictor of reduced SB. Serial mediation analysis uncovered nuanced indirect pathways from discrimination to SB, with SI, but not family support alone, significantly mediating this relationship. However, reduced family support resulting from discrimination sequentially heightened SI and SB. Despite pervasive societal bias, family and friend acceptance may curb the LGBTQ+ community’s elevated suicide risk by mitigating resultant ideation. These insights highlight the need for public health initiatives promoting social support and LGBTQ+ inclusivity laying the groundwork to safeguard this population’s psychological wellbeing.

Prevalence of 24-hour movement behavior guidelines among youth with prescribed eyeglasses/contact lenses and anxiety

BackgroundThis study examined the prevalence of meeting 24-h movement behavior (24-HMB: physical activity [PA], screen time [ST], and sleep duration [SL]) guidelines in U.S. children and adolescents (youth) with prescribed eyeglasses/contact lenses and anxiety, followed by an investigation on its associated prevalence across specific demographic variables (e.g., ethnicity, highest level of education of household members). MethodsYouth (N = 1729) who were prescribed eyeglasses/contact lenses and had anxiety were included in this cross-sectional study. A multinomial logistic regression analysis was used to examine the odds ratio of meeting 24-HMB guidelines when considering specific sociodemographic factors. ResultsMost participants met some proportion of 24-HMB guidelines, with 407 participants (23.54%) meeting two guidelines (PA + ST, PA + SL, and ST + SL), while 103 participants (5.96%) met three guidelines (PA + ST + SL). Furthermore, youth with prescribed eyeglasses/contact lenses and anxiety demonstrated a significantly lower prevalence of meeting the combined guidelines (PA + SL, ST + SL, and PA + ST + SL) in relative to the age-matched group without prescribed eyeglasses/contact lenses and anxiety (ps < 0.001). ConclusionsOnly a small percentage of the U.S. youth with prescribed eyeglasses/contact lenses and anxiety met the combined components of 24-HMB guidelines (especially compared with participants without prescribed eyeglasses/contact lenses and anxiety). Thus, there is a strong need for public health initiatives to promote healthy lifestyle behaviors in this vulnerable population including higher levels of regular physical activity, lower time spent sedentary and appropriate sleep duration.

Self-Medication Knowledge, Attitude and Practice among the Population of Jamshoro City: A Cross-Sectional Study

Background: Self-medication is a globally prevalent practice, with varying degrees of awareness and regulation across different regions. In developing countries like Pakistan, the practice poses significant public health challenges, including the risk of medication misuse and antibiotic resistance. Jamshoro, a city with a diverse demographic and educational landscape, provides a unique setting to explore the knowledge, attitudes, and practices of self-medication among its residents. Objective: This study aimed to assess the extent of self-medication practices among the adult population in Jamshoro, focusing on their knowledge, attitudes, and the types of medications commonly used. It sought to identify potential risks associated with self-medication and propose recommendations for safer practices. Methods: A descriptive cross-sectional survey was conducted from February to April 2023, involving 400 participants selected through non-probability convenience sampling. The survey encompassed questions related to demographic information, knowledge about self-medication, attitudes towards its practice, and the frequency and types of medications used. Data were collected using both online questionnaires distributed via Google Forms and face-to-face interviews, ensuring a comprehensive understanding of self-medication behaviors. Ethical approval was obtained from the Research Ethics Committee of Liaquat University of Medical and Health Sciences (LUMHS), with the study adhering to the Helsinki Declaration's ethical standards. Data analysis was performed using SPSS Version 25, utilizing descriptive statistics to summarize findings. Results: The majority of respondents were male (55.5%) and undergraduates (64.5%), with students representing 66% of the sample. A significant portion (87.3%) reported a lack of knowledge regarding self-medication, and 90.3% had never taken medication without a physician’s prescription. About 64% were aware of the difference between over-the-counter (OTC) and prescription drugs, and 82.5% recognized the risk of antibiotic resistance. Self-medication practices were infrequent among participants, with 32.5% engaging in it only occasionally. The study also found a predominant preference for private healthcare facilities (68.5%) over public ones. Conclusion: The findings indicate a substantial knowledge gap regarding self-medication among the population of Jamshoro, despite a general tendency to consult healthcare professionals for medical issues. There is a critical need for public health initiatives to educate the community on safe medication practices, the risks of antibiotic resistance, and the importance of adhering to prescribed treatments.

Age-Related Differences in Accelerometer-Assessed Physical Activity and Sleep Parameters Among Children and Adolescents With and Without Autism Spectrum Disorder

Physical inactivity and sleep disorders are health-related concerns of youth with autism spectrum disorder (ASD) that can persist from childhood and exacerbate core symptoms. However, evidence on group differences in accelerometer-assessed physical activity and sleep parameters among youth with and without ASD is inconclusive and age-specific effects remain unclear. To synthesize evidence on group differences in accelerometer-assessed physical activity and sleep parameters and examine the moderating effects of age between children and adolescents with and without ASD. American Psychological Association PsychInfo, CINAHL Ultimate, ERIC, MEDLINE, SPORTDiscus with Full Text, and Web of Science from inception to February 2023. Two independent reviewers screened articles for observational research comparing accelerometer-assessed physical activity levels and sleep parameters in children and adolescents with and without ASD. After developing a standardized form, relevant data were extracted. Quality was assessed using the McMaster Critical Review Form and rated based on sample, measurement, and analyses. The Preferring Reporting Items for Systematic Reviews and Meta-Analyses guideline was followed. The primary outcomes were actigraphy-measured MVPA, sleep latency, sleep efficiency, total sleep time, and wake after sleep onset. Data were pooled using a random-effects model. Hedges g was used to express the effect size index. Meta-regression on age was also performed to investigate the potential moderating effects. Collectively, 1757 studies were initially identified. Among 104 articles that were assessed, 28 were included, comprising moderate-to-vigorous physical activity (MVPA), 4 sleep parameters, and 73 independent effect sizes. A total of 28 studies were included in analysis, comprising 805 children and adolescents with ASD and 1573 without ASD (age range, 5.1-16.9 years). Compared with peers without ASD, children and adolescents with ASD had a small-to-moderate difference in MVPA (g = -0.450; 95% CI, -0.622 to -0.277), total sleep time (g = -0.332; 95% CI, -0.574 to -0.090), sleep efficiency (g = -0.424; 95% CI, -0.645 to -0.203), and a moderate difference in sleep latency (g = 0.514; 95% CI, 0.351 to 0.677) measured by actigraphy. Children and adolescents with ASD experienced an age-related decline in moderate-to-vigorous physical activity (β = -0.049 [95% CI, -0.097 to -0.001]; P = .045), indicating that younger children with ASD showed a smaller difference in MVPA compared with their peers without ASD. Moderating effects of age on sleep parameters were not significant. The findings of this meta-analysis suggested that children and adolescents with ASD had lower MVPA and worse sleep than peers without ASD, and the difference in MVPA varied with age. These findings reinforce the need for public health initiatives aimed at reducing these group disparities.

Prevalence and Risk Factors of Metabolic Syndrome: A Prospective Study on Cardiovascular Health.

Background and objectives: This article highlights the relationship between metabolic syndrome and cardiovascular disease, providing a comprehensive overview of its risk factors and prevalence. Metabolic syndrome, characterized by a cluster of interconnected risk factors, significantly increases the risk of developing cardiovascular disease and type II diabetes. Materials and methods: This study, conducted over a one-year period, involved 117 patients aged between 30 and 79 years old. Various parameters were analyzed, such as gender, age, education level, provenance from urban or rural environment, smoking, alcohol consumption, dietary aspects, physical activity, and their contribution to the appearance of metabolic syndrome. Central adiposity and high blood pressure emerged as prominent elements of the condition. Results: The findings underscore the importance of a healthy lifestyle in the prevention and management of metabolic syndrome. Encouraging regular physical activity, maintaining a balanced diet, rich in fresh vegetables and fruits, and avoiding harmful behaviors, such as smoking or alcohol consumption, are essential in reducing the risk of metabolic syndrome and its associated cardiovascular complications. Conclusions: The study highlights the need for public health initiatives, as well as individualized preventive strategies to combat the rising prevalence of metabolic syndrome. Through promoting awareness of its risk factors and implementing effective interventions, healthcare professionals can contribute to better cardiovascular health worldwide. Further research in this area will continue to enhance our understanding of metabolic syndrome and refine preventive and therapeutic approaches for its management.

Temporal discrepancies in “rapid” HIV testing: explaining misdiagnoses at the point-of-care in Zimbabwe

BackgroundRapid diagnostic tests have revolutionized the HIV response in low resource and high HIV prevalence settings. However, disconcerting levels of misdiagnosis at the point-of-care call for research into their root causes. As rapid HIV tests are technologies that cross borders and have inscribed within them assumptions about the context of implementation, we set out to explore the (mis)match between intended and actual HIV testing practices in Zimbabwe.MethodsWe examined actual HIV testing practices through participant observations in four health facilities and interviews with 28 rapid HIV testers. As time was identified as a key sphere of influence in thematic analyses of the qualitative data, a further layer of analysis juxtaposed intended (as scripted in operating procedures) and actual HIV testing practices from a temporal perspective.ResultsWe uncover substantial discrepancies between the temporal flows assumed and inscribed into rapid HIV test kits (their intended use) and those presented by the high frequency testing and low resource and staffing realities of healthcare settings in Zimbabwe. Aside from pointing to temporal root causes of misdiagnosis, such as the premature reading of test results, our findings indicate that the rapidity of rapid diagnostic technologies is contingent on a slow, steady, and controlled environment. This not only adds a different dimension to the meaning of “rapid” HIV testing, but suggests that errors are embedded in the design of the diagnostic tests and testing strategies from the outset, by inscribing unrealistic assumptions about the context within which they used.ConclusionTemporal analyses can usefully uncover difficulties in attuning rapid diagnostic test technologies to local contexts. Such insight can help explain potential misdiagnosis ‘crisis points’ in point-of-care testing, and the need for public health initiatives to identify and challenge the underlying temporal root causes of misdiagnosis.

Risk of Long COVID in People Infected With Severe Acute Respiratory Syndrome Coronavirus 2 After 2 Doses of a Coronavirus Disease 2019 Vaccine: Community-Based, Matched Cohort Study.

We investigated long COVID incidence by vaccination status in a random sample of UK adults from April 2020 to November 2021. Persistent symptoms were reported by 9.5% of 3090 breakthrough severe acute respiratory syndrome coronavirus 2 infections and 14.6% of unvaccinated controls (adjusted odds ratio, 0.59 [95% confidence interval, .50–.69]), emphasizing the need for public health initiatives to increase population-level vaccine uptake.

Modeling recent gun purchases: A social epidemiology of the pandemic arms race

In this paper, we document the social patterning of recent gun purchases to advance a contemporary social epidemiology of the pandemic arms race. We employ cross-sectional survey data from the 2020 Health, Ethnicity and Pandemic Study, which included a national sample of 2,709 community-dwelling adults living in the United States. We use binary logistic regression to model recent pandemic gun purchases as a function of age, sex, race/ethnicity, nativity status, region of residence, marital status, number of children, education, household income, pandemic job change, religious service attendance, pandemic religion change, and political party. Overall, 6% of the sample reported purchasing a new gun during the pandemic. Multivariate regression results suggest that pandemic gun purchasers tend to be male, younger, US-born, less educated, recently unemployed, experiencing changes in their religious beliefs, Republicans, and residents of southern states. To our knowledge, we are among the first to formally document a new population of pandemic gun owners that is characterized by youth, US-nativity, and religious volatility. Our analyses underscore the need for public health initiatives designed to enhance gun-related safety during pandemics, including, for example, addressing underlying motivations for recent gun purchases and improving access to training programs.

Mental health service utilization among African immigrants in the United States.

This study utilized Andersen's model of health behavior to explore factors associated with mental health service utilization. We also examine rates for mental health service use, treatment preferences, and barriers to care. Data were collected utilizing web-based surveys. The sample consisted of first and second-generation African immigrants who had struggled with emotional or behavioral problems in the past 12 months (N = 323). Hierarchical logistic regression analyses were conducted to examine predictors of mental health service utilization. The majority of participants (79.5%) met criteria for probable major depression, and 63% sought mental health services. Findings showed that mental health service utilization was more significantly predicted by enabling and need factors. Age (odds ratio [OR] = 1.03), religiosity (OR = 1.11), acculturative stress (OR = 1.68), neighborhood risk (OR = 0.54), and work-productivity loss (OR = 2.93) were associated with increased likelihood of mental health service use (p < 0.05). Most common barriers to service use were hopes of self-healing (56.3%) followed by financial barriers (46.2%). Findings highlight the need for public health initiatives to increase mental health literacy and financial accessibility to mental health services in response to the high mental health need and identified barriers to care in this population.

Reflection of Eating Awareness and Life Engagement of University Students on the Coronavirus (COVID-19) Pandemic

Study Objectives: With the restrictions in the pandemic process and the distance education process, changes have occurred in the diet of students. In such periods, which affect human life in a significant way in terms of public health, nutrition must be managed well. The study was conducted to evaluate the eating awareness of university students during the COVID-19 pandemic period and to examine its relationship with their engagement in life. Methods: The population of the cross-sectional study consists of the students of Munzur University. As a precaution regarding the COVID-19 pandemic, the participants were reached on the internet. Results: Eating awareness was statistically higher in men, married people, those with normal weight, and older students. While the life engagement among university students was high, the mean scores of eating awareness and its sub-components were moderate. Life engagement was significantly higher in sports science students than students in other academic units. There was a weak but significant relationship between eating awareness and engagement in life. Conclusion: Eating awareness of university students during the pandemic is at a moderate level. Students with high eating awareness are attached to life more. The highest life engagement among academic units is among sports science students. There is a need for public health initiatives to increase the awareness of eating among the students, against COVID-19 and possible future pandemics.

Predictors of Dietary Diversity of Indigenous Food-Producing Households in Rural Fiji.

Fiji, like other Pacific Islands, are undergoing economic and nutrition transitions that increase the risk of noncommunicable diseases (NCDs) due to changes of the food supply and dietary intake. This study aimed to examine dietary diversity (DD) in indigenous food-producing households in rural Fiji. Surveys were conducted with households from the Nadroga-Navosa, Namosi and Ba Provinces of Western Fiji in August 2018. Participants reported on foods consumed in the previous 24 h per the Household Dietary Diversity Score. Data was analysed using multinomial logistic regression. Of the 161 households, most exhibited medium DD (66%; M = 7.8 ± 1.5). Commonly consumed foods included sweets (98%), refined grains (97%) and roots/tubers (94%). The least consumed foods were orange-fleshed fruits (23%) and vegetables (35%), eggs (25%), legumes (32%) and dairy (32%). Households with medium DD were more likely to be unemployed (OR 3.2, p = 0.017) but less likely to have ≥6 occupants (OR = 0.4, p = 0.024) or purchase food ≥2 times/week (OR = 0.2, p = 0.023). Households with low DD were more likely to have low farm diversity (OR = 5.1, p = 0.017) or be unemployed (OR = 3.7, p = 0.047) but less likely to have ≥6 occupants (OR = 0.1, p = 0.001). During nutrition transitions, there is a need for public health initiatives to promote traditional diets high in vegetables, fruits and lean protein and agricultural initiatives to promote farm diversity.

China's Belt and Road Initiative: Incorporating public health measures toward global economic growth and shared prosperity.

The unprecedented globalization of trade, travel, climate change, protectionism, and geopolitical populism, as well as pandemic health threats are no longer issues for a single nation. In the field of public health, China's Belt and Road Initiative (BRI) offers immense opportunities for partnership and collective actions involving multiple countries to combat globalization-linked infectious and/or chronic diseases, emerging pandemics, and outbreaks of potential threats to both laboratory information management systems and health information management. The national and global health challenges have increasingly proved that economic prosperity cannot be achieved when huge knowledge and capacity gaps exist in health systems. There is thus a need for public health initiatives aimed at strengthening the health systems beyond sovereign borders to influence global geo-economics. We highlight situational insights that offer approaches and strategies for increasing public health investment and capacity development in the countries along the Belt and Road, enhancing public and global health cooperation alongside participation in disease control and elimination, promoting public health governance and data sharing for pandemic threats, and building shared values and benefits in public health through Sino-African cooperation and the BRI. Our approach also examines the values of the China's BRI in relation to public health, projections and initiatives for increasing new investment and development capacity in public health systems, and enhanced public and global health cooperation and participation toward the BRI's framework and scope.

Women's obstetric and reproductive health care discourse in online forums: Perceived access and quality pre- and post-Affordable Care Act

This corpus-based study examines women's framing of health issues in online forums (MedHelp.org, AphroditeWomensHealth.com, and Connect.MayoClinic.org) prior to, during, and after implementation of the Affordable Care Act (ACA). Since worldviews affect how women describe health issues, their discourse is both a way to see ideology indexed in the forums, as well as how that discourse has been shaped by policy. Posts were collected December 2016–April 2017 and annotated using the UAM (Universidad Autónoma de Madrid) Corpus Tool to examine emergent categories and compare them to three time periods: pre-, during, and post-ACA. Data within posts were coded as to the linguistic moves being made. Three frequent categories of linguistic function in the data were identified: experience-sharing, advice-requesting and offering, and rationale-offering (N = 1268). These linguistic moves were sub-divided into further categories (e.g., under advice requesting, a request for diagnosis), and a discourse-analytical perspective provides insight into the values indexed in each. Before ACA, forum participants cited access, fear, and a history of unhelpful medical visits as obstacles to seeking care. After implementation, obstacles cited were prior unhelpful visits, followed by access, and uncertainty regarding care-seeking appropriateness. While ACA implementation reduced lack of insurance as an obstacle to obtaining healthcare, online forums indicate that patients continue to find doctors' visits unhelpful, instead choosing to seek medical advice from the lay public. Patients' distrust of the medical profession persisted following ACA implementation. There is a need for public health initiatives to improve this relationship in order to augment health care outcomes.

Substance use disorders: Need for public health initiatives

Substance use disorders (SUDs) are associated with substantial contribution to the global burden of disease due to high prevalence, early age of onset, and chronic course. The associated physical health complications such as HIV, hepatitis B and C, and opportunist infections, stigma, myths and misconceptions, and a huge treatment gap further increase the problem. Thus, there is a strong need to take public health initiatives. Conventionally, common substances of abuse include licit substances such as tobacco and alcohol and illicit substances such as opioids, cannabis products, cocaine, barbiturates, amphetamines, and prescription drugs. The new psychoactive substances have brought a new challenge. Conventionally, the three approaches of supply reduction, demand reduction and harm reduction have been used to deal with the problem of SUDs. Preventive strategies encompassing primary, secondary, and tertiary methods need to be formally planned to meet this massive challenge. Creating awareness about the problem in the community and targeting myths and misconceptions are important to reduce the treatment gap. There is need to ensure availability and accessibility of affordable and acceptable treatment facilities, provide evidence-based treatment, and ensure ethical standards in care including coordination between health, social, and legal agencies. Relapse prevention and rehabilitation also need to be an important component of the public health policy. A well-planned public health approach involving all stakeholders is likely to be the most appropriate method to deal with the challenges imposed by the SUDs.

A qualitative examination of factors underlying transitions in problem gambling severity: Findings from the Leisure, Lifestyle, & Lifecycle Project

Background: The current study sought to explore the narrative accounts of individuals who underwent changes in their problem gambling severity, and identify subjective factors underlying these transitions. Additionally, respondents’ perceived change in their gambling behavior was compared with a validated measure of problem gambling severity.Methods: Participants were recruited from The Leisure, Lifestyle, & Lifecycle Project (LLLP), a prospective cohort study based in Alberta, Canada. In-depth, semi-structured telephone interviews were conducted with a subset of participants identified as showing a significant increase or decrease in problem gambling severity between Wave 4 and 5 of the LLLP (n = 41). Principles of phenomenology and grounded theory were used to thematically code interviews.Results: About half of respondents increased in problem gambling severity between Wave 4 and 5 (n = 22), while 19 respondents decreased. For those who perceived this change (n = 13), the most common factors underlying increases in problem gambling severity were the same factors underlying decreases and included financial, social, and internal reasons. More than half of the sample (n = 28) perceived stability in, or a change in their gambling behavior that was incongruent with their problem gambling severity score. These respondents tended to endorse a greater degree of gambling fallacies, dissonant feelings, and mental health issues, compared to those who had accurately perceived their change.Conclusions: The findings suggest that many individuals may not accurately perceive transitions in their gambling. Gambling fallacies and dissonant feelings seem to underlie this discrepancy, highlighting the need for public health initiatives to focus on correcting these erroneous beliefs.

Relationships Between Problem-Gambling Severity and Psychopathology as Moderated by Income.

Background and aimsProblem and pathological gambling have been associated with elevated rates of both Axis-I and Axis-II psychiatric disorders. Although both problem gambling and psychiatric disorders have been reported as being more prevalent among lower income vs. middle/higher income groups, how income might moderate the relationship between problem-gambling severity and psychopathology is incompletely understood. To examine the associations between problem-gambling severity and psychopathology in lower income and middle/higher income groups.MethodsData from the first wave of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) (n = 43,093) were analyzed in adjusted logistic regression models to investigate the relationships between problem-gambling severity and psychiatric disorders within and across income groups.ResultsGreater problem-gambling severity was associated with increased odds of multiple psychiatric disorders for both lower income and middle/higher income groups. Income moderated the association between problem/pathological gambling and alcohol abuse/dependence, with a stronger association seen among middle/higher income respondents than among lower income respondents.Discussion and conclusionsThe findings that problem-gambling severity is related to psychopathology across income groups suggest a need for public health initiatives across social strata to reduce the impact that problem/pathological gambling may have in relation to psychopathology. Middle/higher income populations, perhaps owing to the availability of more “disposable income,” may be at greater risk for co-occurring gambling and alcohol-use psychopathology and may benefit preferentially from interventions targeting both gambling and alcohol use.

The voice of non-pregnant women on alcohol consumption during pregnancy: a focus group study among women in Sweden.

BackgroundConsensus is that fetal exposure to alcohol is harmful. Abstinence while trying to conceive and throughout pregnancy is recommended. Despite this, there are many women who consume alcohol around conception and until pregnancy recognition. The aim of this study was to explore the voice of non-pregnant women concerning alcohol consumption and its relation to pregnancy.MethodsData were collected through seven focus groups interviews with 34 women of fertile age, who were neither pregnant nor mothers. Semi-structured interviews were undertaken, recorded and transcribed verbatim and then analysed using thematic analysis.ResultsThree main themes were identified in the analysis: an issue that cannot be ignored; awareness and uncertainty concerning alcohol and pregnancy; and transition to parenthood. Alcohol was an integral part of the women’s lives. A societal expectation to drink alcohol was prevalent and the women used different strategies to handle this expectation. Most women agreed not to drink alcohol during pregnancy although their knowledge on the specific consequences was scanty and they expressed a need for more information. Most of the participants found drinking alcohol during pregnancy to be irresponsible and saw pregnancy as a start of a new way of life.ConclusionsSocial expectations concerning women’s alcohol use change with pregnancy when women are suddenly expected to abstain. Although most study participants shared an opinion for zero tolerance during pregnancy, their knowledge regarding consequences of drinking during pregnancy were sparse. In order for prospective mothers to make informed choices, there is a need for public health initiatives providing information on the relationship between alcohol consumption and reproduction.

Association between second-hand smoking and acute coronary heart disease among Arab women with multiple risk factors.

Active smoking is a well-established risk factor for coronary heart disease (CHD). However, the role of second-hand smoking (SHS) needs further investigation. We aimed to study the association between SHS and CHD in Arab women in Israel. A matched case-control study among non-smoking Arab women. The case group included women discharged from hospital after having acute coronary event. The control group was women without CHD who were individually matched for age and type-2 diabetes. The women were interviewed with structured questionnaires on exposure to SHS and on attitudes towards such exposure, and underwent anthropometric measurements. A total of 146 women were included, the majority had type-2 diabetes (68.5%) and were overweight or obese (89.4% of cases and 93.2% of controls, P = 0.727). The prevalence of exposure to domestic-SHS after marriage was higher among the cases than controls (91.8% vs. 53.4%, P < 0.001). After adjustment for hypertension, body mass index > 25 and family history, exposure to domestic-SHS after marriage was an independent risk factor for CHD (OR = 6.1, 95% CI 1.93-19.3). Compared with no exposure, the exposed for 2-6 h a day had an OR of 5.68 (1.48-21.73), and for >6 h a day the OR reached 26.12 (4.26-159.92). Women with CHD felt less comfortable voicing their concern about smoking near them and more highly agreed with prohibition of smoking. Exposure to domestic-SHS is independently associated with CHD in Arab women, with a strong dose-response relationship, emphasizing the need for public health initiatives to reduce exposure to domestic-SHS.