Publications by authors named "Maureen Lahiff"

43 Publications

Early childhood factors associated with obesity at age 8 in Vietnamese children: The Young Lives Cohort Study.

BMC Public Health 2021 Feb 5;21(1):301. Epub 2021 Feb 5.

School of Public Health, UC Berkeley-UCSF Joint Medical Program, University of California, 2199 Addison St, 4th floor, Berkeley, CA, USA.

Background: Over recent decades, Vietnam has experienced rapid economic growth, a nutrition transition from the traditional diet to highly-processed and calorie-dense foods and beverages, and an increasing prevalence of childhood overweight/obesity (ow/ob). The goal of this study is to describe the patterns of ow/ob in a longitudinal sample of Vietnamese children from ages 1 to 8, and the sociodemographic and behavioral factors associated with ow/ob at age 8.

Methods: This study is a secondary data analysis of a geographically-representative, longitudinal cohort of 1961 Vietnamese children from the Young Lives Cohort Study from 2002 to 2009. Thirty-one communities were selected with oversampling in rural communities, and children age 1 were recruited from each community using simple random sampling. Surveys of families and measurements of children were collected at child ages 1, 5, and 8. Our specified outcome measure was childhood ow/ob at age 8, defined by the World Health Organization's thresholds for body-mass-index (BMI) for age Z-scores. Associations between early and concurrent socio-behavioral factors, childhood nutrition and physical activity variables were analyzed using STATA 15. Bivariate and multivariable analyses were completed utilizing logistic regression models.

Results: The prevalence of ow/ob increased from 1.1% in both sexes at age 1 to 7% in females and 13% in males at age 8. Bivariate analyses show greater likelihood of ow/ob at age 8 was significantly associated with early life sociodemographic factors (at age 1), male sex (OR = 2.2, 1.6-3.1), higher wealth (OR = 1.1-1.4), and urban residence (OR = 4.3, 3-6). In adjusted analyses, ow/ob at age 8 was associated with early nutrition practices at age 5, including frequent consumption of powdered milk (OR = 2.8, 1.6-4.6), honey/sugar (OR = 2.7, 1.8-4.1), prepared restaurant/fast foods (OR = 4.6, 2.6-8.2), and packaged sweets (OR = 3.4, 2.3-4.9). In addition, breastfeeding for 6 months or longer was protective against obesity at age 8 (OR = 0.3, 0.1-0.9).

Conclusions: We found that increased consumption of powdered milk, honey/sugar, packaged sweets, and prepared restaurants/fast foods are associated with childhood ow/ob. In contrast, breastfeeding for 6 months or longer was protective against childhood ow/ob. These findings suggest that public health programs and campaigns aimed to prevent childhood ow/ob in Vietnam should target early feeding practices.
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http://dx.doi.org/10.1186/s12889-021-10292-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7866641PMC
February 2021

Intergenerational Associations Between Parental Incarceration and Children's Sexual Risk Taking in Young Adulthood.

J Adolesc Health 2019 03 1;64(3):398-404. Epub 2018 Dec 1.

University of California, Berkeley, School of Public Health, Berkeley, California.

Purpose: Research on parental incarceration and the health of offspring is relatively scarce despite studies linking childhood adverse experiences to a range of physical and mental health conditions. This study aimed to estimate the associations between parental incarceration and sexual risk outcomes (early sexual onset, inconsistent condom use, and sexually transmitted infections [STIs]) in young adulthood.

Methods: We used logistic regression to estimate associations of sexual risk taking behaviors with parental incarceration during childhood in a sample of 3,972 participants in The National Longitudinal Study of Adolescent to Adult Health (Add Health) between 2001 and 2009.

Results: Parental incarceration was associated with early sexual onset (adjusted odds ratio [AOR] = 1.4, 95% confidence interval [CI] = 1.03-2.03) and STIs (AOR =2.0, 95% CI = 1.3-3.2). Maternal incarceration was associated with increased odds of early sexual onset (AOR = 3.6, 95% CI = 1.9-6.7), inconsistent condom use (AOR = 3.4, 95% CI = 1.3-8.9), and STIs (AOR = 5.5, 95% CI = 1.7-17.6). Additionally, paternal incarceration and parental incarceration occurring before age 10 were associated with STIs (AOR = 1.7, 95% CI = 1.1-2.8; AOR = 2.0, 95% CI = 1.1-3.7).

Conclusions: Parental incarceration, especially maternal imprisonment, is associated with risky sexual behavior and sexually transmitted infections in young adults in the United States. Intervening during or prior to the adolescent developmental period may ameliorate risky sexual behaviors and related health outcomes among children of incarceration parents.
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http://dx.doi.org/10.1016/j.jadohealth.2018.09.028DOI Listing
March 2019

Hispanic Immigrant Father Involvement with Young Children in the United States: A Comparison with US-Born Hispanic and White non-Hispanic Fathers.

Matern Child Health J 2018 08;22(8):1118-1126

School of Public Health, University of California, Berkeley, 50 University Hall #7360, Berkeley, CA, 94720-7360, USA.

Objectives Fathering is known to foster child development and health, yet evidence on Hispanic immigrant fathers' involvement with their young children is sparse. This study assessed disparities in pregnancy intendedness and father involvement with children ages 0-4 among Hispanic immigrant co-resident fathers versus two reference groups: US-born Hispanic and US-born White fathers. We hypothesized that differentials in involvement were associated with socioeconomic and cultural factors. Methods Using 2011-2013 data from the National Survey of Family Growth (N = 598), we performed bivariate, logistic and linear regression analyses to assess disparities in pregnancy intendedness and five father involvement outcomes (physical care, warmth, outings, reading and discipline). The models controlled for socio-economic, structural, health and cultural covariates. Results Pregnancy intendedness did not differ significantly between Hispanic immigrant fathers and the two reference groups. Compared with US-born Hispanics, unadjusted models showed that immigrant fathers were less likely to engage in physical care, warmth and reading, (p ≤ 0.05) though the differences were attenuated when controlling for covariates. Hispanic immigrant fathers were less likely than US-born White fathers to engage in each of the father involvement outcomes (p ≤ 0.05), with the disparity in reading to their child persisting even after controlling for all covariates. Conclusions for Practice We found marked socio-economic and cultural differences between Hispanic immigrant and US-born Hispanic and White fathers which contribute to disparities in father involvement with their young children. Hispanic immigrant status is an important determinant of involved fathering and should be taken into account when planning public health policies and programs.
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http://dx.doi.org/10.1007/s10995-018-2496-zDOI Listing
August 2018

Violent Injury and Neighborhood Racial/Ethnic Diversity in Oakland, California.

J Urban Health 2017 12;94(6):882-891

Highland Hospital-Alameda Health System, Department of Emergency Medicine, 1411 E. 31st Street, Oakland, CA, 94602, USA.

Racial and ethnic segregation has been linked to a number of deleterious health outcomes, including violence. Previous studies of segregation and violence have focused on segregation between African Americans and Whites, used homicide as a measure of violence, and employed segregation measures that fail to take into account neighborhood level processes. We examined the relationship between neighborhood diversity and violent injury in Oakland, California. Violent injuries from the Alameda County Medical Center Trauma Registry that occurred between 1998 and 2002 were geocoded. A local measure of diversity among African American, White, Hispanic, and Asian populations that captured interactions across census block group boundaries was calculated from 2000 U.S. Census data and a Geographic Information System. The relationship between violent injuries and neighborhood level of diversity, adjusted for covariates, was analyzed with zero-inflated negative binomial regression. There was a significant and inverse association between level of racial and ethnic diversity and rate of violent injury (IRR 0.30; 95% CI: 0.13-0.69). There was a similar relationship between diversity and violent injury for predominantly African American block groups (IRR 0.23; 95% CI: 0.08-0.62) and predominantly Hispanic block groups (IRR 0.08; 95% CI: 0.01-0.76). Diversity was not significantly associated with violent injury in predominantly White or Asian block groups. Block group racial and ethnic diversity is associated with lower rates of violent injury, particularly for predominantly African American and Hispanic block groups.
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http://dx.doi.org/10.1007/s11524-017-0202-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5722733PMC
December 2017

Community-Level HIV Stigma as a Driver for HIV Transmission Risk Behaviors and Sexually Transmitted Diseases in Sierra Leone: A Population-Based Study.

J Acquir Immune Defic Syndr 2017 08;75(4):399-407

*Division of Infectious Diseases, Department of Medicine, University of California at San Francisco (UCSF), San Francisco, CA; †Division of Biostatistics, School of Public Health, University of California at Berkeley, Berkeley, CA; ‡Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA; §Harvard Medical School, Boston, MA; ‖Mbarara University of Science and Technology, Mbarara, Uganda; and ¶Division of HIV, ID and Global Medicine, Department of Medicine, San Francisco General Hospital, UCSF, San Francisco, CA.

Introduction: Although HIV stigma has been identified as an important risk factor for HIV transmission risk behaviors, little is known about the contribution of community-level HIV stigma to HIV transmission risk behaviors and self-reported sexually transmitted diseases (STDs) or how gender may modify associations.

Methods: We pooled data from the 2008 and 2013 Sierra Leone Demographic and Health Surveys. For HIV stigma, we examined HIV stigmatizing attitudes and HIV disclosure concerns at both individual and community levels. Outcomes of HIV transmission risk behaviors were recent condom usage, consistent condom usage, and self-reported STDs. We assessed associations with multivariable logistic regressions. We also analyzed gender as an effect modifier of these associations.

Results: Of 34,574 respondents, 24,030 (69.5%) who had heard of HIV were included in this analysis. Community-level HIV stigmatizing attitudes and disclosure concerns were associated with higher odds of self-reported STDs (adjusted odds ratio = 2.07; 95% confidence interval: 1.55 to 2.77; adjusted odds ratio = 2.95; 95% confidence interval: 1.51 to 5.58). Compared with men, community-level HIV stigmatizing attitudes among women were a stronger driver of self-reported STDs (interaction P = 0.07). Gender modified the association between community-level HIV disclosure concerns and both recent and consistent condom usage (interaction P = 0.03 and P = 0.002, respectively). Community-level HIV disclosure concerns among women were observed to be a driver of risky sex and self-reported STDs.

Conclusions: This study shows that community-level HIV stigma may be a driver for risky sex and self-reported STDs, particularly among women. Our findings suggest that community-held stigmatizing beliefs and HIV disclosure concerns among women might be important targets for HIV stigma reduction interventions.
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http://dx.doi.org/10.1097/QAI.0000000000001418DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5524569PMC
August 2017

Respiratory Problems Associated with Surfing in Coastal Waters.

Ecohealth 2017 03 8;14(1):40-47. Epub 2016 Nov 8.

Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, USA.

A pilot project was conducted to examine the health status and possible adverse health effects associated with seawater exposure (microbial water-quality indicators and phytoplankton abundance and their toxins) of surfers in Monterey Bay, Central California coastal waters. Forty-eight surfers enrolled in the study and completed an initial health background survey and weekly health surveys online using Survey Monkey. Descriptive statistics and generalized estimating equation, a regression technique, were used to identify longitudinal and correlated results. The surfers were predominately Caucasian, male, and physically active. They surfed approximately 4 h a week. Their average age was 34 years. The data indicated that the surfers were generally "healthy," with a low prevalence of diabetes, high cholesterol, and hypertension. Their most common health problems were allergies and asthma. During the study, 10% of the surfers reported gastrointestinal symptoms and 29% reported upper respiratory symptoms. This study suggests surfers were significantly more likely to report upper respiratory symptoms when they had a history of allergies, housemates with upper respiratory symptoms, and/or a history of previous adverse health symptoms while surfing during a "red tide" (an event often associated with the presence of phytoplankton toxins). Additionally, female surfers reported upper respiratory symptoms more than males.
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http://dx.doi.org/10.1007/s10393-016-1197-6DOI Listing
March 2017

Factors associated with oncology patients' involvement in shared decision making during chemotherapy.

Psychooncology 2017 Nov 5;26(11):1972-1979. Epub 2016 Oct 5.

Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA.

Objective: Oncology patients are increasingly encouraged to play an active role in treatment decision making. While previous studies have evaluated relationships between demographic characteristics and decision-making roles, less is known about the association of symptoms and psychological adjustment characteristics (eg, coping styles and personality traits) and decision-making roles.

Methods: As part of a larger study of symptom clusters, patients (n = 765) receiving chemotherapy for breast, gastrointestinal, gynecological, or lung cancer provided information on demographic, clinical, symptom, and psychological adjustment characteristics. Patient-reported treatment decision-making roles (ie, preferred role and role actually played) were assessed using the Control Preferences Scale. Differences among patients, who were classified as passive, collaborative, or active, were evaluated using χ analyses and analyses of variance.

Results: Over half (56.3%) of the patients reported that they both preferred and actually played a collaborative role. Among those patients with concordant roles, those who were older, those with less education and lower income, and those who were less resilient were more likely to prefer a passive role. Several psychological adjustment characteristics were associated with decision-making role, including coping style, personality, and fatalism.

Conclusions: Oncology patients' preferences for involvement in treatment decision making are associated with demographic characteristics as well as with symptoms and psychological adjustment characteristics, such as coping style and personality. These results reaffirm the complexities of predicting patients' preferences for involvement in decision making. Further study is needed to determine if role or coping style may be influenced by interventions designed to teach adaptive coping skills.
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http://dx.doi.org/10.1002/pon.4284DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5698800PMC
November 2017

Household Food Insecurity Is Not Associated with Overall Diet Quality Among Pregnant Women in NHANES 1999-2008.

Matern Child Health J 2016 11;20(11):2348-2356

Division of Public Health Nutrition, School of Public Health, University of California, Berkeley, 207-B University Hall, Berkeley, CA, 94720, USA.

Objective: Analyze the association between household food security status and diet quality during pregnancy.

Methods: Cross-sectional analysis of pregnant women from the National Health and Nutrition Examination Survey from 1999 to 2008. Of the 1158 pregnant women with complete household food security information, we analyzed 688 women who had complete dietary information and household incomes ≤300 % of the Federal Poverty Level (FPL). Diet quality was measured by the Alternate Healthy Eating Index modified for Pregnancy (AHEI-P) from 1 to 2 24 h dietary recalls. Multivariate linear and logistic regression models were implemented to assess the association between household food security status and AHEI-P, adjusting for age, nativity, marital status, race/ethnicity, education, and household income.

Results: Among women with household incomes ≤300 % of the FPL, 19 % were food insecure and 4 % were marginally food secure. The mean AHEI-P score was 41.9 (95 % CI 40.4, 43.3). Household food insecurity was not associated with overall diet quality. However, living in a food insecure household compared to a food secure household was associated with a 2.3 (1.3, 4.1) greater odds of having a calcium component score greater than the median intake of calcium scores among food secure women in the sample.

Conclusions For Practice: In a nationally representative sample of pregnant women, 80 % lived in a fully food secure household. Improving household food security during pregnancy is a public health opportunity to improve health outcomes; however household food security status may not be associated with overall diet quality.
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http://dx.doi.org/10.1007/s10995-016-2058-1DOI Listing
November 2016

Adolescent Pregnancies in the United States: How Obstetric and Sociodemographic Factors Influence Risk of Cesarean Delivery.

Am J Perinatol 2017 01 20;34(2):123-129. Epub 2016 Jun 20.

Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon.

 To determine how an adolescent's risk of cesarean varies by maternal age and race/ethnicity, and evaluate the contribution of obstetric and sociodemographic factors to mode of delivery.  This is a retrospective cohort study of 604,287 births to women aged 13 to 23 years. Regression techniques were used to determine maternal ages at lowest risk of primary cesarean in each major racial/ethnic group before and after adjustment for various cesarean risk factors.  Adolescent age was associated with lower risk of cesarean compared with young adults (17.2% at age 13 years vs 24.8% at age 23 years,  < 0.05). After stratification by race/ethnicity, Non-Hispanic Black women had the highest probability of cesarean, while Asian/Pacific Islanders had the lowest probability across all ages. When compared with young adults of the same race/ethnicity, young adolescents continued to have a lower risk of cesarean, decreased by at least 30% until age 18 years (White) and 17 years (other racial/ethnic groups). These associations persisted after adjustment for obstetric and sociodemographic risk factors.  Young maternal age is protective against cesarean delivery in all racial/ethnic groups. Adolescents also experience racial/ethnic disparities in mode of delivery similar to those observed in adults, which were unexplained by either obstetric or sociodemographic factors.
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http://dx.doi.org/10.1055/s-0036-1584580DOI Listing
January 2017

Female Sterilization and Poor Mental Health: Rates and Relatedness among American Indian and Alaska Native Women.

Womens Health Issues 2016 Mar-Apr;26(2):168-75. Epub 2015 Nov 19.

University of California, Berkeley, School of Public Health, Berkeley, California.

Objective: To describe the reproductive and mental health of American Indian and Alaska Native (AI/AN) women, an understudied population.

Methods: Data from the 2004 Behavioral Risk Factor Surveillance System survey were analyzed to determine the 1) prevalence of female sterilization among a nationally representative sample of reproductive age AI/AN women and 2) the association of female sterilization and poor mental health among AI/AN women compared with non-Hispanic White, non-Hispanic Black, and Hispanic women.

Results: Nearly 25% of AI/AN women reported female sterilization, a prevalence higher than the comparison racial/ethnic groups (p < .005). Adjusting for sociodemographic characteristics, AI/AN women reporting female sterilization had nearly 2.5 times the odds of poor mental health compared with AI/AN women not reporting female sterilization (p = .001). The same magnitude of relationship between female sterilization and poor mental health was not found for non-Hispanic White, non-Hispanic Black, and Hispanic women.

Conclusions: The prevalence of female sterilization is greater among AI/AN women compared with non-Hispanic White, non-Hispanic Black, and Hispanic women, and AI/AN women reporting female sterilization have higher odds of reporting poor mental health. Common cultural experiences, such as a shared ancestral history of forced sterilizations, may be relevant, and could be considered when providing reproductive and mental health services to AI/AN women.
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http://dx.doi.org/10.1016/j.whi.2015.10.002DOI Listing
January 2017

Mexico's Seguro Popular Appears To Have Helped Reduce The Risk Of Preterm Delivery Among Women With Low Education.

Health Aff (Millwood) 2016 Jan;35(1):80-7

Sylvia Guendelman is a professor in the Division of Community Health and Human Development and chair of the Maternal and Child Health Program in the School of Public Health, University of California, Berkeley.

Beginning in 2001 Mexico established Seguro Popular, a health insurance scheme aimed at providing coverage to its large population of uninsured people. While recent studies have evaluated the health benefits of Seguro Popular, evidence on perinatal health outcomes is lacking. We conducted a population-based study using Mexican birth certificate data for 2010 to assess the relationship between enrollment in Seguro Popular and preterm delivery among first-time mothers with singleton births in Mexico. Seguro Popular enrollees with no formal education had a far greater reduction in risk of preterm delivery, while enrollees with any formal education experienced only slight reduction in risk, after maternal age, marital status, education level, mode of delivery, and trimester in which prenatal care was initiated were controlled for. Seguro Popular appears to facilitate access to health services among mothers with low levels of education, reducing their risk for preterm delivery. Providing broad-scale health insurance coverage may help improve perinatal health outcomes in this vulnerable population.
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http://dx.doi.org/10.1377/hlthaff.2015.0594DOI Listing
January 2016

Prevalence and Correlates of HIV Infection among Street Boys in Kisumu, Kenya.

PLoS One 2015 13;10(10):e0140005. Epub 2015 Oct 13.

University of California, Berkeley-University of California at San Francisco Joint Medical Program, UC Berkeley School of Public Health, Berkeley, California, United States of America.

Introduction: Despite their perceived vulnerability to HIV, East African street youth have been neglected in HIV prevention research. We examined HIV seroprevalence and correlates of HIV infection in a sample of male street youth in Kisumu, Kenya.

Methods: We enrolled a street-recruited sample of 13-21 year old street youth. Participants completed a survey followed by voluntary HIV counseling and testing. Survey items included demographics, homelessness history, survival activities, sexual behavior and substance use. We examined the relationship between predictor variables, markers of coercion and marginalization and HIV.

Results: The sample included 296 males. Survival activities included garbage picking (55%), helping market vendors (55%), begging (17%), and working as porters (46%) or domestic workers (4%). Forty-nine percent of participants reported at least weekly use of alcohol and 32% marijuana. Forty-six percent of participants reported lifetime inhalation of glue and 8% fuel. Seventy-nine percent of participants reported lifetime vaginal sex, 6% reported lifetime insertive anal sex and 8% reported lifetime receptive anal sex. Twelve (4.1%; 95% CI: 2.3-7.0) participants tested positive for HIV. Of those, all had been on the street for at least one year and all had engaged in vaginal sex. Occupations placing youth at particular risk of coercion by adults, including helping market vendors (prevalence ratio (PR) = 8.8; 95% CI: 1.2-67.5) and working as domestic workers (PR = 4.6; 95% CI: 1.1-19.0), were associated with HIV infection. Both insertive anal sex (PR = 10.2; 95% CI: 3.6-29.4) and receptive anal sex (PR = 3.9; 95% CI: 1.1-13.4) were associated with HIV infection. Drug use, begging, and garbage picking were not associated with HIV infection.

Conclusions: Although HIV prevalence in our sample of street youth is comparable to that of similarly-aged male youth in Nyanza Province, our findings highlight behavioral factors associated with HIV infection that offer opportunities for targeted prevention among street youth in East Africa.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0140005PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4604137PMC
June 2016

Impact of a private sector living wage intervention on depressive symptoms among apparel workers in the Dominican Republic: a quasi-experimental study.

BMJ Open 2015 Aug 3;5(8):e007336. Epub 2015 Aug 3.

University of California Berkeley School of Public Health, Berkeley, California, USA.

Objectives: Poverty reduction interventions through cash transfers and microcredit have had mixed effects on mental health. In this quasi-experimental study, we evaluate the effect of a living wage intervention on depressive symptoms of apparel factory workers in the Dominican Republic.

Setting: Two apparel factories in the Dominican Republic.

Participants: The final sample consisted of 204 hourly wage workers from the intervention (99) and comparison (105) factories.

Interventions: In 2010, an apparel factory began a living wage intervention including a 350% wage increase and significant workplace improvements. The wage increase was plausibly exogenous because workers were not aware of the living wage when applying for jobs and expected to be paid the usual minimum wage. These individuals were compared with workers at a similar local factory paying minimum wage, 15-16 months postintervention.

Primary Outcome Measures: Workers' depressive symptoms were assessed using the Center for Epidemiologic Studies-Depression Scale (CES-D). Ordinary least squares and Poisson regressions were used to evaluate treatment effect of the intervention, adjusted for covariates.

Results: Intervention factory workers had fewer depressive symptoms than comparison factory workers (unadjusted mean CES-D scores: 10.6 ± 9.3 vs 14.7 ± 11.6, p = 0.007). These results were sustained when controlling for covariates (β = -5.4, 95% CI -8.5 to -2.3, p = 0.001). In adjusted analyses using the standard CES-D clinical cut-off of 16, workers at the intervention factory had a 47% reduced risk of clinically significant levels of depressive symptoms compared with workers at the comparison factory (23% vs 40%).

Conclusions: Policymakers have long grappled with how best to improve mental health among populations in low-income and middle-income countries. We find that providing a living wage and workplace improvements to improve income and well-being in a disadvantaged population is associated with reduced depressive symptoms.
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http://dx.doi.org/10.1136/bmjopen-2014-007336DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4538264PMC
August 2015

High school students' experiences of bullying and victimization and the association with school health center use.

J Sch Health 2015 May;85(5):318-26

School of Social Welfare, University of California, 50 University Hall, #7360 Berkeley, CA 94720-7360.

Background: Bullying and victimization are ongoing concerns in schools. School health centers (SHCs) are well situated to support affected students because they provide crisis intervention, mental health care, and broader interventions to improve school climate. This study examined the association between urban adolescents' experiences of school-based bullying and victimization and their use of SHCs.

Methods: Data was analyzed from 2063 high school students in 5 Northern California school districts using the 2009-2010 California Healthy Kids Survey. Chi-square tests and multivariate logistic regression were used to measure associations.

Results: Students who were bullied or victimized at school had significantly higher odds of using the SHCs compared with students who were not, and were also significantly more likely to report confidentiality concerns. The magnitude of associations was largest for Asian/Pacific Islander students, though this was likely due to greater statistical power. African American students reported victimization experiences at approximately the same rate as their peers, but were significantly less likely to indicate they experienced bullying.

Conclusions: Findings suggest that SHCs may be an important place to address bullying and victimization at school, but confidentiality concerns are barriers that may be more common among bullied and victimized youth.
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http://dx.doi.org/10.1111/josh.12256DOI Listing
May 2015

Bringing patients' social context into the examination room: an investigation of the discussion of social influence during contraceptive counseling.

Womens Health Issues 2015 Jan-Feb;25(1):13-21. Epub 2014 Dec 7.

Department of Family and Community Medicine and Obstetrics, Gynecology and Reproductive Sciences, University of California-San Francisco, San Francisco, California.

Background: Although social networks are an increasingly recognized influence on contraceptive use, little is known about if and how social influences are discussed during women's contraceptive counseling visits.

Methods: We performed a mixed-methods analysis of audio recordings of contraceptive counseling visits. We examined predictors of discussion of social influence arising in a contraceptive counseling visit and analyzed the content and process of social influence discussions.

Results: Social influences were mentioned in 42% of the 342 visits included in the sample, with these discussions most commonly initiated by patients. Younger patients were more likely to have social influence mentioned than older patients. The content of social influence focused on side effects and adverse events, with the sources of influence being predominantly patients' friends and the media, with little input from partners. Providers were more likely to engage around the content of the social influence than the social influence itself.

Conclusion: The frequency with which social influence was mentioned in these visits supports the importance of women's social context on their contraceptive decision making. However, the fact that patients initiated the discussion in the majority of cases suggests that providers may not recognize the relevance of these influences or may not be comfortable engaging with them. Increasing providers' ability to elicit and engage patients about their social context with regard to contraception could enhance providers' ability to understand women's contraceptive preferences and provide appropriate counseling to address their specific concerns or questions.
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http://dx.doi.org/10.1016/j.whi.2014.10.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4275361PMC
November 2015

The association between a living wage and subjective social status and self-rated health: a quasi-experimental study in the Dominican Republic.

Soc Sci Med 2014 Nov 28;121:91-7. Epub 2014 Sep 28.

University of California Berkeley School of Public Health, Berkeley, CA, USA.

Poverty, both absolute and relative, is associated with poorer health. This is of particular concern in middle- and low-income countries facing a significant and growing burden of disease. There has been limited research specifically on whether interventions that increase income may foster better health outcomes. The establishment of a "living wage" apparel factory in the Dominican Republic provided a minimum income standard for factory workers, thus creating a natural experiment through which to study the effects of increased income on health indicators. The primary component of the intervention was a 350% wage increase, but apparel workers in the intervention factory also received education and professional development and were exposed to an enhanced occupational health and safety program. Workers at the intervention factory (n = 99) were compared with workers at a matched apparel factory (n = 105). Data were collected via in-person interviews in July and August of 2011, which was 15-16 months after workers were initially hired at the intervention site. Primary analyses used employment at the intervention factory as the independent variable and examined associations with two dependent variables: subjective social status and self-rated health. Results showed that receiving a 350% higher wage was associated with substantially higher subjective social status scores, as well as higher global and comparative self-rated health scores; effects were strongest in women. Subjective social status and self-rated health are associated with future health outcomes, so these results indicate that income increases for apparel workers may have positive long-term health outcomes, particularly for women.
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http://dx.doi.org/10.1016/j.socscimed.2014.09.051DOI Listing
November 2014

Acculturation, inner peace, cancer self-efficacy, and self-rated health among Latina breast cancer survivors.

J Health Care Poor Underserved 2014 Nov;25(4):1586-602

Cancer self-efficacy (CSE) and spiritual well-being (SWB) have been associated with better self-rated health (SRH) among breast cancer survivors (BCS), but have not been well studied among Latina BCS (LBCS). Multivariate logistic regression analyses of secondary data from a cross-sectional population-based telephone survey of 330 LBCS explored relationships of language acculturation, CSE, and SWB subdomains of inner peace and faith with SRH. English proficiency was associated with SRH, independent of other covariates (OR=2.26, 95% CI 1.15, 4.45). Cancer self-efficacy attenuated this effect and was positively associated with SRH (OR=2.24, 95% CI 1.22, 4.10). Adding inner peace (a SWB subscale) attenuated the association of CSE and SRH (OR=1.67, 95% CI 0.88, 3.18). Inner peace remained associated with SRH (OR= 2.44, 95% CI 1.30, 4.56), controlling for covariates. Findings support the importance of a sense of inner peace and control over breast cancer to LBCS’ perceived health.
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http://dx.doi.org/10.1353/hpu.2014.0158DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4348407PMC
November 2014

Delays in time to surgery for minorities with temporal lobe epilepsy.

Epilepsia 2014 Sep 9;55(9):1339-46. Epub 2014 Jul 9.

School of Public Health, University of California Berkeley, Berkeley, California, U.S.A; Stanford University School of Medicine, Stanford, California, U.S.A.

Objectives: To determine whether adult minority patients with medically refractory temporal lobe epilepsy (TLE) experience significantly longer times to anterior temporal lobectomy (ATL) following presurgical evaluation.

Methods: A retrospective cohort study of 223 adult patients with epilepsy (PWE) and unilateral mesial temporal sclerosis who completed presurgical evaluation in the epilepsy monitoring unit at University of California, San Francisco, between January 1, 1993 and December 31, 2010, with follow-up through December 31, 2012. Log-rank test was performed for Kaplan-Meier survival curves of time to ATL stratified by race/ethnicity and by limited English proficiency (LEP). Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards and Weibull modeling.

Results: African Americans (AAs) and Asian/Pacific Islanders (Asian/PIs) experienced significantly longer times to surgery than whites in Kaplan-Meier plots (log-rank test p = 0.02 and p = 0.005, respectively). AAs and Asian/PIs also had longer times to surgery after adjusting for frailty, LEP, sex, age, mesial temporal sclerosis (MTS) laterality, and nonconcordant ictal electroencephalography (EEG) (adjusted HR = 0.22, p = 0.006; adjusted HR = 0.25, p = 0.003, respectively). Patients with LEP experienced significantly longer times to surgery than patients proficient in English (log-rank test p = 0.0085; adjusted HR = 0.48, p = 0.041). In Cox modeling, nonconcordant ictal EEG studies (adjusted HR = 0.47, p = 0.01), left-sided MTS (adjusted HR = 0.69, p = 0.023), and female sex (adjusted HR = 0.72, p = 0.048) were risk factors for longer times to surgery.

Significance: AA and Asian/PI patients as well as those with LEP have significantly longer times to ATL following presurgical evaluation. Future studies should be aimed at identifying the source of these disparities and developing targeted interventions to address them. A PowerPoint slide summarizing this article is available for download in the Supporting Information section here.
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http://dx.doi.org/10.1111/epi.12700DOI Listing
September 2014

Breastfeeding versus formula-feeding and girls' pubertal development.

Matern Child Health J 2015 Mar;19(3):519-27

School of Public Health, University of California, Berkeley, Berkeley, CA, USA,

To examine the association of breastfeeding or its duration with timing of girls' pubertal onset, and the role of BMI as a mediator in these associations. A population of 1,237 socio-economically and ethnically diverse girls, ages 6-8 years, was recruited across three geographic locations (New York City, Cincinnati, and the San Francisco Bay Area) in a prospective study of predictors of pubertal maturation. Breastfeeding practices were assessed using self-administered questionnaire/interview with the primary caregiver. Girls were seen on at least annual basis to assess breast and pubic hair development. The association of breastfeeding with pubertal timing was estimated using parametric survival analysis while adjusting for body mass index, ethnicity, birth-weight, mother's education, mother's menarcheal age, and family income. Compared to formula fed girls, those who were mixed-fed or predominantly breastfed showed later onset of breast development [hazard ratios 0.90 (95 % CI 0.75, 1.09) and 0.74 (95 % CI 0.59, 0.94), respectively]. Duration of breastfeeding was also directly associated with age at onset of breast development (p trend = 0.008). Associations between breastfeeding and pubic hair onset were not significant. In stratified analysis, the association of breastfeeding and later breast onset was seen in Cincinnati girls only. The association between breast feeding and pubertal onset varied by study site. More research is needed about the environments within which breastfeeding takes place in order to better understand whether infant feeding practices are a potentially modifiable risk factor that may influence age at onset of breast development and subsequent risk for disease in adulthood.
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http://dx.doi.org/10.1007/s10995-014-1533-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4263683PMC
March 2015

Variation in adherence to the treatment guidelines for Neisseria gonorrhoeae by clinical practice setting, California, 2009 to 2011.

Sex Transm Dis 2014 May;41(5):338-44

From the *School of Public Health, University of California, Berkeley, CA; †Sexually Transmitted Disease Control Branch, California Department of Public Health, Richmond, CA; and ‡Sexually Transmitted Disease, Prevention and Control Services, San Francisco Department of Public Health, San Francisco, CA.

Background: Declining susceptibility of Neisseria gonorrhoeae to available antimicrobial agents has prompted repeated updates of the Centers for Disease Control and Prevention (CDC) treatment guidelines. The only regimen currently recommended as first-line treatment is dual therapy consisting of an intramuscular dose of ceftriaxone together with azithromycin or doxycycline. The objective of this analysis is to identify how adherence to the CDC guidelines varies by clinical practice setting.

Methods: A geographically representative random sample of N. gonorrhoeae cases reported from 2009 to 2011 was analyzed. Weighted generalized linear models were fit to calculate cumulative incidence ratios for receipt of non-recommended treatment regimen in relation to clinical practice setting, adjusted for age, race, and whether or not the participant was a man who has sex with men.

Results: Data from 3178 participants were available for analysis. Overall, 14.9% (weighted) of participants received non-recommended treatment. Among participants with gonorrhea identified by surveillance data as having received non-recommended treatment, the largest proportions were treated at private physicians' offices or health maintenance organizations (34.7% of participants receiving non-recommended treatment), family planning facilities (22.3%), and emergency departments/urgent care centers (12.8%).

Conclusions: Barriers to adherence to the CDC treatment guidelines for gonorrhea seem to be experienced in a variety of clinical practice settings. Despite only moderate rates of nonadherence, interventions targeting private physicians/health maintenance organizations and family planning facilities may produce the largest absolute reductions in guideline-discordant treatment.
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http://dx.doi.org/10.1097/OLQ.0000000000000113DOI Listing
May 2014

Type of primary education is associated with condom use at sexual debut among Chilean adolescents.

Sex Transm Dis 2014 May;41(5):306-11

From the *Department of Obstetrics and Gynecology, Clínica Alemana de Santiago, Universidad del Desarrollo, Chile; †Maternal Child Health Program, School of Public Health, University of California, Berkeley; and ‡Division of Biostatistics, School of Public Health, University of California, Berkeley.

Background: Although condom use in adolescence is related to higher lifetime educational attainment, the association between primary education (from kindergarten to eighth grade) and adolescent sexual behavior is not well understood. This study examined the association between type of school in which primary education was completed-public, charter, or private-and condom use at sexual debut among Chilean adolescents.

Methods: Drawing on the 2009 Chilean National Youth Survey, a population-based sample of general community youth aged 15 to 29 years, we conducted a study of the 4217 participants who reported onset of sexual activity during adolescence. Bivariate and multple logistic regression was used to examine the relationship between type of primary school attended (60.1% public, 30.3% charter, and 9.6% private) and condom use at sexual debut while controlling for sociodemographic characteristics and sexual behavior.

Results: Compared with students who completed their primary education in private or charter schools, students who completed their primary education in public schools had 1.85 (95% confidence interval, 1.12-3.04) and 1.67 (95% confidence interval, 1.26-2.23) higher odds, respectively, of not using condoms at sexual debut. Odds were similar for students living in urban settings, whereas there were too few students attending private schools in rural areas to allow meaningful estimates.

Conclusions: Independent of household income, primary schooling is associated with sexual health behaviors among Chilean adolescents living in urban areas and can serve as a target for public health interventions designed to prevent sexually transmitted infections in adolescence.
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http://dx.doi.org/10.1097/OLQ.0000000000000122DOI Listing
May 2014

High Expectations Across Multiple Domains, Peer Norms, and Physical Dating Violence Among California Adolescents.

J Interpers Violence 2014 Jul 10;29(11):2035-2053. Epub 2014 Feb 10.

University of California, Berkeley, USA.

The purpose of this study is, first, to assess whether high expectation messages (from school, home, and community), and peer norms, were associated with physical dating violence victimization (PDV) among a representative sample of California middle and high school students, and second, to assess whether these associations differed by gender and grade level and/or were mediated by self-efficacy. Data from 7th-, 9th-, and 11th-grade respondents of the 2008-2010 California Healthy Kids Survey (CHKS) were analyzed (N = 85,198). CHKS is an anonymous, school-based cross-sectional survey. Logistic regression was used to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for expectations in each domain (school, community, and home), peers norms, and their cumulative effects on physical dating violence victimization. We examined interactions for expectations and for peer norms by gender and grade level, and tested the mediation effect of self-efficacy. Ten percent of students reported experiencing physical dating violence victimization in the past year. Students who reported high overall expectations (in multiple domains) had significantly lower odds of experiencing dating violence (OR = 0.24, CI = [0.20, 0.28]) compared with those who reported very low expectations. This association held across all expectation domains and peer norms when tested in separate models and also when tested together in a single model. High expectations in the home domain and peer norms showed the lowest odds. Associations between high expectations and dating violence were similar across gender and grade levels. Self-efficacy partially mediated the associations between high expectations and dating violence. Suggestions for future research are presented.
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http://dx.doi.org/10.1177/0886260513516007DOI Listing
July 2014

Association between phthalates and attention deficit disorder and learning disability in U.S. children, 6-15 years.

Environ Res 2014 Jan 19;128:64-9. Epub 2013 Nov 19.

Center for Environmental Research and Children's Health (CERCH), School of Public Health, University of California Berkeley, Berkeley, CA 94720, USA. Electronic address:

Objective: This study investigates the association between urinary phthalate metabolite levels and attention deficit disorder (ADD), learning disability (LD), and co-occurrence of ADD and LD in 6-15-year-old children.

Methods: We used cross-sectional data from the National Health and Nutrition Examination Survey (NHANES, 2001-2004). Phthalate metabolites with ≥75% detection in urine samples were examined. The study population comprised 1493 children with parent-reported information on ADD or LD diagnosis and phthalate concentrations in urine. Phthalate concentrations were creatinine-adjusted and log10-transformed for analysis. All models controlled for child sex, age, race, household income, blood lead, and maternal smoking during pregnancy.

Results: There were 112 ADD cases, 173 LD cases, and 56 ADD and LD cases in the sample. After adjusting for potential confounders, we found increased odds of ADD with increasing urinary concentration of di-2-ethylhexyl phthalates (OR: 2.1; 95% CI: 1.1, 3.9) and high molecular weight phthalates (OR: 2.7; 95% CI: 1.2, 6.1). In addition, dibutyl phthalates (OR: 3.3; 95% CI: 0.9, 12.7) and high molecular weight phthalates (OR: 3.7; 95% CI: 0.9, 14.8) were marginally associated with increased odds of co-occurring ADD and LD. We did not find associations for any phthalate and LD alone. We observed stronger associations between phthalates and ADD and both ADD and LD in girls than boys in some models.

Conclusions: We found cross-sectional evidence that certain phthalates are associated with increased odds of ADD and both ADD and LD. Further investigations with longitudinal data are needed to confirm these results.
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http://dx.doi.org/10.1016/j.envres.2013.10.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3889659PMC
January 2014

Solid fuel use for household cooking: country and regional estimates for 1980-2010.

Environ Health Perspect 2013 Jul 3;121(7):784-90. Epub 2013 May 3.

Department of Public Health and Environment, World Health Organization, Geneva, Switzerland.

Background: Exposure to household air pollution from cooking with solid fuels in simple stoves is a major health risk. Modeling reliable estimates of solid fuel use is needed for monitoring trends and informing policy.

Objectives: In order to revise the disease burden attributed to household air pollution for the Global Burden of Disease 2010 project and for international reporting purposes, we estimated annual trends in the world population using solid fuels.

Methods: We developed a multilevel model based on national survey data on primary cooking fuel.

Results: The proportion of households relying mainly on solid fuels for cooking has decreased from 62% (95% CI: 58, 66%) to 41% (95% CI: 37, 44%) between 1980 and 2010. Yet because of population growth, the actual number of persons exposed has remained stable at around 2.8 billion during three decades. Solid fuel use is most prevalent in Africa and Southeast Asia where > 60% of households cook with solid fuels. In other regions, primary solid fuel use ranges from 46% in the Western Pacific, to 35% in the Eastern Mediterranean and < 20% in the Americas and Europe.

Conclusion: Multilevel modeling is a suitable technique for deriving reliable solid-fuel use estimates. Worldwide, the proportion of households cooking mainly with solid fuels is decreasing. The absolute number of persons using solid fuels, however, has remained steady globally and is increasing in some regions. Surveys require enhancement to better capture the health implications of new technologies and multiple fuel use.
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http://dx.doi.org/10.1289/ehp.1205987DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3701999PMC
July 2013

Work-family balance after childbirth: the association between employer-offered leave characteristics and maternity leave duration.

Matern Child Health J 2014 Jan;18(1):200-208

Division of Biostatistics, School of Public Health, University of California, Berkeley, CA, USA.

Early return to work after childbirth has been increasing among working mothers in the US. We assessed the relationship between access to employer-offered maternity leave (EOML) (both paid and unpaid) and uptake and duration of maternity leave following childbirth in a socio-economically diverse sample of full-time working women. We focus on California, a state that has long provided more generous maternity leave benefits than those offered by federal maternity leave policies through the State Disability Insurance program. The sample included 691 mothers who gave birth in Southern California in 2002-2003. Using weighted logistic regression, we examined the EOML-maternity leave duration relationship, controlling for whether the leave was paid, as well as other occupational, personality and health-related covariates. Compared with mothers who were offered more than 12 weeks of maternity leave, mothers with <6 weeks of EOML and those offered 6-12 weeks had five times higher odds of returning to work within 12 weeks; those offered no leave had six times higher odds of an early return. These relationships were similar after controlling for whether the leave was paid and after controlling for other occupational and health characteristics. Access to and duration of employer-offered maternity leave significantly determine timing of return to work following childbirth, potentially affecting work-family balance. Policy makers should recognize the pivotal role of employers in offering job security during and after maternity leave and consider widening the eligibility criteria of the Family and Medical Leave Act.
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http://dx.doi.org/10.1007/s10995-013-1255-4DOI Listing
January 2014

Undocumented immigration status and diabetes care among Mexican immigrants in two immigration "sanctuary" areas.

J Immigr Minor Health 2014 Apr;16(2):229-38

UC Berkeley-UCSF Joint Medical Program, Berkeley, CA, USA.

The objective of this study is to investigate the relationship between immigration status and the patient experience of health care, diabetes self-management, and clinical outcomes among Mexican immigrants with diabetes receiving health care in two immigration sanctuary cities. We used data from the Immigration, Culture and Health Care study, a cross-sectional survey and medical record study of low-income patients with diabetes recruited from public hospitals and community clinics in the San Francisco Bay Area and Chicago. Undocumented Mexican, documented Mexican immigrants, and US-born Mexican-Americans' health care experiences, diabetes self-management, and clinical outcomes were compared using multivariate linear and logistic regressions. We found no significant differences in reports of physician communication, or in measures of diabetes management between undocumented and documented immigrants. All three groups had similar clinical outcomes in glycemic, systolic blood pressure, and lipid control. These results indicate that, at least in some settings, undocumented Mexican immigrants with diabetes can achieve similar clinical outcomes and report similar health care experiences as documented immigrants and US-born Mexican-Americans.
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http://dx.doi.org/10.1007/s10903-012-9741-0DOI Listing
April 2014

Maternal pre-pregnancy BMI, gestational weight gain, and age at menarche in daughters.

Matern Child Health J 2013 Oct;17(8):1391-8

Division of Community Health and Human Development, University of California, Berkeley, CA, USA.

Life course theory suggests that early life experiences can shape health over a lifetime and across generations. Associations between maternal pregnancy experience and daughters' age at menarche are not well understood. We examined whether maternal pre-pregnancy BMI and gestational weight gain (GWG) were independently related to daughters' age at menarche. Consistent with a life course perspective, we also examined whether maternal GWG, birth weight, and prepubertal BMI mediated the relationship between pre-pregnancy BMI and daughter's menarcheal age. We examined 2,497 mother-daughter pairs from the 1979 National Longitudinal Survey of Youth. Survival analysis with Cox proportional hazards was used to estimate whether maternal pre-pregnancy overweight/obesity (BMI ≥ 25.0 kg/m(2)) and GWG adequacy (inadequate, recommended, and excessive) were associated with risk for earlier menarche among girls, controlling for important covariates. Analyses were conducted to examine the mediating roles of GWG adequacy, child birth weight and prepubertal BMI. Adjusting for covariates, pre-pregnancy overweight/obesity (HR = 1.20, 95 % CI 1.06, 1.36) and excess GWG (HR = 1.13, 95 % CI 1.01, 1.27) were associated with daughters' earlier menarche, while inadequate GWG was not. The association between maternal pre-pregnancy weight and daughters' menarcheal timing was not mediated by daughter's birth weight, prepubertal BMI or maternal GWG. Maternal factors, before and during pregnancy, are potentially important determinants of daughters' menarcheal timing and are amenable to intervention. Further research is needed to better understand pathways through which these factors operate.
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http://dx.doi.org/10.1007/s10995-012-1139-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3582726PMC
October 2013

Contraceptive features preferred by women at high risk of unintended pregnancy.

Perspect Sex Reprod Health 2012 Sep 19;44(3):194-200. Epub 2012 Jul 19.

Department of Community Health Sciences, School of Public Health, University of California, Los Angeles, CA, USA.

Context: Available contraceptives are not meeting many women's needs, as is evident by high levels of typical-use failure, method switching and discontinuation. To improve women's satisfaction with contraceptive methods, determining what features they prefer and how these preferences are satisfied by available methods and methods under development is crucial.

Methods: The importance of 18 contraceptive method features was rated by 574 women seeking abortions--a group at high risk of having unprotected intercourse and unintended pregnancies--at six clinics across the United States in 2010. For each available and potential method, the number of features present was assessed, and the percentage of these that were "extremely important" to women was calculated.

Results: The three contraceptive features deemed extremely important by the largest proportions of women were effectiveness (84%), lack of side effects (78%) and affordability (76%). For 91% of women, no method had all of the features they thought were extremely important. The ring and the sponge had the highest percentage of features that women deemed extremely important (67% each). Some streamlined modes of access and new contraceptive technologies have the potential to satisfy women's preferences. For example, an over-the-counter pill would have 71% of extremely important features, and an over-the-counter pericoital pill, 68%; currently available prescription pills have 60%.

Conclusion: The contraceptive features women want are largely absent from currently available methods. Developing and promoting methods that are more aligned with women's preferences presumably could help increase satisfaction and thereby encourage consistent and effective use.
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http://dx.doi.org/10.1363/4419412DOI Listing
September 2012

Aspects of culturally competent care are associated with less emotional burden among patients with diabetes.

Med Care 2012 Sep;50(9 Suppl 2):S69-73

Joint Medical Program, University of California, San Francisco & Berkeley, CA 94143, USA.

Background: Diabetes distress is associated with poor diabetes self-management and worse clinical outcomes. Whether there is an association between patient experience of health care and degree of emotional burden (EB) of diabetes distress is not known.

Objective: To investigate whether aspects of culturally competent care are associated with the EB of diabetes distress.

Design: Cross-sectional survey consisting of face-to-face interviews.

Subjects: A total of 502 ethnically diverse patients with diabetes receiving care in safety-net clinics in 2 cities.

Measures: The main outcome measure was high EB on the Diabetes Distress Scale (mean score ≥ 3). The predictors were 3 domains (Doctor Communication--Positive Behaviors, Trust, and Doctor Communication-Health Promotion) of the Consumer Assessment of Healthcare Providers and Systems--Cultural Competence (Consumer Assessments of Healthcare Providers and Systems' Cultural Competence Item Set) instrument.

Results: Of 502 patients, 263 (52%) reported high EB. In adjusted logistic regressions controlling for sociodemographic and clinical factors, patient report of optimal Doctor Communication-Positive Behaviors (adjusted odds ratio, 0.46; 95% confidence interval, 0.39-0.54), and optimal Trust (adjusted odds ratio, 0.65; 95% confidence interval, 0.54-0.78) were associated with lower EB. Doctor Communication-Health Promotion Communication was not associated with EB.

Discussion: Patient report of better doctor communication behavior and higher trust in physician are inversely associated with high EB among patients with diabetes. Further research should determine whether interventions improving patient physician communication and trust can lower the EB of diabetes.
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http://dx.doi.org/10.1097/MLR.0b013e3182641127DOI Listing
September 2012

Civil unrest and birthweight: an exploratory analysis of the 2007/2008 Kenyan Crisis.

Soc Sci Med 2012 May 23;74(9):1324-30. Epub 2012 Feb 23.

Maternal and Child Health, School of Public Health, University of California Berkeley, USA.

For decades, Africa has been plagued by political and ethnic conflict, the health ramifications of which are often not investigated. A crisis occurred recently in Kenya following the 2007 presidential election. Ethnic violence ensued, targeting the incumbent President Kibaki's Kikuyu people. The violence occurred primarily in Nairobi and the Rift Valley of Kenya. We sought to examine the association between exposure to the 2007/2008 Kenyan Crisis and birthweight. Using the 2008/2009 Kenyan Demographic and Health Survey (KDHS), we compared birthweights of infants in utero or not yet conceived during the 15 months after the political turmoil following the 2007 presidential election (exposed) to those who were born before the crisis (unexposed). There were 663 "exposed" and 687 "unexposed" infants. Multivariate regression was used. We examined the possibility of two-way and three-way interactions between exposure status, ethnicity (Kikuyu versus non-Kikuyu), and region (violent region versus not). Overall, exposure to the Kenyan Crisis was associated with lower birthweight. Kikuyu women living in a violent region who were exposed during their 2nd trimester had the greatest difference in birthweight in comparison to all unexposed infants: 564.4g lower (95% CI 285.1, 843.6). Infants of Kikuyu exposed during the 2nd trimester and living in a violent region weighed 603.6g less (95% CI 333.6, 873.6) than Kikuyu infants born during the unexposed period. Political unrest may have implications for the birthweight of infants, particularly among targeted populations. Given the adverse sequelae associated with lowered birthweight, these results suggest that particular attention should be paid to pregnant women and targeted ethnic groups following such events.
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http://dx.doi.org/10.1016/j.socscimed.2012.01.019DOI Listing
May 2012