Introduction: Country-level evidence from Africa on the prevalence of tobacco use and the role played by both demographic and socioeconomic factors, as influences on the use of tobacco products, is sparse. This paper analyzes the determinants of tobacco use in Ghana and explores the association between tobacco use and poverty in the country. Methods: Data from the 2008 Ghana Demographic and Health Survey, a nationally representative survey of households (n = 12,323), were used to generate descriptive statistics and characterize tobacco use in the country. A logistic regression model was used to evaluate the relationships between tobacco use and age, place of residence, region, education status, wealth, marital status, alcohol use, and whether the person has children. Unadjusted and adjusted odds ratios were calculated for tobacco users and nonusers on the likelihood of their purchase of selected commodities indicative of living standards. Results: Tobacco use was significantly higher among those living in poverty stricken regions, those with less education, lower levels of wealth, parents, and alcohol users. Tobacco use was significantly higher among men (7%) than women (0.4%), and it increased to a peak age of 41.4 years before it declined. Using tobacco was also associated with a lower likelihood of purchasing health insurance. Discussion: Tobacco use is inextricably related to poverty in Ghana. Policies should be formulated to target populations and regions with higher tobacco prevalence to combat both poverty and tobacco use simultaneously.

Objective To examine why the Framework Convention on Tobacco Control did not include an explicit trade provision and delineate the central arguments in the debate over trade provision during the negotiations. Methods Triangulate interviews with participants in the FCTC negotiations, the FCTC negotiations documents, and tobacco industry documents. Results An explicit FCTC trade provision on relation between international trade and public health became a contentious issue during the negotiations. As a result, two conflicting positions, health-over-trade and opposition to health-over-trade emerged. Opposition to explicit trade language giving health priority was by both tobacco industry and countries that generally supported strong FCTC provisions because of concerns over 'disguised protectionism' and setting a precedent whereby governments could forfeit their obligations under pre-existing treaties. Owing to lack of consensus among political actors involved in the negotiations, a compromise position eliminating any mention of trade emerged, which was predicated on belief among some in the public health community that public health would prevail in future trade versus health conflicts. Conclusion The absence of an explicit FCTC trade provision was due to a political compromise rather than the impact of international trade agreements and decisions on public health and lack of consensus among health advocates. This failure to include an explicit trade provision in the FCTC suggests that the public health community should become more involved in trade and health issues at all levels of governance and press the FCTC Conference of the Parties for clarification of this critical issue.

Purpose: We sought to identify unique barriers and facilitators to breast cancer screening participation among women aged 40 and older from Mississippi who were categorized as current, overdue, and never screeners. Methods: Cross-sectional data from a 2003 population-based survey with 987 women aged 40 and older were analyzed. Chi-square analysis and multinomial logistic regression examined how factors organized under the guidance of the Model of Health Services Utilization were associated with mammography screening status. Results: Nearly one in four women was overdue or had never had a mammogram. Enabling factors, including poor access to care (no annual checkups, no health insurance) and to health information, lack of social support for screening, and competing needs, were significantly associated with being both overdue and never screeners. Pertaining to factors unique to each screening group, women were more likely to be overdue when they had no usual source of health care and believed that treatment was worse than the disease. In turn, women were more likely to be never screeners when they were African American, lacked a provider recommendation for screening, and held the fatalistic view that not much could be done to prevent breast cancer. Conclusion: Similar and unique factors impact utilization of mammography screening services among women. Those factors could inform efforts to increase screening rates.

Objectives. To examine the differences in adolescent birth rates by deprivation and Health Professional Shortage Areas (HPSAs) in rural and urban counties of the United States in 2017 and 2018. Methods. We analyzed available data on birth rates for females aged 15 to 19 years in the United States using the restricted-use natality files from the National Center for Health Statistics, American Community Survey 5-year population estimates, and the Area Health Resources Files. Results. Rural counties had an additional 7.8 births per 1000 females aged 15 to 19 years (b = 7.84; 95% confidence interval [CI] = 7.13, 8.55) compared with urban counties. Counties with the highest deprivation had an additional 23.1 births per 1000 females aged 15 to 19 years (b = 23.12; 95% CI = 22.30, 23.93), compared with less deprived counties. Rural counties with whole shortage designation had an additional 8.3 births per 1000 females aged 15 to 19 years (b = 8.27; 95% CI = 6.86, 9.67) compared with their urban counterparts. Conclusions. Rural communities across deprivation and HPSA categories showed disproportionately high adolescent birth rates. Future research should examine the extent to which contraceptive access differs among deprived and HPSA-designated rural communities and the impact of policies that may create barriers for rural communities.

Introduction. This paper deals with the impact of contextual features, such as sex, age, mother tongue, health status, health literacy, Internet use experience, and frequency of health information seeking on health information searching. Method. An interactive information retrieval approach was used to study users' searching behaviour. An online survey and experiment using simulated situation technique were used as data collection methods. The online survey gathered data about user features, such as sex, age, mother tongue, health status, health literacy, Internet use experience, and health information seeking. An experiment was then carried out using four simulated tasks to collect information about health information searching. Analysis. The multiple linear regression analysis method was used to identify contextual factors affecting query length and number of queries. In addition, binary logistic regression analysis method was used to identify contextual factors affecting result clicking. Results. Frequent health information seeking leads to more queries and long query length, and English as a mother tongue and being healthy contribute to long query length. Queries with spelling errors and those formulated outside task descriptions are found to be ineffective. Conclusion. Contextual features such as frequency of health information seeking, mother tongue, and health status influence query formulation. In addition, spelling errors and source of query affect the effectiveness of queries. The findings could be useful for health information retrieval systems to learn and predict users’ information needs to aid effective retrieval.

No description available.

Background: The use of long-acting reversible contraceptive (LARC) methods, such as intrauterine devices (IUDs) and implants has demonstrated high effectiveness in preventing pregnancy. While LARC use in Title X programs has increased over the past decade, little is know about the extent to which gains are occurring uniformly across states. Methods: We examined state-level changes in LARC use among Title X clients between 2012 and 2016 using a repeated cross-sectional study design. States were characterized by the proportion of reproductive age women in need of publicly funded contraception. Variation in LARC use by level of need was examined using GEE models. Results: Across all states, LARC use in Title X clinics increased from 9.1% to 16.2% during the study period. In 2012, LARC use in the states with the highest and lowest level of need differed by 2.3 percentage points (7.8% compared to 10.1%). By 2015 the gap in LARC use between high and low need states widened to reach 5.3 percentage points, more than double what was observed in 2012. However, by 2016 the margin of the gap narrowed. Conclusions: Observed increases in LARC use among states with the highest level of need for publically funded services are much lower than what is observed among states with the lowest level of need. However, we did find this gap is narrowing. This finding is important given states with greater need are those with higher proportions of low-income and younger women who are at greater risk for experiencing unintended pregnancies.

A dissertation submitted in fulfilment of the requirements for the degree Doctor of Philosophy in Community Psychology in the Department of Psychology University of Zululand, 2002. / From the beginning community psychology was concerned with social change, particularly in those systems of society where psychologists were active participants in the process of community empowerment. This study was an on-going attempt of community psychology to give psychology away to the people, especially those who were under-privileged. The study emphasized community participation/involvement in the projects which were formed to assist the poor local communities of Empangeni in the fight against poverty. The specific aims of the study were, among other things, the: * identification and optimization of local expertise within disadvantaged communities visited by co-researchers. * sharing of information and knowledge, through co-researchers, on the prevention of illness and the promotion of health. Participatory action research was used as it allowed all participants (professionals and non-professionals) to have equal partnership in the process of knowledge and information exchange. What emerged from the study was that community development projects could play a significant role in uplifting the standard of living of the poor people. Moreover, ensuring effective community participation was a daunting task which necessitated patience and understanding among all those who were involved. It appeared that if community participation was to contribute towards achieving community empowerment, it should be approached holistically, recognizing the complexity of the community, and at the same time respecting its culture and uniqueness. Communal spirituality and intentionality, as opposed to individualism, were significant in restoring a sense of universality and belongingness to the group. These ideals instilled in each individual member of the group a sense of power, hope and self-reliance which they all needed for the sustainability of the community development projects. / National Research Foundation

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Science in Nursing Johannesburg 2018. / Background Client satisfaction is an increasingly important concept in service delivery, especially in the health sector. Knowing whether clients are satisfied has a multi-faceted effect. Besides being a determinant of quality service and care, satisfaction encourages happy clients to return to the service/company, so that the company retains their clientele, and may attract more. Purpose The purpose of this study was to explore and describe the employees’ level of satisfaction with the occupational health practitioners (OHPs) at one of the occupational health services (OHSs) in the Gert Sibande District in the Mpumalanga Province. Objectives The purpose of this study was to: 1. ascertain the specific demographics of employees presenting at the occupational health service (OHS) 2. ascertain and describe employees’ overall satisfaction with the occupational health practitioner’s (OHP’s) consultation on their visit 3. describe employees’ levels of satisfaction with how they were managed on their visit 4. explore and describe employees’ perceptions regarding the OHS environment 5. describe the level of trust in the relationship between the employee and the OHP. Research design and method This study made use of a quantitative cross-sectional descriptive study design to measure satisfaction experienced by clients entering and using a specific occupational health service. The survey method used was based on the Patient Satisfaction with Occupational Health Physicians tool developed by Verbeek, de Boer, van der Weide et al. (2005). Data analysis Data was captured using the guidelines provided by Verbeek et al. (2005) and was analysed using the Data Analysis and Statistical Software Version 14.1 software (STATA) computer package. Descriptive and inferential statistics were used to analyse the data. Statistical assistance was provided by a biostatistician at the Health Sciences Faculty of the University of the Witwatersrand in Johannesburg. Data were presented in tables and figures. Categorical data was presented using frequencies (number of occurrences) and percentages. Main findings Participants surveyed had a mean age of 33.87, with the majority being male, while the highest education attained was at the secondary level. Although 43.4% of participants had never used the service before, the arithmetic mean of the overall satisfaction rating with the OHP service was found to be 9.06 out of 10, implying that both new and returning participants experienced a high level of satisfaction. Most subscales showed an overall mean rating of more than 4, again implying that participants were satisfied with the services rendered. Conclusion Literature reveals that limited research has been done on South African employees’ levels of satisfaction with occupational health practitioners (OHPs). For this reason the researcher decided to ascertain and describe employees’ overall level of satisfaction with OHPs, finding a high level of satisfaction amongst the participants in this study. Ultimately, employees’ satisfaction is a strong indicator of quality of care, and employees should be able to voice their opinions on the quality of care received. Recommendations The occupational health nurse practitioner (OHNP) should be encouraged to participate in research- and evidence-based practice, as well as to formulate satisfaction surveys related to the specific workplace based on the workers’ needs, in order to identify strengths and weaknesses in the service provided. Further studies should be conducted on OHP services in South Africa. These studies can take place in different industries and provinces to ascertain if the results obtained herein are generally prevalent or will be contradicted. Furthermore, alternate methods of data collection such as qualitative one-on-one interviews should be used to yield more in-depth information on the satisfaction of employees with OHSs. Keywords Employee, Occupational Health Practitioner, Satisfaction, Occupational Health Service, Survey / LG2018

Background: Unintended pregnancies remain an important public health issue. Modern contraception is an important clinical service for reducing unintended pregnancy. This study examines contraception use among a representative sample of women residing in two southeastern U.S. states. Methods: A cross-sectional statewide survey assessing women's contraceptive use and reproductive health experiences was conducted in Alabama and South Carolina. Characteristics of the study population were compared across contraceptive use categories and multivariable regression analysis was performed examining relationships between covariates of interest and contraceptive use outcomes. Results: Approximately 3,775 women were included in the study population. Overall, 26.5% of women reported not using any contraception. Short-acting hormonal methods were the most commonly reported (26.3%), followed by permanent methods (24.4%), long-acting reversible contraception (LARC; 14.3%), and barrier/other methods (8.5%). Nonuse was more prevalent among women with some college or an associate's degree, incomes between $25,000 and $50,000, no health insurance, and longer gaps in care. LARC use among women with Medicaid as a pay source was higher than use among privately insured women and higher in South Carolina than Alabama. Both nonuse and LARC use were higher among women with no insurance. Conclusions: Study findings are largely consistent with previous research using similar population-based surveys. LARC use was higher among the study population relative to what is observed nationally. Factors enabling access to contraceptive services, particularly for lower income women, were associated with contraception use patterns. These findings provide important context for understanding individuals’ access to resources and are important for fostering increased access to contraceptive services among women in these two states.