<p> Excessive alcohol consumption (EAC) is an important public health problem. Several researchers have examined work-related influences on EAC, but few have investigated the predictors of EAC related to business travel. This study measured the association between EAC and frequency of business travel, duration of business travel, and job industry among U.S. business travelers. Research was conducted within the social-ecological theoretical framework. Snowball sampling was used to gather data from 187 business travelers. Data were evaluated using bivariate analysis to assess the association between measures of EAC and each independent variable. Multiple logistic regression was used to adjust for covariates. Respondents aged 45-54 and 55 and older had significantly lower odds of binge drinking than those aged 18-34, <i> OR</i> = 0.33, 95% CI [.11, .98], <i>p</i> &lt; .05; and <i> OR</i> = .13, 95% <i>CI</i> [.03, .55], <i>p</i> &lt; .01, respectively. Females aged 55 and older and all females who traveled frequently in the previous month had lower odds of binge drinking compared to females 18-34 and infrequent female travelers (<i>OR</i> = .03, 95% <i>CI</i> [.00, .37], <i>p</i> &lt; .01; <i> OR</i> = .34, 95% <i>CI</i> [.12, .99], <i>p</i> &lt; .05, respectively). Both males (compared to females) and Protestants (compared to Catholics) had lower odds of heavy drinking (<i>OR</i> = .34, <i>CI</i> [.14,.84], P &lt; .05; <i>OR</i> = .301, <i> CI</i> [.09,.99], P &lt; .05, respectively). Results highlight the prevalence of EAC among business travelers, particularly among females. Multilevel interventions are proposed, which may reduce health-related disparities associated with EAC among this population of business travelers.</p>

<p> Low immunization in Nigeria is associated with high prevalence of childhood diseases. The purpose of this qualitative phenomenological study was to describe caregivers&rsquo; perceptions of routine immunization of their children ages 24 to 36 months. Caregivers&rsquo; attitudes, cultural beliefs, and knowledge regarding immunization were examined. The health belief model was used to guide study. Interviews were conducted with 5 caregivers of fully immunized and 5 caregivers of partially and nonimmunized children. Digital recordings were analyzed using NVivo 10 to identify themes and subthemes. Attitudes of caregivers with fully immunized children included both perceived barriers (distance to health center, lack of information) and perceived benefits (vaccine safety and effectiveness), whereas caregivers with incomplete vaccinations reported multiple transportation-related barriers. Cultural beliefs were limited to religious beliefs and emerged as a theme among both caregiver groups, where full vaccination associated with Christian beliefs and lack of vaccination with belief in traditional healers. Caregivers&rsquo; knowledge associated with full vaccination included cues to action (information from nurses and reminders by others) and self-efficacy (kept vaccination cards ready and prepared for vaccination day), and incomplete vaccination associated with lack of reminders and preparation. Perceived severity, susceptibility, and benefits were associated with full vaccination status, while lack of perceived severity, susceptibility, cues to action, and self-efficacy constituted barriers to vaccination. Social change implications include education on disease severity, susceptibility, and vaccination safety, and expanding transportation, access to vaccination centers, and religious outreach programs to increase immunization of Nigerian children.</p>

<p> Introduction: Analyzing trends in breast cancer mortality can ensure a precise characterization of changes over time and can be important in public health decision making. Most reported trends are limited to incidence and mortality rates among Whites and Blacks, without categorization regarding tumor clinical characteristics. This study analyzed breast cancer mortality trends among different race-ethnic groups using various approaches such as partitioning rates by factors associated at the time of diagnosis; taking into consideration age, cohort and period effects; and by evaluating geographical variations.</p><p> Methods: Incidence and mortality data from 1990 to 2012 of female invasive breast cancer among women aged 18-84 years in United States (U.S.) was provided by the National Cancer Institute. The following analyses were conducted: (1) calculation of incidence based mortality (IBM) rates by estrogen receptor (ER) status according to race-ethnicity; (2) examination of temporal trends using age-period-cohort (APC) analysis on incidence and mortality rates; and, (3) spatiotemporal analysis of the county level age-standardized breast cancer mortality rates to identify significant geographical areas with higher risk. </p><p> Results: IBM rates for ER+ tumors increased while those of ER- tumors decreased among all race-ethnic groups. APC analysis showed that race-ethnic disparities were largely among the ER- tumors and temporal trends of the ER+ tumors were similar across the race-ethnic groups, with identical effects across the various birth cohorts. Geographical variation in the breast cancer county-level mortality rate was mostly explained by age-standardization and county level risk factors, although the effect of these factors was greater in rural areas of western U.S.</p><p> Conclusion: Temporal trends in the IBM rates were more reflective of the recent changes in the incidence trends of female invasive breast cancer. Trends of ER+ tumors were similar across all race-ethnic groups suggesting a common risk factor for the persistent increase in the incidence and mortality of these tumors. Spatial analysis shows that the higher mortality risk in certain rural counties of western U.S. might be due to poor survival than an elevated incidence and the need for better health care access in these medically underserved areas. These results might explain the observed ethnic and geographic variations in breast cancer mortality, and in turn, could support a stronger theoretical basis for public health policy.</p>

<p> Baby boomers are a large population rapidly transitioning into older adulthood. As the proportion of older adults will be higher in the coming decade than at any previous point in history, the aging of the population has placed successful aging at the forefront of public health and health care efforts. Baby boomers have disproportionately low rates of successful aging and physical activity, even though physical activity is known to contribute to successful aging. Existing exercise programs are ineffective as evidenced by the widespread access to but poor participation in exercise programs. Archery exercise is a relatively unexplored, yet promising, physical activity intervention for baby boomers. This exploratory and qualitative case study was the first to explore the role of archery exercise in promoting successful aging through physical activity among baby boomers. A purposeful sample of 12 non-institutionalized baby boomers living in a Midwest community were enrolled in a six-week archery exercise program. A total of 8 females and 3 males with varying physical activity levels completed the program. Information from post-program, semi-structured interviews were triangulated with findings from a literature review. Key themes emerging from the interpretive analysis included physical benefits, mental benefits, positive social experience, appropriateness and benefit for older adults, and motivation to continue. Physical benefits included upper body strength, balance, and improvement to individual limitations. Mental benefits included concentration, movement control, confidence, and relief from individual mental challenges. Participants believed archery exercise is appropriate and beneficial for older adults because of the enjoyment, low intensity, rewarding, shareable, individualized, and multiple component aspects. The study demonstrates archery exercise is a promising physical activity intervention for baby boomers in this community. Future research is needed to explore the impact of archery exercise in other communities and among other older adult populations. Awareness about what constitutes physical activity is needed to encourage participation in exercise programs. Collaboration between public health, sporting, and community stakeholders is needed to deliver additional community-based, multiple component exercise programs to baby boomers. Archery exercise may be an effective physical activity intervention to address population aging concerns, although more research is needed to justify this claim.</p>

Background: After the collapse of the Soviet Union in 1990, fifteen former Soviet Union countries (fSU) have been undergoing transition. The Belarusian rate of transition has been slower than the others, and population health is likely to have been affected differently. Aims: This study aimed to explore changes in population health in Belarus between 1990 and 2010, and to analyse and describe changes in the health status of Belarusians between 2001 and 2010. Methods: A mixed-method study was conducted, comprising: (i) a review of the published literature, (ii) an analysis of routine health-related statistics, (iii) a review of the national public health reforms, (iv) a secondary analysis of data from two population surveys conducted in Belarus in 2001 and 2010, and (v) a statistical analysis of data from a new Health Category Response Scale (HRCS) survey. Results: Population health initially deteriorated as living standards fell in the early 1990's. An increase in morbidity and mortality from the major non-communicable diseases, and a decrease in life expectancy, followed patterns of increasing hyperinflation and rising unemployment. Around 1994, the economic situation reversed. Major public health reforms were implemented from 1999. Around 2000, mortality indicators for some diseases improved, but not all, while morbidity continued to increase. The secondary analysis of the cross-sectional data (2001 and 2010) and the HCRS survey conducted in Belarus in 2010 showed that Belarusians perceived their health to be better in 2010 than in 2001. Conclusions: In the early 1990's, population health in Belarus deteriorated. Around 2000, some mortality health indicators showed improvement, but by 2010, they had not yet reached their 1990 levels. In contrast, morbidity health indicators continued to deteriorate throughout 1990 to 2010.

<p> Despite decades of the implementation of the directly observed therapy short-course (DOTS), Sierra Leone is ranked among the 30 highest TB-burdened countries. Several factors account for unfavorable treatment outcomes, among which are patient characteristics. Previous studies have only focused on treatment compliance without any consideration for the factors that lead to noncompliance to treatment. The purpose of this study was to investigate patient characteristics that are associated with treatment noncompliance (treatment not completed) among TB patients undergoing the DOTS program in Sierra Leone. A retrospective longitudinal quantitative design was used to analyze secondary data from the completed records of 1,633 TB patients, using the Andersen&rsquo;s behavioral model of health services utilization as a theoretical framework work. Descriptive statistics and bivariate and multivariate logistic regressions were used to analyze the data. The results show that there was no significant association between treatment completion and age, gender, and TB-case category. On the other hand, being HIV-positive decreases the odds of treatment completion. Also, the educational level, geographic location, and year of treatment were significantly associated with treatment completion. Overall, program performance improved as the number of dropouts decreased significantly between 2013 and 2015. The social change implication of this study was that it identified HIV-positive patients and rural communities as areas needing specific attention such as the assignment of case managers to ensure compliance thereby improve DOTS program performance, thereby reducing the incidence and transmission of TB. </p>

<p> Children of Hispanic origin have the highest prevalence of asthma of all ethnic groups in the United States, especially Puerto Rican children, who have a prevalence of 12.9%. Treatment nonadherence has been identified as one contributing factor. The purpose of this qualitative study was to explore the reasons for nonadherence to the asthma treatment regimen among Puerto Rican children. Parents and health care providers of asthmatic children were interviewed regarding their beliefs about asthma as a disease, its effect on the child&rsquo;s life, and their experience with asthma treatment. Two models served as the theoretical framework: the health belief model and the Institute of Medicine model framework for asthma disparities. Interview data were collected from 8 parents using a questionnaire, and a focus group was conducted with 3 health care professionals. Data were manually coded to identify emerging themes. Even though parents reported fear of asthma medications and medication side effects, none of the parents stopped the asthma treatment. Results also indicated that lack of education about asthma, asthma treatment, and asthma action plan was evident in 75% of the parents. None of the parents who migrated to the United States from Puerto Rico received education about asthma while living in Puerto Rico. Health care professionals reported that although parents are familiar with asthma, they do not understand that it is a chronic disease that requires daily treatment. Findings may be used to create an asthma education plan tailored to the needs of the Hispanic population. </p><p>

<p> This dissertation research focuses on the risk factors associated with high-risk HPV infection (HR-HPV) and abnormal cervical cytology in Nepali women residing in Nepal&rsquo;s Far-West district of Achham. The first part of this dissertation assesses the HR-HPV test concordance of self-collected vs. clinician-collected cervico-vaginal specimens. Of 261 women with both clinician- and self-collected cervical samples, 25 tested positive for HR-HPV, resulting in an overall HR-HPV prevalence of 9.6% (95% Confidence Interval [CI]: 6.3&ndash;13.8). The overall Kappa value for clinician- and self-collected tests was 0.64 (95% CI: 0.48&ndash;0.84), indicating a &ldquo;good&rdquo; level of agreement. The second part of this dissertation investigates the association between 251 women whose husband&rsquo;s migrate for work and their high-risk HPV (HR-HPV) infection status and their abnormal cervical cytology status. Half of study participants (50.8%) had husbands who reported migrating for work at least once. Women 34 years and younger were significantly less likely to test positive for HR-HPV than women older than 34 years (OR 0.22, 95% CI 0.07&ndash;0.71). HR-HPV infection and abnormal cervical cytology status were not directly associated with a husband&rsquo;s migration. The last part of this dissertation investigates the link between rates of sexually transmitted disease (STD) symptoms and geospatial differences among migrant workers using the Nepal Demographic Health Survey (NDHS). Data was restricted to 9,607 married women in the 2011 NDHS. Multivariate logistic regression models assessing the odds of reporting STD symptoms in the 2011 NDHS found that women whose husbands migrated for a year or more were more likely to report STD symptoms than women whose husbands were not currently migrating for work if they lived in Nepal&rsquo;s Mid-West region (OR 1.93 95%CI 1.02&ndash;3.67) or Nepal&rsquo;s Far-West region (OR 2.89 95%CI 1.24&ndash;6.73). The burden of increased risk factors for HR-HPV infection and abnormal cervical cytology could result in increases in HPV prevalence in the wives of Nepali migrant workers.</p>

<p><i>Background</i>. Male circumcision (MC) is approximately 60% effective against heterosexual HIV transmission among men. MC is being scaled-up across East and southern Africa. If men engage in riskier sex after becoming circumcised (termed &ldquo;risk compensation&rdquo;), the protective effect of MC could be diminished. Several governments in East and southern Africa have signaled their intention to scale-up Infant Male Circumcision (IMC) to mitigate potential risk compensation and because the procedure is simpler, safer and less expensive. </p><p> <i>Methods</i>. Data for this dissertation come from two sources. The first is the randomized controlled trial of male circumcision for HIV prevention and post-trial follow-up data collected between 2002 and 2010. The trial randomized 2,784 HIV negative men to immediate or delayed circumcision. After a median of 24 months of follow-up, uncircumcised men were offered the surgery and follow-up continued to 72-months. Generalized estimating equations models with incorporation inverse probability of treatment and censor weights were used to estimate the association between circumcision status and four time-varying measures of sexual risk-taking behavior: no condom use at last sex, sex the same day as meeting someone in the previous six months, >2 sexual partners in the previous six months and exchange of sex for gifts or money in the previous six months. The second data source is the Mtoto Msafi study and post-study routine infant circumcision service provision. The case-control study was conducted in 2010 at five government health facilities in western Kenya. Cases were mothers and fathers accepting circumcision for their son. Controls were parents who declined IMC services. A questionnaire comprising 41 questions was administered. Clinical variables relating to the circumcision procedure, including clinical provider, experience level of provider, age of the infant, and adverse event data were collected during the study and after study completion. </p><p> <i>Results</i>. In the risk compensation analysis, no condom use at last sex increased modestly over time for both circumcised and uncircumcised men (OR for 6-month increase in time 1.06). Compared to uncircumcised men, circumcised men had increased odds of no condom use at last sex (OR=1.17, p=0.006). There was no evidence of risk compensation in the other sexual behavioral outcome variables. In the infant circumcision analysis, factors associated with accepting IMC among mothers in multivariable logistic regression modeling were: father circumcised, both partners Luo (vs. father uncircumcised, both partners Luo OR=5.47, p&lt;0.001) and agreeing with the father about the IMC decision (OR=5.00, p&lt;0.001). Among fathers, factors associated with accepting IMC were: being circumcised and Luo (vs. uncircumcised and Luo OR=3.96, p&le;0.001) and having higher endorsement of MC (OR=3.79, p&lt;0.001). Fathers were the primary decision makers in most instances (66%). Few parents (3%) reported they would prefer a future son to remain uncircumcised. With respect to safety, the overall AE rate among infants reviewed post-operatively was 2.7% (18/678; 95%CI: 1.4, 3.9). There was one severe AE involving excision of a small piece of the lateral aspect of the glans penis. Other AEs were mild or moderate and were treated conservatively. Babies one month of age or older were more likely to have an AE (OR 3.20; 95%CI: 1.23, 8.36). AE rate did not differ by nurse versus clinical officer or number of previous procedures performed. </p><p> <i>Conclusions</i>. Both circumcised and uncircumcised men were less likely to use condoms over time. Further studies on risk compensation following MC may not be warranted. Fathers are important in the IMC decision-making process. Fathers, as well as mothers, should be targeted for optimal scale-up of IMC services. Circumcision programs should offer services for males of all ages, since male circumcision at some age is highly acceptable to both men and women. IMC services provided in Kenyan Government hospitals in the context of routine IMC programming have AE rates comparable to those in developed countries. The optimal time for IMC is within the first month of life. </p>

<p> Lyme disease (LD) has become the most prevalent vector-borne disease in the United States and the sixth Nationally Notifiable disease. Surveillance of Lyme disease from the 1992-2016 has shown a sustained documented expansion of LD moving south into the border of Virginia and North Carolina, west into West Virginia, Tennessee, northwest into North Dakota, and North into Canada. This expansion of LD seems to be associated with expansion of the disease vector <i>Ixodes scapularis</i>, with newly established populations in the southwestern Appalachian and Piedmont regions of Virginia. The goal of the study was to characterize the entomological risk of the spread of LD from VA into NC. To determine the distribution and infection prevalence of <i> I. scapularis</i> along a northeastern-to-southwestern gradient from VA to NC, tick-flagging and hunter-harvested deer tick collecting approaches were used with samples tested by the CDC for infection. Flagging was comprised of periodic sampling sessions from October 2015 to July 2017, conducted at Fairy Stone, Mayo River, Hanging Rock, Pilot Mountain, Yadkin Island Park, and Lake Norman State Parks. Hunted deer processing stations Hilltop Farms (Walnut Cove, NC) and Game Butchers (Troutman, NC), were used for collecting ticks from hunter-harvested deer covering counties for the northern, central and southern North Carolina Piedmont regions. </p><p> Ticks collected by flagging were suggestive of a north-to-south trend with no significant difference among the northernmost State Parks and a significant difference in abundance between the northern and southernmost State Parks. The highest number of <i>I. scapularis</i> ticks (0.7 per 100m) was collected from the north-most Virginia&rsquo;s Fairy Stone and Hanging Rock State Parks, but no <i>I. scapularis</i> were collected from the southernmost Lake Norman location. Infection prevalence of ticks collected by flagging exhibited a general north-to-south declining trend. Though not statistically significant with highest infection rate approximately 25% at the north-most Fairy Stone State Park. For deer collected ticks, there was a significant north-to-south decrease in tick burden per deer, with the northern region located on the VA-NC border having the highest number of <i>I. scapularis</i> (6.0 per deer), followed by the central and the southern regions of NC. Infection prevalence of sampled ticks from deer are suggestive of a declining trend although not significant, with the northern region having the highest (17%), followed by the central region (11%), and no infection present in the southern region. <i>Ixodes scapularis</i> results collected from flagging, and hunter-harvested deer are highly suggestive of a north-to-south gradient in <i>I. scapularis</i> densities with Alexander and Iredell being the south-most <i>I. scapularis</i> positive counties. <i>Borrelia burgdorferi</i> infection results also suggest a north-to-south distribution, with <i>B. burgdorferi </i> appearing to have only made it as far south as the central counties of Yadkin and Forsyth. Entomological risk estimates for density of infected nymphs (DIN) and adults (DIA) of flagging and hunted deer also showed a north-to-south trend with Fairy Stone State Park having the highest (0.033) DIN and northern NC region having the highest (0.808) DIA. The results are consistent with first the spread of the vector followed by the pathogen. </p><p>