Search Results (141)

Background: Chlamydia trachomatis is the most prevalent bacterial sexually transmitted infection (STI) globally, linked to severe complications such as pelvic inflammatory disease and infertility. In the Brazilian Amazon, socioeconomic vulnerability and the absence of screening policies exacerbate risks, particularly among female sex workers (FSWs). Objective: This study aimed to determine the seroprevalence of anti-C. trachomatis IgG antibodies among FSWs in five municipalities of Pará State, Brazilian Amazon, and identify epidemiological factors associated with infection. Methods: A retrospective cross-sectional study (2005–2007) included 348 FSWs recruited via convenience sampling. Sociodemographic and behavioral data were collected through questionnaires, and blood samples were analyzed by ELISA for anti-C. trachomatis IgG. Statistical analyses included Fisher’s exact tests, odds ratios (ORs), and 95% confidence intervals (CIs), using SPSS 21.0. Results: Overall seroprevalence was 93.9% (327/348; 95% CI: 83.1–90%). Significant associations included a household income of 1–3 minimum wages (98.4%; p = 0.0002), sexual partners from the same region (98.8%; p = 0.0421), and age >42 years (96.3%). Most reported inconsistent condom use (43.7%), multiple monthly partners (54.6%), and illicit drug use (53.4%). Discussion: The extremely high seroprevalence reflects chronic C. trachomatis exposure, driven by socioeconomic deprivation and limited healthcare access. Comparisons with global data underscore the urgent need for screening policies, absent in Brazil for FSWs, and highlight the vulnerability of this population. Conclusions: The findings reveal an alarming burden of C. trachomatis exposure among Amazonian FSWs. Integrated strategies, including routine screening, sexual health education, and inclusion of FSWs in priority health programs, are critical to reduce transmission and associated complications. Full article

Women’s decision-making autonomy is widely recognized as a critical determinant of maternal, newborn, and child health (MNCH). However, prevailing measures often conflate genuine autonomy with decisions made within traditional gender roles, risking an overstatement of women’s empowerment. This study examines the extent to which reported female decision-making autonomy reflects authentic agency versus role-based compliance in a patriarchal context. A cross-sectional study was conducted among 280 male household heads in Kakamega County, Kenya, whose partners were pregnant or recently postpartum. Using multi-stage cluster sampling and structured interviews, men reported on household and MNCH decision-making and their rationales, categorized as gender-role conformity, belief in gender equality, or other reasons. Although 40.4% reported that their partners made decisions independently, only 11.4% attributed it to a belief in women’s equality; 28% framed it within traditional gender roles. Men were over four times more likely to perceive women’s decisions as role-based than autonomous (AOR = 4.40; 95% CI: 2.48–5.78). Younger men (18–34) were more likely to report female decision-making (AOR = 5.54; 95% CI: 5.08–7.27), without necessarily endorsing egalitarian norms. Findings highlight the urgent need for gender-transformative MNCH interventions that move beyond surface-level autonomy to address deeper structural inequities. Full article

This study examines how U.S. immigration policies enact legal violence and multigenerational punishment through the spousal reunification process, particularly in mixed-status, transnational families. Building on the concept of “deportability,” we introduce “importability” to describe a beneficiary’s potential to secure permanent residency, which varies according to social markers such as race, gender, and region of origin. Drawing from a content analysis of threads on the Immigration Pathways (IP) web forum, we analyze discussions among U.S. citizen petitioners navigating marriage-based green card applications, with a focus on experiences involving administrative processing (AP) (i.e., marriage fraud investigations). Our findings show that couples who do not align with the state’s conception of “proper” family—particularly U.S. citizen women petitioning for Black African partners—face intensified scrutiny, long delays, and burdensome requirements, including DNA tests and surveillance. These bureaucratic obstacles produce prolonged family separation, financial strain, and diminished sense of belonging, especially for children in single-parent households. Through the lens of “importability,” we reveal how legal violence and multigenerational punishment of immigration policies on mixed-status families beyond deportation threats, functioning as a gatekeeping mechanism that disproportionately affects marginalized families. This research highlights the understudied consequences of immigration policies on citizen petitioners and contributes to a broader understanding of inequality in U.S. immigration enforcement. Full article

Background: Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States (U.S.) and a major contributor to several cancers, including cervical, anal, penile, and oropharyngeal cancers. Although a safe and effective vaccine is available, HPV vaccination rates remain suboptimal, particularly among racial, ethnic, and immigrant minority groups. This study explored multiple factors, such as cultural, social, and structural influences, influencing HPV vaccine decision-making among Cape Verdean immigrant parents in the U.S., a population currently underrepresented in HPV research. Methods: Qualitative study using individual, in-depth interviews with Cape Verdean immigrant parents of children aged 11 to 17 years living in the U.S. Interviews were transcribed verbatim and analyzed thematically using the social ecological model (SEM) to identify barriers and facilitators at the intrapersonal, interpersonal, organizational, community, and policy levels. Results: Forty-five Cape Verdean parents (27 mothers, 18 fathers) participated. Fathers were significantly older than mothers (50.0 vs. 41.1 years, p = 0.05). Most were married or partnered (60%), had at least a high school education (84.4%), and reported annual household incomes of US$50,000 or more (66.7%), with no significant gender differences. Nearly all spoke Creole at home (95.6%). Fathers had lower acculturation than mothers (p = 0.05), reflecting less adaptation to U.S. norms and language use. Most parents had limited knowledge of HPV and the vaccine, with gendered beliefs and misconceptions about risk. Only seven mothers (25.9%) reported receiving a provider recommendation; all indicated that their children had initiated vaccination (1 dose or more). Mothers were the primary decision-makers, though joint decision-making was common. Trust in providers was high, but poor communication and the lack of culturally and linguistically appropriate materials limited informed decision-making. Stigma, misinformation, and cultural taboos restricted open dialogue. Trusted sources of information included schools, churches, and Cape Verdean organizations. While parents valued the U.S. healthcare system, they noted gaps in public health messaging and provider engagement. Conclusions: Findings revealed that HPV vaccine uptake and hesitancy among Cape Verdean immigrant parents in the U.S. were influenced by individual beliefs, family dynamics, healthcare provider interactions, cultural norms, and structural barriers. These findings highlight the need for multilevel strategies such as culturally tailored education, community engagement, and improved provider communication to support informed vaccination decisions in this population. Full article

Background: Traditional Male Circumcision (TMC) has been practiced in many parts of the world. However, the impact thereof on reducing HIV transmission is still unclear. This study aimed to examine the prevalence and determinants of TMC and the associated risk of HIV transmission in Lesotho. Method: Using data from the 2023–24 Lesotho Demographic and Health Survey, the analysis included a weighted sample of 3202 men aged 15–59 years. Missing data was addressed through multiple imputations, and multilevel logistic regression was used to assess the factors associated with TMC, incorporating intra-class correlation to evaluate cluster-level variation. Results: The findings revealed that 51.0% (95% CI: 49.3–52.7) of men in Lesotho had undergone TMC. Older men, particularly those aged 35 years and above, were more likely to be circumcised compared to younger men aged 15–24 years (AOR = 1.63; 95% CI: 1.46–1.86). Other individual-level factors positively associated with TMC included smoking, being married to one partner, previous sexual experience, and rural residence. Conversely, men with formal education, unknown or undisclosed HIV status, residing in the Berea or Maseru districts, and those from middle- or high-income households were less likely to undergo TMC. Conclusion: The study highlights significant variation in TMC practices across communities and identifies both individual and contextual factors influencing its uptake. These insights underscore the need for culturally sensitive, voluntary, and medically safe circumcision programs. Public health initiatives should consider these determinants when designing interventions to ensure a safer and more effective implementation of TMC in Lesotho. Full article

Flourishing in children is an indicator of positive development in the areas of emotional, social, and cognitive development. Using a recent dataset from the US National Survey of Children’s Health, this study investigates the association between access to a quality healthcare system and flourishing indicators in school-aged children with autism. The outcome variable describes the proportion of children aged 6–17 with autism meeting the flourishing criteria, which include measures related to learning, resilience, and self-regulation. The main independent variable includes six core indicators for school-aged children and adolescents, which assess whether the family feels like a partner in their child’s care, the child has a medical home, receives regular medical and dental preventive care, has adequate insurance, has no unmet needs or barriers to accessing services, and has prepared for transition to adult healthcare. Multivariable logistic regression models were used to examine the relationships between various independent variables and the outcome of interest. The results show that children with autism who receive comprehensive and coordinated care are more likely to flourish compared to those without such care for five of these six indicators, while controlling for sex, race, parental education, household income, self-reported autism severity, general health status, and the number of adverse childhood experiences. Children with autism are more likely to flourish when their families and healthcare providers work together effectively. Addressing gaps in the quality care system is essential for developing holistic approaches that empower children with autism to thrive and reach their full potential. Supportive health policies and effective coordination between families and healthcare providers are crucial for fostering the flourishing of children with autism, ensuring comprehensive, individualized, and continuous care. Full article

Although the relationship between grandparent and grandchild is often unique due to the supportive and foundational roles grandparents can have in the lives of young or youthful grandchildren, the extent of grandparent–grandchild coresidence globally is under-researched. We harmonized household roster survey data on grandchild coresidence using population-based data on adults 55+ years across 24 countries. Grandchild coresidence rates ranged from 41.1% in Mexico to 0.1% in Sweden. Across contexts, grandchild coresidence was more common among women (compared to men), non-partnered individuals (compared to partnered individuals), those who reported difficulty with activities of daily living (compared to those without such difficulties), and those with education levels below the median (compared to those above the median). Logit regressions indicated gaps in rates of grandchild coresidence by partner status, ADL status, and education were generally not driven by income or other socio-demographic variables. Coresidence with adult grandchildren was not uncommon in most countries with non-negligible rates of grandchild coresidence. In about 25% of households of middle-aged and older adults coresiding with grandchildren, grandchildren ages 0–5 years were present. Future research should consider the meaning of grandparent–grandchild coresidence for the health outcomes of middle-aged and older adults globally, particularly when grandparents are not caregivers of grandchildren. Full article

Background: the distribution of human papillomavirus (HPV) infection, vaccination rates, and awareness levels varies across China. Methods: this study examined HPV infection prevalence, vaccine uptake, and barriers among 2440 women aged 30–64 in Shenzhen, China, using partial least squares structural equation modeling (PLS-SEM) to analyze associated factors. Results: The overall HPV prevalence was 14.2% (347/2440), with HPV52 being the most common type, followed by HPV58 and HPV53. Factors significantly associated with HPV infection included more sexual partners, genital tract infections, manual labor, and single marital status (p < 0.05), whereas higher education demonstrated a protective association (p < 0.05). The HPV vaccination rate was 41.8% in ages 30–45. There were direct effect indicators of younger age, fewer pregnancies, and premenopausal status (p < 0.05) on HPV vaccine uptake, whereas inversely associated factors included divorce/widowed, lower household income, irregular menstruation, more deliveries, no contraception, and lack of HPV knowledge. Among 828 unvaccinated individuals, 47.9% of those aged 46–64 were willing if the age restrictions were expanded, with the main barrier being a lack of vaccine knowledge (40.7%). Willingness was significantly associated with younger age and healthcare occupation (p < 0.05), but negatively with eastern Shenzhen residence, lower household income, no HPV disease awareness, abnormal leucorrhea, lack of HPV knowledge, and belief against post-vaccination screening (p < 0.05). Conclusions: Socioeconomic disparities in HPV infection and vaccination rates in Shenzhen highlight intervention priorities. The impact of HPV knowledge underscores the need for effective health communication. The vaccination willingness and infection status among women aged 45+ provide supporting evidence for expanding HPV vaccination to older age groups. Full article

Intimate partner violence (IPV) continues to be a serious public health issue, particularly in Ghana. It is crucial to create evidence-based, preventative measures to stop IVP. This study empirically investigated the factors related to married women’s perceptions of male IPV against women. The United Nations Sustainable Development Goals (SDGs) (Goal 5.2) advocate for the elimination of male violence against women by governments, hence this study contributes to monitoring the progress being made. This study employed cross-sectional secondary data from Ghana Multiple Indicator Cluster Surveys (MICS) conducted in 2018 with a sample of 14,237 women aged 15–49. Data were analyzed using descriptive statistics and bivariate and multivariate logistic regressions, and the results were presented as odds ratios (ORs) with a confidence interval (CI) of 95%. Women’s justification of male IPV against women was correlated with socio-demographic factors such as education level, marital status, age of the woman, area of residence (rural or urban), ethnic background, and economic disadvantage (wealth status). Higher educated women (OR 0.248 [95% CI 0.185–0.332, p < 0.001]) were less likely to justify male IPV against women than women with no/less formal education. Women who were in the richest quintile (OR 0.766 [95% CI 0.634–0.926, p = 0.006]) were less likely than those in the poorest/lowest quintile to rationalize/justify intimate partner violence. In terms of ethnicity of the household head, the Ga/Dangme (OR 0.86 [95% CI 0.714–1.036, p = 0.112]) had lower odds of justifying male IPV against women compared to the Akan. The government, through the Ministry of Gender and Child Protection and women’s advocacy groups, should devise strategies, programs, and policies to empower women through formal education and economically through job training and employment support for women and victims to help them achieve financial independence and reduce negative attitudes toward women and the prevalence of male IPV against women. Full article

This study aims to explore the link between exposure to tobacco smoke among nonsmokers and the risk of lung cancer in the United States. We searched six databases for studies on second-hand smoke (SHS) and lung cancer following PRISMA guidelines. Following the random effects model and specific statistical methods, our meta-analysis analyzed studies based on SHS exposure type. A total of 19 eligible studies were included in the review and 15 in the meta-analysis. We covered exposure from parents (childhood), spouses and partners (household), and work-related exposure (colleagues), with higher risk among non-smoking children and domestic partners. Findings reveal a consistent link between SHS exposure and increased lung cancer risk for this population (exposure effect sizes: 1.05–3.11). Analysis of childhood SHS exposure reveals a distinct increased risk associated with parental exposure. For nonsmokers living with smoking spouses, there is a marked 41% increase in risk. Higher risk was associated with more and more prolonged SHS exposure. Exposure to SHS in the workplace shows a correlation with lung cancer risk. Our findings highlight increased SHS-related lung cancer risk, particularly among non-smoking children and domestic partners, intensifying with the amount and duration of exposure, indicating the significant impact of SHS within domestic environments. Full article

The integration or resettlement efforts aimed at self-reliance of refugees are requisite for their adaptation to social and economic shocks and consequently to their human development and contribution to economic growth. This study analyses the drivers of financial inclusion and social integration and estimates the respective gender gap among households in Kakuma Refugee Camp, Kenya. Based on a 2019 socio-economic survey dataset, the study constructs indices to reveal the extent of financial inclusion and social integration. Using the ordered logistic regression, factors such as earning wages, asset accumulation, food security, social capital, education, and access to information demonstrate significant explanatory power for financial inclusion and social integration. The Blinder-Oaxaca decomposition technique for measuring the gender gap reveals that women are significantly better off with respect to financial inclusion compared to men. These results suggest that gendered financial inclusive and social integration programs can build refugee self-reliance. Accordingly, government and development partners should promote gender-inclusive strategies for refugees in Kenya. This study contributes to the literature on refugee financial inclusion and social integration by offering gender-specific insights into their barriers and enablers in protracted displacement contexts. Full article

Background/Objectives: Community–academic partnerships offer unique opportunities to leverage expertise and resources to modify structural factors that address community priorities. However, few in-depth examples of successful partnerships in rural communities to improve food security are available. This manuscript describes the process of building a partnership to reduce food insecurity in a rural Kentucky community. Methods: The research team worked with Cooperative Extension to form a community advisory board (CAB) representative of diverse sectors of the community who had interest in food security, agriculture, and/or nutrition. The CAB convened regularly, in-person or virtually, to review community assessment information and identify, select, and adapt relevant multi-level interventions. CAB members were invited to complete two surveys and participate in a listening session to provide feedback on working with academic partners. Results: Over the first two years of the project, 17 people served on the CAB. Early in the project, the CAB prioritized interventions for working families, relatives raising children, and lower income households. Some ideas were able to come to fruition (e.g., family cooking social classes, raised garden beds), while others were explored but were unable to gain momentum (e.g., mobile market) due to challenges with feasibility, organizational capacity, and/or interest. CAB members reported high engagement and strong communication between community and academic partners. Conclusions: Full exploration of potential solutions suggested by CABs may build trust between community and academic partners and could provide a strategic selection process for multi-level, evidence-based interventions deemed feasible for addressing complex issues such as food insecurity and nutritional health outcomes. Full article

Increased life expectancy and reduced fertility mean more generations are living simultaneously but with fewer members. There is also a growing group of older people (aged 80 and over) who need care and support. This impacts mutual support within families and the care provided by public or private care organisations. Across OECD countries, on average, 60% of people aged 65 years and older in 2020 reported receiving support from family members, friends and people in their social network, living inside or outside their household but not care organisations. European research shows that when older persons do not have a partner (anymore), they rely on their adult children for care and support. Given that adult children frequently serve as primary providers of informal care, our study examines their perspectives and motivations to provide future care alongside the demands and expectations of their old parents. Our study adopts a multi-actor interview approach and simultaneously looks at the perspective of 40 adult children and one of their older aged parents (65 years or older). We apply the distributive justice theory to understand how children and parents assess the expectation and fairness of support. This paper contributes to the existing literature about support behaviour between parents and children, expanding insights about the fairness of support, expectations and willingness from a multi-actor approach. Through the lens of child–parent dyads, it is seen that the principles of the distributive justice theory can be perceived as not so strict, and within family relationships, one or more principles can coexist and have underlying mechanisms. This study shows the complexity and often ambivalence of family solidarity by adopting a multi-actor approach. One of the main findings is that contrasting dyads who reject the reciprocal act of support experience feelings of guilt or misunderstanding, resulting in stress and worry. A child may not follow the expected support pattern from the parent due to competing demands such as work or the prioritisation of young children, which can reduce the support given to the older parent. Besides general contrasts and similarities between child–parent support perspectives, the analysis looked into differences regarding gender and legal relationships. Our findings only found gendered care expectations. Future research should entangle this by looking into feelings of closeness, emotional connection and considering the dynamic character of filial support over time, especially between siblings. Full article

We use the microeconomic theory that takes into account household production and human activity in the non-market sphere to analyze the phenomena of a macroeconomic nature. We check the activation of women in the labor market, a phenomenon observed in Western European countries and the United States, among others. The decision to become economically active reduces the opportunity to devote time to previously undertaken activities, including a reduction in the time spent on housework. This often involves a significant change in the structure of consumption, which, at the macroeconomic level, is associated with the creation of new jobs and a change in the structure of the economy. Structural change is understood as the transfer of economic activity between the three main sectors of the system, namely agriculture, industry and services. This study uses microeconomic data from two waves of the TUS in Poland. The so-called marketization hypothesis was tested separately for three groups of women aged 18–24, 25–44 and 45–59. When estimating the parameters of the models, characteristics such as having a partner, having children under six and educational attainment were taken into account. The calculations show that women aged 25–44 are relatively active in the labor market, but it is those aged 18–24 who fulfill all of the conditions that support the marketization hypothesis. Full article

Many women justify intimate partner violence (IPV), resulting in adverse health outcomes. This study investigates the relationship between household ownership of information and communication technologies (ICTs), along with the frequency of listening to the radio and watching television with women’s attitudes towards IPV in Bangladesh. The cross-sectional study analyzed a weighted sample of 20,032 women and used a multivariable logistic regression analysis to determine the association between predictor variables and outcome variables. The results showed that 19.47% of women justified wife beating for at least one reason. We found that household ownership of computers (AOR = 0.73 [95% CI = 0.57, 0.95]), women in households with three ICTs (AOR = 0.67 [95% CI = 0.47, 0.96]), and women who watched television at least once a week (AOR = 0.85 [95% CI = 0.74, 0.97]) were associated with decreased odds of justifying wife beating for at least one reason after adjustment for the frequency of reading newspaper or magazine, age, wealth, education, religion, and type of place of residence. The study suggests that not all ICTs affect women’s attitudes toward IPV equally. Computers and television were more influential than other ICTs. This finding suggests that awareness-building and educational programs targeted towards women via computer and television may deliver better outcomes about gender norms. Full article