Assurances of Voluntary Compliance: A Regulatory Mechanism to Reduce Youth Access to E-Cigarettes and Limit Retail Tobacco Marketing

Objectives. To evaluate assurances of voluntary compliance (AVCs) between state attorneys general and retail chains by assessing e-cigarette sales to underage decoys and tobacco marketing violations in corporate-owned stores (that sign AVCs) and franchise stores (that do not sign AVCs). Methods. Decoys 18 to 19 years of age attempted to purchase e-cigarettes without presenting ID in California convenience stores (n = 540). Auditors characterized the presence and content of age-of-sale signage and advertising for tobacco products. Data were collected and analyzed in 2018. Results. Corporate-owned stores were less likely than were franchise stores to violate ID requests (adjusted odds ratio [AOR] = 0.29; 95% confidence interval [CI] = 0.12, 0.71) and to sell e-cigarettes illegally (AOR = 0.37; 95% CI = 0.15, 0.88). Regardless of AVC category, advertising violations were common in stores (vaping products, 26.3%; other tobacco products, 74.3%). Conclusions. The differences in violation rates found in corporate and franchise stores imply that AVCs could reduce youth access to e-cigarettes. However, merchant education and routine enforcement are needed to better leverage restrictions on retail tobacco marketing in AVCs. Public Health Implications. Strengthening compliance with existing AVCs and establishing new agreements with retailers shown to be in violation through federal or state inspections could reduce youth access to e-cigarettes and exposure to tobacco marketing.

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Urinary incontinence and associated factors among pregnant women attending antenatal care in public health facilities of Mekelle city, Tigray, Ethiopia

Women s Health ◽

10.1177/1745506520952009 ◽

2020 ◽

Vol 16 ◽

pp. 174550652095200

Author(s):

Arsema Berhe ◽

Abayneh Alamer ◽

Kiflom Negash ◽

Belete Assefa

Keyword(s):

Public Health ◽

Urinary Incontinence ◽

Confidence Interval ◽

Pelvic Floor ◽

Pregnant Women ◽

Odds Ratio ◽

Associated Factors ◽

Adjusted Odds Ratio ◽

Pelvic Floor Muscle ◽

Mekelle City

Background: Urinary incontinence is any involuntary leakage of urine. It has serious negative health impacts on quality of life in pregnant women. According to the scientific committee of the International Continence Society report, worldwide prevalence of urinary incontinence estimated ranges between 32% and 64% among pregnant women. However, there is scarcity of evidence on prevalence and associated factors of urinary incontinence in Ethiopia. Objective: The aims of this study were to assess prevalence and associated factors of urinary incontinence among pregnant women attending antenatal care in public health facilities of Mekelle city, Tigray, Ethiopia. Methodology: Institution-based cross-sectional study design was conducted. Data were collected using an interviewer-administered structured questionnaire. Physical examination was done to assess the strength of pelvic floor muscles. The data were entered to EPI Info version 7 and analyzed using SPSS version 23. Bivariate and multivariate logistic regression analyses were done to investigate the factors associated with urinary incontinence. Results: Among 317 respondents, the prevalence of urinary incontinence was 23%. The contributing factors that had statistically significant association with urinary incontinence were gestational age (adjusted odds ratio: 9.6 (1.87–49.39, 95%), parity (adjusted odds ratio: 6.32 (1.48–27.05), 95% confidence interval), prior miscarriage (adjusted odds ratio: 6.28 (2.15–18.28), 95% confidence interval), constipation (adjusted odds ratio: 8.25 (3.12–21.84), 95% confidence interval), respiratory problem (adjusted odds ratio: 6.31 (2.05–19.43), 95% confidence interval), and weak pelvic floor muscle (adjusted odds ratio: 7.55 (2.51–22.67), 95% confidence interval). Conclusion: The prevalence of urinary incontinence is moderate compared to other studies. Gestational age, parity, prior miscarriage, having constipation, having respiratory problem, and weak pelvic floor muscle had significant association with urinary incontinence. This finding will help to increase the awareness of health care professionals involved in the care of pregnant women about urinary incontinence.

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Obesity, walking pace and risk of severe COVID-19: Analysis of UK Biobank

10.1101/2020.07.10.20150003 ◽

2020 ◽

Cited By ~ 2

Author(s):

Thomas Yates ◽

Cameron Razieh ◽

Francesco Zaccardi ◽

Samuel Seidu ◽

Melanie J Davies ◽

...

Keyword(s):

Public Health ◽

Risk Factor ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Normal Weight ◽

Functional Fitness ◽

Brisk Walking ◽

Uk Biobank ◽

Obesity Status ◽

Emerging Risk

Obesity is an emerging risk factor for coronavirus disease-2019 (COVID-19). Simple measures of physical fitness, such as self-reported walking pace, could also be important risk factors, but have not been well documented. This analysis includes 414,201 UK Biobank participants with complete covariate and linked COVID-19 data. We analysed the risk of severe (in-hospital) COVID-19 across categories of obesity status and walking pace. As of June 20th 2020 there were 972 cases of severe COVID-19 that had occurred within the cohort. Compared to normal weight individuals, the adjusted odds ratio (OR) for severe COVID-9 in those with obesity was 1.49 (1.24, 1.78). Compared to those with a brisk walking pace, the OR in slow walkers was 1.84 (1.49, 2.27). Slow walkers had the highest risk of severe COVID-19 regardless of obesity status. For example, compared to normal weight brisk walkers, the odds of severe COVID-19 in obese brisk walkers was 1.39 (0.99, 1.98), whereas the odds in normal weight slow walkers was 2.48 (1.56, 3.93). Self-reported walking pace, a simple measure of functional fitness, appears to be a risk factor for severe COVID-19 that is independent of obesity. This may help inform simple pragmatic public health risk stratification and preventative strategies.

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The COVID-19 Epidemic in Madagascar: clinical description and laboratory results of the first wave, March-September 2020

10.22541/au.161088504.46456502/v1 ◽

2021 ◽

Author(s):

Rindra Randremanana ◽

Soa-Fy Andriamandimby ◽

Jean Marius Rakotondramanga ◽

Norosoa Razanajatovo ◽

Reziky Mangahasimbola ◽

...

Keyword(s):

Public Health ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Mitigation Measures ◽

Reference Laboratory ◽

National Reference Laboratory ◽

Electronic Database ◽

National Reference ◽

Laboratory Results ◽

Clinical Description

Background: Following the first detection of SARS-CoV-2 in passengers arriving from Europe on 19 March 2020, Madagascar took several mitigation measures to limit the spread of the virus in the country. Methods: Nasopharyngeal and/or oropharyngeal swabs were collected from travellers to Madagascar, suspected SARS-CoV-2 cases, and contact of confirmed cases. Swabs were tested at the national reference laboratory using real-time RT-PVR. Data collected from patients were entered in an electronic database for subsequent statistical analysis. All distribution of laboratory confirmed cases were mapped and six genomes of viruses were fully sequenced. Results: Overall, 26,415 individuals were tested for SARS-CoV-2 between 18 March and 18 September 2020, of whom 21.0% (5,553/26,145) returned positive. Among laboratory-confirmed SARS-CoV-2 positive patients, the median age was 39 years (CI95%: 28-52), and 56.6% (3,311/5,553) were asymptomatic at the time of sampling. The probability of testing positive increased with age with the highest adjusted odds ratio of 2.2 [95% CI: 1.9-2.5] for individuals aged 49 years and more. Viral strains sequenced belong to clades 19A, 20A, and 20B in favour of several independent introduction of viruses. Conclusions. Our study describes the first wave of the COVID-19 in Madagascar. Despite early strategies in place Madagascar could not avoid the introduction and spread of the virus. More studies are needed to estimate the true burden of disease and make public health recommendations for a better preparation to another wave.

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Prevalence of depressive symptoms due to COVID-19 and associated factors among healthcare workers in Southern Ethiopia

SAGE Open Medicine ◽

10.1177/20503121211032810 ◽

2021 ◽

Vol 9 ◽

pp. 205031212110328

Author(s):

Zelalem Jabessa Wayessa ◽

Girma Tufa Melesse ◽

Elias Amaje Hadona ◽

Wako Golicha Wako

Keyword(s):

Public Health ◽

Depressive Symptoms ◽

Confidence Interval ◽

Odds Ratio ◽

Healthcare Workers ◽

Associated Factors ◽

Adjusted Odds Ratio ◽

Southern Ethiopia ◽

Medical Illness ◽

The West

Objectives: Globally, novel coronavirus disease 2019 (COVID-19) has spread rapidly since it was first identified and challenging the provision of essential services for low-resource countries. Healthcare workers involved in providing care are at high risk of developing mental health problems. The aim of this was to determine the prevalence of depressive symptoms due to COVID-19 and associated factors among healthcare workers in the West Guji zone in public health facilities, southern Ethiopia. Methods: A facility-based cross-sectional study was conducted in public health facilities found in the West Guji zone. A simple random sampling technique was employed to select 283 study subjects. This study was used to assess the prevalence of depression symptoms using Depression, Anxiety and Stress Scale-21, a depression subscale. Descriptive statistics, binary and multiple logistic regressions were used. Adjusted odds ratios (AORs) with 95% confidence interval will be estimated to assess the strength of associations and statistical significance will be declared at a p-value < 0.05. Results: Out of 283 eligible healthcare workers, 275 respondents had participated in this study with a 97.2% response rate. The prevalence of depressive symptoms was 21.5%. The independent predictors associated with depressive symptoms due to COVID-19 were age (adjusted odds ratio = 2.35, 95% confidence interval = 1.126–3.95), family size (adjusted odds ratio = 3.56, 95% confidence interval = 1.09–11.62), alcohol use (adjusted odds ratio = 4.31, 95% confidence interval = 1.76–10.55), medical illness (adjusted odds ratio = 9.56, 95% confidence interval = 3.71–24.59), having training on COVID-19 (adjusted odds ratio = 0.37, 95% confidence interval = 0.17–0.81), and lack of knowledge on COVID-19 (adjusted odds ratio = 15.34, 95% confidence interval = 6.32–37.21). Conclusion: The prevalence of depressive symptoms among healthcare workers due to COVID-19 was high. Factors associated with depressive symptoms were age, family size, alcohol use, medical illness, having training on COVID–19, and lack of knowledge on COVID-19.

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Predictors of pregnant women’s intention to vaccinate against coronavirus disease 2019: A facility-based cross-sectional study in southwest Ethiopia

SAGE Open Medicine ◽

10.1177/20503121211038454 ◽

2021 ◽

Vol 9 ◽

pp. 205031212110384

Author(s):

Shewangizaw Hailemariam ◽

Besufekad Mekonnen ◽

Nigusie Shifera ◽

Biruk Endalkachew ◽

Molla Asnake ◽

...

Keyword(s):

Public Health ◽

Confidence Interval ◽

Pregnant Women ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Public Health Intervention ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Southwest Ethiopia

Objective: Ethiopia is planning to vaccinate 20% of its population against the coronavirus disease 2019 pandemic by the end of 2021—however, there is no single piece of evidence regarding pregnant women’s intention to be vaccinated against coronavirus disease 2019; hence, the objective of this study was to investigate predicting factors of intention to be vaccinated against coronavirus disease 2019 among pregnant women in Bench-Sheko Zone, southwest Ethiopia. Methods: Facility-based cross-sectional study was undertaken from 1 February to 1 March 2021 in southwest Ethiopia. The study was carried out among pregnant women who came for antenatal care service in the selected public health facilities. Interviewer-administered structured tool was used to collect the data. Data were entered into EpiData (version 3.1) and then analyzed using SPSS (version 20). Results: The study revealed that only 31.3% (95% confidence interval: 26.7–35.2) of the participants had an intention to be vaccinated against coronavirus disease 2019 when the vaccine will be made available in Ethiopia. Participants’ intention to be vaccinated against coronavirus disease 2019 was significantly associated with attaining secondary school and above (adjusted odds ratio = 4.24, 95% confidence interval: 2.23–9.32), residing in urban areas (adjusted odds ratio = 2.57, 95% confidence interval: 1.22–5.40), being compliant with coronavirus disease 2019 guidelines (adjusted odds ratio = 5.86, 95% confidence interval: 3.40–10.09), and having good perception toward coronavirus disease 2019 vaccine (adjusted odds ratio = 3.04, 95% confidence interval: 1.64–5.62). Conclusion: Above all, in this study, pregnant women’s intention to vaccinate against coronavirus disease 2019 was very low when compared with previous studies. Hence, before commencing the coronavirus disease 2019 vaccination program in Ethiopia, it is essential to launch a widespread public health education campaign that could improve people’s perception of the vaccine. Besides, the upcoming public health intervention programs better put special emphasis on community members with lower educational attainment backgrounds and rural residents.

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ENDS Device Type and Initiation of Combustible Tobacco Products Among Adolescents

Nicotine & Tobacco Research ◽

10.1093/ntr/ntaa115 ◽

2020 ◽

Author(s):

Aslesha Sumbe ◽

Stephanie L Clendennen ◽

Samuel C Opara ◽

Christian D Jackson ◽

Baojiang Chen ◽

...

Keyword(s):

Tobacco Use ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Focal Point ◽

Sociodemographic Factors ◽

Population Based ◽

Tobacco Product ◽

Tobacco Products ◽

Logistic Regression Models ◽

Device Type

Abstract Introduction The aim of this study was to determine whether Electronic Nicotine Delivery Systems (ENDS) device type (disposable devices, replaceable cartridges, and refillables) at initial or first ENDS use predicts subsequent initiation of combustible tobacco products (cigarettes, hookah, cigars) among adolescents and/or differentiates between those who initiate use of both ENDS and combustible tobacco products at the same time. Methods The study examined data from the Texas Adolescent Tobacco and Marketing Surveillance System (TATAMS), a longitudinal population-based cohort of students in major metropolitan areas of Texas (n = 3907; N = 461 069). Data were collected every 6 months, from 2014 to 2018; 33.9% (n = 1324; N = 151 784) of the sample initiated ENDS use across this period. Unadjusted and adjusted logistic regression models were used to assess the odds of initiating combustible tobacco products at a subsequent or similar wave as ENDS initiation, given initial ENDS device type. Results After adjusting for sociodemographic factors, the odds of initiating combustible tobacco use subsequent to ENDS initiation were significantly lower among those who reported using Cartridges as their initial device type compared to those who reported Refillables as their initial device type (adjusted odds ratio = 0.42 [0.18–0.98], p = .05). In addition, after controlling for sociodemographic variables, the odds of initiating combustible tobacco use in the same wave as ENDS initiation were significantly higher among those who reported using Cartridges as their initial device type, compared with those who reported Refillables as their initial device type (adjusted odds ratio = 2.31 [1.05–5.10], p = .04). No significant differences were found in adjusted models when Disposables were compared to Refillables and Cartridges to Disposables. Conclusion ENDS device type differentiates between adolescents who start using combustible tobacco products at the same time as initial ENDS use, or subsequently. Implications Previous research has shown ENDS use predicts subsequent combustible use among adolescents, but there is lack of research on the role of specific ENDS device types and the timing of initiation. Findings from this longitudinal study show that initiation of combustible tobacco product use varies by initial ENDS device type among adolescents. These findings can become a focal point for developing interventions for adolescents and could have regulatory implications for ENDS products.

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Salmonella and Shigella among patients with diarrhea at public health facilities in Adama, Ethiopia: Prevalence, antimicrobial susceptibility pattern, and associated factors

SAGE Open Medicine ◽

10.1177/2050312119846041 ◽

2019 ◽

Vol 7 ◽

pp. 205031211984604

Author(s):

Bedada Teshome ◽

Zelalem Teklemariam ◽

Desalegn Admassu Ayana ◽

Dadi Marami ◽

Nega Asaminew

Keyword(s):

Public Health ◽

Confidence Interval ◽

Odds Ratio ◽

Associated Factors ◽

Adjusted Odds Ratio ◽

Health Facilities ◽

Susceptibility Pattern ◽

Public Health Facilities ◽

Antimicrobial Susceptibility Pattern ◽

Bacterial Diarrhea

Background: The frequent occurrence of bacteria-associated diarrhea together with increased antimicrobial resistance poses a significant public health challenge worldwide. Objectives: The aim of this study was to assess the prevalence, antimicrobial susceptibility pattern, and associated factors of Salmonella and Shigella among patients with diarrhea at public health facilities in Adama, Ethiopia. Methods: A cross-sectional study was conducted among 232 patients with diarrhea at public health facilities in Adama, Ethiopia, from February 2017 to March 2017. Data were collected using a structured questionnaire. Stool samples were examined for Salmonella and Shigella species using the culture and serological methods. Descriptive statistics were used to summarize the findings. Logistic regression models were used to assess the association of independent variables with the outcome. A p-value ⩽ 0.05 was considered to be statistically significant. Results: The prevalence of Salmonella and Shigella-associated acute diarrhea was 18.1%. The most common isolates were Shigella dysenteriae (23.8%) and Salmonella typhi (21.4%). S. dysenteriae was 80% resistant to both chloramphenicol and tetracycline. S. typhi was 66.7% resistant to ampicillin, ciprofloxacin, and tetracycline. Those patients aged 11–20 years (adjusted odds ratio: 4.61, 95% confidence interval: 2.48, 7.34), who feed raw vegetables (adjusted odds ratio: 3.67, 95% confidence interval: 1.32, 8.59), and who did not wash hands with soap before a meal (adjusted odds ratio: 2.68, 95% confidence interval: 1.96, 7.48) and after using the toilet (adjusted odds ratio: 3.25, 95% confidence interval: 1.43, 7.36) had higher odds of acute bacterial diarrhea. Conclusion: S. dysenteriae and S. typhi were the major causes of acute diarrhea. Most of the isolates showed resistance to ampicillin, ciprofloxacin, and tetracycline. Patients aged 11–20 years, who feed raw vegetables, and who did not wash hands with soap before the meal and after using the toilet had higher odds of acute bacterial diarrhea. Continuous surveillance and the implementation of infection prevention strategies are needed to mitigate acute bacterial diarrhea.

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Regulating Tobacco: The Need for a Public Health Judicial Decision-Making Canon

The Journal of Law Medicine & Ethics ◽

10.1111/j.1748-720x.2002.tb00394.x ◽

2002 ◽

Vol 30 (2) ◽

pp. 281-289 ◽

Cited By ~ 3

Author(s):

Richard A. Daynard

Keyword(s):

Public Health ◽

Tort Law ◽

The United States ◽

Judicial Decision ◽

Tobacco Products ◽

Products Liability ◽

Judicial Decision Making ◽

Convenience Stores ◽

New Development ◽

Young Smokers

Cigarette smoke is by far the leading preventable cause of death and disease in the United States. It has been estimated to kill between 419,000 and 589,000 smokers and up to 65,000 non-smokers each year. This premier status is hardly a new development, having been true for most of the last century, and known to be true at least since the first Surgeon General’s Report in 1964.Why then are tobacco products exempt from any significant federal oversight or control? Why do cigarette advertisements, pitched to young smokers and non-smokers, continue to be plastered on every available surface inside and outside many convenience stores and to adorn the pages of popular magazines? Why, decades since the makers of far less dangerous products began to be held accountable in tort law, was the first payment by a cigarette company on a products liability judgment not made until 2001?

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Comparison of Clinical Outcomes of Persons Living With HIV by Enrollment Status in Washington, DC: Evaluation of a Large Longitudinal HIV Cohort Study (Preprint)

10.2196/preprints.16061 ◽

2019 ◽

Author(s):

Jenevieve Opoku ◽

Rupali K Doshi ◽

Amanda D Castel ◽

Ian Sorensen ◽

Michael Horberg ◽

...

Keyword(s):

Cohort Study ◽

Health Outcomes ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Hiv Care ◽

Disease Stage ◽

People Living With Hiv ◽

Hiv Disease ◽

Persons Living With Hiv ◽

Living With Hiv

BACKGROUND HIV cohort studies have been used to assess health outcomes and inform the care and treatment of people living with HIV disease. However, there may be similarities and differences between cohort participants and the general population from which they are drawn. OBJECTIVE The objective of this analysis was to compare people living with HIV who have and have not been enrolled in the DC Cohort study and assess whether participants are a representative citywide sample of people living with HIV in the District of Columbia (DC). METHODS Data from the DC Health (DCDOH) HIV surveillance system and the DC Cohort study were matched to identify people living with HIV who were DC residents and had consented for the study by the end of 2016. Analysis was performed to identify differences between DC Cohort and noncohort participants by demographics and comorbid conditions. HIV disease stage, receipt of care, and viral suppression were evaluated. Adjusted logistic regression assessed correlates of health outcomes between the two groups. RESULTS There were 12,964 known people living with HIV in DC at the end of 2016, of which 40.1% were DC Cohort participants. Compared with nonparticipants, participants were less likely to be male (68.0% vs 74.9%, P<.001) but more likely to be black (82.3% vs 69.5%, P<.001) and have a heterosexual contact HIV transmission risk (30.3% vs 25.9%, P<.001). DC Cohort participants were also more likely to have ever been diagnosed with stage 3 HIV disease (59.6% vs 47.0%, P<.001), have a CD4 <200 cells/µL in 2017 (6.2% vs 4.6%, P<.001), be retained in any HIV care in 2017 (72.9% vs 59.4%, P<.001), and be virally suppressed in 2017. After adjusting for demographics, DC Cohort participants were significantly more likely to have received care in 2017 (adjusted odds ratio 1.8, 95% CI 1.70-2.00) and to have ever been virally suppressed (adjusted odds ratio 1.3, 95% CI 1.20-1.40). CONCLUSIONS These data have important implications when assessing the representativeness of patients enrolled in clinic-based cohorts compared with the DC-area general HIV population. As participants continue to enroll in the DC Cohort study, ongoing assessment of representativeness will be required.

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Gamma models for estimating the odds ratio for a skewed biomarker measured in pools and subject to errors

Biostatistics ◽

10.1093/biostatistics/kxz028 ◽

2019 ◽

Author(s):

Dane R Van Domelen ◽

Emily M Mitchell ◽

Neil J Perkins ◽

Enrique F Schisterman ◽

Amita K Manatunga ◽

...

Keyword(s):

Odds Ratio ◽

Adjusted Odds Ratio ◽

Lower Cost ◽

Cost Effective ◽

Ratio Estimation ◽

Statistical Efficiency ◽

Function Model ◽

Processing Error ◽

Wide Range ◽

Pooled Samples

SUMMARYMeasuring a biomarker in pooled samples from multiple cases or controls can lead to cost-effective estimation of a covariate-adjusted odds ratio, particularly for expensive assays. But pooled measurements may be affected by assay-related measurement error (ME) and/or pooling-related processing error (PE), which can induce bias if ignored. Building on recently developed methods for a normal biomarker subject to additive errors, we present two related estimators for a right-skewed biomarker subject to multiplicative errors: one based on logistic regression and the other based on a Gamma discriminant function model. Applied to a reproductive health dataset with a right-skewed cytokine measured in pools of size 1 and 2, both methods suggest no association with spontaneous abortion. The fitted models indicate little ME but fairly severe PE, the latter of which is much too large to ignore. Simulations mimicking these data with a non-unity odds ratio confirm validity of the estimators and illustrate how PE can detract from pooling-related gains in statistical efficiency. These methods address a key issue associated with the homogeneous pools study design and should facilitate valid odds ratio estimation at a lower cost in a wide range of scenarios.

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