Ritesh Mistry

Women's autonomy and pregnancy care in rural India: A contextual analysis

Studies in low-income countries have shown that womens autonomy (i.e. the freedom of women to exercise their judgment in order to act for their own interests) influences a number of reproductive and child health outcomes, including the use of pregnancy care services. However, studies have not examined the full spectrum of pregnancy care services needed for safe motherhood and have not accounted for community context. This study analyzed data on women and their villages from the cross-sectional population-based National Family Health Survey-2 (1998-1999) of rural India to investigate whether womens autonomy (measured in the 3 dimensions of decision-making autonomy, permission to go out, and financial autonomy) was associated with the use of adequate prenatal, delivery and postnatal care. The findings indicate womens autonomy was associated with greater use of pregnancy care services, particularly prenatal and postnatal care. The effect of womens autonomy on pregnancy care use varied according to the region of India examined (North, East and South) such that it was most consistently associated with pregnancy care use in south India, which also had the highest level of self-reported womens autonomy. The results regarding village level factors suggest that public investment in rural economic development, primary health care access, social cohesion and basic infrastructure such as electrification and paved roads were associated with pregnancy care use. Improvements in womens autonomy and these village factors may improve healthier child bearing in rural India.

Has the relation between income inequality and life expectancy disappeared? Evidence from Italy and top industrialised countries

Objective: To investigate the relation between income inequality and life expectancy in Italy and across wealthy nations. Design and setting: Measure correlation between income inequality and life expectancy at birth within Italy and across the top 21 wealthy countries. Pearson correlation coefficients were calculated to study these relations. Multivariate linear regression was used to measure the association between income inequality and life expectancy at birth adjusting for per capita income, education, and/or per capita gross domestic product. Data sources: Data on the Gini coefficient (income inequality), life expectancy at birth, per capita income, and educational attainment for Italy came from the surveys on Italian household on income and wealth 1995–2000 and the National Institute of Statistics information system. Data for industrialised nations were taken from the United Nations Development Program’s human development indicators database 2003. Results: In Italy, income inequality (β = −0.433; p<0.001) and educational attainment (β = 0.306; p<0.001) were independently associated with life expectancy, but per capita income was not (β = 0.121; p>0.05). In cross national analyses, income inequality had a strong negative correlation with life expectancy at birth (r = −0.864; p<0.001). Conclusions: In Italy, a country where health care and education are universally available, and with a strong social safety net, income inequality had an independent and more powerful effect on life expectancy at birth than did per capita income and educational attainment. Italy had a moderately high degree of income inequality and an average life expectancy compared with other wealthy countries. The cross national analyses showed that the relation between income inequality and population health has not disappeared.

Integrating Clinical, Community, and Policy Perspectives on Human Papillomavirus Vaccination

Infection with genital human papillomavirus (HPV) may cause anogenital cancers, oropharyngeal cancers, anogenital warts, and respiratory papillomas. Two prophylactic vaccines (a bivalent and a quadrivalent vaccine) are now licensed and currently in use in a number of countries. Both vaccines prevent infection with HPV-16 and HPV-18, which together cause approximately 70% of cervical cancers, and clinical trials have demonstrated 90%-100% efficacy in preventing precancerous cervical lesions attributable to HPV-16 and HPV-18. One vaccine also prevents HPV-6 and HPV-11, which cause 90% of genital warts. A growing literature describes psychosocial, interpersonal, organizational, and societal factors that influence HPV vaccination acceptability. This review summarizes the current literature and presents an integrated perspective, taking into account these diverse influences. The resulting integrated framework can be used as a heuristic tool for organizing factors at multiple levels to guide intervention development and future research.

Relation between Emotion Regulation and Mental Health: A Meta-Analysis Review

This meta-analysis examined the relationship between emotion regulation strategies (cognitive reappraisal, expressive suppression) and mental health (measured by life-satisfaction, positive affect, depression, anxiety, and negative affect). 48 studies, which included 51 independent samples, 157 effect sizes, and 21,150 participants, met the inclusion criteria. The results showed that cognitive reappraisal was correlated significantly and positively with positive indicators of mental health (r=.26) and negatively with negative indicators of mental health (r=–.20). Expressive suppression was correlated negatively with positive indicators of mental health (r=–.12), and positively with negative indicators of mental health (r=.15). Expressive suppression was correlated positively with positive indicators of mental health within the category of samples with Western cultural values (r=–.11) but not the category with Eastern cultural values. Moreover, the correlation of expressive suppression and negative indicators of mental health was stronger in the Western cultural values category (r=.19) than in the Eastern cultural values category (r=.06). Therefore, it is necessary for follow-up studies about emotion regulation and mental health to consider some moderator variable like the culture.

Parenting-related stressors and self-reported mental health of mothers with young children

OBJECTIVES We assessed whether there were associations between maternal mental health and individual and co-occurring parenting stressors related to social and financial factors and child health care access. METHODS We used cross-sectional data from the 2000 National Survey of Early Childhood Health. The 5-item Mental Health Inventory was used to measure self-reported mental health. RESULTS After we controlled for demographic covariates, we found that the following stressors increased the risk of poor maternal mental health: lack of emotional (odds ratio [OR] = 3.4; 95% confidence interval [CI] = 2.0, 5.9) or functional (OR=2.2; 95% CI=1.3, 3.7) social support for parenting, too much time spent with child (OR=3.5; 95% CI=2.0, 6.1), and difficulty paying for child care (OR=2.3; 95% CI=1.4, 3.9). In comparison with mothers without any parenting stressors, mothers reporting 1 stressor had 3 times the odds of poor mental health (OR = 3.1; 95% CI = 2.1, 4.8), and mothers reporting 2 or more stressors had nearly 12 times the odds (OR = 11.7; 95% CI = 7.1, 19.3). CONCLUSIONS If parenting stressors such as those examined here are to be addressed, changes may be required in community support systems, and improvements in relevant social policies may be needed.

Cancer control planners' perceptions and use of evidence-based programs.

The Cancer Prevention and Control Research Network surveyed 282 cancer control planners to inform its efforts to increase the use of evidence-based cancer control programs (EBPs; programs that have been scientifically tested and have successfully changed behavior). Respondents included planners from organizations in state Comprehensive Cancer Control coalitions as well as other governmental and nongovernmental organizations and community-based coalitions. Respondents provided information about personal and organizational characteristics, their cancer control programs, their attitudes toward EBPs, and their awareness and use of Web-based resources for EBPs. Although findings showed strong preferences for cancer control programs that have been shown to work, less than half of respondents (48%) had ever used EBP resources. Regardless of whether they had used EBP resources, almost all respondents (97%) indicated that further training would help them and their organizations adopt and adapt EBPs for use in their communities. The most frequently endorsed training needs were finding and securing additional resources (such as funding and technical assistance), followed by adapting EBPs for cultural appropriateness. The Cancer Prevention and Control Research Network consortium is using these findings to develop a Web-based interactive training and decision support tool that is responsive to the needs identified by the survey respondents.

Role modeling, risk, and resilience in California adolescents

PURPOSE To examine the relationship between role model presence, type of role model, and various health-risk and health-protective behaviors among California adolescents. METHODS We used cross-sectional data on 4,010 multiethnic adolescents aged 12-17 years from the 2003 California Health Interview Survey, a population-based random-digit dial telephone survey of more than 40,000 California households. The survey, conducted every other year since 2001, collects extensive demographic, health, and health-related information. RESULTS Fifty-nine percent of adolescents identified a role model. Affluent teens were more likely to have a role model than lower income teens. Role models were generally of the same ethnicity and gender as the teens; ethnic congruence was higher among African Americans and whites than Latinos and Asians; gender congruence was higher among males. Type of role model was significantly associated with health-related behaviors. Identification of a teacher was strongly associated with positive health behaviors. Correlations with health-promoting behaviors were generally smaller in magnitude but consistently positive among family member and athlete role models. Peer or entertainer role models were associated with health-risk behaviors. CONCLUSION Not only role model presence but also the type of role model is an important predictor of adolescent health-related behaviors. Our findings have implications for designing youth targeted interventions and policies involving role models.

Adolescent smoking risk increases with wider income gaps between rich and poor.

Data from a state-wide survey of California middle and high school students (N=20,203) were used to assess whether county income inequality and poverty rates were associated with adolescent smoking. Greater county income inequality, but not poverty rates, was associated with higher established smoking risk (p=0.0019). The association was stronger in males than females, whites than other ethnic groups, and urban than rural settings. Neither county income inequality nor poverty rates were associated with experimental smoking. The findings suggest that it may be important to consider and address economic inequality in the prevention and control of adolescent tobacco use.

Banning tobacco sales and advertisements near educational institutions may reduce students’ tobacco use risk: evidence from Mumbai, India

Background Indias Cigarettes and Other Tobacco Products Act bans tobacco sales and advertisements within 100 yards of educational institutions. In school-adjacent neighbourhoods in Mumbai, we assessed adherence to these policies and whether tobacco vendor and advertisement densities were associated with students’ tobacco use. Methods High school students’ tobacco use was measured using a multistage cluster sampling survey (n=1533). Field geographic information systems data were obtained for all tobacco vendors and advertisements within 500 m of schools (n=26). Random-effects multilevel logistic regression was used to estimate associations of tobacco vendor and advertisement densities with ever tobacco use, current smokeless tobacco use and current tobacco use. Results There were 1741 tobacco vendors and 424 advertisements within 500 m of schools, with 221 vendors (13%) and 42 advertisements (10%) located within 100 m. School-adjacent tobacco vendor density within 100 m was not associated with the tobacco use outcomes, but tobacco advertisement density within 100 m was associated with all outcomes when comparing highest to lowest density tertiles: ever use (OR: 2.01; 95% CI 1.00 to 4.07), current use (2.23; 1.16, 4.28) and current smokeless tobacco use (2.01; 1.02, 3.98). Tobacco vendor density within 200, 300, 400 and 500 m of schools was associated with current tobacco use and current smokeless tobacco use, but not ever use. Conclusions The tobacco sales ban near educational institutions could be expanded beyond 100 m. Greater enforcement is needed regarding the current bans, particularly because advertisement density within 100 m of schools was associated with all students’ tobacco use outcomes.

The parent-provider relationship: does race/ethnicity concordance or discordance influence parent reports of the receipt of high quality basic pediatric preventive services?

Recent research among adults suggests that having a provider of the same race/ethnicity may enhance the quality of health care above and beyond just having any regular source of care. It is not known whether such relationships exist in pediatric care. The purpose of this study is to identify the distribution and methods by which families have a race/ethnicity concordant provider of well-child care and examine whether differences exist in the receipt of basic preventive services (BPS) and familycentered care (FCC) among those with concordant, discordant, and no regular providers. Analyses are stratified by geography to assess whether urban versus nonurban setting moderates these differences. This study uses publicly available data from the 2000 National Survey of Early Childbood Health (NSECH), a nationally representative, cross-sectional telephone survey of parents of children ages 4–35 months (n=1,996). African Americans and Latinos were more likely than whites to lack a regular provider of well-child care (60.9% and 65.7% vs. 50.6%) and less likely to have a concordant provider (9.8% and 5.7% vs. 38.5%) (P<.0011). African Americans with a regular provider were about three times more likely to establish a concordant relationship in urban versus nonurban settings (32.4% vs. 12.5%, P<.011), No statistically significant differences in BPS or FCC were found by concordance versus discordance for any group, a finding that held regardless of geographic setting. White children with no regular provider received better BPS than those with a discordant provider (e.g., excellent BPS of 37.2% vs. 27.1%, P<..05), but children with no regular provider were more likely than those with either concordant or discordant providers to have lower FCC in one (Latinos, whites) or three domains (African Americans). Despite racial/ethnic differences in the likelihood of having a concordant regular provider of well-child care, no disparities were found in BPS or FCC associated with discordance, even after stratification by urban/nonurban setting. Lacking a regular provider was associated with lower FCC versus having either a concordant or discordant provider, suggesting that efforts to improve these aspects of well-child care might focus less on linking children with a race/ethnicity concordant provider and more on social, cultural, and linguistic factors that impact having any regular provider.