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Greenberg M.T.,Pennsylvania State University | Dariotis J.K.,Family and Reproductive Health | Gould L.F.,Academy for Educational Development | Rhoades B.L.,Pennsylvania State University
Journal of Abnormal Child Psychology | Year: 2010

Youth in underserved, urban communities are at risk for a range of negative outcomes related to stress, including social-emotional difficulties, behavior problems, and poor academic performance. Mindfulness-based approaches may improve adjustment among chronically stressed and disadvantaged youth by enhancing self-regulatory capacities. This paper reports findings from a pilot randomized controlled trial assessing the feasibility, acceptability, and preliminary outcomes of a school-based mindfulness and yoga intervention. Four urban public schools were randomized to an intervention or wait-list control condition (n∈=∈97 fourth and fifth graders, 60.8% female). It was hypothesized that the 12-week intervention would reduce involuntary stress responses and improve mental health outcomes and social adjustment. Stress responses, depressive symptoms, and peer relations were assessed at baseline and post-intervention. Findings suggest the intervention was attractive to students, teachers, and school administrators and that it had a positive impact on problematic responses to stress including rumination, intrusive thoughts, and emotional arousal. © 2010 Springer Science+Business Media, LLC.

Lutter C.K.,Family and Community Health | Chaparro C.M.,Academy for Educational Development | Grummer-Strawn L.M.,Centers for Disease Control and Prevention
Health Policy and Planning | Year: 2011

Background Breastfeeding has large benefits for mothers and infants. The short-term benefits for child survival and reduced morbidity differ by population subgroup because of differences in underlying risk factors. Although breastfeeding is more common among poor than well-off women, how breastfeeding patterns change between these subgroups is important from a policy perspective as the poor will benefit more from increased duration of breastfeeding.Methods We use nationally representative data from eight countries in Latin America and the Caribbean to document changes in breastfeeding duration between 1986 and 2005, and separate the overall change into the portion attributable to changing population characteristics and the portion resulting from changing breastfeeding behaviour within population subgroups.Results Breastfeeding duration increased in six out of the eight countries and the changes observed are largely explained by changing behaviour within population subgroups rather than changing population characteristics. Changes in breastfeeding duration did not tend to be equitably distributed, but in four countries (Bolivia, Brazil, Colombia and Peru) the population subgroups whose children are most at risk for mortality and increased morbidity from not being breastfed were least likely to show improvements in breastfeeding duration. Between 1986 and 2004 in Peru, breastfeeding duration declined by 0.6 months among rural women while increasing by 9.7 months among urban women; it increased by 6.3 months among women with prenatal care but only by 3.7 months among women with no prenatal care. Changes in breastfeeding in Guatemala and Haiti tended to favour the well-off compared with the poor, though not consistently. In Nicaragua changes in breastfeeding duration tended to favour the less well-off.Discussion While promoting breastfeeding is a must for all women, to maximize its benefits for child survival and health, additional efforts are needed to reach poorly educated and rural women with little access to health care. © 2010 The Author.

Friedman A.L.,Centers for Disease Control and Prevention | Bloodgood B.,Academy for Educational Development
Journal of Women's Health | Year: 2010

Background: Chlamydia is a leading cause of pelvic inflammatory disease (PID), which can lead to ectopic pregnancy, chronic pelvic pain, and infertility. Annual Chlamydia screening is recommended for all sexually active women aged ≤25 years, yet only about 40% of eligible women are screened each year in the United States. To promote Chlamydia screening for the prevention of infertility, the Centers for Disease Control and Prevention (CDC) is developing direct-to-consumer efforts for sexually active young women and key influencers. To inform this effort, CDC sought to explore girls'/women's understandings of sexually transmitted disease (STD) and Chlamydia testing and STD communications and information sources. Methods: Two waves of one-on-one interviews (n=125) were conducted in 10 metropolitan areas with African American, Caucasian, and Latina females, aged 15-25 years. Results: Most participants were not knowledgeable about Chlamydia or its screening; their discussions about it suggested low levels of perceived susceptibility or relevance to Chlamydia and screening. STDs are rarely discussed in home or social settings or with partners or close friends; yet young women may turn to interpersonal sources if concerned about an STD. Providers are the primary and preferred source of STD information for girls and women, although missed opportunities for engaging young women in STD/sexual health discussions were identified in clinical and other settings. Conclusions: Providers, family members, friends, and partners may serve as important intermediaries for reaching young women and encouraging STD/Chlamydia screening. Resources are identified that could be leveraged and/or developed to facilitate such interactions. Copyright © 2010, Mary Ann Liebert, Inc.

Zere E.,Academy for Educational Development | Oluwole D.,Academy for Educational Development | Kirigia J.M.,World Health Organization | Mwikisa C.N.,World Health Organization | Mbeeli T.,Ministry of Health and Social Services
BMC Pregnancy and Childbirth | Year: 2011

Background: The fifth Millennium Development Goal (MDG5) aims at improving maternal health. Globally, the maternal mortality ratio (MMR) declined from 400 to 260 per 100000 live births between 1990 and 2008. During the same period, MMR in sub-Saharan Africa decreased from 870 to 640. The decreased in MMR has been attributed to increase in the proportion of deliveries attended by skilled health personnel. Global improvements maternal health and health service provision indicators mask inequalities both between and within countries. In Namibia, there are significant inequities in births attended by skilled providers that favour those that are economically better off. The objective of this study was to identify the drivers of wealth-related inequalities in child delivery by skilled health providers.Methods: Namibia Demographic and Health Survey data of 2006-07 are analysed for the causes of inequities in skilled birth attendance using a decomposable health concentration index and the framework of the Commission on Social Determinants of Health.Results: About 80.3% of the deliveries were attended by skilled health providers. Skilled birth attendance in the richest quintile is about 70% more than that of the poorest quintile. The rate of skilled attendance among educated women is almost twice that of women with no education. Furthermore, women in urban areas access the services of trained birth attendant 30% more than those in rural areas. Use of skilled birth attendants is over 90% in Erongo, Hardap, Karas and Khomas Regions, while the lowest (about 60-70%) is seen in Kavango, Kunene and Ohangwena. The concentration curve and concentration index show statistically significant wealth-related inequalities in delivery by skilled providers that are to the advantage of women from economically better off households (C = 0.0979; P < 0.001).Delivery by skilled health provider by various maternal and household characteristics was 21 percentage points higher in urban than rural areas; 39 percentage points higher among those in richest wealth quintile than the poorest; 47 percentage points higher among mothers with higher level of education than those with no education; 5 percentage points higher among female headed households than those headed by men; 20 percentage points higher among people with health insurance cover than those without; and 31 percentage points higher in Karas region than Kavango region.Conclusion: Inequalities in wealth and education of the mother are seen to be the main drivers of inequities in the percentage of births attended by skilled health personnel. This clearly implies that addressing inequalities in access to child delivery services should not be confined to the health system and that a concerted multi-sectoral action is needed in line with the principles of the Primary health Care. © 2011 Zere et al; licensee BioMed Central Ltd.

Abroms L.C.,George Washington University | Padmanabhan N.,U.S. National Cancer Institute | Thaweethai L.,George Washington University | Phillips T.,Academy for Educational Development
American Journal of Preventive Medicine | Year: 2011

Background: With the proliferation of smartphones such as the iPhone, mobile phones are being used in novel ways to promote smoking cessation. Purpose: This study set out to examine the content of the 47 iPhone applications (apps) for smoking cessation that were distributed through the online iTunes store, as of June 24, 2009. Methods: Each app was independently coded by two reviewers for its (1) approach to smoking cessation and (2) adherence to the U.S. Public Health Service's 2008 Clinical Practice Guidelines for Treating Tobacco Use and Dependence. Each app was also coded for its (3) frequency of downloads. Results: Apps identified for smoking cessation were found to have low levels of adherence to key guidelines in the index. Few, if any, apps recommended or linked the user to proven treatments such as pharmacotherapy, counseling, and/or a quitline. Conclusions: iPhone apps for smoking cessation rarely adhere to established guidelines for smoking cessation. It is recommended that current apps be revised and future apps be developed around evidence-based practices for smoking cessation. © 2011 American Journal of Preventive Medicine.

Pelletier D.,Cornell University | Corsi A.,Cornell University | Hoey L.,Cornell University | Faillace S.,Academy for Educational Development | Houston R.,John Snow International
Journal of Nutrition | Year: 2011

As evidence from small-scale trials has accumulated concerning the efficacy of low-cost interventions to address undernutrition, the design, implementation, and strengthening of large-scale programs to deliver these interventions has become a high priority. This scaling up process involves a large number of technical, logistical, administrative, political, and social considerations and little research exists on how to address these in a systematic way. This paper introduces the Program Assessment Guide (PAG), a set of analysis and decision tools that seeks to fill this gap, and reports on its application in Kyrgyzstan and Bolivia. The PAG places a special focus on eliciting and systematizing contextual knowledge and experience through a structured, participatory workshop and is grounded in theory, principles, and experience from program planning, management, change management, and intervention planning. When applied in Kyrgyzstan and Bolivia, the PAG was successful in helping workshop participants identify key implementation bottlenecks, questionable assumptions in the program theory, and feasible ways to address some of the shortcomings. These experiences also identified the need for a number of modifications to the PAG related to the workshop design itself, the preparations prior to the workshop, and follow-up after the workshop. The PAG represents one approach for strengthening decisions related to the design and large-scale implementation of interventions. The development and full-scale testing of alternative methods such as these for strengthening program analysis and decision making is an important and intellectually challenging subject for further research. © 2011 American Society for Nutrition.

Sanghvi T.G.,Academy for Educational Development | Wainwright E.,Us Agency For International Development
Food and Nutrition Bulletin | Year: 2010

Background. According to a World Health Organization (WHO) review of nationally representative surveys from 1993 to 2005, 42% of pregnant women have anemia worldwide. Almost 90% of anemic women reside in Africa or Asia. Most countries have policies and programs for prenatal iron-folic acid supplementation, but coverage remains low and little emphasis is placed on this intervention within efforts to strengthen antenatal care services. The evidence of the public health impact of iron-folic acid supplementation and documentation of the potential for scaling up have not been reviewed recently. Objective. The purpose of this review is to examine the evidence regarding the impact on maternal mortality of iron-folic acid supplementation and the evidence for the effectiveness of this intervention in supplementation trials and large-scale programs. Methods. The impact on mortality is reviewed from observational studies that were analyzed for the Global Burden of Disease Analysis in 2004. Reviews of ironfolic acid supplementation trials were analyzed by other researchers and are summarized. Data on anemia reduction from two large-scale national programs are presented, and factors responsible for high coverage with iron-folic acid supplementation are discussed. Results. Iron-deficiency anemia underlies 115,000 maternal deaths per year. In Asia, anemia is the second highest cause of maternal mortality. Even mild and moderate anemia increase the risk of death in pregnant women. Iron-folic acid supplementation of pregnant women increases hemoglobin by 1.17 g/dL in developed countries and 1.13 g/dL in developing countries. The prevalence of maternal anemia can be reduced by one-third to one-half over a decade if action is taken to launch focused, large-scale programs that are based on lessons learned from countries with successful programs, such as Thailand and Nicaragua. Conclusions. Iron-folic acid supplementation is an under-resourced, affordable intervention with substantial potential for contributing to Millennium Development Goal 5 (maternal mortality reduction) in countries where iron intakes among pregnant women are low and anemia prevalence is high. This can be achieved in the near term, as policies are already in place in most countries and iron-folic acid supplements are already in lists of essential drugs. What is needed is to systematically adopt lessons about how to strengthen demand and supply systems from successful programs. © 2010, The United Nations University.

Deressa W.,Addis Ababa Institute of Technology | Fentie G.,Academy for Educational Development | Girma S.,Academy for Educational Development | Reithinger R.,Us Agency For International Development
Tropical Medicine and International Health | Year: 2011

Objective To evaluate the ownership and use of insecticide-treated nets (ITNs) by the local community 2years after a free distribution campaign in Ethiopia. Methods This is a population-based survey using a two-stage cluster sample design in 115 randomly selected clusters in Oromia and Amhara regional states of Ethiopia, performed in June 2009. Data on the possession and use of ITNs were collected using structured and pre-tested questionnaires through house-to-house visits. Bivariate and multivariate logistic regression analyses were performed to examine the effect of participant's malaria knowledge, location and ITN characteristics on the use of ITNs. Results A total of 2874 households participated in the study, and 90.6% of the study population was knowledgeable about ITNs. About 49.1% of households reported at least one ITN; 28.4% owned two or more. ITN coverage was significantly lower in Oromia (34.9%) than in Amhara (76.8%, P<0.001). The average number of ITNs per ITN-owning household was 1.8. In all surveyed households, only 21.8% of all family members, 29.4% of all children under the age of 5years and 23.2% of all pregnant women had slept under an ITN the night preceding the survey. Among ITN-owning households, 63.0% of all children under the age of 5years and 52.1% of pregnant women had slept under an ITN the night before the survey. Using multivariate analysis, factors significantly associated with ITN use were number of ITNs in the household, number of ITNs hung over the bed in the household, women's knowledge of ITNs and women's lack of problem in using ITNs, whereas region, area of residence and ITN status were not. Conclusions Household ITN ownership and use remain below the current Roll Back Malaria targets of universal coverage. A replacement strategy is urgently needed to scale-up coverage and use of ITNs. © 2011 Blackwell Publishing Ltd.

Objective To assess the effect of using stunting versus underweight as the indicator of child under nutrition for determining whether countries in Latin America and the Caribbean are on track to meet the component of Millennium Development Goal (MDG) 1 pertaining to the eradication of hunger, namely to reduce under //nutrition by half between 1990 and 2015. Methods The prevalence of underweight and stunting among children less than 5 years of age was calculated for 13 countries in Latin America and the Caribbean by applying the WHO Child Growth Standards to nationally-representative, publicly available anthropometric data. The predicted trend (based on the trend in previous years) and the target trend (based on MDG 1) for stunting and underweight were estimated using linear regression. Findings The choice of indicator affects the conclusions regarding which countries are on track to reach MDG 1. All countries are on track when underweight is used to assess progress towards the target prevalence, but only 6 of them are on track when stunting is used instead. Another two countries come within 2 percentage points of the target prevalence of stunting. Conclusion Whether countries are determined to be on track to meet the nutritional component of MDG 1 or not depends on the choice of stunting versus underweight as the indicator. Unfortunately, underweight is the indicator officially used to monitor progress towards MDG 1. In Latin America and the Caribbean, the use of underweight for this purpose will fail to take account of the large remaining burden of stunting.

To understand the factors contributing to changes in breastfeeding duration, we analyzed data from seven countries in Latin America and from Haiti to document changes in breastfeeding duration between 1986 and 2005. We used a novel method that permits the overall change to be separated into the portion attributable to changing population characteristics (e.g., greater urban population or increased maternal employment) and the portion resulting from changing breastfeeding behaviors within population subgroups (e.g., more breastfeeding among urban women). Our results indicate that in the low-to-middle-income countries studied, which are experiencing socioeconomic and demographic changes, improvements in breastfeeding duration occurred. These improvements are explained almost entirely by changing breastfeeding behaviors, which were particularly evident in certain subgroups of women, such as those with higher levels of education, and very little by changing population characteristics. The socioeconomic and demographic changes we studied that were previously associated with less breastfeeding no longer appear to have a large negative effect. Our findings show that individual behaviors are amenable to change and that changes in individual behaviors collectively contribute to positive national trends in breastfeeding. © 2010, The United Nations University.

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