Smoking Behaviors Among Pregnant Women: A Romanian Case Study

Smoking behavior during pregnancy is one of few preventable factors associated with poor health outcomes for both women and children. The post-communist countries in Central and Eastern Europe face many challenges in this realm, as tobacco control efforts have not adequately addressed this behavioral health issue that has arisen since 1989. To better inform these efforts in Romania, this study categorizes the determinants of pregnant women’s prior smoking, current smoking, and current smoke exposure by using both quantitative and qualitative analysis. We find that those living with other smokers, exposed to smoke on a daily basis, and experiencing stress during pregnancy are most at risk for harmful smoking behaviors. We suggest that future efforts involve both structural and service-based changes that are catered towards pregnant women. Structural changes include multi-sector integration for tobacco control, health system coordination and implementation of smoking cessation counseling, and improved monitoring of existing programs. Service-based changes include education programs, community-based efforts, and involving women’s partners in the smoking cessation process

MASS PROBATION: INDIVIDUAL AND COMMUNITY EFFECTS OF SENTENCING SEVERITY ON MENTAL HEALTH INEQUITIES

The impact of incarceration on mental health is well known at individual and community levels. Yet, most studies measure incarceration alone and miss additional exposure to the criminal legal system over time. It remains unknown if probation, a form of criminal legal community supervision, is better for mental health than incarceration. This dissertation investigates the individual and community effects of probation on mental health and inequities in this relationship in the United States. This dissertation uses the National Longitudinal Survey on Youth 1997 (NLSY97), a nationally representative data set of adolescents followed into their mid-thirties (1997-2017), and North Carolina administrative data (2009-2019). Using the NLSY97, we calculated the average number of criminal legal events (e.g., arrests, charges, probation, incarceration) per person per study visit separately by race and juvenile encounters. Restricting to individuals with adult criminal legal encounters, we used parametric g-computation to estimate the impact on mental health of reducing sentencing (e.g., incarceration to probation) at individuals’ first adult criminal legal encounter, overall and by race. With administrative data, we evaluated temporal and geographic correlations of county-level probation and self-inflicted injury and suicide and used repeated cross-section, multivariable spatial error models to assess associations.There were seven arrests, 30 charges, nine probation encounters, and 13 incarceration events /100 NLSY97 participants by age 35. Juvenile sanctions were most common for Black individuals. Among those experiencing juvenile sanctions, Black and White individuals had similar numbers of adult encounters, but Black individuals had more arrests and incarceration stays. Among the 1,886 individuals with an adult encounter, median age at first encounter was 20. Under hypothetical interventions to reduce sentencing, we did not see better mental health overall or when stratified by race. In North Carolina counties, we found positive spatial autocorrelation suggesting spatial determinants of probation, self-inflicted injury, and suicide and that probation was positively associated with self-inflicted injury and suicide. Research on health effects of criminal legal encounters must consider encounters beyond incarceration, life course patterns and their racial inequities, and community-level consequences. By focusing on these factors, it becomes clear that structural changes to the criminal legal system are necessary.Doctor of Philosoph

The Influence of Men's Social Networks and Social Norms on Family Planning in Benin

Objectives: This analysis aims to assess men’s social networks and norms surrounding family planning (FP) and the relation of these factors to couple’s FP intentions.Methods: We examined pre- and post-intervention surveys completed by men in the Tékponon Jikuagou intervention, which worked to engage women and men in FP discussions by catalyzing diffusion of new ideas through women’s and men’s networks.Results: Most men had few network members, talked with few members about FP, and did not discuss FP with their partner(s), yet most believed it was acceptable to discuss FP. Among social factors, FP communication with network contacts had the most significant relationship with FP intentions.Discussion/Conclusion: These findings indicate both a need and opportunity for increased FP related dialogue in these communities.Master of Public Healt

Longitudinal Pre-Exposure Prophylaxis (PrEP) Acceptability, Initiation and Adherence among Criminal Justice-Involved Adults in the USA: The Southern PrEP Cohort Study (SPECS) Protocol

INTRODUCTION: HIV prevalence among criminal justice (CJ)-involved adults is five times higher than the general population. Following incarceration, CJ-involved individuals experience multilevel barriers to HIV prevention. Pre-exposure prophylaxis (PrEP) is a widely available, daily medication efficacious in preventing HIV. Little is known about PrEP knowledge, acceptability, initiation and sustained use among CJ-involved persons or about how these outcomes vary by multilevel factors. The Southern Pre-Exposure Prophylaxis Study (SPECS) will investigate barriers and facilitators for PrEP initiation and sustained use among CJ-involved adults, building a foundation for PrEP interventions for this underserved population. METHODS AND ANALYSIS: SPECS uses a mixed-methods sequential design, including a multisite, prospective cohort study in three southern states-North Carolina, Florida and Kentucky-and subsequent qualitative interviews. HIV-negative adults clinically indicated for PrEP with CJ-involvement in the past year (n=660; 220 per site)-will be recruited for four quantitative interviews separated by 6 months, with 18 months of follow-up. Interviews will measure CJ involvement, substance use, sexual behaviours, PrEP acceptability and use, healthcare access and utilisation, support systems and psychological and emotional well-being. We will estimate probabilities of PrEP acceptability and use in a CJ-involved population using descriptive and multivariable analyses. After the follow-up, a subsample that never initiated PrEP, initiated but did not sustain PrEP or sustained PrEP will be asked to participate in a qualitative interview to contextualise their experiences and decisions around PrEP. An inductive approach will guide qualitative analyses. ETHICS AND DISSEMINATION: PrEP initiation and sustained use rates are unknown among CJ-involved adults. This research will identify individual, social and structural factors that predict PrEP initiation and use. Data generated from the study have the potential to guide research and the development and tailoring of PrEP interventions to CJ-involved populations and provide context to HIV-related outcomes for those with CJ experiences

Overlapping Crises: Climate Disaster Susceptibility and Incarceration

Climate-related disasters are becoming more frequent all over the world; however, there is significant variability in the impact of disasters, including which specific communities are the most vulnerable. The objective of this descriptive study was to examine how climate disaster susceptibility is related to the density of incarceration at the county level in the United States. Percent of the population incarcerated in the 2010 census and the Expected Annual Loss (EAL) from natural hazards were broken into tertiles and mapped bivariately to examine the overlap of areas with high incarceration and susceptibility to climate disasters. Over 13% of counties were in the highest tertile for both incarceration and EAL, with four states containing over 30% of these counties. The density of incarceration and climate disaster susceptibility are overlapping threats that must be addressed concurrently through (1) decarceration, (2) developing standardized guidance on evacuated incarcerated individuals during disasters, and (3) more deeply understanding how the health of everyone in these counties is jeopardized when prisons suffer from climate disasters

Suicides in state prisons in the United States: Highlighting gaps in data

Objectives Our objectives were to document data availability and reporting on suicide mortality in state prison systems. The United States leads the world in mass incarceration, a structural determinant of health, but lacks real-time reporting of prison health statistics. This absence is particularly notable in suicides, a leading cause of death that carceral policies play a key role in mitigating. Methods Suicide data for each state prison system from 2017–2021 were gathered through statistical reports, press releases, and Freedom of Information Act requests. We graded states based on data availability. Results Only sixteen states provide updated, frequent, granular, freely provided suicide data. An additional thirteen states provided frequently updated data but that had little granularity, was incomplete, or was not freely provided. Eight states provided sparse, infrequent, or outdated data, and thirteen provided no data at all. Conclusions The 2000 Death in Custody Reporting Act requires that states provide these data freely, yet the majority of states do not. There is a need for reliable, real-time data on suicides, suicide attempts, and conditions of confinement to better understand the harms of the carceral system and to advocate for change

Carceral epidemiology: mass incarceration and structural racism during the COVID-19 pandemic

The COVID-19 pandemic and the ongoing epidemic of mass incarceration are closely intertwined, as COVID-19 entered US prisons and jails at astounding rates. Although observers warned of the swiftness with which COVID-19 could devastate people who are held and work in prisons and jails, their warnings were not heeded quickly enough. Incarcerated populations were deprioritised, and COVID-19 infected and killed those in jails and prisons at rates that outpaced the rates among the general population. The COVID-19 pandemic highlighted what has been long-known: mass incarceration is a key component of structural racism that creates and exacerbates health inequities. It is imperative that the public health, particularly epidemiology, public policy, advocacy, and medical communities, are catalysed by the COVID-19 pandemic to drastically rethink the USA's criminal legal system and the public health emergency that it has created and to push for progressive reform

Incarcerated workers: overlooked as essential workers

Objective To use the example of COVID-19 vaccine prioritization for incarcerated workers to call attention to the need to prioritize incarcerated workers’ health. Methods From November to December 2020, we searched publicly available information (e.g. Department Of Corrections websites and press releases) for 53 US prison systems, including all states, Immigration and Customs Enforcement, the Federal Bureau of Prisons, and Puerto Rico. Coders reviewed if states had prison labor policies, if states had COVID-19 specific prison labor policies, the location of work, industries both pre- and during the COVID-19 pandemic, the scope of work, and hourly wage. Findings were compared to the Centers for Disease Control and Prevention’s occupational vaccine prioritization recommendations. Results Every facility has incarcerated individuals working in some capacity with some resuming prison labor operations to pre-pandemic levels. All but one prison system has off-site work locations for their incarcerated population and many incarcerated workers have resumed their off-site work release assignments. Additionally, every state has incarcerated workers whose job assignments are considered frontline essential workers (e.g. firefighters). In at least five states, incarcerated workers are participating in frontline health roles that put them at higher risk of acquiring COVID-19. Yet, no state followed the Centers for Disease Control and Prevention recommended vaccination plan for its incarcerated population given their incarcerated workers’ essential worker status. Conclusion The Centers for Disease Control and Prevention recommended that incarcerated people be prioritized for vaccination primarily due to the risk present in congregate style prison and jail facilities. Furthermore, our review found that many incarcerated people perform labor that should be considered “essential”, which provides another reason why they should have been among the first in line for COVID-19 vaccine allocation. These findings also highlight the need for incarcerated workers’ health to be prioritized beyond COVID-19

Maternal depression in rural Pakistan: the protective associations with cultural postpartum practices

Background Traditional postpartum practices are intended to provide care to mothers, but there is mixed evidence concerning their impact on postpartum depression (PPD). It remains unknown if there is a unique impact of postpartum practices on PPD separately from other types of social support, or if practices differentially affect those with existing prenatal depression. In Pakistan, chilla (چله) is a traditional postpartum practice in which women receive relief from household work, additional familial support, and supplemental food for up to 40 days postpartum. This study aims to understand if chilla protects against PPD independent of other support and whether this relationship varies by prenatal depression status. Methods Data come from the Bachpan cohort study in rural Pakistan. Chilla participation and social support (Multidimensional Scale of Perceived Social Support) were assessed at 3 months postpartum. Women were assessed for major depressive episodes (MDE) with the Structured Clinical Interview, DSM-IV and for depression symptom severity with the Patient Health Questionnaire (PHQ-9) in their third trimester and at 6 months postpartum. Adjusted linear mixed models were used to assess the relationship between chilla participation and PPD. Results Eighty-nine percent of women (N = 786) participated in chilla and almost 70% of those that participated took part in all of chilla’s aspects. In adjusted models, chilla participation was inversely related to MDE (OR = 0.56;95%CI = 0.31,1.03) and symptom severity (Mean Difference (MD) = − 1.54;95%CI: − 2.94,-0.14). Chilla participation was associated with lower odds of MDE (OR = 0.44;95%CI = 0.20,0.97) among those not prenatally depressed and with lower symptom severity among those prenatally depressed (MD = -2.05;95%CI:-3.81,-0.49). Conclusions Chilla is inversely associated with both MDE and symptom severity at 6 months postpartum above and beyond social support. Specifically, chilla is inversely associated with MDE among those not prenatally depressed and with lower symptom severity among those prenatally depressed. This relationship signals an opportunity for interventions aimed at preventing and treating PPD in this region to draw upon chilla and similar traditional postpartum practices in creating community-based, low-cost, sustainable interventions for maternal mental health

Collateral consequences of COVID-19 for people on probation and parole

BACKGROUND: While the severe detrimental impact of COVID-19 on incarcerated people is well known, little is known about the experience of COVID-19 on those on community supervision. Our objective was to better understand the experience of the COVID-19 pandemic and its collateral consequences for those on community supervision (e.g., probation, parole). Beginning in December 2020, we conducted 185 phone surveys about COVID-19 with participants in The Southern Pre-Exposure Prophylaxis (PrEP) Study across its three sites - Florida, Kentucky, and North Carolina. We conducted rapid assessment interviews with both closed- and open-ended questions. We calculated descriptive statistics for close-ended questions and conducted a content analysis for open-ended questions. RESULTS: The COVID-19 pandemic affected those on community supervision through their experiences in the community and while incarcerated with over one-quarter of participants being reincarcerated during this time. In addition to many (128/185) experiencing COVID-19 symptoms, about half (85/185) of participants reported a diagnosis in their network with 16 of those participants losing loved ones to the pandemic. Participants experienced disruptions to their social network, healthcare, and livelihoods. Though many maintained their support systems, others felt isolated and depressed. Experiences during COVID-19 exacerbated difficulties already faced by those with criminal involvement. CONCLUSIONS: The public health community must recognize those experiencing probation and parole, not only those housed in carceral facilities, as disproportionately impacted by the COVID-19 pandemic. We must tailor programs and services to meet their needs