The Effects of Childhood Social Support and Family Resiliency on Mental Health in Adulthood

The effect of social support on the overall health and quality of life in adulthood has been well documented particularly in chronic disease populations. Very few studies examined the relationships between childhood social support, family resiliency and mental health in adulthood in the community and among disadvantaged minority populations. We examined the role of social support and family resilience during childhood on subsequent mental health-related quality of life (HRQoL) in adulthood among racial/ethnic minorities. A needs assessment survey which was designed to explore health determinants and quality of life indicators using a community-based participatory research (CBPR) approach in a low-income community in Tampa was analyzed. Participants were predominantly low-income non-Hispanic black and Hispanic population (n=187). The outcome mental HRQoL was measured using the validated Centers for Disease Control and Prevention’s (CDC) “Healthy Days Measure” instrument. We utilized sequential multivariable logistic regression models to examine the independent effects of childhood social support and family resiliency on mental HRQoL in adulthood. Approximately 12.3% of study participants reported poor mental HRQoL (i.e. ≥14 unhealthy days due to mental health). Childhood social support and family resiliency were significant predictors of mental HRQoL in adulthood, after controlling for sociodemographic characteristics. Sleep and composite health issues in adulthood were also associated with mental HRQoL. Our analyses highlight an opportunity to promote mental health through support of interventions that improve positive family relationships and reduce the burden of chronic health issues among non-Hispanic black and Hispanic children

The Effects of Maternal Folate on Fetal Brain and Body Size among Smoking Mothers

The adverse effects of maternal smoking on infant mortality and morbidity has been well documented in the literature. Maternal tobacco use is causally associated with fetal growth restriction and correlates negatively with folate intake and metabolism. Studies have examined the association between smoking and folate levels during pregnancy, but very few have assessed this relationship using objective and accurate measures of both variables. Furthermore, despite evidence of a causal association between smoking in pregnancy and intrauterine growth restriction, and a plausible relationship between tobacco use and low maternal folate which is required for optimal fetal growth, no experimental study has investigated the potential benefit of folic acid in mitigating the adverse effects of maternal smoking on fetal outcomes. The objectives of this study were to investigate the relationship between maternal smoking and folate levels and examine the efficacy of higher-strength folic acid supplementation, in combination with enrollment in a smoking cessation program, in promoting fetal body and brain growth. Our hypothesis was that women who smoke during pregnancy have lower peri-conceptional folic acid reserves than non-smoker pregnant women and that folic acid reserves will decrease with increasing cotinine level. Additionally, smoker pregnant women on higher-strength folic acid (4mg daily) in combination with smoking cessation programs will experience faster fetal brain growth and have infants with larger body size at birth compared to smokers on the standard dose of folic acid (0.8mg daily). Participants were pregnant women (smokers and non-smokers) who received antenatal care between 2010-2014 at the Genesis Clinic of Tampa, a community health center affiliated with the Department of Obstetrics and Gynecology of the University of South Florida (USF). They were aged 18-44 years and had a gestational age of less than 21 weeks at study enrollment. To determine the peri-conceptional folic acid reserves in smoking versus nonsmoking women during pregnancy and associated sociodemographic factors, baseline (crosssectional) data from a double-blinded randomized controlled trial were analyzed using Tobit regression models (n=496). Smoking information was assessed using salivary cotinine, a sensitive and specific tobacco use biomarker. Folate reserve was measured using red blood cell folate. To investigate the efficacy of higher-strength folic acid on fetal body and brain size, baseline and follow-up data from pregnant smokers enrolled in the randomized controlled trial were utilized (n=345). All primary analyses of the clinical trial data were conducted on a modified intention-to-treat basis and included participants who completed the trial with an observed endpoint, irrespective of compliance to protocol. Multilevel modeling, linear regression, and log-binomial regression analyses were conducted. A significant inverse association between salivary cotinine level and periconceptional red blood cell folate concentration was found among pregnant women in the early to midpregnancy period. Smokers on high-dose folate during pregnancy had infants with a 140.38g higher birth weight than infants of their counterparts on standard dose folate (P =0.047). Mothers who received higher strength folate had a 31.0% lower risk of having babies with SGA compared to their mothers on the standard-dose (adjusted relative risk-ARR=0.69, 95% CI: 0.46–1.03; (P =0.073)). High-dose folate had no significant effect on the intrauterine rate of growth in head circumference, and head circumference and brain weight at birth in our trial sample. However, the brain-body ratio of infants of mothers who received high-dose treatment was 0.33 percentage-point lower than that for infants of mothers who received the standard dose of folate (P =0.044). Higher strength folic acid supplementation in pregnant women who smoke might be a cost-effective and safe option to improve birth outcomes and reduce low birth weight and SGA associated infant morbidity and mortality. Future studies with larger sample sizes and diverse populations are indicated to confirm or refute the results of this study. Randomized controlled trials starting during the preconception period and with follow-up until delivery are warranted, to identify the most folate-sensitive period of fetal growth and determine the optimal dose of folic acid supplement. Further research investigating several pathways through which the effects of prenatal smoking on adverse birth outcomes can be mitigated is needed

Factors Associated with Married Women’s Support of Male Circumcision for HIV Prevention in Uganda: A Population Based Cross–Sectional Study

Background: Despite the protective effect of male circumcision (MC) against HIV in men, the acceptance of voluntary MC in priority countries for MC scale – up such as Uganda remains limited. This study examined the role of women’s sociodemographic characteristics, knowledge of HIV and sexual bargaining power as determinants of women’s support of male circumcision (MC). Methods: Data from the Uganda AIDS Indicator Survey, 2011 were analyzed (n = 4,874). Bivariate and multivariate logistic regression analyses with random intercept were conducted to identify factors that influence women ’ ssupport of MC. Results: Overall, 67.0 % (n = 3,276) of the women in our sample were in support of MC but only 28.0 % had circumcised partners. Women who had the knowledge that circumcision reduces HIV risk were about 6 times as likely to support MC than women who lacked that knowledge [AOR (adjusted odds ratio) = 5.85, 95 % CI (confidence interval) = 4.83 – 7.10]. The two indicators of women’s sexual bargaining power (i.e., ability to negotiate condom use and ability to refuse sex) were also positively associated with support of MC. Several sociodemographic factors particularly wealth index were also positively associated with women’s support of MC. Conclusions: The findings in this study will potentially inform intervention strategies to enhance uptake of male circumcision as a strategy to reduce HIV transmission in Uganda

Trends in reproductive health indicators in Nigeria using demographic and health surveys (1990–2013)

There is an urgent need to improve reproductive health (RH) in Nigeria – the most populous country in Africa. In 2015, Nigeria had the highest number of maternal deaths in the world. This study assessed the trends in select RH indicators in Nigeria over two decades. Data used were from Nigeria Demographic and Health Surveys (NDHS) conducted between 1990 and 2013. The NDHS uses a two-stage cluster sampling design to select nationally representative samples of reproductive-age women. The study sample ranged from 7620 to 38,948 women aged 15–49 across the five surveys. Trends in modern contraceptive prevalence rate, skilled antenatal care, skilled birth attendance, and adolescent birth were assessed. The results show increasing trends in modern contraceptive prevalence rate from 4% in 1990 to 11% in 2013 (p < .001); in skilled antenatal care from 57% in 1990 to 61% in 2013 (p < .001); and in skilled birth attendance from 31% in 1990 to 40% in 2013 (p < .001). The trend in adolescent birth decreased from 24% in 1990 to 17% in 2013 (p < .001). Marked disparities exist as rural, poor, and less educated women bear the greatest burden. Interventions should target the at-risk populations to improve their access and use of RH services