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Adolescents and young adults face elevated risks of sexual and interpersonal violence (SIV) compared to adults. Technology has been used to help mitigate this issue by mapping incidents, supporting victims, and promoting behavior change to prevent re-occurrence. However, there is a risk that technology could facilitate abuse. Ensuring technology use is safe and ethical in the context of SIV is critical. This protocol provides a roadmap for a scoping review to synthesize global literature on how technology has been used to address SIV among adolescents and young adults. It aims to identify evidence and strategies for enhancing the safety, privacy, and effectiveness of technologies to prevent and respond to SIV. A scoping review was chosen because the evidence in this field is still emerging and fragmented. This approach allows us to map the breadth of existing research, highlight gaps, and make recommendations on the pathways forward. A search strategy was developed to identify English-language studies published since 2008, the year of the emergence of smartphones in the United States, in databases such as PubMed, EMBASE, Web of Science, and Scopus. We will include qualitative, quantitative, and mixed-methods studies that use technology (e.g., mobile apps, websites) to address SIV among youth. This scoping review protocol was prepared following the Joanna Briggs Institute guidelines and Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P), which will be adhered to during content analysis review process. Covidence, a web-based platform for systematic review management, will be used to manage screening and data extraction. Two independent reviewers will screen and extract data, with disagreements resolved by a third reviewer. The findings of the proposed scoping review have the potential to contribute to improving technology safety, data privacy, and ethical considerations in the context of reporting and tracking SIV, alongside informing future metrics, policies, guidelines, and platform designs, contributing to the creation of more secure and effective tools for SIV reporting and tracking. This protocol has been registered in the Open Science Framework (OSF): https://doi.org/10.17605/OSF.IO/WUNT9.

Although interactive voice response (IVR) is a promising mobile phone survey (MPS) method for public health data collection in low- and middle-income countries (LMICs), participation rates for this method remain lower than traditional methods. This study tested whether using different introductory messages increases the participation rates of IVR surveys in two LMICs, Bangladesh and Uganda. We conducted two randomized, controlled micro-trials using fully-automated random digit dialing to test the impact of (1) the gender of the speaker recording the survey (i.e., survey voice); and (2) the valence of the invitation to participate in the survey (i.e., survey introduction) on response and cooperation rates. Participants indicated their consent by using the keypad of cellphones. Four study arms were compared: (1) male and informational (MI); (2) female and information (FI); (3) male and motivational (MM); and (4) female and motivational (FM). Bangladesh and Uganda had 1705 and 1732 complete surveys, respectively. In both countries, a majority of the respondents were males, young adults (i.e., 18-29-year-olds), urban residents, and had O-level/above education level. In Bangladesh, the contact rate was higher in FI (48.9%), MM (50.0%), and FM (55.2%) groups than in MI (43.0%); the response rate was higher in FI (32.3%) and FM (33.1%) but not in MM (27.2%) and MI (27.1%). Some differences in cooperation and refusal rates were also observed. In Uganda, MM (65.4%) and FM (67.9%) had higher contact rates than MI (60.8%). The response rate was only higher in MI (52.5%) compared to MI (45.9%). Refusal and cooperation rates were similar. In Bangladesh, after pooling by introductions, female arms had higher contact (52.1% vs 46.5%), response (32.7% vs 27.1%), and cooperation (47.8% vs 40.4%) rates than male arms. Pooling by gender showed higher contact (52.3% vs 45.6%) and refusal (22.5% vs 16.3%) rates but lower cooperation rate (40.0% vs 48.2%) in motivational arms than informational arms. In Uganda, pooling intros did not show any difference in survey rates by gender; however, pooling by intros showed higher contact (66.5% vs 61.5%) and response (50.0% vs 45.2%) rates in motivational arms than informational arms. Overall, we found higher survey rates among female voice and motivational introduction arms compared to male voice and informational introduction arm in Bangladesh. However, Uganda had higher rates for motivational intro arms only compared to informational arms. Gender and valence must be considered for successful IVR surveys. Name of the registry: ClinicalTrials.gov. Trial registration number: NCT03772431. Date of registration: 12/11/2018, Retrospectively Registered. URL of trial registry record: https://clinicaltrials.gov/ct2/show/NCT03772431?term=03772431&cond=Non-Communicable+Disease&draw=2&rank=1. Protocol Availability: https://www.researchprotocols.org/2017/5/e81.

India has consistently had one of the highest birth sex ratios (i.e., most males per female) globally. This analysis seeks to describe the sex composition of live births over the past decades among subgroups of the Indian population considering ongoing efforts to mitigate sex selection practices. Distribution of sex from the birth history data from three cross-sectional rounds of India’s National Family Health Survey (2005-06, 2015-16, 2019-21) were used. We describe changes in the sex composition of live births across time through different phases of the PreNatal Diagnostics Technique Act by place of residence, caste, education, and wealth. Multilevel random effects logit regression models were used to estimate odds ratios and adjusted estimates for the different periods. The proportion of male births remained stable across the 1980s and early 1990s for the country overall, followed by a decrease until 2000 and plateauing subsequently. This trend was not uniform, with the Northern region peaking in 2000 before falling to lower levels, while the Southern region peaked in the 80s and trending downward in the 1990s. Spatial analysis and regression models showed a decrease in the proportion of male births during 2004-11 time period in the Northern region compared to 1995-2003 time period with the higher wealth quintiles decreasing the most. The proportion of male births elicited through birth histories in India has trended downward influenced by demographic changes but the decrease was not uniform across regions and sub-groups, possibly influenced by antenatal sex selection practices. Research in context panel Evidence before this study: India is known to consistently have one of the highest sex ratios at birth (SRB) globally, largely driven by sex selection practices. This has been attributed to a variety of behavioral and social factors, including cultural norms around son preference and economic factors due to need for agricultural labor. Added value of this study: This study extends existing literature by using data from the birth history elicited from women across multiple rounds of a cross-sectional national survey. This study leverages multilevel random effects models to assess the change in trends of the sex ratio while adjusting for relevant covariates. Implications of all the available evidence: This analysis of birth trends reveal a decrease in the proportion of male births across the time periods examined, and it provides granular detail regarding the changes in terms of where, when, and within which subgroups, and to what magnitude. This extends findings from prior literature better informing ongoing research and intervention with the hope of achieving greater gender equity in India.

Sex hormones, such as oestrogen and progesterone, affect neurotransmitter signalling molecules like dopamine and serotonin, leading to differences in depression incidence and treatment responses among women and men.9 While these biological sex variations are important, it is limiting to examine health data by only sex, as outcomes may also be influenced by social factors related to gender and gender identity. Gender is defined as a social and cultural construct involving roles, behaviours, identities and expressions that societies associate with being male, female or other gender identities.10 11 It is shaped by socialisation and norms, and expectations and may vary across cultures and historical periods.12 Gender-disaggregated data are crucial because sex assigned at birth does not always match one’s gender identity; it is necessary to specify both sex and gender when seeking to identify inequities.4 Returning to the mental health example, socially reinforced roles associated with masculinity and femininity contribute to distinct mental health challenges among gender binary, non-binary and transgender populations.9 For instance, women may be more prone to mental distress due to the emotional and physical burden of caregiving roles, while men may be less likely to disclose or seek help for psychological distress because of societal expectations tied to masculinity, often leaving their conditions untreated.13 Gender-diverse individuals, including those who identify as non-binary, face an elevated risk of depression, anxiety and related conditions compared with their cisgender and transgender peers because of persistent stigma, discrimination, social exclusion and a lack of access to affirming and competent mental healthcare.14 Political, cultural and technical barriers to collecting gender-diverse data Collecting gender-diverse data (beyond the binary) presents multiple challenges across global contexts. [...]some governments do not recognise non-binary or transgender identities, leading to exclusion from national surveys and official statistics.15 Stigma and discrimination can deter individuals from disclosing their gender identity, especially in environments where such identities are criminalised or heavily stigmatised.15 Additionally, the lack of standardised definitions and indicators for gender diversity hinders data collection.15 Misclassification can occur when data collectors misunderstand the distinction between sex and gender or are reluctant to collect such information. Conclusion Considering the influence of gender on health, we encourage WHO to prioritise the accuracy and reporting of sex and gender data—and disaggregation into multiple categories—for data included in the Health Inequality Data Repository. [...]WHO should encourage countries around the world to collect and disseminate gender data alongside sex-specific data.

The increased subscription and ownership of mobile phones have created opportunities to improve health, education, or economic outcomes, including mobile phone surveys (MPS) to collect health data. Most MPS used cross-sectional survey designs. We explored the potential of MPS to collect panel data using anonymous surveys with agreement in age and gender, and participants’ retention across survey waves in three low- and middle-income countries (LMICs): Bangladesh, Colombia, and Uganda. Using random digit dialing, participants were recruited from 6 age-gender strata (i.e., 18-29-, 30-44-, and 45+-year-old males and females). Three interactive voice response survey waves were sent at two-week intervals. In Wave 1, the number of complete interviews in Bangladesh, Colombia, and Uganda was 2693, 5912, and 4813, respectively. In all waves, the proportion of 18-29-year-olds responding to the surveys was higher than that of 30-44- or 50+-year-olds. Bangladesh (83.7% in Wave 1) and Uganda (70.1% in Wave 1) had a higher proportion of males than females, while it was different in Colombia (45.6% in Wave 1). Regarding the reporting of age and gender in survey waves, we observed a high agreement in all three countries; the Kappa statistic was 0.89 (agreement: 93.7%) from Wave 1 to Wave 2 and 0.90 (agreement: 94.5%) from Wave 1 to Wave 3. In Wave 1, the response and refusal rates were, respectively, 0.26% and 0.19% in Bangladesh; 0.65% and 0.89% in Colombia; and 2.63% and 0.71% in Uganda. From Wave 1 to Wave 2, the attrition rate was 37.2% in Bangladesh, 43.7% in Colombia, and 39.2% in Uganda. From Wave 1 to Wave 3, the attrition rate was 64.2%, 62.8%, and 58.4% in Bangladesh, Colombia, and Uganda, respectively. Despite high attrition across survey waves, the agreement about responses was substantial in all countries and MPS has the potential to be implemented in LMICs. More research is required to improve the retention and increase enrollment in some sociodemographic groups (e.g., older people or women). Future studies could also be benefitted from adding validation questions to ensure the participation by the same respondent.

Background Research that investigates the negative health effects of stigma beyond the individual and interpersonal levels is increasingly using the concept of “structural stigma.” This scoping review investigates how the concept of “structural stigma” has been used and operationalized in health-related literature to date in order to characterize its usage and inform future operationalizations. Methods A systematic search and screening process identified peer-reviewed, English-language research articles that used the term “structural stigma” available prior to January 1, 2024 in five databases (i.e., PubMed, PsycINFO, Embase, Web of Science, CINAHL). Results Of the 298 articles identified, over half (53%) were published from 2021 onward. Articles most commonly were set in the United States ( n  = 163, 55%), investigated stigma toward sexual minority people ( n  = 163, 55%), and cited the introduction of a special issue of Social Science & Medicine as their source of the concept ( n  = 84, 28%). Most articles (64%) used at least one additional conceptual framework, most commonly minority stress theory ( n  = 107, 36%). Quantitative operationalizations ( n  = 102) engaged most in the conceptual domain of laws and government-level policies, while qualitative operationalizations ( n  = 68) engaged most with institutional (i.e., non-government-level) policies, practices, and procedures. Conclusions As the use of “structural stigma” is increasing, operationalizations can better leverage the concept’s breadth and account for individuals’ intersectional lived experiences. This will necessitate bridging across methodologies and bodies of research on related negative social processes.

Extant research has long documented the association between domestic violence and homelessness. Yet, there appear to be few interventions to address the housing needs of survivors of domestic violence, and none on a digital platform. Our primary objective is to determine the feasibility of a full-scale intervention trial of a web-based tool that screens and educates survivors of domestic violence on affordable housing programs in New York City. Our secondary objectives are to assess the perceived usability and acceptability of the tool. The study will take place in a community-based domestic violence center in New York City. Treatment will consist of study participants not using (SC) or using (SC+) the tool, in or outside of private meetings with a case manager to discuss housing and other benefits. The frequency of the meetings will vary depending on the participant's needs. The study will measure changes in housing knowledge, housing self-efficacy, and staff trust through two electronic surveys, administered at times 0 and 2 weeks. Following a historical cohort control group design, we will sequentially recruit participants, starting with SC and followed by SC+. After data collection for SC+ ends, we will invite staff from the partner site to individual, web-based interviews to share their experiences of and recommendations for implementing the tool. Recruitment for the SC arm commenced in March 2022 and was completed in April 2023. After a year, 23 participants completed the study: 75 were screened, 44 were deemed eligible, 35 enrolled, and in the end, 23 participants completed baseline and follow-up surveys. Given the length of time it took to recruit for SC and the limited time overall that we had for the study, the study team decided to follow an expedited recruitment timeline for SC+. Recruitment for SC+ commenced in January 2024 and is anticipated to end by May 2024. Recruitment for the staff interviews will take place in June 2024. We expect to complete the study and be ready to compile the results by the end of June 2024. The protocol describes a feasibility study that can inform future research on housing or digital tools for a similar study population. Data from the study will also be used to inform revisions to the tool. DERR1-10.2196/63162.

Background In Saudi Arabia, the rapid growth of digital media and smartphone use has raised concerns about problematic usage and its impacts on well-being, especially among young people. Research on stakeholder perspectives regarding intervention strategies remains limited. Objective This study aimed to gather insights from societal stakeholders, including youth, parents, policymakers, industry leaders, clinicians, educators, and digital media users, to inform culturally tailored interventions for digital well-being in Saudi Arabia. Methods A purposeful non-random sample of 92 participants representing different stakeholder groups was recruited to complete an online survey, answering questions about their experiences and perspectives on digital media use. Primary stakeholder group was assigned based on participant self-selection. We analyzed distributions of categorical variables related to media use time, reasons for use, impacts, self-regulation strategies, and perceived effectiveness of interventions (e.g., education programs, media campaigns, Internet use restrictions). Results Of the participants, 63.0% were male, and 46.7% were under 25 years old. Regular digital media users, individuals with problematic Internet use, and clinicians/health professionals comprised 26.1%, 18.5%, and 18.5% of respondents, respectively. Extensive screen time was common, with 47.8% reporting four or more hours of recreational digital use on weekdays and 56.6% on weekends. Participants reported both positive impacts (e.g., social connections, school/work performance) and negative impacts (e.g., sleep disruption, reduced physical activity) of digital media use. Efforts to regulate media use were reported by 72.8%, with strategies like deleting apps or digital detoxes. At least 50.0% of participants endorsed all proposed intervention approaches as likely effective for improving digital well-being, with educational programs for parents, school programs, and regulatory apps receiving over 75.0% support. Children and adolescents were seen as key target groups for these interventions. Conclusions Findings from this diverse stakeholder sample suggest that digital well-being interventions in Saudi Arabia should prioritize youth, focusing on education-based approaches and apps for media regulation. Incorporating these perspectives can lead to culturally relevant interventions addressing the unique challenges of digital media use in Saudi Arabia. The generalizability of the findings may be limited due to sample size and potential overrepresentation of certain stakeholder groups.

ObjectivesThis study explores the drug use behaviour in the US general population in the early days of the COVID-19 pandemic with a focus on the relationship between sociopsychological factors, mobility restrictions from March to June 2020 and mental health conditions.DesignA retrospective anonymous online survey representing a cross-section of the US population in 2020.SettingA qualified panel of 500 000 Qualtrics participants stratified by gender, race, age and geographical region to represent the US population.Participants3340 participants voluntarily consented to respond.MeasuresOutcome measure for illicit and non-medical use of prescription drugs based on the National Institute on Drug Abuse-Modified Alcohol, Smoking and Substance Involvement Screening Test Level-2 Substance Use for Adult Questionnaire and predictor measures include self-reports of mobility behaviours, demographics and mental states using psychometrically validated scales.Resultsχ2 tests showed that those who stayed home reported higher odds (p<0.05) of use across all 10 types of drugs. Logistic regression revealed that those with children at home, larger social circles, and pain, depression or trauma had higher odds, but older individuals and women had lower odds (p<0.05) of drug use.ConclusionsMobility restriction was a risk factor for drug use. Demographics and mental health conditions were important covariates, underscoring the need for further research on unintended consequences of infection control policies during national health crises.

Voluntary medical male circumcision (VMMC) is a critical HIV prevention tool. Since 2007, sub-Saharan African countries with the highest prevalence of HIV have been mobilizing resources to make VMMC available. While implementers initially targeted adult men, demand has been highest for boys under age 18. It is important to understand how male adolescents can best be served by quality VMMC services. A systematic literature review was performed to synthesize the evidence on best practices in adolescent health service delivery specific to males in sub-Saharan Africa. PubMed, Scopus, and JSTOR databases were searched for literature published between January 1990 and March 2014. The review revealed a general absence of health services addressing the specific needs of male adolescents, resulting in knowledge gaps that could diminish the benefits of VMMC programming for this population. Articles focused specifically on VMMC contained little information on the adolescent subgroup. The review revealed barriers to and gaps in sexual and reproductive health and VMMC service provision to adolescents, including structural factors, imposed feelings of shame, endorsement of traditional gender roles, negative interactions with providers, violations of privacy, fear of pain associated with the VMMC procedure, and a desire for elements of traditional non-medical circumcision methods to be integrated into medical procedures. Factors linked to effective adolescent-focused services included the engagement of parents and the community, an adolescent-friendly service environment, and VMMC counseling messages sufficiently understood by young males. VMMC presents an opportune time for early involvement of male adolescents in HIV prevention and sexual and reproductive health programming. However, more research is needed to determine how to align VMMC services with the unique needs of this population.