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This study examined the hypothesis that HIV-related stigma mediates the effect of alcohol use on health-related quality of life (HRQoL) among alcohol consuming Indian men living with HIV (PLWH). The study used baseline data from a randomized controlled clinical trial entitled ‘Alcohol and ART adherence: Assessment, Intervention, and Modeling in India. Participants completed surveys assessing demographic characteristics, alcohol use, HIV-related stigma, HRQoL. Mediation analysis was conducted to establish the mediation effect of HIV-related stigma on the relationship between alcohol use and HRQoL. The final mediation model showed that the effect of alcohol use on HRQoL were partially mediated by overall HIV-related stigma. Specially, 27.1% of the effects of alcohol use on HRQoL was mediated through overall HIV stigma. In the HIV stigma subdomain analyses, negative self-image mediated 14% and concerns with public attitudes (anticipated stigma) mediated 17.3% of the effect of alcohol use on HRQoL respectively. The findings suggest that efforts to reduce the negative impact of alcohol use on HRQoL and improve HRQoL among PLWH should include interventions addressing both alcohol use and specific forms of HIV-related stigma.

Globally, the pursuit of exclusive breastfeeding (EBF) remains a formidable challenge. The surge in popularity of mobile health interventions demonstrates its potential as a promising avenue for promoting breastfeeding practices. Nevertheless, research investigating breastfeeding monitoring interventions via mobile health remains scarce among diverse populations. This study aimed to use an app called Breastfeeding Aiding Tool to monitor breastfeeding and provide tailored feedback to improve EBF, maternal breastfeeding self-efficacy, and depression status. In an unblinded randomized controlled trial, the intervention leveraged the app to monitor breastfeeding practices recorded by users and to provide automatic feedback, facilitating non-face-to-face education and consultation in a WeChat group by 3 health care workers. Mothers in the control group received the same education and consultation services via the WeChat group. Lactating mothers and their healthy primiparous infants aged 35 to 49 days were recruited from 2 clinics, and the online follow-up period was 2 months. Information about breastfeeding practices, maternal breastfeeding confidence, and maternal depression status were collected through SoJump. From September 2022 to January 2024, a total of 141 eligible mother-infant dyads were recruited offline and allocated to the two groups; 109 (n=55, 50.5% in the intervention group and n=54, 49.5% in the control group) dyads completed the 2-month online follow-up and were included in the analysis, among which 27 (49%) mothers actively engaged with the app. In the per-protocol analysis sample, the rate of EBF of the app-using group was 57% (16/28), compared to 48% (39/81) in the comparison group (P=.41; odds ratio [OR] 1.44, 95% CI 0.60-3.41; adjusted OR 1.66, 95% CI 0.59-4.68). The rate of full breastfeeding (comprising predominant breastfeeding and EBF) was significantly higher in the mothers using the app than in the nonusers (26/28, 93% vs 59/81, 73%; P=.03; OR 4.85, 95% CI 1.06-22.15; adjusted OR 5.55, 95% CI 1.07-28.83). Maternal breastfeeding self-efficacy in the app-using group improved by an average of 1.36 (95% CI -3.79 to 1.50), while it declined slightly, by 0.16 (95% CI -3.16 to 2.84), in the nonusing group; the difference between the 2 groups was not significant (P=.61). The depression scores in the app-using group decreased by an average of 2.29 (95% CI -5.19 to 0.62), whereas they increased by 1.07 (95% CI -0.58 to 2.73) in the nonusing group; there was a significant difference between the two groups (P=.046). Our findings underscore the significant potential of the Breastfeeding Aiding Tool app as an aid to breastfeeding guidance in sustaining breastfeeding practices, reducing formula use, and enhancing positive maternal breastfeeding emotions. To further validate the effectiveness of improving EBF and self-efficacy, studies should aim to address barriers to the app's acceptability and enroll a larger cohort of mothers. Chinese Clinical Trial Registry ChiCTR2200065220; https://www.chictr.org.cn/showprojEN.html?proj=182939.

This paper discusses patterns of daily smokeless tobacco (SLT) use and correlates of poly SLT use among married women aged 18-40 years in a Mumbai slum community with implications for tobacco control. Using a mixed methods approach, the study included a structured survey with 409 daily SLT users and in-depth interviews with 42 women. Participants for the survey were selected using a systematic sampling procedure (one woman in every fourth eligible household). Univariate and bivariate analysis, and multiple logistic regressions were conducted to identify demographic and social factors associated with women's use of poly SLT products. To illustrate survey results, in-depth interviews were analyzed using Atlas ti software. Sixty-four percent of the women surveyed used only one type of SLT; of these, 30% used mishri, 32% used pan with tobacco and the rest used chewed tobacco (11%), gul (17%) or gutkha (10%). Thirty-six percent used more than one type of SLT. Poly SLT users chewed or rubbed 50% more tobacco as compared to single users (mean consumption of tobacco per day: 9.54 vs. 6.49 grams; p<0.001). Women were more likely to be poly SLT users if they were illiterate as compared to literate (adjusted odds ratio [AOR]=1.67; 95% confidence interval [CI]=1.07-2.71), if they had lived in Mumbai for 10 years or more, versus less than ten years (AOR=1.67, 95% CI=1.03-2.71); and if their husband was a poly SLT user as compared to a non SLT user (AOR=2.78, 95% CI=1.63-4.76). No differences were noted between pregnant and non-pregnant women in SLT consumption patterns. Tobacco control policies and programs must focus specifically on both social context and use patterns to address SLT use among women of reproductive age with special attention to poly SLT users, an understudied and vulnerable population.

Background Quality of life outcomes have been used frequently in clinical trials of oral health interventions. This study assessed the effects of a randomized trial on oral health related quality of life comparing an individual-based oral hygiene intervention to a community-based intervention. Methods Participants were recruited from six low-income senior housing residences. Buildings were randomly assigned to receive the individual-based intervention followed by the community-based intervention or to receive the community-based intervention followed by the individual intervention. Participants’ oral hygiene was assessed at baseline (T0), one month after the first intervention (T1) and one month after the second intervention (T2) and six months after the T2 assessment (T3). Oral hygiene was measured by the Gingival Index (GI) and Plaque scores (PS). Surveys collected data on beliefs, attitudes, behaviors and self-reported health status at T0, T1 and T2. Only oral hygiene and quality of life, measured by the General Oral Health Assessment Index (GOHAI), was assessed at all time points. general linear mixed models (GLMM) were used to assess changes in GOHAI over time, the interaction of condition by time and the contribution of psychosocial, behavioral, health status and background variables to changes in GOHAI. Results 331 people completed T0 assessments; 306 completed T1; 285 completed T2 and 268 completed T3. Scores on GOHAI at T0 ranged from 10 to 48 with a mean of 39.7 (sd = 7.8) and a median of 42. At T1, mean GOHAI was 40.7 (sd = 8.2), at T2 mean GOHAI was 41.1 (sd = 7.8) and at T3, GOHAI was 42.3 (sd = 8.2). GLMM showed that GOHAI improved significantly from T0 to T3 ( p  = 0.01) but the time by intervention interaction was not significant indicating that both interventions were effective in improving GOHAI but one intervention was not better than the other. Ethnicity, health status, worries, self-efficacy, number of missing teeth and symptoms of dry mouth were related to improvements in GOHAI. Neither GI nor PS were related to GOHAI. Conclusions The participants reported relatively good oral health related quality of life which improved significantly over time. Improvement occurred among all participants regardless of condition, suggesting that either intervention would be effective in future studies. Trial Registry : Clinicaltrials.gov, Clinical Trials ID #NCT02419144; Title: A Bi-level Intervention to Improve Older Adult Oral Health Status; Registered 04/07/2015 URL: https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S0005H9X&selectaction=Edit&uid=U0000KBK&ts=2&cx=-rajj5q

Community Science is an experiment. The premise is that centering on a broad range of disciplinary, and interdisciplinary, science called for, created, and conducted by teams of place‐based community residents and professional scientists will positively push the boundaries of what we understand as science, from discoveries to solutions. In this pursuit, we define science broadly: natural science, both physical and living; social science; health science; and ingrained ways of knowing that have been emerging and evolving since time immemorial within Indigenous cultures. Community is similarly a term that signifies a wide range of publics engaged in a myriad of ways; from those who may engage in only a single activity, to those who are formative to the work, including those who span the boundaries between the worlds describing community and science. Just as we seek those on the creative edge as authors, we depend on those with deep experience in both the scientific discipline and the community, whatever form it may take, to serve as peer reviewers. Part of our publication experiment is to step back and ask the questions: who are “peers?” Can we expand the approachability and usefulness of published work beyond traditional scientific professionalism and disciplinary boundaries through thoughtful selection of reviewers who are more, and perhaps different, than the degree‐credentialed professionals journal editors have traditionally turned to? And will these peers and near‐peers have the ability to set aside time from their own work to bring community science to the forefront and participate in patient, positive, thoughtful reviews? Key Points The editors thank the 2024 peer reviewers

A chronic Kidney Disease of unknown etiology (CKDu) has emerged with disproportionately high prevalence across dry lowland agricultural communities globally. Here we present the results of a prospective cohort of 293 patients with CKDu in the endemic region of Wilgamuwa, Sri Lanka, in whom we measured baseline kidney function and undertook quarterly follow up over 2 years. Well water was the primary historic drinking water source in the region, although a majority (68%) of participants reported switching to reverse osmosis water during study follow ups. Participants who reported ever drinking from well water had estimated glomerular filtration rates −6.7 (SD: 2.8) ml/min/1.73 m 2 lower than participants who did not drink from well water historically ( p  = 0.0184) during the study period. Geospatial analysis identifies a cluster within the region where CKDu progression is significantly higher than the surrounding area. Samples of household wells ( n  = 262) indicated 68% had detectable agrochemical compounds with concentration above global water quality standards. It is expected that the detected contaminants compounds are indicators of poor water quality and that there is likely additional agrochemical exposure including commercial additives that may contribute to CKDu onset and/or progression. Thus, our study finds that well water exposure during a person’s lifetime in this region is associated with kidney function decline and identifies and quantifies putative nephrotoxic agrochemicals above safe drinking water concentrations in these wells.