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Despite the benefits of childhood vaccinations, vaccination rates in low-income countries (LICs) vary widely. Increasing coverage of vaccines to 90% in the poorest countries over the next 10 years has been estimated to prevent 426 million cases of illness and avert nearly 6.4 million childhood deaths worldwide. Consequently, we sought to provide a comprehensive examination of contemporary vaccination patterns in East Africa and to identify common and country-specific barriers to complete childhood vaccination. Using data from the Demographic and Health Surveys (DHS) for Burundi, Ethiopia, Kenya, Rwanda, Tanzania, and Uganda, we looked at the prevalence of complete vaccination for polio, measles, Bacillus Calmette-Guérin (BCG) and DTwPHibHep (DTP) as recommended by the WHO among children ages 12 to 23 months. We conducted multivariable logistic regression within each country to estimate associations between complete vaccination status and health care access and sociodemographic variables using backwards stepwise regression. Vaccination varied significantly by country. In all countries, the majority of children received at least one dose of a WHO recommended vaccine; however, in Ethiopia, Tanzania, and Uganda less than 50% of children received a complete schedule of recommended vaccines. Being delivered in a public or private institution compared with being delivered at home was associated with increased odds of complete vaccination status. Sociodemographic covariates were not consistently associated with complete vaccination status across countries. Although no consistent set of predictors accounted for complete vaccination status, we observed differences based on region and the location of delivery. These differences point to the need to examine the historical, political, and economic context of each country in order to maximize vaccination coverage. Vaccination against these childhood diseases is a critical step towards reaching the Millennium Development Goal of reducing under-five mortality by two-thirds by 2015 and thus should be a global priority.

To measure HPV vaccine acceptance among unvaccinated adolescent males and parents and correlate acceptance with knowledge, awareness, and personal experience. Adolescent males ages 11–21 years old and their parents completed questionnaires measuring attitudes and knowledge about HPV vaccination and personal experience. Acceptance was defined as wanting the vaccine and conditional acceptance as wanting the vaccine if it would protect against genital warts or cervical cancer. Adolescent (n=154) and parent (n=121) vaccine acceptance was low (16% and 34%, respectively); however, conditional acceptance was higher. While adolescents had similar conditional acceptance for a vaccine against genital warts and cervical cancer, parents reported higher conditional acceptance for protection against genital warts. Independent predictors of acceptance included personal experience and demographic variables. HPV vaccine acceptance among adolescents and parents was low. Conditional acceptance levels highlight the importance of education about a few important benefits of HPV vaccination, which may increase vaccination rates.

Rates of STIs, HIV, and pregnancy remain high among adolescents in the US, and recent approaches to reducing sexual risk have shown limited success. Future expectations, or the extent to which one expects an event to actually occur, may influence sexual risk behavior. This prospective study uses longitudinal data from the National Longitudinal Survey of Youth 1997 (n = 3,205 adolescents; 49.8 % female) to examine the impact of previously derived latent classes of future expectations on sexual risk behavior. Cox regression and latent growth models were used to determine the effect of future expectations on age at first biological child, number of sexual partners, and inconsistent contraception use. The results indicate that classes of future expectations were uniquely associated with each outcome. The latent class reporting expectations of drinking and being arrested was consistently associated with the greatest risks of engaging in sexual risk behavior compared with the referent class, which reported expectations of attending school and little engagement in delinquent behaviors. The class reporting expectations of attending school and drinking was associated with having greater numbers of sexual partners and inconsistent contraception use but not with age at first biological child. The third class, defined by expectations of victimization, was not associated with any outcome in adjusted models, despite being associated with being younger at the birth of their first child in the unadjusted analysis. Gender moderated specific associations between latent classes and sexual risk outcomes. Future expectations, conceptualized as a multidimensional construct, may have a unique ability to explain sexual risk behaviors over time. Future strategies should target multiple expectations and use multiple levels of influence to improve individual future expectations prior to high school and throughout the adolescent period.

Objectives Young parents may be particularly vulnerable to poor mental health during the postpartum period. Little research exists, however, to adequately describe trajectories of depressive symptoms during their transition to parenthood, particularly among young fathers. Therefore, we aim to explore trajectories of depressive symptoms from pregnancy through 1 year postpartum among young expectant mothers and their partners. Methods Data are derived from a longitudinal cohort of pregnant adolescent females (ages 14–21; n = 220) and their male partners (n = 190). Multilevel regression models examined the impact of time on depressive symptoms, and generalized linear regression models examined predictors of experiencing elevated depressive symptoms. Results Depressive symptoms significantly decreased from pregnancy through 1 year postpartum among young females. Overall, depressive symptoms did not significantly change over time among young males. Predictors of elevated depressive symptoms common across genders included social support and relationship satisfaction. Marijuana use resulted in almost twice the odds of experiencing elevated depressive symptoms among young fathers (OR 1.82; 95 % CI 1.04, 3.20). Conclusion for Practice Providing strategies for strengthening social support networks among young parents may be an effective way to improve mental health among young parents, particularly during this period of potential social isolation. Additionally, providing tools to strengthen relationships between partners may also be effective for both young mothers and fathers. Substance use may be a marker for depressive symptoms among young fathers and thus screening for substance use could be important to improving their mental health. Future research is needed to better understand how IPV affects mental health, particularly among young fathers.

To conduct a cross-national comparative study of the prevalence and correlates of female genital cutting (FGC) practices and beliefs in western Africa. Data from women who responded to the Multiple Indicator Cluster Surveys between 2005 and 2007 were used to estimate the frequencies of ever having been circumcised, having had a daughter circumcised, and believing that FGC practices should continue. Weighted logistic regression using data for each country was performed to determine the independent correlates of each outcome. The prevalence of FGC was high overall but varied substantially across countries in western Africa. In Sierra Leone, Gambia, Burkina Faso and Mauritania, the prevalence of FGC was 94%, 79%, 74% and 72%, respectively, whereas in Ghana, Niger and Togo prevalence was less than 6%. Older age and being Muslim were generally associated with increased odds of FGC, and higher education was associated with lower odds of FGC. The association between FGC and wealth varied considerably. Burkina Faso was the only country in our study that experienced a dramatic reduction in FGC prevalence from women (74%) to their daughters (25%); only 14.2% of the women surveyed in that country said that they believe the practice should continue. The prevalence of FGC in western Africa remains high overall but varies substantially across countries. Given the broad range of experiences, successful strategies from countries where FGC is declining may provide useful examples for high-prevalence countries seeking to reduce their own FGC practices.

Objective To examine patterns of conflict-related violence and intimate partner violence (IPV) and their associations with emotional distress among Congolese refugee women living in Rwanda. Design Cross-sectional study. Setting Two Congolese refugee camps in Rwanda. Participants 548 ever-married Congolese refugee women of reproductive age (15–49 years) residing in Rwanda. Primary outcome measure Our primary outcome was emotional distress as measured using the Self-Report Questionnaire-20 (SRQ-20). For analysis, we considered participants with scores greater than 10 to be experiencing emotional distress and participants with scores of 10 or less not to be experiencing emotional distress. Results Almost half of women (49%) reported experiencing physical, emotional or sexual violence during the conflict, and less than 10% of women reported experiencing of any type of violence after fleeing the conflict. Lifetime IPV was reported by approximately 22% of women. Latent class analysis derived four distinct classes of violence experiences, including the Low All Violence class, the High Violence During Conflict class, the High IPV class and the High Violence During and After Conflict class. In multivariate regression models, latent class was strongly associated with emotional distress. Compared with women in the Low All Violence class, women in the High Violence During and After Conflict class and women in the High Violence During Conflict had 2.7 times (95% CI 1.11 to 6.74) and 2.3 times (95% CI 1.30 to 4.07) the odds of experiencing emotional distress in the past 4 weeks, respectively. Furthermore, women in the High IPV class had a 4.7 times (95% CI 2.53 to 8.59) greater odds of experiencing emotional distress compared with women in the Low All Violence class. Conclusions Experiences of IPV do not consistently correlate with experiences of conflict-related violence, and women who experience high levels of IPV may have the greatest likelihood for poor mental health in conflict-affected settings.

IntroductionFew studies have investigated how intimate partner violence (IPV), and patterns of IPV experiences, may impact children’s school attendance in low- and middle-income countries.MethodsUsing baseline data from a sub-sample of 659 women in Mexico City enrolled in a randomized controlled trial who reported having a child under age 18 and in school, multilevel latent class analysis (LCA) was used to classify women based on their reported IPV experiences. Multilevel risk regression analyses examined associations between latent class membership and IPV-related disruptions in children’s schooling. Latent classes were identified in a prior study.ResultsOverall, 23.3% of women reported their child’s school attendance was disrupted due to IPV. LCA identified four distinct classes of IPV experiences: Low Physical and Sexual Violence (39.1%); Low Physical and High Sexual Violence class (14.8%), High Physical and Low Sexual Violence and Injuries (36.5%); and High Physical and Sexual Violence and Injuries (9.6%). Compared with women in the Low Physical and Sexual Violence class, women in the High Physical and Sexual Violence and Injuries class and women in the High Physical and Low Sexual Violence and Injuries class were at greater risk of IPV disrupting children’s school attendance (ARR 3.39, 95% CI 2.34, 4.92; ARR 2.22, 95% CI 1.54, 3.19, respectively). No other statistically significant associations emerged.DiscussionHigh disruptions in children’s school attendance due to IPV were reported and were differentially related to patterns of IPV experiences. Findings underscore the need to understand underlying mechanisms. Future work integrating both violence against women and violence against children is needed.

Objectives. Strong evidence exists to support an intergenerational cycle of adolescent fatherhood, yet such a cycle has not been studied. We examined whether paternal adolescent fatherhood (i.e., father of study participant was age 19 years or younger when his first child was born) and other factors derived from the ecological systems theory predicted participant adolescent fatherhood. Methods. Data included 1496 young males who were interviewed annually from the National Longitudinal Survey of Youth 1997. Cox regression survival analysis was used to determine the effect of paternal adolescent fatherhood on participant adolescent fatherhood. Results. Sons of adolescent fathers were 1.8 times more likely to become adolescent fathers than were sons of older fathers, after other risk factors were accounted for. Additionally, factors from each ecological domain—individual (delinquency), family (maternal education), peer (early adolescent dating), and environment (race/ethnicity, physical risk environment)—were independent predictors of adolescent fatherhood. Conclusions. These findings support the need for pregnancy prevention interventions specifically designed for young males who may be at high risk for continuing this cycle. Interventions that address multiple levels of risk will likely be most successful at reducing pregnancies among partners of young men.

Future expectations have been important predictors of adolescent development and behavior. Its measurement, however, has largely focused on single dimensions and misses potentially important components. This analysis investigates whether an empirically-driven, multidimensional approach to conceptualizing future expectations can substantively contribute to our understanding of adolescent risk behavior. We use data from the National Longitudinal Survey of Youth 1997 to derive subpopulations of adolescents based on their future expectations with latent class analysis. Multinomial regression then determines which covariates from Bronfenbrenner’s ecological systems theory are associated with class membership. After modeling these covariates, we examine whether future expectations is associated with delinquency, substance use, and sexual experience. Our analysis suggests the emergence of four distinct classes labeled the Student Expectations, Student/Drinking Expectations, Victim Expectations, and Drinking/Arrest Expectations classes according to their indicator profiles. These classes differ with respect to covariates associated with membership; furthermore, they are all statistically and differentially associated with at least one adolescent risk behavior. This analysis demonstrates the additional benefit derived from using this multidimensional approach for studying future expectations. Further research is needed to investigate its stability and role in predicting adolescent risk behavior over time.

ObjectiveTo examine whether greater state-level spending on social and public health services such as income, education and public safety is associated with lower rates of teenage births in USA.DesignEcological study.SettingUSA.Participants50 states.Primary outcome measureOur primary outcome measure was teenage birth rates. For analyses, we constructed marginal models using repeated measures to test the effect of social spending on teenage birth rates, accounting for several potential confounders.ResultsThe unadjusted and adjusted models across all years demonstrated significant effects of spending and suggested that higher spending rates were associated with lower rates of teenage birth, with effects slightly diminishing with each increase in spending (linear effect: B=−0.20; 95% CI −0.31 to 0.08; p<0.001 and quadratic effect: B=0.003; 95% CI 0.002 to 0.005; p<0.001).ConclusionHigher state spending on social and public health services is associated with lower rates of teenage births. As states seek ways to limit healthcare costs associated with teenage birth rates, our findings suggest that protecting existing social service investments will be critical.