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Introduction MCH training programs in schools of public health provide specialized training to develop culturally competent and skilled MCH leaders who will play key roles in public health infrastructure. Previous literature has reported on the effectiveness of MCH training programs (e.g., number of trainees, improvement in knowledge/skills); less attention has been devoted to understanding factors influencing program implementation during times of rapid change, while considering internal and external contexts (e.g., global pandemic, social unrest, uncertainty of funding, mental health issues, and other crises). Purpose This article describes a graduate-level MCH leadership training program and illustrates how an implementation science framework can inform the identification of determinants and lessons learned during one year of implementation of a multi-year program. Assessment Findings reveal how CFIR can be applicable to a MCH training program and highlight how constructs across domains can interact and represent determinants that serve as both a barrier and facilitator. Key lessons learned included the value of accountability, flexibility, learner-centeredness, and partnerships. Conclusion Findings may apply to other programs and settings and could advance innovative training efforts that necessitate attention to the multi-level stakeholder needs (e.g., student, program, institution, community, and local/regional/national levels). Applying CFIR could be useful when interpreting process and outcome evaluation data and transferring findings and lessons learned to other organizations and settings. Integrating implementation science specifically into MCH training programs could contribute to the rigor, adaptability, and dissemination efforts that are critical when learning and sharing best practices to expand leadership capacity efforts that aim to eliminate MCH disparities across systems., Author(s): Cheryl A. Vamos [sup.1] , Abraham A. Salinas-Miranda [sup.1] [sup.2] , Ellen M. Daley [sup.1] , Russell S. Kirby [sup.1] , Karen D. Liller [sup.1] [sup.3] , Jennifer Marshall [...]

This study examined the associations between COVID-19 stress and anxiety and depression among international college students and assessed if this relationship was moderated by coping and social support. 219 international students at a large US university. A cross-sectional online survey utilizing validated scales was conducted from October 1 to 25, 2020. Path analyses assessed the effects of COVID-19 stress on anxiety and depression, and whether coping and social support moderated these relationships in international students. COVID-19 stress was significantly associated with anxiety and depression in international students. Maladaptive coping moderated the relationship between COVID-19 stress and anxiety but did not moderate the relationship with depression. Neither adaptive coping or social support moderated the relationship between COVID-19 stress and anxiety or depression. Results confirm the need for additional mental health services to reach international college students at risk of anxiety and depression during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

There is a dearth of scientific knowledge regarding suicidal ideation (SI) and adverse childhood experiences (ACEs) in Haiti. We conducted a community survey with a convenience sample of 673 residents from Haiti's Cité Soleil (January - June 2021) to address these gaps. Participants answered questions on SI, on ACEs from the ACE international questionnaire (ACE-IQ) section 5 abuse-related items, on adult experiences of non-partner sexual violence, on use of alcohol to manage stress and on trauma responses. Latent Class Analysis identified a five-class-model of poly-victimization ranging from Class 1 (no abuse) to Class 5 (combination of emotional, physical, and sexual abuse). SI prevalence was 65.3%. Women were nearly twice as likely as men to report SI (95% CI = 1.08–2.74). Class 1 comprised 25% of participants. Class 5 members were almost four times more likely to endorse SI than Class 1 members (95% CI = 1.52–9.10). Class 4 members were roughly four times more likely to endorse SI than Class 1 members. (95% CL = 1.83–7.81). Class 3 members were nearly twice as likely to endorse SI as Class 1 members (95% CI = 1.03–3.35). Participant survivors of NPSV were three times more likely to report SI than non-victims (95% CI = 1.61–5.67). Alcohol use to manage stress increased odds of SI by 1.59 (95% CI = 1.01–2.52). Hypervigilance increased the odds of SI by 3.21 (95% CI = 1.84–5.58). Limitations include recall bias, non-generalizability, use of self-reported data, and ACE-IQ's limitations. Early identification and prevention of SI, ACE, NPSV, alcohol use, and trauma are warranted. [ABSTRACT FROM AUTHOR]

Sleep health is critical to overall health and quality of life. We investigated distinct patterns of sleep in Haitian men and women in post-earthquake Haiti, in an urban neighborhood impacted by non-partner sexual violence (NPSV). Latent Class Analysis enabled our development of a three-class model (3: Sleep Disturbance [SD] Often, 2: SD Sometimes, 1: No SD). We assessed relationships between class membership and SD correlates (e.g., experience of NPSV, feelings of depression, suicide intentions, physical health). More men (31.7%) than women (22.9%) experienced NPSV. Overall SD symptoms included 58% insomnia (nearly 2 times the 30% prevalence reported in the U.S.) and 40% restless sleep (>5 times the 7.7% prevalence reported outside of Haiti). Mean SD score for NPSV victims was significantly higher than that for non-victims. In multivariate models, women and men who reported higher level of suicide intentions, and poorer physical health had increased odds of membership in Class 3 (SD often). For women, odds of membership in Class 3 increased consonant with endorsement of NPSV. Reporting depression as mostly/constantly was associated with SD Class 3 for women, but not for men. Consideration of sex differences in sleep patterns and in NPSV experience is crucial and underscores healthy sleep among other critical intervention targets for recovery of NPSV traumatized residents in Haiti and in similar LMIC. [ABSTRACT FROM AUTHOR]

Objectives The end of the era of millennium development goals (MDGs) ushered in the sustainable development goals (SDGs) with a new target for the reduction of under-five mortality rates (U5MR). Although U5MR decreased globally, the reduction was insufficient to meet MDGs targets because significant socioeconomic inequities remain unaddressed across and within countries. Thus, further progress in achieving the new SDGs target will be hindered if there is no adequate prioritization of important socioeconomic, healthcare, and environmental factors. The objective of this study was to assess factors that account most for the differences in U5MR between countries around the globe. Methods We conducted an ordinary least squares (OLS) regression-based prioritization analysis of socioeconomic, healthcare, and environmental variables from 109 countries to understand which factors explain the differences in U5MR best. Results All indicators examined individually affected differences in U5MR between countries. However, the results of multivariate OLS regression showed that the most important factors that accounted for the differences were, in order: fertility rate, total health expenditure per capita, access to improved water and sanitation, and female employment rate. Conclusions To achieve the new global target for U5MR, policymakers must focus on certain priority areas, such as interventions that address access to affordable maternal healthcare services, educational programs for mothers, especially those who are adolescents, and safe drinking water and sanitation., Author(s): Michael Acheampong [sup.1] , Chukwudi Ejiofor [sup.2] , Abraham Salinas-Miranda [sup.2] Author Affiliations: (1) 0000 0001 2353 285Xgrid.170693.aSchool of Geosciences, University of South Florida, 4202 E. Fowler Avenue, NES [...]

The purpose of this study was to evaluate the mutual impact of community and individual factors on youth's perceptions of community safety, using structural equation modeling (SEM) conceptualized by syndemic theory. This study used survey data collected from a county wide sample of middle and high school students (N=25,147) in West Central Florida in 2015. The outcome variable was youth's perceptions of community safety. Predictors were latent individual and community factors constructed from 14 observed variables including gun accessibility, substance use, depressive symptoms, and multiple neighborhood disadvantage questions. Three structural equation models were conceptualized based on syndemic theory and analyzed in Mplus 8 using weighted least squares (WLS) estimation. Each model's goodness of fit was assessed. Approximately seven percent of youth reported feeling unsafe in their community. After model modifications, the final model showed a good fit of the data and adhered to the theoretical assumption. In the final SEM model, an individual latent factor was implied by individual predictors measuring gun accessibility without adult's permission (β=0.70), sadness and hopelessness (β=0.52), alcohol use (β=0.79), marijuana use (β=0.94), and illegal drug use (β=0.77). Meanwhile, a community latent factor was indicated by multiple community problems including public drinking (β=0.88), drug addiction (β=0.96), drug selling (β=0.97), lack of money (β=0.83), gang activities (β=0.90), litter and trash (β=0.79), graffiti (β=0.91), deserted houses (β=0.86), and shootings (β=0.93). A second-order syndemic factor that represented the individual and community factors showed a very strong negative association with youth's safe perception (β=-0.98). This study indicates that individual risk factors and disadvantaged community conditions interacted with each other and mutually affected youth's perceptions of community safety. To reduce these co-occurring effects and improve safe perceptions among youth, researchers and practitioners should develop and implement comprehensive strategies targeting both individual and community factors. [ABSTRACT FROM AUTHOR]

Intimate partner violence (IPV) is a significant public health issue with detrimental consequences for women's reproductive, mental, and physical health. In Haiti, IPV is a major obstacle to women's development. Yet, the determinants of IPV victimization are still not well understood. In this study, we utilized the 2016–2017 Haiti Demographic and Health Survey to determine the prevalence of IPV victimization and its subtypes (emotional, physical, and sexual abuse) among married or cohabiting women (N = 3,805) of reproductive age (15–49) by their current husband/partner. Logistic regression was conducted to explore the association between IPV and household, individual, husband/partner, and relationship characteristics. The prevalence of IPV victimization was 32.5% with the majority reporting emotional (24.7%) followed by physical (16.8%) and sexual (10.5%) violence. Increased odds of IPV victimization were found among women with children in the household (adjusted odds ratio [AOR] = 1.45, 95% confidence interval [CI] = [1.03, 2.02]), with attitudinal acceptance of wife-beating (AOR = 1.45, 95% CI = [1.05, 2.02]), and those who witnessed their father beating their mother (AOR = 1.49, 95% CI = [1.18, 2.67]). Higher odds of reporting IPV victimization were also found among women whose partner drank alcohol (AOR = 2.89, 95% CI = [2.29, 3.65]), who were in a polygynous relationship (AOR = 1.76, 95% CI = [1.23, 2.40]), and displayed one or more controlling behaviors (AOR = 1.92, 95% CI = [1.42, 2.59]). Women who reported being afraid of their partner had greater odds of IPV victimization (AOR = 16.22, 95% CI = [8.38, 31.39]). Decreased odds of reporting IPV were associated with women living in rural areas (AOR = 0.73, 95% CI = [0.53, 1.00]) and those unmarried, but living with their partner (AOR = 0.62, 95% CI = [0.43, 0.90]). Our findings identify subgroups of women in Haiti that may be vulnerable to IPV victimization. Thus, we recommend a differentiated approach to IPV prevention strategies and interventions that consider women's family structure in the household as well as individual, partner, and relationship characteristics. [ABSTRACT FROM AUTHOR]