Resilience Among Small Community-based Organizations During the COVID-19 Pandemic: Insights for Future Public Health Crises.

The coronavirus disease 2019 pandemic has created numerous challenges for many community-based organizations to sustain delivery of services and programs. This paper offers perspectives from leadership of three small community-based organizations serving diverse populations in the Hartford, Connecticut, region on how they were impacted and responded to disruptions during the first year of the coronavirus disease 2019 pandemic. Community-based organizations' commitment to the populations they serve and agility with regard to programming, staffing, and finances were highlighted as key to their resilience, enabling them to serve their clients with stability.

Impact of dental fluorosis on the oral health related quality of life of adolescents in an endemic area.

Introduction: Oral diseases and conditions affect the physical, social, and psychological well-being of an individual. The aim of this study was to determine the association between the severity of dental fluorosis and oral health related quality of life (OHRQoL) among 15-year-old school children residing in an endemic area for dental fluorosis in Sri Lanka.

Design: A cross-sectional study was conducted among 989, 15-year-old school children who were lifetime residents of Kurunegala district.

Alcohol Use, HIV Stigma and Quality of Life Among Alcohol Consuming Men Living with HIV in India: A Mediation Analysis.

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.

Sexual Risk Behaviors, HIV Prevalence and Access to Reproductive Health Services Among Young Women Migrant Workers in the Industrial Zones in Vietnam.

Young migrant workers working in the industrial zones (IZ) in low and middle-income countries are at risk for HIV and other sexually transmitted diseases. This study examines the sex-related risks of young women migrant workers in the IZ in Vietnam. This cross-sectional survey was conducted among 1,061 young migrant women working in the IZ park in Hanoi, Vietnam.

Oral health-related quality of life outcomes in a randomized clinical trial to assess a community-based oral hygiene intervention among adults living in low-income senior housing.

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.

Evaluating mechanisms of change in an oral hygiene improvement trial with older adults.

Background: This paper compares the relationship between theoretically-driven mechanisms of change and clinical outcomes across two different interventions to improve oral hygiene of older adults participating in a group randomized trial.

Methods: Six low-income senior residences were paired and randomized into two groups. The first received a face to face counseling intervention (AMI) and the second, a peer-facilitated health campaign (three oral health fairs).

Does sequencing matter? A cross-over randomized trial to evaluate a bi-level community-based intervention to improve oral hygiene among vulnerable adults.

Objectives: To evaluate whether the cumulative effect of an individual-level intervention followed by a building-level intervention, both based on Fishbein's Integrated Model of Behavior Change, has a better effect on oral hygiene clinical outcomes than the sequence of the building-level intervention followed by the individual-level intervention; to determine the added effect of each intervention on the other; to identify the psychosocial mechanisms that might explain the differences.

Methods: Six low-income senior housing complexes were enrolled in the study, and participants were recruited from these buildings. Buildings were randomly assigned to receive either the individual counselling intervention first followed by the building-level intervention, or the building-level intervention first followed by the individual intervention.

Multilevel and Multifactorial Interventions to Reduce Alcohol Consumption and Improve ART Adherence and Related Factors Among HIV Positive Men in Mumbai, India.

Alcohol use has a deleterious effect on the health status of persons living with HIV, negatively affecting antiretroviral adherence and increasing the risk of transmission. Alcohol use is not an isolated behavior but intimately linked to stigma and poor psychological status among other factors. This paper utilizes a crossover design to test the efficacy of three multilevel interventions, individual counselling (IC), group intervention (GI) and collective advocacy (CA) for change, among HIV positive males who consume alcohol, treated at five ART Centers in urban Maharashtra, India.

Evaluating Cognitive/Emotional and Behavioral Mediators of Oral Health Outcomes in Vulnerable Older Adults.

Inconsistent outcomes of oral hygiene interventions require testable theories combining cognitive and behavioral domains to guide intervention and improve results. This article evaluates the integrated model as a cognitive-behavioral approach to improve oral health clinical outcomes in ethnically diverse low-income older adults. Baseline data from a clinical trial utilizing the integrative model (IM) model evaluated predictors of gingival index (GI) and plaque score (PS).

Black-White Disparities in Social and Behavioral Determinants of Health Index and Their Associations with Self-rated Health and Functional Limitations in Older Adults.

Background: To characterize cumulative risk scores of social and behavioral determinants of health (SDoH) and examine their association with self-rated general health and functional limitations between non-Hispanic black and white older adults in the United States.

Method: We used data from the 2013-2014 National Health and Nutrition Examination Survey (NHANES), with a nationally representative sample of black and white adults aged 65 or older (n = 954 unweighted). We quantified the cumulative risk scores of SDoH (eg, food insecurity, education and poverty), ranging from 0 (no risk at all) to 8 (highest risk), and used multivariable-adjusted logistic and Poisson regression analyses to assess the association of SDoH by racial group with self-rated health and functional limitations, adjusting for other covariates.

A multilevel intervention to reduce stigma among alcohol consuming men living with HIV receiving antiretroviral therapy: findings from a randomized control trial in India.

Objective: To examine the effectiveness of a multilevel intervention to reduce HIV stigma among alcohol consuming men living with HIV in India.

Design: A crossover randomized controlled trial in four sites.

Setting: Government ART centres (ARTCs) offering core services in the greater Mumbai area.

Viral load outcomes in a cohort of alcohol-consuming people living with HIV receiving antiretroviral therapy in Mumbai, India.

We examined the association between alcohol consumption, adherence and viral load (VL) in a cohort of 940 alcohol-consuming, human immunodeficiency virus (HIV)-positive men receiving antiretroviral therapy in Mumbai. Some of the participants (16.7%) had missed >1 doses in the last four days and 17.

Building a new scale to measure worries about oral hygiene self-management in vulnerable older adults.

Objective: This paper describes a new scale to measure worries about self-management of oral hygiene in low-income older adults.

Background: Oral hygiene that prevents oral diseases and worsening of chronic conditions improves with instruction, but other cognitive/emotional factors impede oral hygiene practice especially among older adults. Many scales measure dental anxiety, but none measures oral hygiene self-management worries.

Improving Oral Health in Older Adults and People With Disabilities: Protocol for a Community-Based Clinical Trial (Good Oral Health).

Background: Low-income older adults experience disparities in oral health problems, including caries and periodontal disease, that can exacerbate already high levels of chronic and acute health problems. Behavioral interventions have been shown to improve oral health status but are typically administered in institutional rather than community settings. Furthermore, multiple simultaneous interventions at different levels in the locations where people live and work are likely to have more impact and sustainability than single interventions in clinical settings.

Gingivitis and plaque scores among residents of low-income senior housing.

Objectives: The purpose of this paper is to present Gingival Index (GI) and Plaque Scores (PS) of older and disabled adults living in low-income senior housing and their association with sociodemographic, health status and oral health behaviours.

Methods: Participants were recruited from six low-income senior housing residences in Connecticut. Primary outcome measures were Gingival Index (GI) and Plaque Scores (PS).

Depression Among Alcohol Consuming, HIV Positive Men on ART Treatment in India.

Depression, as well as other psychosocial factors, remains largely unaddressed among people living with HIV (PLHIV) in low and middle-income countries. Depression is a common occurrence among PLHIV and is elevated in those who consume alcohol. This paper will document the presence of depressive symptoms in alcohol-consuming male PLHIV receiving antiretroviral treatment (ART) in India.

Evaluating Alternative Designs of a Multilevel HIV Intervention in Maharashtra, India: The Impact of Stakeholder Constraints.

Multilevel interventions combine individual component interventions, and their design can be informed by decision analysis. Our objective was to identify the optimal combination of interventions for alcohol-using HIV+ individuals on antiretroviral drug therapy in Maharashtra, India, explicitly considering stakeholder constraints. Using an HIV simulation, we evaluated the expected net monetary benefit (ENMB), the probability of lying on the efficiency frontier (PEF), and annual program costs of 5,836 unique combinations of 15 single-focused HIV risk-reduction interventions.

Kidney progression project (KiPP): Protocol for a longitudinal cohort study of progression in chronic kidney disease of unknown etiology in Sri Lanka.

Over the last two decades, a global epidemic of chronic kidney disease of unknown etiology (CKDu) has emerged in rural, arid, agricultural, lowland areas. Endemic regions have reported 15 to 20% prevalence among residents aged 30-60 years. CKDu is a progressive and irreversible disease resulting in renal failure and death in the absence of dialysis or a kidney transplant.

Challenges in Indian Women’s Readiness to Quit Smokeless Tobacco Use.

Introduction: In India, there are few cessation programs for women smokeless tobacco (SLT) users who want to quit. This paper uses Fishbein’s IM model to identify women SLT users’ challenges to quitting and multilevel correlates of “readiness to quit”. Methods: A survey of SLT use among women of reproductive age was conducted in 2010-13 in an urban slum community of Mumbai with a representative sample of 409 married women aged 18 to 40 years using at least one type of SLT daily.

The role of Ecstasy (MDMA) in managing intimacy and conflict in stable relationships.

This paper discusses motivations for the use of MDMA among young adults in intimate relationships living in resource poor environments, where structural constraints limit potential for economic mobility and impact upon interpersonal relations. Drawing from in-depth interviews with men and women in intimate relationships with one or more partners, we report the range of motivations for MDMA use and their association with indicators of relationship quality, specifically trust and romantic exclusivity. Findings demonstrate that both men and women use MDMA primarily for the purpose of sexual enjoyment.

Sexual culture in low-income older adult housing: norms, behaviours and risks.

This paper explores the behaviours and meanings associated with intimacy and sexuality among older adults with diverse partners living in subsidised senior housing. It utilises survey and qualitative data from a mixed methods of ageing/HIV exposure to illustrate gendered views on sexual and intimate behaviours, and attitudes towards transactional/commercial sex. Data suggest that women were cautious about engaging in intimate relationships, while men sought them and the companionship they provided to address loneliness.

Community Involvement in Health Systems Strengthening to Improve Global Health Outcomes: A Review of Guidelines and Potential Roles.

Definitions of health systems strengthening (HSS) have been limited in their inclusion of communities, despite evidence that community involvement improves program effectiveness for many health interventions. We review 15 frameworks for HSS, highlighting how communities are represented and find few delineated roles for community members or organizations. This review raises the need for a cohesive definition of community involvement in HSS and well-described activities that communities can play in the process.

Identifying the Intersection of Alcohol, Adherence and Sex in HIV Positive Men on ART Treatment in India Using an Adapted Timeline Followback Procedure.

People living with HIV (PLHIV) on anti-retroviral treatment (ART) who drink are less adherent and more likely to engage in unprotected sex but the connections among these events are correlational. Using an adapted Timeline Follow-Back (A-TLFB) procedure, this paper examines the day by day interface of alcohol, medication adherence and sex to provide a fine grained understanding of how multiple behavioral risks coincide in time and space, explores concordance/discordance of measures with survey data and identifies potential recall bias. Data are drawn from a survey of behavior, knowledge and attitudes, and a 30 day TLFB assessment of multiple risk behaviors adapted for the Indian PLHIV context, administered to 940 alcohol-consuming, HIV positive men on ART at the baseline evaluation stage of a multilevel, multi-centric intervention study.

The Role of Alcohol on Antiretroviral Therapy Adherence Among Persons Living With HIV in Urban India.

Objective: The purpose of this study was to estimate the prevalence of alcohol use among men living with HIV on antiretroviral therapy (ART) and examine the association of alcohol use and psychosocial variables on ART adherence. The study was a cross-sectional survey supplemented by medical records and qualitative narratives as a part of the initial formative stage of a multilevel, multicentric intervention and evaluation project.

Method: A screening instrument was administered to men living with HIV (n = 3,088) at four ART Centers using the Alcohol Use Disorders Identification Test-consumption questions (AUDIT-C) to determine alcohol use for study eligibility.