Factors associated with body mass index among university students in Bangladesh Abstract Aim We aimed to assess the body mass index (BMI) of university students and evaluate its associated factors. Subjects and methods We conducted a study in Sylhet City, Bangladesh using stratified random sampling (n = 1,143) and collected students’ socio-demographic data and about their eating habits. We used analysis of variance (ANOVA) models to analyze the data. Results We found that the majority (67.2%) of the students had a normal BMI. Among the students, 35% were female and 25% had their own income. Moreover, 55% reported skipping breakfast and among all the students, 50% skipped meals due to class pressure. The female students had a lower BMI (estimate: –0.70, 95% CI: −1.13, −0.28) than the male students. We also found that students from higher age groups and the students who had their own income also had a higher BMI. Furthermore, students with irregular meal intake had a lower BMI (estimate: –0.85; 95% CI: −1.3, −0.40) than those who took their meals regularly. Conclusion The majority of the students belonged to the normal BMI group and were in the habit of regular meals. Slightly more than 50% of the students skipped their breakfast and about half of the students reported that class pressure caused them to skip meals. To promote healthy eating habits among university students, effective programs should be initiated which could include introducing dietary guidelines and enhancing self-discipline.

Trends in the implementation of health impact assessments in the United States: exploring the role of educational attainment, poverty, and government ideology Abstract Aim Health impact assessment (HIA) is a systematic tool for policy-makers to identify the potential health effects of proposed new laws and programs. We examined HIA implementation trends from 2007 to 2014 and explored whether factors such as state government ideology, legal provision, educational attainment, and poverty were associated with HIA implementation across the United States. Subjects and methods This was a retrospective, longitudinal study of HIA implementation among the 50 US states from 2007 through 2014. We developed a regression model to assess our outcome. Results Between 2007 and 2014, HIA implementation increased by 300%. Planning and implementation of most HIAs was led by government agencies (50%), non-profit organizations (27%), and educational institutions (21%). California, Oregon, Minnesota, and Washington were states with the highest number of completed HIAs. Characteristics associated with a significantly higher rate of HIA implementation were high educational attainment level (defined as the percentage of the population with a minimum bachelor’s degree or higher) and high poverty level (defined as the percentage of the population living below the Federal Poverty Level). Government ideology or legal provision was not significantly associated with the rate of HIA implementation. Conclusions HIA-supportive legal provisions could potentially provide unprecedented opportunities for the promotion of public health and health equity and, although HIA implementation has been increasing, such mechanisms are possibly highly underutilized. Educational institutions are in a unique position to bridge the gap between knowledge and practice of HIAs by facilitating HIA awareness among policy-makers in health and non-health sectors.

Determining the level of sexually transmitted diseases (STDs) awareness in Ota, Nigeria Abstract Aim The aim of this research is to determine the level and factors that contribute to the awareness of sexually transmitted diseases in Ota in the Ado/Odo local government area of Ogun State, Nigeria. Subjects and methods A questionnaire designed to suit the demographic was administered to selected residents of Ota, Ogun State, Nigeria. The subjects were mainly adolescents, and purposive sampling was adopted. Chi-square test of association was used to establish relationships between the various sociodemographic and awareness variables. Results The results showed the following: a) in general, the awareness level of STDs is moderate, b) there is widespread misconception about STDs, c) Age is significantly associated with parental counselling (p = 0.019), friends and relatives (p = 0.023), religious counselling (p = 0.026) and NGOs (p = 0.001), d) gender is significantly associated with parental counselling (p = 0.05), NGOs (p = 0.012), and medical consultation (p = 0.008), e) educational background is significantly associated with medical consultation (p = 0.019), and f) religion is a predictor of general knowledge about and preventive measures for STDs, at a 0.05 level of significance. Conclusion There is low awareness of the non-risk factors, and moderate awareness concerning general knowledge, mode of transmission, and preventive measures against STDs. A high level of awareness is recommended if reduction of the prevalence of STDs is to be achieved. Parental, religious, and NGO counselling is strongly recommended. Religious organisations have to be fully engaged in order to reduce the spread of STDs.

Association between mobile phone usage and hypertension among adults in an urban area of Puducherry: a case control study Abstract Aim To measure the association between mobile phone usage and hypertension among adults. Subject and methods This community-based case control study was conducted in the urban field practice area of a medical college in Puducherry, India. Individuals with average BP ≥ 140/90 mmHg on three readings or hypertension diagnosed within the past year were defined as cases. Controls were individuals with average BP ≤ 130/85 mmHg on three readings. Fifty cases and 50 controls were matched for age and gender and interviewed using a structured questionnaire. Binary logistic regression was employed to calculate the adjusted odds ratios. Paired t test and chi-square tests were done to measure the p value. Results Most of the study participants knew how to use the calling facility on their mobile phones, whereas only two-thirds of them were able to use the SMS facility. Only one-third owned a smartphone. The risk of hypertension was six times higher among those who had been using a mobile phone for more than 8 years [adjusted odds ratio 6.2 (1.6–23.8)] and four times higher among those who used the calling facility for more than 60 min per day [adjusted odds ratio 4.2 (1.1–16.7)]. Conclusion There was a significant positive association between hypertension and duration of mobile phone usage. However, further studies are required to confirm our findings.

Determinants of the age of mother at first birth in Bangladesh: quantile regression approach Abstract Objective This paper attempts to explore the determinants that determine the mother’s age at first birth in Bangladesh by using a data set obtained from Bangladesh Demographic and Health Survey (BDHS)-2014. Study design The sampling frame used for the 2014 BDHS is the complete list of enumeration areas (EAs) covering the whole country prepared by the Bangladesh Bureau of Statistics for the 2011 population census of the People’s Republic of Bangladesh. An EA is a geographic area covering on average 113 households. However, the 2014 BDHS sample was stratified and selected in two stages. In the first stage, 600 EAs were selected with probability proportional to the EA size. Also, in the second stage of selection, a fixed number of 30 households per cluster will be selected with an equal probability systematic selection from the newly created household listing. Methods The quantile regression model produces more unbiased estimates than the linear regression model when the data do not follow the assumed normal distribution. Thus, this paper considers the quantile regression model. Results The results suggest that variables such as the type of place of residence, religious status, husband’s age and his occupation, body mass index, and wealth index of the respondent are positively related to the age of mother at first birth. However, variables such as current age, highest educational level, and occupation of the respondent, division and husband/partner’s education level are negatively related to the age of mother at first birth. Conclusion The results show that the average age of mothers at first birth is just under 18 years, which is just under the age of marriage in Bangladesh. It is quite alarming to the government of Bangladesh. Therefore, the government should take the necessary steps to achieve an increase in the age of mothers at first birth.

Positive impact of educational intervention on knowledge, attitude, and practice towards dengue among university students in Malaysia Abstract Introduction Dengue continues to have a significant effect on the general population of Malaysia, particularly in urban areas, and it is important to ensure that members of the public have adequate awareness to curb the disease. Aim This study assesses the baseline knowledge, attitude, and practice (KAP) levels among university students and the impact of educational intervention on KAP levels. Subjects and methods The study consists of part 1 (baseline study) with 307 students and part 2 (impact of the intervention study) with 85 students. A validated self-administered questionnaire was used to determine KAP levels. For part 2, baseline KAP was obtained before the intervention, and the post-intervention KAP was obtained after 1 month. Results In part 1, only 26.1% have a good knowledge level regarding dengue, but the majority have good attitude (88.6%) and practice (71.0%). In part 2, the knowledge levels obtained pre-intervention were poor (mean score, 10 ± 2.46), while attitude and practice were good (mean scores, 8.82 ± 1.35 and 6.92 ± 2.5, respectively). The mean scores post-intervention increased for all KAP domains after the health campaign with knowledge at 12.61 ± 0.17, attitude 9.01 ± 1.09, and practice 7.11 ± 2.49. This study revealed that educational intervention was effective in creating awareness about dengue and that the social media is the most used and preferred source of information for respondents for learning about dengue. Conclusion Health authorities could implement a nationwide dengue awareness programme focusing on social media and other media as a platform to disseminate information regarding disease and outbreaks and to promote healthy lifestyles.

Emotional factors are critical motivators for tobacco use according to smokers’ own perception Abstract Aim Psychological factors play an important role in tobacco dependence. However, few investigations have focused on smokers’ own perception about motivations for tobacco consumption using open-ended questions. Subject and method In this study, we used the Collective Subject Discourse (CSD) method to investigate the motivations for tobacco use according to smokers’ own perception in 135 current smokers. Results The vast majority of patients (83.7%) reported that they smoked cigarettes when seeking relief or emotional comfort. When asked why they smoked, most declared they smoked due to stress, anxiety, or nervousness. Long-term smokers reporting using cigarettes to feel pleasure, in contrast to short-term smokers, who mostly reported they smoked because they felt stress or anxiety (p < 0.001). Most of the patients (71.2%) also reported emotional factors as the reason for increasing the desire to smoke. Heavy smokers smoked more in moments when they felt alone compared to light smokers (p = 0.034). Conclusion The smokers’ collective discourses demonstrate that from their own perception, psychological factors are the motivational basis for their use of cigarettes. Therefore, most smokers are conscious of the impact of emotional factors on smoking dependence, and this may play a critical role in quit-smoking programs, as well as presenting an important factor for public health.

Effectiveness of a peer-led HIV/AIDS education program on HIV-related health literacy of jailed adolescents in Tunis, Tunisia Abstract Aim The aim of this study was to evaluate the effectiveness of a peer-led HIV/AIDS education program in improving HIV-related health literacy, knowledge, risk perception, preventive self-efficacy and behavioral intention of jailed adolescents. Subject and methods A quasi-experimental study design with pre- and post-intervention measurement was conducted at a juvenile detention center in Tunis, Tunisia. One hundred two adolescents out of 112 answered the validated questionnaires at both baseline and follow-up. The intervention consisted of two sections: a 45-min lecture and a 30-min promotional video. The data on HIV-related health literacy, knowledge, risk perception, preventive self-efficacy and behavioral intention were collected up to 30 days prior to the start of the intervention, November 2017, and 30 days following the end of the intervention period, February 2018. Results When changes over time, from baseline to follow-up, were compared between the intervention and comparison groups, differences were found for HIV-related health literacy (p = 0.029), knowledge (p = 0.031), risk perception (p = 0.043), preventive self-efficacy (p = 0.031) and behavioral intention (p = 0.019). Conclusion The peer-led HIV/AIDS education program contributes to the development of HIV-related health literacy of jailed adolescents. It is possible to elaborate aspects of HIV-related health literacy in a non-formal education setting.

Measures of spatial accessibility to health centers: investigating urban and rural disparities in Kermanshah, Iran Abstract Aim Availability of and accessibility to health services are critical factors to maintain the wellbeing of any society. This study aims to investigate the spatial patterns and accessibility levels of urban and rural residents to health centers—i.e., hospitals—in the case of Kermanshah Province located at the western part of Iran. Subject and methods The study employs a spatial analysis technique as the methodological approach. Datasets were obtained from the latest population statistics—i.e., the 2011 Population and Housing Census—and public and private hospitals in the Kermanshah Province. Access levels to health centers were calculated in a geographical information system environment with network analysis capability. Results The results revealed that: (a) spatial distribution of health centers in the Kermanshah Province follows a random pattern, (b) health centers are mainly concentrated in the Kermanshah Township, (c) there is a clear inequality in terms of access to health centers in the Kermanshah Province, (d) children, women, and the elderly residing in rural areas are found to be the most vulnerable groups. Conclusion The bipolar status of the rural population’s access to healthcare compared with those residing in the Kermanshah Township clearly underlines an unequal structure of the health system in the Kermanshah Province. There is, hence, a need for effective interventions of policymakers and health managers in the province to eliminate this disparity.

Influence of internet addiction on academic, sportive, and recreative activities in adolescents Abstract Purpose Internet addiction (IA) is an increasing health problem worldwide. This study aimed to investigate the impact of IA on male and female adolescents and on their academic, sports, and recreative activities. Method The study was cross-sectional. Adolescents (N = 1291; mean = 16.2 ± 1.1 year) were questioned on the following factors: smart phone, iPad, and computer use; daily internet use time; academic success; success in sports activities. Results The IA ratio of the whole group was 25.2%, but it was significantly higher in the female group (35.5%; p = 0.00). When we divided the group according to gender, age (p = 0.002), smart phone use (p = 0.045), sports activity (p = 0.000), sports success (p = 0.000), and healthy eating (p = 0.000) were higher in males; duration of daily internet use (p = 0.00), recreative activity (p = 0.021), musculoskeletal pain (p = 0.000), morning stiffness (p = 0.017), difficulty concentrating (p = 0.000), headaches (p = 0.000), numbness in hands (p = 0.011), forgetfulness (p = 0.000), gastrointestinal problems (p = 0.021), dizziness/imbalance (p = 0.001), and IA (p = 0.000) were higher in females. Conclusion Although the use of mobile phones was lower in the adolescent female group, daily smartphone use times, IA, IA scores, and somatoform symptoms were found to be higher, independent of body mass index. IA has adverse effects on mental and physical health in adolescents. It is necessary to raise awareness in this regard to ensure the transition into healthy adults.