"I'm putting a Band-Aid on a bullet hole the only way I know how:" a qualitative study of barriers and facilitators to opioid misuse and recovery in Nevada.

Nevada, like the rest of the United States, is undergoing substantial challenges with opioid misuse and overdose deaths, further exacerbated by the COVID-19 pandemic. While much of the attention around opioid overdose prevention is centered on treatment and recovery, it is important to understand the factors that influence initiation of use, and the function opioids play in people's everyday lives. We conducted qualitative semi-structured individual interviews using purposive and snowball sampling among 35 people across Nevada with a current or prior history of illegal opioid or nonmedical opioid use. Our study aimed to understand why people start to use drugs, why they continue to use, what motivates them to continue to use or to seek treatment, and why individuals maintain recovery or return to use. We found five significant themes as perceived by the participants: that trauma is a risk factor for drug misuse; that the function of opioids in everyday life is a source of temporary relief but highly disruptive in the longer term; that recovery is most often a complicated and nonlinear process; that there are many barriers to accessing services that are both logistical and psychosocial; and that compassion, hope, and having a sense of purpose are crucial to the recovery process. The experiences of the study participants portray opioid use as a rational choice to escape the emotional ramifications of trauma. However, due to the physiological dependence and physical risk of opioids, drug policies that criminalize addiction, societal stigma, and the barriers to timely access of harm reduction, treatment, and recovery services, opioid users often become trapped in a distressing and dangerous cycle. Lastly, respondents indicated that hope, value, belonging, and purpose are powerful factors in cultivating intrinsic motivation for making positive changes and fostering resilience in the recovery process. Opioid misuse services should help meet basic needs and incorporate holistic approaches to recovery that acknowledge past trauma and the complexity of the recovery process.

Age-related patterns of early childhood development practices amongst rural families in Burkina Faso: findings from a nationwide survey of mothers of children aged 0-3 years.

BACKGROUND: Around two thirds of children in Sub-Saharan Africa are at risk of not meeting their developmental potential. Scalable interventions, based on an understanding of local contexts, that promote nurturing care in children's early years are needed. OBJECTIVES: To investigate age-related patterns of Early Childhood Development (ECD) practices amongst caretakers of children aged 0-3 years in rural households in Burkina Faso, in order to inform the design of a mass media campaign to be evaluated through a randomized controlled trial. METHODS: A household survey using a structured questionnaire was used to collect data from 960 rural mothers of children aged 0-3 years in a regionally stratified random sample of 130 villages. RESULTS: The mother was the main caretaker and engaged most in ECD-related activities at all ages (0-3 years). The father, grandmother and older children also engaged in ECD-related activities with older children (aged 1-3 years). Singing and playing occurred moderately frequently. Singing in the last three days: 36% at age 0-5 months increasing to 84% at age 3 years; playing in the last three days: 26% at age 0-5 months, increasing to 65% at age 3 years. Activities such as reading, counting, drawing, 'showing and naming' and 'chatting' were limited, particularly in the child's first year. Reasons for not engaging in these activities include lack of literacy, lack of books and toys or playthings and a belief that the child was too young. CONCLUSION: Opportunities for learning, especially through verbal interactions, appeared to be limited during the developmentally crucial first three years, most notably in the first year of life. The challenge for ECD intervention development in Burkina Faso will be finding ways to promote more responsive interactions at an early age and finding ways of mobilizing other family members to become more engaged in stimulating activities in the child's early years.

Can health promotion videos 'go viral'? A non-randomised, controlled, before-and-after pilot study to measure the spread and impact of local language mobile videos in Burkina Faso.

BACKGROUND: Mobile phones present a new health communications opportunity but use of mobile videos warrants more exploration. Our study tested a new idea: to produce health promotion videos in languages for which films have never previously been produced to see if they were widely shared. OBJECTIVE: To investigate whether the novelty of films in local languages focusing on health messages would be shared 'virally' among the target population. METHODS: A non-randomised, controlled, before-and-after study was used to evaluate the reach and impact of the intervention. We gave short health promotion videos on memory cards to distributors in eight intervention villages. Ten control villages, where no video distribution took place were randomly selected. We conducted cluster-level difference-in-difference logistic regression to assess self-reported knowledge indicators. We calculated odds ratios for intervention relative to control at baseline and endline and p-values for the change in odds ratios. RESULTS: Seven hundred and eight mothers were interviewed across all villages at baseline and 728 different mothers and 726 men were interviewed in the same villages a year later in October 2015. At endline, 32% of women and 44% of men in the intervention arm had ever seen a film on a mobile phone in Lobiri, compared to 1% of women and 2% of men in the control arm. There was a significant increase in the odds of knowing about giving Orasel to a child with diarrhoea in the intervention area relative to the control area. Awareness of the need to take a child with fever or symptoms of pneumonia to a health centre increased in the intervention area, but not significantly. CONCLUSIONS: Viral sharing of films on mobile phones has the potential to be an effective health promotion tool for communities whose languages are not served by existing mass media channels.

'Grandmother, aren't you going to sing for us?' Current childcare practices and caregivers' perceptions of and receptivity to early childhood development activities in rural Burkina Faso.

INTRODUCTION: Effective stimulation and responsive caregiving during the first 2 years is crucial for children's development. By age 3-4 years, over 40% of children in sub-Saharan Africa fail to meet basic cognitive or socioemotional milestones, but there are limited data on parenting and childcare practices. This study, conducted to inform the design of a mass media intervention, explored practices, perceptions, motivators and obstacles to childhood development-related practices among parents and caregivers of children aged 0-2 years in rural Burkina Faso. METHODS: We performed two rounds of six focus groups with 41 informants in two villages, using an adapted version of the Trials of Improved Practices methodology. These first explored beliefs and practices, then introduced participants to the principles and benefits of early childhood development (ECD) and provided illustrative examples of three practices (interactive ways of talking, playing and praising) to try with their children. One week later, further discussions explored participants' experiences and reactions. Data were analysed inductively using thematic content analysis. RESULTS: Existing activities with young children were predominantly instructive with limited responsive interaction and stimulation. Participants were receptive to the practices introduced, noted positive changes in their children when they adopted these practices and found engagement with children personally rewarding. CONCLUSION: Interactive, stimulating activities with young children did not appear to be widespread in the study area, but caregivers were receptive to information about the importance of early stimulation for children's development. ECD messages should be tailored to the local sociocultural context and consider time limitations.

Physical activity and calorie intake mediate the relationship from depression to body fat mass among female Mexican health workers.

BACKGROUND: Depression is a foremost cause of morbidity throughout the world and the prevalence of depression in women is about twice as high as men. Additionally, overweight and obesity are major global health concerns. We explored the relationship between depression and body fat, and the role of physical activity and diet as mediators of this relationship in a sample of 456 adult female Mexican health workers. METHOD: Longitudinal and cross-sectional analyses using data from adult women of the Health Workers Cohort Study (HWCS) Measures of body fat mass (kg from DEXA), dietary intake (kcal from FFQ), leisure time activity (METs/wk) and depression (CES-D) were determined in two waves (2004-2006 and 2010-2011). We explored the interrelation between body fat, diet, leisure time, physical activity, and depression using a cross-lagged effects model fitted to longitudinal data. We also fitted a structural equations model to cross-sectional data with body fat as the main outcome, and dietary intake and physical activity from leisure time as mediators between depression and body fat. RESULTS: Baseline depression was significantly related to higher depression, higher calorie intake, and lower leisure time physical activity at follow-up. From our cross-sectional model, each standard deviation increase in the depression score was associated with an average increase of 751 ± 259 g (± standard error) in body fat through the mediating effects of calorie intake and physical activity. CONCLUSIONS: The results of this study show how depression may influence energy imbalance between calories consumed and calories expended, resulting in higher body fat among those with a greater depression score. Evaluating the role of mental conditions like depression in dietary and physical activity behaviors should be positioned as a key research goal for better designed and targeted public health interventions. TRIAL REGISTRATION: The HealthWorkers Cohort Study (HWCS) has been approved by the Institutional IRB. Number: 2005-785-012.

Breastfeeding practices, beliefs, and social norms in low-resource communities in Mexico: Insights for how to improve future promotion strategies.

INTRODUCTION: Breastfeeding is recommended exclusively for the first 6 months after birth, with continued breastfeeding for at least 2 years. Yet prevalence of these recommendations is low globally, although it is an effective and cost-effective way to prevent serious infections and chronic illness. Previous studies have reported that social support greatly influences breastfeeding, but there is little evidence on perceived social norms in Mexico and how they affect actual behavior. OBJECTIVE: Our objective was to investigate breastfeeding intention, practices, attitudes, and beliefs, particularly normative, among low-resource communities in central and southern Mexico. METHODS: We performed a secondary analysis using the theory of planned behavior with cross-sectional data, which included semi-structured individual interviews with fathers (n 10), 8 focus groups with mothers (n 50), and 8 focus groups with women community leaders (n 44) with a total of 104 participants. Our data also included a quantitative survey among pregnant women and mothers (n 321). RESULTS: Women reported supplementing breast milk with water and teas soon after birth, as well as introducing small bites of solid food a few months after birth. Social norms appeared to support breastfeeding, but not exclusive breastfeeding or breastfeeding for periods longer than about a year. This may be partially explained by: a) behavioral beliefs that for the first 6 months breast milk alone is insufficient for the baby, and that water in addition to breast milk is necessary to hydrate an infant and b) normative beliefs related to the appropriateness of breastfeeding in public and as the child gets older. CONCLUSIONS: Future strategies should focus on positively influencing social norms to support recommended practices, and emphasize the specific reasons behind the recommendations. Future efforts should take a multi-pronged approach using a variety of influences, not only directed at healthcare providers but close family members, including fathers.