Surveillance beyond camp settings in humanitarian emergencies: findings from the Humanitarian Health Information Management Working Group.

INTRODUCTION: Surveillance is an essential component of health and nutrition information management during humanitarian situations. Changes in the nature and scope of humanitarian assistance activities have created new challenges in health surveillance, particularly outside of camp-based settings. OBJECTIVES: The primary aim of the Humanitarian Health Information Management Working Group was to identify challenges and areas that need further elucidation in a range of non-camp settings, including urban and rural as well as low- and middle-income countries. RESULTS: Three major themes emerged: (1) standardization of measures and methodologies; (2) context in data collection and management; and (3) hidden populations and the purpose of surveillance in urban settings. Innovative examples of data collection and management in community-based surveillance were discussed, including task-shifting, health worker to community member ratio, and literacy needs. CONCLUSIONS: Surveillance in non-camp settings can be informed by surveillance activities in camp-based settings, but requires additional consideration of new methods and population needs to achieve its objectives.

Adherence to recent screening mammography among Latinas: findings from the California Women's Health Survey.

OBJECTIVES: Latinas are less likely than other racial/ethnic groups to engage in mammography rescreening, but little research has examined why Latinas overdue for screening have not had a mammogram recently. This study investigates the factors that affect adherence to screening mammography guidelines among previously screened Latinas. METHODS: Data are from a population-based, random-digit-dial annual probability survey of California women. Participants included 1298 Latinas aged > or =40 who ever had a mammogram. Multivariate logistic regression was used to examine what factors differentiate adherence to recent screening (having a mammogram < or =2 years ago) from being overdue for screening (having a last mammogram >2 years ago). Perceived barriers to screening were also examined among women overdue for a mammogram. Relationships between self-reported perceived barriers to screening and the identified differentiating factors were assessed using chi-square tests. RESULTS: Adherence to recent mammography was reported by 83.9% of previously screened Latinas. When controlling for significant covariates, factors associated with adherence to recent screening included being aged 50-64, having a college education, preferring to interview in Spanish, having health insurance, and reporting a usual source of care (p < 0.05). Lack of affordability was the most frequently cited perceived barrier to screening among Latinas overdue for screening. Age, education, health insurance, and usual source of care were significantly associated with specific perceived barriers to screening mammography. CONCLUSIONS: Results underscore the impact that affordability of, knowledge about, and convenience in obtaining mammograms have on adherence to recent screening. Strategies to improve mammography adherence among Latinas may need to consider that solely improving access to insurance or a regular source of healthcare, although important, may not be sufficient to improve rates of Latinas' screening mammography adherence.

Lifetime interpersonal violence and self-reported chlamydia trachomatis diagnosis among California women.

OBJECTIVE: To examine the relationship between cumulative exposure to various types of interpersonal violence throughout the life span and self-reported history of Chlamydia trachomatis (CT) diagnosis in a population-based sample of California women. METHODS: This was a cross-sectional analysis of a population-based survey of California women aged 18-44 years (n = 3521). Participants reported their experience of multiple types of interpersonal violence: physical or sexual abuse in childhood or adulthood and intimate partner violence (IPV) in the past 12 months. Current posttraumatic stress disorder (PTSD) and depressive symptoms were also reported. Separate logistic regression models assessed the association between experiencing each type of interpersonal violence, as well as women's cumulative exposure to violence, and past CT diagnosis, adjusting for age, race/ethnicity, and poverty, as well as mental health problems. RESULTS: Six percent of women reported a past diagnosis of CT, and 40.8% reported experiencing at least one type of interpersonal violence in their lifetime. All types of violence were significantly associated with higher odds of having a past CT diagnosis even after controlling for sociodemographics. Women who reported experiencing four or more types of violence experiences had over five times the odds of reporting a lifetime CT diagnosis compared with women who never experienced interpersonal violence (adjusted odds ratio = 5.71, 95% CI 3.27-9.58). Current PTSD and depressive symptoms did not significantly affect the relationship between a woman's cumulative experience of violence and her risk of past CT diagnosis. CONCLUSIONS: There is a robust association between experiencing multiple forms of violence and having been diagnosed with CT. Women who seek treatment for sexually transmitted diseases (STDs), such as CT, should be assessed for their lifetime history of violence, especially violence in their current intimate relationships. Sexual risk reduction counseling may also be important for women who have a history of risky sexual behaviors and who are likely to be reinfected.

Unemployment among women: examining the relationship of physical and psychological intimate partner violence and posttraumatic stress disorder.

Prior research has demonstrated that intimate partner violence (IPV) is associated with employment instability among poor women. The current study assesses the broader relationship between IPV and women's workforce participation in a population-based sample of 6,698 California women. We examined past-year IPV by analyzing specific effects of physical violence, psychological violence, and posttraumatic stress disorder (PTSD) symptoms as predictors of unemployment. Results indicated substantial rates of unemployment among women who reported IPV, with rates of 20% among women who experienced psychological violence, 18% among women who experienced physical violence, and 19% among women with PTSD symptoms. When the relationship was adjusted for demographic characteristics and educational attainment, PTSD (adjusted odds ratio [AOR] = 1.60; 95% confidence interval [CI] = 1.22, 2.09) and psychological violence (AOR = 1.78; 95% CI = 1.36, 2.32), but not physical violence, were associated with unemployment. Implications for supported employment programs and workplace responses to IPV are discussed.