Timely and comprehensive analyses of causes of death stratified by age, sex, and location are essential for shaping effective health policies aimed at reducing global mortality. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 provides cause-specific mortality estimates measured in counts, rates, and years of life lost (YLLs). GBD 2023 aimed to enhance our understanding of the relationship between age and cause of death by quantifying the probability of dying before age 70 years (70q0) and the mean age at death by cause and sex. This study enables comparisons of the impact of causes of death over time, offering a deeper understanding of how these causes affect global populations. GBD 2023 produced estimates for 292 causes of death disaggregated by age-sex-location-year in 204 countries and territories and 660 subnational locations for each year from 1990 until 2023. We used a modelling tool developed for GBD, the Cause of Death Ensemble model (CODEm), to estimate cause-specific death rates for most causes. We computed YLLs as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. Probability of death was calculated as the chance of dying from a given cause in a specific age period, for a specific population. Mean age at death was calculated by first assigning the midpoint age of each age group for every death, followed by computing the mean of all midpoint ages across all deaths attributed to a given cause. We used GBD death estimates to calculate the observed mean age at death and to model the expected mean age across causes, sexes, years, and locations. The expected mean age reflects the expected mean age at death for individuals within a population, based on global mortality rates and the population's age structure. Comparatively, the observed mean age represents the actual mean age at death, influenced by all factors unique to a location-specific population, including its age structure. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 250-draw distribution for each metric. Findings are reported as counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2023 include a correction for the misclassification of deaths due to COVID-19, updates to the method used to estimate COVID-19, and updates to the CODEm modelling framework. This analysis used 55 761 data sources, including vital registration and verbal autopsy data as well as data from surveys, censuses, surveillance systems, and cancer registries, among others. For GBD 2023, there were 312 new country-years of vital registration cause-of-death data, 3 country-years of surveillance data, 51 country-years of verbal autopsy data, and 144 country-years of other data types that were added to those used in previous GBD rounds. The initial years of the COVID-19 pandemic caused shifts in long-standing rankings of the leading causes of global deaths: it ranked as the number one age-standardised cause of death at Level 3 of the GBD cause classification hierarchy in 2021. By 2023, COVID-19 dropped to the 20th place among the leading global causes, returning the rankings of the leading two causes to those typical across the time series (ie, ischaemic heart disease and stroke). While ischaemic heart disease and stroke persist as leading causes of death, there has been progress in reducing their age-standardised mortality rates globally. Four other leading causes have also shown large declines in global age-standardised mortality rates across the study period: diarrhoeal diseases, tuberculosis, stomach cancer, and measles. Other causes of death showed disparate patterns between sexes, notably for deaths from conflict and terrorism in some locations. A large reduction in age-standardised rates of YLLs occurred for neonatal disorders. Despite this, neonatal disorders remained the leading cause of global YLLs over the period studied, except in 2021, when COVID-19 was temporarily the leading cause. Compared to 1990, there has been a considerable reduction in total YLLs in many vaccine-preventable diseases, most notably diphtheria, pertussis, tetanus, and measles. In addition, this study quantified the mean age at death for all-cause mortality and cause-specific mortality and found noticeable variation by sex and location. The global all-cause mean age at death increased from 46·8 years (95% UI 46·6-47·0) in 1990 to 63·4 years (63·1-63·7) in 2023. For males, mean age increased from 45·4 years (45·1-45·7) to 61·2 years (60·7-61·6), and for females it increased from 48·5 years (48·1-48·8) to 65·9 years (65·5-66·3), from 1990 to 2023. The highest all-cause mean age at death in 2023 was found in the high-income super-region, where the mean age for females reached 80·9 years (80·9-81·0) and for males 74·8 years (74·8-74·9). By comparison, the lowest all-cause mean age at death occurred in sub-Saharan Africa, where it was 38·0 years (37·5-38·4) for females and 35·6 years (35·2-35·9) for males in 2023. Lastly, our study found that all-cause 70q0 decreased across each GBD super-region and region from 2000 to 2023, although with large variability between them. For females, we found that 70q0 notably increased from drug use disorders and conflict and terrorism. Leading causes that increased 70q0 for males also included drug use disorders, as well as diabetes. In sub-Saharan Africa, there was an increase in 70q0 for many non-communicable diseases (NCDs). Additionally, the mean age at death from NCDs was lower than the expected mean age at death for this super-region. By comparison, there was an increase in 70q0 for drug use disorders in the high-income super-region, which also had an observed mean age at death lower than the expected value. We examined global mortality patterns over the past three decades, highlighting-with enhanced estimation methods-the impacts of major events such as the COVID-19 pandemic, in addition to broader trends such as increasing NCDs in low-income regions that reflect ongoing shifts in the global epidemiological transition. This study also delves into premature mortality patterns, exploring the interplay between age and causes of death and deepening our understanding of where targeted resources could be applied to further reduce preventable sources of mortality. We provide essential insights into global and regional health disparities, identifying locations in need of targeted interventions to address both communicable and non-communicable diseases. There is an ever-present need for strengthened health-care systems that are resilient to future pandemics and the shifting burden of disease, particularly among ageing populations in regions with high mortality rates. Robust estimates of causes of death are increasingly essential to inform health priorities and guide efforts toward achieving global health equity. The need for global collaboration to reduce preventable mortality is more important than ever, as shifting burdens of disease are affecting all nations, albeit at different paces and scales. Gates Foundation.
Teenage pregnancies remain a pressing issue in Sub-Saharan Africa, including Rwanda. Adolescent girls and young women (AGYW) continue to face a myriad of challenges in accessing sexual reproductive health (SRH) services. This study examines the accessibility and utilization of SRH services provided to AGYW in youth corners in Rwamagana district, Rwanda. It seeks to explore challenges and opportunities for accessing SRH services in youth corners. Utilising a descriptive qualitative research design, the study included 8 in-depth focus group discussions and 4 key informant interviews. Stratified sampling methodology was utilised to increase the representativeness of the AGYW and 71 AGYW participated in the study. The feminist standpoint theory aided in focusing on marginalised voices, analysing power structures and contextualising experiences of AGYW in Rwamagana. The socio-ecological model was used to analyse data using thematic analysis. The findings reveal various SRH services accessed by AGYW in youth corners, including family planning, services regarding sexually transmitted infections (STIs) and menstrual hygiene management. Barriers to service utilisation included limited knowledge about the available services, distance to health facility, unavailability of some services, AGYW being viewed as a prostitute when one is seen with condoms, norms that discourage open discussions about sexual health, and stigma surrounding the use of contraceptives. This was further worsened by the gender norms which create additional hurdles for AGYW, as they navigate societal expectations and restrictions that are not equally imposed on their male counterparts. The inconsistent availability of services coupled with diverse operating schedules also posed a challenge to accessing services. Most AGYW expressed trust in the healthcare providers' ability to maintain confidentiality, given their training and professional obligations. This sense of trust acted as a motivating factor for AGYW to be more open and forthcoming in utilising the available SRH services. Addressing the identified challenges faced by AGYW in accessing SRH services in youth corners will help to promote their well-being and bodily autonomy. Adolescent girls and young women (AGYW) in many communities face challenges in accessing sexual and reproductive health (SRH) services, which are critical for their well-being and rights. This study examines the availability, accessibility, and acceptability of SRH services offered to AGYW in youth corners within the Rwamagana district, while identifying barriers and opportunities for improvement.The research revealed that a variety of SRH services are available at youth corners, including family planning, menstrual hygiene management, and services regarding sexually transmitted infections (STIs). However, despite the availability of these services, many young women face barriers to accessing them. These barriers include a lack of knowledge about the available services, cultural norms that discourage open discussions about sexual health, and stigma surrounding the use of contraceptives.The study highlights the need for greater awareness and education to encourage AGYW to seek sexual reproductive health services. It also calls for community involvement to reduce the cultural stigma and misconceptions surrounding SRH. By addressing these challenges, the accessibility and utilisation for young women can be improved, which in turn will promote their well-being and protect their reproductive rights. This will contribute to reducing teenage pregnancies and empowering AGYW to make informed decisions and choices about their sexual health.
Enteric infectious diseases claim more than 1 million lives annually and are among the top ten causes of death in children younger than 5 years. Remarkable global investment has been dedicated to enteric infectious disease prevention and control; however, the shifting global health landscape is testing the continuance of progress. To evaluate the current status and guide future interventions, we present the latest epidemiological estimates of enteric infectious diseases from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 and assess progress towards the Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD) mortality target of fewer than 20 deaths per 100 000 children younger than 5 years by 2025. We quantified the incidence, mortality, and disability-adjusted life-years (DALYs) of enteric infectious diseases by age, sex, and year across 204 countries and territories from 1990 to 2023. In GBD 2023, the following were considered under the category of enteric infectious diseases: diarrhoeal diseases, enteric fever (typhoid and paratyphoid), invasive non-typhoidal Salmonella spp (iNTS) infections, and other intestinal infectious diseases. We also examined 15 aetiologies contributing to diarrhoeal diseases. Incidence and prevalence were estimated with DisMod-MR (version 2.1), a Bayesian meta-regression tool, drawing on data from systematic reviews, population-based surveys, claims data, and hospital sources. Cause-specific mortality was modelled with Cause of Death Ensemble Modelling based on data from sources including vital registration, mortality surveillance, verbal autopsy, and minimally invasive tissue sampling. Years of life lost and years lived with disability were computed and combined to derive DALYs. For aetiology-specific estimation, population-attributable fractions (PAFs) for 15 pathogens were derived with a counterfactual framework. Point estimates and 95% uncertainty intervals (UIs) were generated from 250 draws from the posterior distribution. In 2023, enteric infectious diseases resulted in an estimated 1·27 million (95% UI 0·963-1·68) deaths globally, declining from 3·69 million (3·04-4·56) in 1990. The global age-standardised mortality rate (ASMR) decreased from 74·1 (62·0-92·9) per 100 000 population to 16·4 (12·6-21·3) per 100 000 population during the same period. Diarrhoeal diseases accounted for most deaths in 2023 (1·11 million [0·811-1·54]), followed by enteric fever and iNTS. South Asia and sub-Saharan Africa remained the most affected regions in 2023, with 599 000 (441 000-882 000) and 501 000 (373 000-648 000) deaths due to enteric infectious diseases, respectively, predominantly from diarrhoeal disease. Rotavirus was the leading cause of all-age diarrhoeal disease deaths (PAF 16·3% [12·0-21·5]), followed by norovirus (10·2% [2·4-17·0]) and Shigella spp (9·3% [5·4-15·2]). Among children younger than 5 years, PAFs of deaths due to diarrhoeal diseases were 40·2% (32·5-48·5) for rotavirus, 24·0% (15·1-36·7) for Shigella spp, and 23·4% (13·7-34·3) for adenovirus. Across 204 countries and territories, 141 met the GAPPD mortality target in 2023. The driving aetiologies among countries that did not meet the target in 2023 varied slightly by GBD super-region, but the highest or second-highest number of deaths in children younger than 5 years were consistently attributed to rotavirus. Astrovirus and sapovirus, newly included in GBD 2023, were responsible for 24 600 (6290-49 000) and 18 800 (4650-44 400) deaths, respectively, in 2023, mainly in children younger than 5 years. Our findings show that mortality and ASMRs of enteric infectious diseases declined substantially between 1990 and 2023. This decline is consistent with the expansion of public health measures and broader socioeconomic development. However, the burden in 2023 remains considerably high, with the highest mortality concentrated in sub-Saharan Africa and south Asia. Considering that more than a quarter of all countries had yet to meet the GAPPD mortality target in 2023, sustained efforts are needed to address the persistent burden in affected countries and to adapt to the changing global health landscape. Gates Foundation.
Rising antimicrobial resistance of Helicobacter pylori is a public health challenge. Genomic-based susceptibility testing allows for the identification of resistance-associated mutations, complementing conventional diagnostics and advancing towards pathogen-based personalised therapies. Our study aimed to identify genes and mutations involved in antimicrobial resistance in H pylori and evaluate the extent to which these markers can be used as predictors of phenotypic resistance against clarithromycin and levofloxacin. In this retrospective phenotypic and genotypic observational study, we included 1011 H pylori whole-genome sequences and strains of known geographical origin from the H pylori Genome Project (HpGP) collection. We performed phenotypic clarithromycin and levofloxacin susceptibility testing on a subset of 419 HpGP strains using Etest at a centralised laboratory. A genomic analysis was conducted to identify 23S rRNA and gyrA variants and build a curated catalogue of mutations associated with resistance to clarithromycin (ie, 23S rRNA 2142A→G, 2142A→C, and 2143A→G) and levofloxacin (ie, gyrA A88V or A88P, N87K or N87I, and D91G, D91N, or D91Y). Genotype-phenotype concordance was assessed to estimate sensitivity and specificity, and the curated catalogue of resistance-associated mutations was applied to the complete HpGP set. Region-specific prevalence of resistance-associated mutations was calculated for a combined dataset including the HpGP genomes and 768 whole-genome sequences retrieved from the US National Center for Biotechnology Information Sequence Read Archive repository. Associations between resistance genotypes, H pylori subpopulations, and minimum inhibitory concentrations (MICs) were tested. Clarithromycin-resistant and levofloxacin-resistant HpGP strains were estimated with a sensitivity and specificity of 100%, with all confidence intervals ranging from 96% to 100%. The combined analysis (n=1779) found the highest prevalence of clarithromycin resistance in the western Pacific region (173 [51·2%] of 338 in southeast Asia and 75 [29·8%] of 252 in eastern Asia), north African region (seven [38·9%] of 18), and western Asian region (12 [31·6%] of 38), whereas the highest prevalence of levofloxacin resistance was found in south Asia (14 [51·85%] of 27), Central America (48 [38·7%] of 124), eastern Europe (four [36·4%] of 11), and southern Africa (three [33·3%] of nine). Similarly, 23S rRNA and gyrA genotypes are variable across H pylori subpopulations. MIC values changed depending on the specific mutation in 23S rRNA (mean clarithromycin MIC 24·61 mg/L [95% CI 12·27-36·96] for 2143A→G and 142·25 mg/L [95% CI 77·88-206·61] for 2142A→G) and gyrA (mean levofloxacin MIC 9·66 mg/L [95% CI 6·75-12·56] for mutations on codon 91, and 27·97 mg/L [95% CI 25·82-30·11] for mutations on codon 87). Mutations in specific genes are reliable indicators to clarithromycin and levofloxacin resistance in H pylori, making them useful markers for the development of diagnostic assays and molecular monitoring. Our results suggest that using clarithromycin and levofloxacin empirically, without previous susceptibility testing, is unsuitable in all geographical regions covered by this study. Intramural Research Program of the US National Cancer Institute, the European Research Council, and the Spanish Ministry of Science and Innovation.
Gender is crucial in understanding the sexual behaviour of adolescents regarding their condom use and sexual experiences. However, not much is known about the role gender plays in adolescents' opinions on condom use and their sexual experiences and other factors that influence these opinions in high-adolescent pregnancy settings in rural Ghana. This study sought to examine the gendered dynamics and factors that shape the opinions of adolescent girls and boys on condom use and how that affects their sexual experiences in the high teenage pregnancy setting of Adaklu District, in the Volta region of Ghana. Data for this study were extracted from a larger primary baseline cross-sectional study among 188 adolescents (109 girls and 79 boys) aged 10-19 years in 30 communities. Data from a semi-structured questionnaire were analyzed using a bivariate analysis and binary logistic regression. The results indicate adolescent girls were less likely (aOR = 0.16, CI 0.06-0.43) to agree to the opinion that condoms are an effective way of preventing HIV compared to boys. Adolescent girls are less likely to agree to the opinion that they have been pressured into sex (aOR = 0.15; CI 0.06-0.39), but have higher odds (aOR = 2.58; CI 1.33-1.64) to agree that purchasing condoms is embarrassing for them compared to males. Regarding age, adolescents 10-14 years are less likely (aOR = 0.43; CI 0.19-0.99) to agree that condoms are an effective in preventing HIV compared to those aged 15-19 years. Adolescents aged 10-14 years had higher odds (aOR = 2.91; CI 1.28-6.63) to agree that purchasing condoms is embarrassing for them to compared to the 15-19 year olds. Employment status of adolescents significantly influences their opinion on condom use, where adolescents who are currently employed are more likely to agree to the opinion that it would be embarrassing for them to go and purchase condoms compared to the unemployed ones. Gender, age and employment status of adolescents are critical to their sexual and reproductive health and wellbeing, as the study findings show distinct sexual experiences of adolescent boys and girls. These important factors should be considered when formulating sexual and reproductive health policies and programs for adolescents to meet their needs. RéSUMé: CONTEXTE: Le genre est crucial pour comprendre le comportement sexuel des adolescent(e)s en ce qui concerne l’utilisation des préservatifs et les expériences sexuelles. Cependant, on ne sait pas grand-chose sur le rôle que joue le genre dans les opinions des adolescent(e)s sur l’utilisation du préservatif et leurs expériences sexuelles et sur d’autres facteurs qui influencent ces opinions dans un contexte à forte prévalence de grossesses chez les adolescentes dans les zones rurales du Ghana. Cette étude visait à examiner les dynamiques de genre et les facteurs qui façonnent les opinions des adolescentes et des adolescents sur l’utilisation du préservatif et la façon dont cela affecte leurs expériences sexuelles dans un contexte à forte prévalence de grossesses chez les adolescentes du district Adaklu, dans la région de la Volta au Ghana. MéTHODES: Les données de cette étude ont été extraites d’une étude transversale de base préliminaire plus large menée auprès de 188 adolescent(e)s (109 filles et 79 garçons) âgé(e)s de 10 à 19 ans dans 30 communautés. Les données d’un questionnaire semi-structuré ont été analysées à l’aide d’une analyse bivariée et d’une régression logistique binaire. RéSULTATS: Les résultats indiquent que les adolescentes étaient moins susceptibles (aOR (rapport de cotes corrigé) = 0,16, IC (intervalle de confiance = 0,06–0,43) d’être d’accord avec l’opinion selon laquelle les préservatifs sont un moyen efficace de prévention du VIH par rapport aux garçons. Les adolescentes sont moins susceptibles d’être d’accord avec l’opinion selon laquelle elles ont subi des pressions pour avoir des rapports sexuels (aOR = 0,15 ; IC = 0,06–0,39), mais elles sont plus susceptibles (aOR = 2,58 ; IC = 1,33–1,64) de convenir que l’achat de préservatifs est embarrassant pour elles par rapport aux hommes. En ce qui concerne l’âge, les adolescent(e)s de 10 à 14 ans sont moins susceptibles (aOR = 0,43 ; IC = 0,19–0,99) de convenir que les préservatifs sont un moyen efficace de prévention du VIH par rapport à ceux et celles âgé(e)s de 15 à 19 ans. Les adolescent(e)s âgé(e)s de 10 à 14 ans étaient plus susceptibles (aOR = 2,91 ; IC = 1,28–6,63) de convenir que l’achat de préservatifs est embarrassant pour eux(elles) par rapport aux 15–19 ans. La situation d’emploi des adolescents influence considérablement leur opinion sur l’utilisation du préservatif, où les adolescents qui ont actuellement un emploi sont plus susceptibles d’être d’accord avec l’opinion selon laquelle il serait embarrassant pour eux d’aller acheter des préservatifs par rapport à ceux qui sont au chômage. CONCLUSION: Le sexe, l’âge et la situation d’emploi des adolescents sont essentiels à leur santé sexuelle et reproductive ainsi qu’à leur bien-être, car les résultats de l’étude montrent des expériences sexuelles distinctes chez les garçons et les filles. Ces facteurs importants doivent être pris en compte lors de la formulation de politiques et de programmes de santé sexuelle et reproductive pour les adolescent(e)s afin de répondre à leurs besoins.
While working in educational settings remains the second largest area of professional emphasis for Board Certified Behavior Analysts (BCBAs), there is a scarcity of research about how these professionals are prepared to provide services and supports in school-based placements. We investigated perceptions of school-based behavior analysts about their levels of preparation and confidence in applying their understanding of knowledge areas specific to school-based practice (i.e., multidisciplinary teaming, Individual Education Program teams, educational curricula and assessments, grade level benchmark standards and alternate standards for students with extensive support needs, educational law, and case law). Our focus was on identifying facilitators and barriers to effective school-based practice within their initial preparation. Additionally, we investigated how these professionals continued their education in these areas after receiving their initial credential. A total of 116 BCaBAs, BCBAs, or BCBA-Ds across each major geographic area of the United States completed a 26-item survey containing closed and open-ended questions. Most respondents perceived their initial behavior analysis training as providing no or minimal preparation in specific areas related to provision of services in educational settings. Those who had received supervised fieldwork in school settings rated their confidence in application of these areas in their practice higher than those who lacked such experience. Many respondents indicated that they had pursued or planned to seek additional training in these areas. They also identified facilitators and barriers to preparation for effective school-based practice. We discuss the results, implications for systems change, professional practice, and areas of future research. The online version contains supplementary material available at 10.1007/s40617-024-01028-7.
This study aimed to assess the impact of a brief web-based intervention for female college students with high-risk drinking on current drinking habits, as well as future intention and awareness regarding abstaining from alcohol during pregnancy. This quasi-experimental study recruited female college students with high-risk drinking and assigned them to either an intervention group (n=23) or a control group (n=23) based on availability and preference. The intervention group received a brief web-based session (30 minutes) focused on alcohol use prevention for future pregnancies and monitored their daily drinking using a mobile app for 1 month. Outcome measures included the Alcohol Use Disorders Identification Test, variables derived from the Theory of Planned Behavior (attitude, subjective norms, and intention) related to pregnancy, drinking refusal self-efficacy, and alcohol outcome expectancies. Data were analyzed using repeated-measures analysis of variance (ANOVA). There were significant changes in the mean differences from baseline scores between the groups with respect to positive attitudes toward drinking during pregnancy (t=-2.59, p=.013) and intentions to abstain from drinking during pregnancy (t=2.35, p=.005). Repeated-measures ANOVA demonstrated a significant interaction between group and time for both attitude (F=6.69, p=.013) and intention (F=8.58, p=.005). In addition, a significant improvement in drinking refusal self-efficacy was observed (t=2.49, p=.016). The brief web-based intervention significantly improved attitudes toward drinking during pregnancy, intentions to abstain from drinking during pregnancy, and drinking refusal self-efficacy, highlighting both the effectiveness and importance of this intervention.
Supporting people with neurodevelopmental disabilities often requires interdisciplinary collaboration and effective partnerships with clients and their families. Behavior analysts receive intensive training and supervision in a variety of domains; however, expanding interdisciplinary training for behavior analysts is needed. Interdisciplinary training programs, such as the Leadership Education in Neurodevelopmental and Related Disabilities (LEND) programs, offer trainees the opportunity to hone their skills as advocates for people with neurodevelopmental disabilities and collaborators as part of an interdisciplinary team. Historically, many LEND programs have not offered training positions specifically to behavior analysis students or professionals, although some behavior analysts have participated as trainees in other disciplines such as psychology or special education. The benefits, barriers, and possible future directions of interdisciplinary training for behavior analysts within a LEND program are discussed through the experience of the University of Cincinnati LEND Program which added an Applied Behavior Analysis (ABA) training track in 2020.
Adolescent pregnancy is a global issue. In adolescent pregnant women, health practices which are the activities that positively influence maternal, foetal, and neonatal health can be associated with various socio-demographic, psychological, and environmental factors. These can impact the outcomes of the pregnancy and the well-being of both mother and foetal. This study aims to identify health practices and associated factors among adolescent pregnant women. A cross-sectional study was conducted at a tertiary-care hospital. The sample of the study was calculated using a known population sample equation. A total of 128 pregnant women participated including 55 adolescents and 73 adult pregnant women. Data were collected using the 'Participant Description Questionnaire' and the 'Health Practice Questionnaire-II (HPQ-II)'. The research data analysed in this study were obtained from pregnant women who attended an antenatal follow-up clinic and who obtained informed consent to participate in this study. Data analysis was performed using SPSS for Windows Version 22.0 (IBM Corporation, Armonk, New York, USA). Comparative statistical analyses employed the independent sample t-test and the one-way analysis of variance (ANOVA) test; kwhen a difference was detected by ANOVA, the source of this difference was identified using the Tukey test. The Pearson correlation test was used to identify relationships between pairs of continuous variables. The average total HPQ-II score among adolescent pregnant women was 110.6 ± 14.3 compared to 121.3 ± 12.2 among adult pregnant women. Average total HPQ-II scores differed significantly between adolescent and adult pregnant women (p < 0.001). Average total HPQ-II scores among adolescent pregnant women differed significantly according to income level (p < 0.05) and prenatal care status (p < 0.001) while it was significant differences between HPQ-II scores and education level (p < 0.05), health insurance status (p < 0.001), and employment status (p < 0.05) in adult pregnant women. The reported health practices among adolescent pregnant women were poor than those among adult pregnant women in this study. Additionally, as income level increased, health practices among adolescent pregnant women also improved. Moreover, adolescent pregnant women who regularly attended antenatal follow-ups maintained better health practices. Additionally, adult pregnant women who had completed high school or higher education, were employed, and had health insurance exhibited better health practices. Therefore, it is recommended that the frequency of follow-ups for adolescent pregnant women be increased, that their health practices be evaluated, and that education and counselling services be provided that are tailored to their needs. Within the scope of the study, adolescent pregnant women had less access to healthcare services than adult pregnant women.
Risk assessment and evaluation before behavioral assessment and intervention is required by the Behavior Analyst Certification Board® (BACB®) Ethics Code for Behavior Analysts (BACB, 2020). Methods to do so and potential factors to consider are not readily available. Deochand et al. Behavior Analysis in Practice, 13, 978-990, (2020) developed the Functional Analysis Risk Assessment Decision Tool (FARADT) to aid behavior analysts in ethical decision-making regarding whether to conduct a functional analysis. An empirical evaluation of whether use of the FARADT impacts novice users' ratings of risk has not yet been conducted. The present study served as a pilot evaluation of expert and novice behavior analysts' ratings of risk with and without access to the FARADT when given scenarios in which a functional analysis was being considered. Results indicated that for our participants, FARADT decreased variability of risk ratings for novices and produced ratings of risk that more closely matched the intended risk level of the vignette for both experts and novices. Results provided preliminary evidence that decision-making tools may be helpful to both novice and expert behavior analysts.In order to be in compliance with the Ethics Code for Behavior Analysts (Behavior Analyst Certification Board® [BACB®], 2020), it is important that behavior analysts are evaluating risks associated with functional analyses prior to beginning assessment.The FARADT is a tool that may be helpful to both expert and novice behavior analysts as they evaluate the risks inherent in functional analyses.There is limited empirical research on the utility and effectiveness of behavior-analytic decision-making tools.Our findings suggest experts engage in complex covert verbal behavior when evaluating risk.More research is needed on the decision-making processes experts utilize when analyzing complex and nuanced contexts of assessment and treatment. The online version contains supplementary material available at 10.1007/s40617-024-01006-z.
Behavior analysts continually assess the needs of clients and the community at large. Some behavior analysts have educated themselves and become public policy advocates at the local, state, national, and international levels. Across the world, behavior analysts are meeting with legislators to educate them on behavior analytic solutions to societal problems, including but certainly not limited to why people need behavior analytic services. Incorporating a behavior analytic perspective into policies supports best practices in many areas and creates a more humane, positively reinforcing environment for all. Papers published in this special issue of Behavior Analysis in Practice on public policy advocacy demonstrate how such work has positively affected society across the globe. Such work has involved credentialing and regulation of behavior analysts, funding for ABA services, and increasing service capacity. Authors discuss their public policy advocacy efforts, share lessons learned, and discuss implications for future efforts. Many behavior analysts may be unaware of the importance of being involved in public policy and advocacy and how they can make a difference for the benefit of society. Behavior analysts are urged to learn from the work described and adapt and apply it in their community.
In their seminal work published in 1988, Van Houten and colleagues established foundational principles for the rights to effective behavior intervention, ensuring ethical and effective treatment for individuals with behavioral challenges. This revisitation of their pioneering article investigates the enduring relevance of these rights in contemporary practice and the evolving context shaping our considerations. Re-examining these principles reveals their continued pertinence and essential role in safeguarding the welfare of clients and their caregivers. In light of evolving therapeutic approaches and societal changes, it is crucial for behavior analysts to reaffirm their commitment to upholding these rights. By highlighting the challenges and barriers persisting in current practice, this paper aims to ignite a vital conversation within the field, fostering collaboration and innovation to identify solutions that protect the well-being and dignity of the individuals we serve. This re-evaluation underscores the ongoing importance of these rights and encourages practitioners to critically assess how they are applied today. By acknowledging the obstacles and dilemmas that clients, caregivers, and professionals encounter in contemporary practice, we can collectively work toward solutions that ensure the ethical and effective treatment of individuals with behavioral challenges. This paper is a call to action, emphasizing the need for a renewed commitment to these rights and inviting dialogue to drive progress in the field of behavior analysis.
Behavior analysis is an emerging field of practice across the world. However, a lack of global standardization has led to disparities in the quality and scope of practice in different countries. In Latin America, the field of behavior analysis is still relatively new, and the issue of regulation has been a significant challenge for professionals seeking to establish and expand their practice. This paper provides an overview of the current situation in the regulation of behavior analysis in 15 Latin American countries, examining each country's regulations, laws, and coverage, and identifying the challenges and opportunities for implementing and enforcing behavior analysis practices. By identifying these challenges and opportunities, this paper seeks to contribute to the ongoing efforts of behavior analysts in Latin America to establish a robust and sustainable framework for the regulation of behavior analysis.
Premature pregnancy among adolescents remains a critical public health challenge, particularly among ethnic populations in low-resource settings. Health literacy has been identified as a key determinant of reproductive decision-making and preventive behaviors. This study aims to assess the levels of health literacy and examine their association with pregnancy prevention behavior among ethnic students in northern Thailand. A cross-sectional study was conducted with 128 in-school ethnic adolescent girls, using validated instruments to measure health literacy across three domains: basic, interactive, and critical health literacy, and pregnancy prevention behavior. Descriptive statistics, Pearson's correlation, and multiple linear regression were used to analyze the data. The participants exhibited moderate overall health literacy, with high scores in decision-making skills but relatively low scores in basic and interactive literacy. Pearson's correlation analysis revealed that critical literacy was positively associated with prevention behavior (r = 0.336, p < 0.001), while interactive literacy showed a negative correlation (r = -0.247, p < 0.001). Multiple regression analysis further confirmed these associations. Critical literacy significantly predicted pregnancy prevention behavior (β = 0.438, p < 0.001), whereas interactive literacy had a significant adverse effect (β = -0.568, p < 0.001). The model explained 17.8% of the variance in behavior (R 2 = 0.178). The findings underscore the importance of critical health literacy in fostering preventive behaviors among ethnic adolescents. Tailored interventions should emphasize evaluative and judgmental skills while addressing culturally rooted communication challenges. These insights may inform inclusive reproductive health policies in ethnic and underserved communities.
Globally, complications from pregnancy and childbirth are the leading causes of death among adolescent girls aged 15-19 years. In Zambia, nearly three in ten adolescent girls have begun childbearing, with rates as high as 35% in rural areas. These high rates contribute to adverse maternal and newborn outcomes, perpetuating intergenerational cycles of poverty and limiting opportunities for education and economic empowerment among young mothers. This study explored factors associated with adolescent pregnancy in Zambia. This cross-sectional study utilized data from the 2018 Zambia Demographic and Health Survey. A total of 2,996 adolescents aged 15-19 years were included in the analysis. This study utilized the socioecological model to select potential influencing factors for adolescent pregnancy. Descriptive and multivariable analyses were conducted using SPSS version 22 software. The prevalence of adolescent pregnancy was 29.9%. Most adolescents had no sexual partners (59.0%), and 49.7% had initiated sexual intercourse. Factors independently associated with adolescent pregnancy included increasing age, marital status (AOR = 5.4; 95% CI: 3.7, 7.9), knowledge about contraception (AOR = 3.4; 95% CI: 1.2, 9.8), use of contraception (AOR = 3.4; 95% CI: 1.2, 9.8), literacy level (AOR = 1.7; 95% CI: 1.1, 2.6), and exposure to family planning messages in newspapers or magazines (AOR = 2.6; 95% CI: 1.1, 6.4). Other factors included wealth status (AOR = 2.3; 95% CI: 1.2, 4.1 for richer versus richest, AOR = 3.8; 95% CI: 1.9, 7.6 for middle versus richest, AOR = 3.4; 95% CI: 1.7, 6.8 for poor versus richest, AOR = 4.2; 95% CI: 2.0, 8.9 for poorer versus richest) and age at first sexual intercourse (AOR = 2.1; 95% CI: 1.3, 3.4 for 15-17 versus 18-19, AOR = 3.8; 95% CI: 2.1, 6.9 for less than 15 versus 18-19). Key factors associated with adolescent pregnancy in Zambia include older age, early marriage, low literacy, low socioeconomic status, early sexual initiation, and limited exposure to family planning messages via newspapers. Interventions to address this problem should include behavioral change communication strategies that discourage early sexual debut, especially among older adolescents. Furthermore, leveraging media platforms, particularly newspapers, in disseminating accurate messages on contraception and enforcing statutory laws on the legal age of marriage are crucial efforts in addressing this problem.
Background/Objectives: The increasing global population and rising demand for protein-rich foods present significant challenges for the agri-food system. Cultivated meat, produced through cellular agriculture, is emerging as a promising alternative to traditional livestock farming, offering potential environmental and ethical benefits. However, its adoption remains controversial due to concerns about sustainability, safety, and cultural acceptance. This study investigates Italian consumers' perceptions, knowledge, and willingness to purchase cultivated meat, considering psychological, demographic, and social factors. Methods: A structured online survey was conducted involving 437 Italian meat consumers, integrating established psychometric scales to assess key attitudes. Logistic regression analysis was applied to identify determinants of consumer acceptance. Results: Findings reveal that while awareness of cultivated meat is relatively high (81.92%), willingness to purchase it is low, at just 35.47%. The main motivations for interest are environmental sustainability (54.61%) and innovation appeal (25.00%), while the primary barriers are health concerns (31.58%) and doubts about production processes (34.59%). The results also show that food neophobia, environmental awareness, and inclination toward food innovation significantly influence purchasing decisions. Additionally, demographic factors, such as age, gender, income, and household size, play a crucial role. Conclusions: This study provides insights into consumer behavior toward food innovations, informing policymakers and industry stakeholders on strategies to enhance acceptance and promote sustainable food alternatives.
Since its inception over four decades ago, numerous types and modifications to functional analysis (FA) have been published, likely in part to provide practitioners with a feasible, acceptable, safe, and ecologically valid assessment to inform the treatment of problem behavior. Even so, there are still cases in which an FA is not possible in a given setting or yields undifferentiated results, making conclusions from the FA difficult to interpret. Rather than relying on less rigorous and precise assessment methods (e.g., indirect reports) as part of the functional behavior assessment (FBA) process to inform treatment, a practitioner could employ a concurrent operant analysis (COA). A COA is an assessment that relies on direct observation and experimental manipulations that may be useful for supplementing the FBA process when an FA is not ideal or possible. Further, COAs may be beneficial in that they may avoid the potential drawbacks and criticisms (e.g., evoking problem behavior) that may be more likely associated with FAs than COAs. Despite the benefits of a COA, it has been slow to appear in research for the assessment and treatment of problem behavior. In this clinical tutorial, we provide a comprehensive, step-by-step description using hypothetical, illustrative examples, along with several resources to assist in developing, implementing, and analyzing a COA.
Behavior analytic practice is fundamentally prosocial, aimed at helping individuals by expanding their repertoires to be more meaningfully effective. Behavior analysis, however, has faced criticism for lacking qualities of compassionate practices such as warmth and flexibility. Recently, more attention is being paid to how we might foster such practices consistent with behavior analytic principles. A concise but comprehensive functional definition would support these efforts by making compassion directly actionable. This paper provides a brief review of the features of compassion as characterized in the behavior analytic literature, examines converging functional dimensions in a comprehensive conceptual analysis, and proposes a functional definition of compassion in terms of the interlocking functional relations involved for provider and recipient of compassion. Finally, we will explore implications of this conceptualization in terms of recommendations for creating compassionate contexts for learning and nurturing compassionate behavior.
Most outcome research on Applied Behavior Analysis (ABA) treatment suggests that high intensity yields the best outcomes for patients with autism spectrum disorder (ASD). However, little is known about what impacts the determinations behavior analysts make regarding individualized treatment intensity recommendations. We conducted a cross-sectional survey of behavior analysts with experience developing and overseeing behavior analytic treatment for individuals with ASD (N = 559). We asked participants to report how 36 patient, familial, and logistical factors impact their treatment intensity recommendations using a 7-point Likert scale (ranging from significantly decrease to significantly increase recommended treatment intensity). Results indicated variation in the factors that impact recommendations as well as the direction of impact, with the greatest agreement that patient diagnosis and skills deficits lead to increased treatment intensity recommendations. Although the data reveal patterns and areas of seemingly greater consensus, the significant variability in clinicians' approaches to individualizing treatment intensity recommendations indicates a need for future research on training and standards for clinicians to ensure appropriate treatment intensity recommendations are provided to all patients receiving ABA treatment.
Toe walking, which is defined as walking with a bilateral toe-to-toe gait, is common among children with intellectual and developmental disabilities and can result in a number of medical problems. Both medical and behavioral treatments for toe walking have been evaluated. In the current study, we surveyed caregivers of individuals who engage in toe walking about their use of various medical and behavioral treatments. Results suggest that the use of medical treatments is more common, and most respondents reported that they were unaware that behavioral treatment of toe walking is an option. Most respondents reported that the hypothesized function of toe walking by their child is automatic positive reinforcement, although more than half attributed toe-walking to a disorder (e.g., autism spectrum disorder), a physical cause (e.g., tight muscles), or reported they did not know why their child engaged in toe walking. Surgery and increased response effort via weighted boots were the medical and behavioral treatments, respectively, perceived to be most effective in treating toe walking. To assist the behavior analytic community in managing toe-walking cases, we also provide some specific recommendations for practitioners, including a description of the advantages and disadvantages of behavioral treatments for toe walking and a decision tree for behavior analysts unfamiliar with the literature on this topic.