Background Methamphetamine use not only impacts health and the economy but also causes social impairment, particularly among the poorly educated and underprivileged young populations among the hill tribes in northern Thailand. Youths are the most vulnerable population for methamphetamine use due to various factors, including parenting styles, childhood exposure, and location of the village. This qualitative approach aimed to investigate the perceived factors influencing the initiation of methamphetamine use among the Akha and Lahu youths in northern Thailand. Methods A qualitative approach was used to elicit the information from key informants of Akha and Lahu youths who lived in villages in Chiang Rai province. A sixteen-question guideline was developed and examined for quality by three experts in the field and piloted before use. In-depth interviews were conducted among 19 Akha and 22 Lahu youths, serving as key informants from four villages, in a private and confidential room in their villages between June and August 2018. Each interview lasted approximately an hour. A thematic analysis was performed to evaluate the information. Results In total, 41 participants (19 Akha and 22 Lahu) from 4 villages participated in the study. According to the context and content obtained, four major perceived factors (low self-esteem, family member use, positive expectation regarding methamphetamine use, and availability), and five supportive factors (social norm perception, school dropout, family level problems, poor economic, and no Thai citizenship) were found to contribute to the initiation of methamphetamine use among the Akha and Lahu youths in northern Thailand. Conclusions Akha and Lahu youths are initiating methamphetamine use due to several factors, including living in a poor family and in a remote area. All relevant government agencies with a mission to prevent and protect against methamphetamine use should consider the perceived factors influencing the initiation of methamphetamine use in these populations in order to develop a powerful program to stop methamphetamine use. Electronic supplementary material The online version of this article (10.1186/s12889-019-7226-y) contains supplementary material, which is available to authorized users.

Background Methamphetamine (MA) is a commonly used substance among youths, particularly those who are living in poor economic conditions with low levels of education and who have had bad childhood experiences. The Akha and Lahu hill tribe youths living on the Thailand-Myanmar-Laos border are identified as the group most vulnerable to MA use in Thailand. The study aimed to estimate the prevalence of MA use and determine its associations with childhood experiences among Akha and Lahu youths aged 15-24 years in northern Thailand. Methods A cross-sectional study was performed. Validated and sealed questionnaires were used to gather information from participants after obtaining the informed consent form. Questionnaires were completed by participants and their parents at home. Logistic regression was used to identify the associations between variables at the α = 0.05 level. Results A total of 710 participants participated in the study: 54.2% were Akha, 52.5% were females, 50.6% were aged 15-17 years, and 11.4% did not have Thai identification card (ID) cards. The overall prevalence of MA use at least once among Akha and Lahu youths was 14.5%. After controlling for all potential confounding factors, 8 variables were found to be associated with MA use. Males had a greater chance of MA use than females (AOR = 4.75; 95% CI = 2.27-9.95). Participants aged 21-24 years had a greater chance of MA use than those aged 15-17 years (AOR = 2.51; 95% CI = 1.11-5.71). Those who had a family member who used MA had a greater chance of MA use than those who did not (AOR = 5.04; 95% CI =

Background Triglycerides are lipids in the human body that are produced from the consumption of daily food and drink. However, elevated serum triglycerides, also known as hypertriglyceridemia (HTG), are key biomarkers indicating an unhealthy status and increased risks of cardiovascular diseases (CVDs) and pancreatitis. Different groups of people have different patterns and styles of cooking and different patterns of consumption, such as hill tribe people, who have their own unique culture and cooking practices. This study aimed to estimate the prevalence of and determine the factors associated with HTG among the hill tribe population in Thailand. Method A cross-sectional study was performed. Data and a-5 mL blood sample were collected from participants who were members of one of the six main hill tribes in Thailand: Akah, Lahu, Hmong, Yao, Karen, and Lisu. People who lived in 30 selected hill tribe villages and aged 30 years over were asked to participate the study. Pearson correlation and logistic regression were used to detect the correlations and determine the associations between variables, respectively, at a significant level of α = 0.05. Results A total of 2552 participants participated this study; 65.9% were females, 72.35% were aged 40–69 years, 76.7% had no education, 48.7% worked in the agricultural section, and 71.2% had an annual income of less than 50,000 baht/family. Regarding the triglyceride level, 41.7% of participants had elevated levels of serum triglyceride or HTG; 16.4% had a borderline high level, and 25.3% had a high level. After controlling for all potential confounder factors, three variables were found to be associated with elevated serum triglycerides. Those who were members of the Lahu and Hmong tribes were 1.62 times (95%CI = 1.25–2.01) and 1.63 times (95%CI = 1.23–2.16) more likely to have elevated serum triglycerides than those who were members of the Akha tribe, respectively. Those who used a high quantity of cooking oil for daily cooking were 0.73 times less likely to have an abnormal level of triglycerides than those who used a low quantity of cooking oil for daily cooking (95%CI = 0.58–0.91), and those who had a waist circumference indicating obesity were 1.28 times more likely to have an abnormal level of triglycerides than those who had a normal waist circumference (95%CI = 1.08–1.52). Conclusion Public health programs that focus on encouraging people to have regular exercise to reduce their body weight, particularly in some tribes, such as Lahu and Hmong, should be implemented.

Background: Depression is a silent health problem that can lead to severe and sometimes fatal outcomes if individuals are not diagnosed and treated properly; this is particularly true in populations with limited education, low economic status and several barriers to accessing health services, such as the hill tribe people in Thailand. Methods: This cross-sectional study aimed to explore the prevalence of and factors associated with depression among hill tribe individuals aged 30 years and over. A validated questionnaire and the Patient Health Questionnaire-9 (PHQ-9) were used for data collection in an interview format in a private and confidential room.Logistic regression was used to detect the associations of variables with depression at a significance level of α ¼ 0.05. Results: A total of 2,552 participants were recruited for the analysis; 65.9% were females, 79.9% were married, 35.8% were aged 50 years and over, and 54.2% were Buddhist. The majority were uneducated (76.7%), were agriculturalists (48.4%), and had a low family income (71.2%). The overall prevalence of depression was 12.0%. In the multivariate analysis, eight variables were found to be significantly associated with depression among hill tribe adults aged 30 years and over in Thailand. Being female, 50 years or older, married, and Christian; living with a relative; smoking; using opium; and having moderate and high stress levels were associated with depression. Conclusion:Effective public health interventions should be considered to reduce the burden of depression in the hill tribe population by focusing on individuals who are female, 50 years or older, married, Christian, and stressed and those who abuse substances.

Background Low-density lipoprotein cholesterol (LDL-C) is one of the most important types of cholesterol and has an impact on health. Certain lifestyle and dietary habits in different populations may leads to increased levels of LDL-C, particularly among those with poor education and economic statuses, such as hill tribe people in Thailand. This study aimed to estimate the prevalence of and determine the factors associated with high LDL-C levels among hill tribe people in northern Thailand. Methods A cross-sectional study was performed to gather information from six main hill tribe populations: Akha, Lahu, Hmong, Yao, Karen, and Lisu. Individuals who were aged over 30 years and living in 30 selected hill tribe villages were invited to participate in the study. A validated questionnaire and 5-mL blood specimens were used to obtain data. Correlation analyses, chi-square tests, t-tests, and logistic regression were used to detect correlations and associations. Results A total of 2552 participants were recruited into the study; 65.9% were females, and 64.1% were aged younger than 60 years old. Approximately 69.6% of participants had abnormal LDL-C levels; 33.6% had above-optimal levels, 24.3% had borderline high levels, 8.0% had high levels, and 3.7% had very high levels. A total of 17.4% of participants had low high-density lipoprotein cholesterol (HDL-C) and high LDL-C levels, while 14.9% had high triglyceride and LDL-C levels. After controlling for sex, age, religion, education, annual family income, and marital status in the multivariate model, three variables were found to be associated with high LDL-C levels: occupation, the amount of lard used in daily cooking, and glycated hemoglobin (HbA1c). Those who were working as agriculturalists had a 1.34-fold greater chance of having abnormal LDL-C than traders and others (95% CI = 1.09–1.34). Those who used moderate and high quantities of lard in their daily cooking had a 1.45-fold (95% CI = 1.15–1.82) and 1.31-fold (95% CI = 1.04–1.68) greater likelihood of having abnormal LDL-C levels than those who used low quantities, respectively. Those who had abnormal HbA1c levels were less likely to develop abnormal LDL-C levels than those who had normal HbA1c levels (AOR = 0.69, 95% CI = 0.51–92). Conclusions Effective public health programs that do not conflict with the cultures of hill tribes are urgently needed, particularly programs encouraging the use of small quantities of lard for daily cooking practices.

Background Thalassemia is a severe disease that occurs due to abnormalities in hemoglobin genes. Various genetic factors in different populations lead to different clinical manifestations of thalassemia disease, particularly among people who have a long history of migration and who have married among tribes, such as the hill tribe people in Thailand. This genetic epidemiological study aimed to estimate the prevalence of various forms of thalassemia among the six main hill tribe populations in Thailand. Methods A cross-sectional study was conducted to obtain information and blood specimens from school children belonging to one of the six main hill tribes in Thailand: Akha, Lau, Hmong, Yao, Karen, and Lisu. Hill tribe children who were attending grades 4–6 in 13 selected schools in Chiang Rai Province, Thailand, were invited to participate in the study. A validated questionnaire and 3 mL blood specimens were collected after obtaining information consent forms from both the children and their parents on a voluntary basis. A complete blood count (CBC) was performed, followed by osmotic fragility (OF) and dichlorophenol indophenol precipitation (DCIP) tests to screen for thalassemia. High-performance liquid chromatography (HPLC) and real-time quantitative polymerase chain reaction (qPCR) were used to identify hemoglobin type and α-thalassemia, respectively. A t-test, chi-square and logistic regression were used to detect the associations between variables at the significance level of α = 0.05. Results A total of 1,200 participants from 6 different tribes were recruited for the study; 50.0% were males, and 67.3% were aged 11–12 years. The overall prevalence of thalassemia carriers according to the screening tests was 9.8% (117 of 1,200). Among the cases, 83 were A2A (59 cases were α-thalassemia 1 carrier or α-thalassemia 2 carrier or homozygous α-thalassemia 2, and 24 cases were β-thalassemia trait with or without α-thalassemia); 1 case was EE (homozygous Hb E with or without α-thalassemia); 31 cases were EA (30 cases were the Hb E trait, and 1 case was Hb E trait with or without α-thalassemia); 1 case was A2A Bart’s H (Hb H disease α-thalassemia 1/α-thalassemia 2); and 1 case was A2A with abnormal Hb. The prevalence of the α-thalassemia 1 trait among the hill tribe population was 2.5%. The greatest prevalence of the α-thalassemia 1 trait was found in the Karen (3.0%) and Hmong (3.0%) tribes. Conclusions The prevalence of some forms of thalassemia in the hill tribe population is higher than that in the Thai and other populations. Effective and available thalassemia screening tests, including essential information to protect the next generation through the specific counseling clinic, are crucial, particularly due to increasing marriages within these populations.

A community-based cross-sectional study was performed to estimate the prevalence of and determine factors associated with undiagnosed type 2 diabetes (T2DM) among hill tribe adults aged 30 years and over. Data were collected from the target hill tribe people living in the 30 selected villages in Chiang Rai Province in northern Thailand. A total of 2365 people were invited to participate in the study; 65.9% were female, 72.4% were aged 40–69 years, 0.9% regularly received preventive healthcare, and only 41.2% understood Thai. The overall prevalence of undiagnosed T2DM was 7.5%. After adjusting for age and sex, two factors were found to be associated with T2DM: triglycerides and high-density lipoprotein cholesterol (HDL-C). Those with high triglyceride levels were 2.80 (95% CI 1.99–3.94) times more likely to be suffering from T2DM than those with a normal triglyceride level. Those with low HDL-C levels were 1.65 (95% CI 1.16–2.34) times more likely to be suffering from T2DM than those with normal HDL-C. Appropriate public health interventions should be developed and implemented to reduce T2DM by providing regular preventive healthcare, educating patients on DM prevention and control, and encouraging regular exercise and reduced consumption of fatty food.

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