ECC might negatively affect children's nutritional status, which might be mediated by the depth of decay, chronic inflammation, and mouth pain. Family-based and prevention-oriented nutrition and oral health programs are needed and should start during pregnancy and infancy.

Globalization and urbanization in Nepal have driven a nutritional transition from an agricultural-based diet to an ultra-processed, sugary diet. This study assessed the nutrition and oral health of 836 children age 6 months to 6 years and their families in rural and urban Nepal. Mothers were interviewed about maternal–child oral health and nutrition, and children received dental exams and height and weight measurements. Analyses utilized SPSS statistical software. Most families lived within a 5-minute walk to a store selling ultra-processed snacks and sugary drinks. While most mothers knew sweets caused tooth decay, half of the children were given sweets daily, and 58.2% of children had dental caries. Caries began in the first 2 years and increased in prevalence and severity to age 6, when 74.3% had caries and 20% experienced mouth pain. Despite greater health knowledge and resources among urban mothers, urban children’s increased access to junk food and frequency of consumption was associated with higher prevalence and severity of caries compared to rural children. Severe caries was associated with malnutrition, especially in rural children. Preventive strategies are needed in early childhood to incorporate nutrition and oral health education and dental care into maternal–child health services, and develop policies to prohibit the sale of junk food around schools.

Purpose-To understand racial/ethnic minority adolescent females' experiences with the vaginal ring.Methods-We conducted in-depth interviews with a clinic-based sample of 32 young women aged 15-24 years who had used the vaginal ring.Results-Qualitative analysis using grounded theory revealed that adolescents undergo a multistage process when trying the ring and adopting ring use. These stages include hearing about the ring, initial reactions, first experiences with insertion and removal, and first sexual experiences. Adolescents subsequently enter an assessment and adjustment stage in which they decide whether to adopt or discontinue ring use. Ultimately they share their experiences with friends. Conclusions-The model developed provides a context within which providers may advise adolescents as they begin use of the ring. Some specific recommendations are offered. KeywordsVaginal ring; adolescence; Adolescent; Contraception; Reproductive health; Qualitative Unintended pregnancy-a major public health problem in the United Statesdisproportionately affects young, unmarried, low-income, and racial/ethnic minority women [1]. Oral contraceptive pills (OCPs) remain the most common method of hormonal contraception used by adolescents [2]. However the need for daily compliance and the occurrence of side effects can lead to method discontinuation [3].The vaginal ring (NuvaRing®, Organon Pharmaceuticals USA), a hormonal contraceptive introduced in 2001, offers adolescents a novel contraceptive option. The ring is self-inserted into the vagina and is left in place for 21 days per cycle followed by a 7-day ring-free period. Effectiveness is not compromised if the ring is removed for less than 3 hours. The ring releases ethinyl estradiol and etonogestrel, a progestin similar to that found in OCPs.

Background: The global "nutrition transition" has increased children's consumption of sugary snacks and beverages (junk food), compounding their risk for poor oral health and malnutrition. The purpose of this study was to examine the relationship between early childhood caries (ECC) and malnutrition in a community context. Methods: This is a baseline and two-year follow-up analysis of a community-based preventive oral health and nutrition intervention for 1,575 children, from birth through age six, in an indigenous population in rural Ecuador. Trained community volunteers, preschool teachers and dentists provided children and families with nutrition and oral health education, toothbrushes and fluoride toothpaste, fluoride varnish, and referral for dental treatment, three times per year. Annual data collection included mother interviews, child dental examinations and measurements of height and weight. Descriptive and bivariate analyses were completed in SPSS. Results: At baseline, nearly half of children consumed junk food daily. ECC began in infancy, increasing steadily thereafter. Among one-year-olds, 53.8% had caries with a mean of 2.1 decayed teeth; and among six-year-olds, 98.6% had caries with a mean of 10.5 decayed teeth, and half experienced mouth pain. At two-year follow-up, reported junk food consumption was cut in half; and the prevalence and severity of caries and mouth pain were reduced. Children who entered the intervention in their first year of life experienced the greatest dental improvements. Children who entered in their first two years and attended the entire two-year intervention experienced a one-third reduction in stunting malnutrition, with greatest improvement among those whose caries increment was controlled. Conclusions: ECC and caries-related malnutrition were reduced for children who participated in this prevention-oriented community oral health and nutrition intervention, especially those beginning in the first two years of life. Oral health and nutrition promotion should be incorporated into all maternal-child health programs, from pregnancy and birth onward.

Over the first 4 years of the program, PRIME-US students and non-PRIME students, faculty, and staff experienced educational benefits consistent with the intended program goals. Long-term evaluation is needed to examine the participants' medical careers and impacts on California's healthcare workforce and patient outcomes. Attention should also be paid to the challenges of implementing new medical education enrichment programs.

Childhood obesity is a public health threat that disproportionally affects Latino youth in the United States. Active and Healthy Families (AHF) is a culturally tailored, family-based program for addressing obesity disparities in a predominantly immigrant Latino population. AHF was the first primary care, culturally tailored intervention for Latino children to significantly reduce BMI in a randomized controlled trial. The 10-week AHF intervention reduced BMI (kg/m) among overweight or obese children by 0.5, compared with an increase of 0.3 in the control group, yielding a -0.8 difference ( p < .01). A unique aspect of the program is its provider team: a physician, dietitian, and promotora. Because early feedback from families highlighted the importance of promotoras specifically, we sought to understand the unique mechanisms of promotora effectiveness in AHF. We conducted in-depth, semistructured interviews with the AHF providers ( n = 5) and parent participants ( n = 23) by phone between November 2012 and May 2013. In a grounded theory analysis, three main categories encompassing five themes emerged: (a) bridging communication by promotoras; (b) promotoras' personal qualities, including themes of kindness and caring and shared experiences with patients; and (c) impactful task performance, including themes of motivation, positive environment, and self-efficacy. Together, the themes serve as the basis of a conceptual model illustrating the process through which promotoras may enhance the impact of team-based obesity programs for the Latino community. Because this study identifies the specific ways through which promotoras can bridge cultural, linguistic, and other divides, it may inform development and dissemination of evidence-based approaches for obesity prevention in the Latino community.

BackgroundGlobalization and increased marketing of non-nutritious foods and beverages are driving a nutrition transition in developing countries, adversely affecting the health of vulnerable populations. This is a visual interpretive study of food, snack, and beverage advertisements (ads) in rural and urban El Salvador to discern the strategies and messages used to promote consumption of highly processed, commercialized products.MethodsDigital photographs of billboard and wall advertisements recorded a convenience sample of 100 advertisements, including 53 from rural areas and 47 from urban areas in El Salvador. Advertisements were coded for location, type of product, visual details, placement and context. Qualitative methods were used to identify common themes used to appeal to consumers.ResultsAdvertisements depicted “modern” fast foods, processed snacks and sugary beverages. Overall, the most prominent themes were: Cheap Price, Fast, Large Size, and Modern. Other themes used frequently in combination with these were Refreshment, Sports/Nationalism, Sex and Gender Roles, Fun/Happy Feelings, Family, Friendship and Community, and Health. In rural areas, beverage and snack food ads with the themes of cheap price, fast, and large size tended to predominate; in urban areas, ads for fast food restaurants and the theme of modernity tended to be more prominent.ConclusionsThe advertisements represented a pervasive bombardment of the public with both explicit and subliminal messages to increase consumerism and shift dietary patterns to processed foods and beverages that are low in micronutrients and high in carbohydrates, sugar, fat and salt—dietary changes that are increasing rates of child and adult diseases including tooth decay, obesity, cardiovascular disease and cancer. Global food and beverage industries must be held accountable for the adverse public health effects of their products, especially in low-middle income countries where there are fewer resources to prevent and treat the health consequences. In addition, public health and governmental authorities should learn from the advertising strategies to promote social marketing of public health messages, and enact and enforce regulations to limit the advertisement and sale of unhealthy products, particularly for children in and around schools. This will create healthier social norms and environments for the entire population.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-1836-9) contains supplementary material, which is available to authorized users.

Malnutrition and dental caries in early childhood remain persistent and intertwined global health challenges, particularly for indigenous and geographically-remote populations. To examine the prevalence and associations between early childhood dental caries, parent-reported mouth pain and malnutrition in the Amazonian region of Ecuador, we conducted a cross-sectional study of the oral health and nutrition status of 1407 children from birth through age 6 in the “Alli Kiru” program (2011–2013). We used multivariate regression analysis to examine relationships between severe caries, parent-reported mouth pain measures, and nutritional status. The prevalence of dental caries was 65.4%, with 44.7% of children having deep or severe caries, and 33.8% reporting mouth pain. The number of decayed, missing and filled teeth (dmft) increased dramatically with age. Malnutrition was prevalent, with 35.9% of children stunted, 1.1% wasted, 7.4% underweight, and 6.8% overweight. As mouth pain increased in frequency, odds for severe caries increased. For each unit increase in mouth pain frequency interfering with sleeping, children had increased odds for being underweight (Adjusted Odds Ratio (AOR): 1.27; 95% CI: 1.02–1.54) and decreased odds for being overweight (AOR: 0.76; 95% CI: 0.58–0.97). This relationship was most pronounced among 3–6 year-olds. Early childhood caries, mouth pain and malnutrition were prevalent in this sample of young children. Parent-reported mouth pain was associated with severe caries, and mouth pain interfering with sleeping was predictive of poor nutritional status. We demonstrate the utility of a parsimonious parent-reported measure of mouth pain to predict young children’s risk for severe early childhood caries and malnutrition, which has implications for community health interventions.