A common reason for nonuse of modern contraceptives is concern about side effects and health complications. This article provides a detailed characterization of the belief that modern contraceptives cause infertility, and an examination of how this belief arises and spreads, and why it is so salient. We conducted focus group discussions and key informant interviews in three rural communities along Kenya's eastern coast, and identified the following themes: (1) the belief that using modern contraception at a young age or before childbirth can make women infertile is widespread; (2) according to this belief, the most commonly used methods in the community were linked to infertility; (3) when women observe other women who cannot get pregnant after using modern contraceptives, they attribute the infertility to the use of contraception; (4) within the communities, the primary goal of marriage is childbirth and thus community approval is rigidly tied to childbearing; and, therefore (5) the social consequences of infertility are devastating. These findings may help inform the design of programs to address this belief and reduce unmet need.

While numerous factors contributing to racial/ethnic health disparities have been identified, the clustering and interaction of these factors as a syndemic or trajectory has not been well-studied (Starfield in Soc Sci Med 64:1355-1362, 2007; Singer in Soc Sci Med 39(7):931-948, 1994). More importantly, for immigrant/refugee populations, the interaction of contributing factors is not documented adequately enough to provide a solid framework for planning, implementation and evaluation of interventions aimed at reducing disparities. In this paper, the authors draw from the literatures on health disparities and immigrant/refugee health, as well as direct program and research experience, to propose an approach for assessment of the diachronic interaction of ecological factors (a trajectory, or "diachronic ecology") contributing to health disparities among immigrant/refugee populations. It is our hope that this approach will contribute to the important effort to collect data supporting the development of interventions and policies that effectively address the dynamic processes through which health disparities are created, maintained, and changed.

While research has demonstrated an association between trauma and mental health, this study examined the association between trauma experienced premigration, during migration, and postmigration, and current mental health status among Latino youth aged 12-17 years old living in the US for < 3 years. Participants reported traumatic events experienced in their home country, during migration, and after settling in the US. Regression models examined trauma experienced at each stage of the migration process predicting current levels of depression, anxiety, and post-traumatic stress disorder. Two-thirds of youth experienced at least one traumatic event, 44% experienced an event once, and 23% experienced two or more traumatic events during migration. Trauma experienced at different migration stages was associated with distinctive mental health outcomes. It is essential that access to culturally sensitive assessment and treatment services be available to ensure transition to a healthy adulthood.

BackgroundGenerating participant engagement in social media applications for health promotion and disease prevention efforts is vital for their effectiveness and increases the likelihood of effecting sustainable behavior change. However, there is limited evidence regarding effective strategies for engaging Latino immigrant youth using social media. As part of the Avance Center for the Advancement of Immigrant/Refugee Health in Washington, DC, USA, we implemented Adelante, a branded primary prevention program, to address risk factors for co-occurring substance use, sexual risk, and interpersonal violence among Latino immigrant adolescents aged 12 to 19 years in a Washington, DC suburb.ObjectiveThe objectives of this study were to (1) characterize Adelante participant Facebook reach and engagement and (2) identify post content and features that resulted in greater user engagement.MethodsWe established the Adelante Facebook fan page in October of 2013, and the Adelante social marketing campaign used this platform for campaign activities from September 2015 to September 2016. We used Facebook Insights metrics to examine reach and post engagement of Adelante Facebook page fans (n=743). Data consisted of Facebook fan page posts between October 1, 2013 and September 30, 2016 (n=871). We developed a 2-phased mixed-methods analytical plan and coding scheme, and explored the association between post content categories and features and a composite measure of post engagement using 1-way analysis of variance tests. P<.05 determined statistical significance.ResultsPosts on the Adelante Facebook page had a total of 34,318 clicks, 473 comments, 9080 likes or reactions, and 617 shares. Post content categories that were statistically significantly associated with post engagement were Adelante program updates (P<.001); youth achievement showcases (P=.001); news links (P<.001); social marketing campaign posts (P<.001); and prevention topics, including substance abuse (P<.001), safe sex (P=.02), sexually transmitted disease prevention (P<.001), and violence or fighting (P=.047). Post features that were significantly associated with post engagement comprised the inclusion of photos (P<.001); Spanish (P<.001) or bilingual (P=.001) posts; and portrayal of youth of both sexes (P<.001) portrayed in groups (P<.001) that were facilitated by adults (P<.001).ConclusionsSocial media outreach is a promising strategy that youth programs can use to complement in-person programming for augmented engagement. The Latino immigrant youth audience in this study had a tendency toward more passive social media consumption, having implications for outreach strategies and engagement measurement in future studies. While study findings confirmed the utility of social marketing campaigns for increasing user engagement, findings also highlighted a high level of engagement among youth with posts that covered casual, day-to-day program activity participation. This finding identifies an underexplored area that should be considered for health messaging, and also su...