BackgroundWe sought to understand the multilevel syndemic factors that are concurrently contributing to the HIV epidemic among women living in the US. We specifically examined community, network, dyadic, and individual factors to explain HIV vulnerability within a socioecological framework.MethodsWe gathered qualitative data (120 interviews and 31 focus groups) from a subset of women ages 18–44 years (N = 2,099) enrolled in the HPTN 064 HIV seroincidence estimation study across 10 US communities. We analyzed data from 4 diverse locations: Atlanta, New York City (the Bronx), Raleigh, and Washington, DC. Data were thematically coded using grounded theory methodology. Intercoder reliability was assessed to evaluate consistency of team-based coding practices.ResultsThe following themes were identified at 4 levels including 1) exosystem (community): poverty prevalence, discrimination, gender imbalances, community violence, and housing challenges; 2) mesosystem (network): organizational social support and sexual concurrency; 3) microsystem (dyadic): sex exchange, interpersonal social support, intimate partner violence; and 4) individual: HIV/STI awareness, risk taking, and substance use. A strong theme emerged with over 80 % of responses linked to the fundamental role of financial insecurity underlying risk-taking behavioral pathways.ConclusionsMultilevel syndemic factors contribute to women’s vulnerability to HIV in the US. Financial insecurity is a predominant theme, suggesting the need for tailored programming for women to reduce HIV risk.Trial registrationClinicaltrials.gov, NCT00995176

BackgroundNon-communicable diseases (NCDs) are rising among US Hispanics, but few studies have examined the preventive health behaviors for these NCDs among Hispanics. This study compared the preventive health behaviors of smoke-free living, physical activity, fruit and vegetable consumption, and avoidance of heavy alcohol use in Hispanics in the United States and Hispanics living along the US-Mexico border.MethodsTwo weighted data sets with information on Hispanic populations were analyzed: 1) the national Behavioral Risk Factor Surveillance Survey (n = 29,942) from 2009; and 2) the Cameron County Hispanic Cohort (n = 1,439) recruited from the US-Mexico border between 2008–2011. To compare the preventive health behaviors of the samples, within a generalized estimating equation framework, weighted univariate and multivariate logistic regression analyses were conducted controlling for age, educational attainment, employment, language, and insurance status. Statistical tests were two-sided with a significance level set at 0.05.ResultsBoth samples reported low engagement in preventive behaviors. However, Hispanic males and females from the US-Mexico border were significantly less likely than the national sample to meet physical activity and fruit and vegetable consumption guidelines. Also, Hispanic males from the US-Mexico border were more likely to engage in heavy alcohol use.ConclusionThe lack of preventive health behaviors among Hispanics living along the US-Mexico border presents a dire prospect for NCD control in the region. Multipronged approaches to address multiple behaviors should be considered.

BackgroundThe U-shaped relationship between alcohol consumption and diabetes mellitus was observed among western populations. However, few studies have systematically evaluated the association in Chinese. We aimed to investigate the associations of alcohol consumption with diabetes mellitus and impaired fasting glycemia (IFG) among middle-aged and elderly Chinese.MethodsWe examined 1,458 men and 1,831 women aged 50 to 70 from Beijing and Shanghai China in a cross-sectional survey. Fasting glucose, adipokines and markers of inflammation were measured. Macronutrients and alcohol consumption were assessed with standardized questionnaires.ResultsCompared with abstainers, alcohol consumption was associated with a decreased risk of having diabetes mellitus in women (OR: 0.41, 95%CI: 0.22-0.78) after controlling for socio-demographic factors, physical activity, smoking, family income, family history of cardiovascular disease or diabetes, macronutrients intake, body mass index, and markers of inflammation and adipokines. In men, both low and high alcohol consumptions were associated with increased risks of having combined diabetes and IFG (ORs 1.36 [95%CI: 1.02-1.82] and 1.50 [95%CI: 1.04-2.15], respectively]. In the multivariable stratified analyses among men, moderate drinkers who had drinking days of ≥ 5 days/week had a deceased likelihood (OR: 0.61, 95%CI: 0.37-0.98) and liquor drinkers had an increased likelihood (OR: 1.47, 95%CI: 1.09-1.98) of having combined diabetes and IFG respectively, compared with the abstainers.ConclusionsAn approximately J-shaped association was observed between alcohol consumption and combined diabetes and IFG among men compared with abstainers in Chinese. Whether moderate alcohol intake could help decrease diabetic risk among Chinese people warrants further investigation.

BackgroundObesity increases the risk of many diseases. However, there has been little literature about the epidemiology of obesity classified by body mass index (BMI) or waist (abdominal obesity) among urban Chinese adults. This study is to fill the gap by assessing the prevalence of obesity and associated risk factors among urban Chinese adults.MethodsA representative sample of 25,196 urban adults aged 18 to 74 years in Northeast China was selected and measurements of height, weight and waist circumference (WC) were taken from 2009–2010. Definitions of overweight and obesity by the World Health Organization (WHO) were used.ResultsThe overall prevalence rates of general obesity and overweight classified by BMI were 15.0% (15.7% for men and 14.3% for women, p<0.01) and 19.2% (20.8% for men and 17.7% for women, p<0.01), respectively, and the overall prevalence rate of abdominal obesity was 37.6% (31.1% for men and women 43.9% for women, p<0.01). Multivariable logistic regression showed that the elderly and those who had a history of parental obesity, alcohol drinking, or former cigarette smoking were at high risk of obesity classified by BMI or WC, whereas those with a higher level of education, higher family income, or a healthy and balanced diet were at low risk of obesity. Analysis stratified by gender showed that men with a higher level education level, a white-collar job, a cadre job, or higher family income were the high risk group, and women with a higher level of education or higher family income were the low risk group.ConclusionsObesity and overweight have become epidemic in urban populations in China; associations of risk factors with obesity differ between men and women.