Faculty Bibliography

OBJECTIVE:Assess cross-sectional relationships between body mass index (BMI), waist circumference (WC), pericardial (PAT), visceral (VAT), and subcutaneous adipose tissue (SAT) volumes with calcified plaque (CP) in African Americans (AAs) and European Americans (EAs) with type 2 diabetes. METHODS:Computed tomography measured PAT, VAT, SAT, and CP in coronary arteries (CAC), carotid arteries, and aorta. Generalized estimating equations models were fitted to test for associations between adiposity and CP, stratified by ethnicity while accounting for familial correlations. RESULTS:AAs (N = 753) vs. EAs (N = 562) had significantly lower PAT and VAT, despite equal or higher BMI. In multivariable models adjusting for age, gender, education, HbA1c, statins, smoking, cardiovascular disease, hypertension, nephropathy, and C-reactive protein, PAT positively associated with presence of CAC in AAs (P < 0.001), not EAs (P = 0.68; ethnicity interaction P < 0.01). Inverse associations were detected between SAT and severity of aorta CP (P < 0.01) in AAs and between BMI, WC, and SAT with severity of aorta CP in all participants. CONCLUSIONS:Ethnic- and gender-specific differences in BMI, WC, PAT, SAT, and VAT were present in AAs and EAs with diabetes. Only PAT was positively associated with CAC in AAs; paradoxical inverse associations were seen between several other adiposity measures and subclinical cardiovascular disease.

Relative to European Americans, evidence supports that African Americans with end-stage renal disease (ESRD) survive longer on dialysis. Renal-risk variants in the apolipoprotein L1 gene (APOL1), associated with nondiabetic nephropathy and less subclinical atherosclerosis, may contribute to dialysis outcomes. Here, APOL1 renal-risk variants were assessed for association with dialytic survival in 450 diabetic and 275 nondiabetic African American hemodialysis patients from Wake Forest and Emory School of Medicine outpatient facilities. Outcomes were provided by the ESRD Network 6-Southeastern Kidney Council Standardized Information Management System. Dates of death, receipt of a kidney transplant, and loss to follow-up were recorded. Outcomes were censored at the date of transplantation or through 1 July 2015. Multivariable Cox proportional hazards models were computed separately in patients with nondiabetic and diabetic ESRD, adjusting for the covariates age, gender, comorbidities, ancestry, and presence of an arteriovenous fistula or graft at dialysis initiation. In nondiabetic ESRD, patients with 2 (vs. 0/1) APOL1 renal-risk variants had significantly longer dialysis survival (hazard ratio 0.57), a pattern not observed in patients with diabetes-associated ESRD (hazard ratio 1.29). Thus, 2 APOL1 renal-risk variants are associated with longer dialysis survival in African Americans without diabetes, potentially relating to presence of renal-limited disease or less atherosclerosis.

BACKGROUND:Electronic aggression is the use of electronic communication technologies to harass others. It is a problem among adolescents and young people worldwide. There is a dearth of information on this problem in developing countries in spite of the increasing use of electronic media technology in these countries. OBJECTIVE:To explore gender differences in the prevalence, effects and reporting of electronic aggression among secondary school students in Oyo state, Nigeria. METHODS:A cross-sectional study was conducted using mixed methods (a quantitative survey of 653 students and 18 in-depth interviews with victims and/or perpetrators). Survey students were selected using multi-stage sampling and in-depth interviewees were selected purposively. History of electronic aggression (as a perpetrator and/or victim) in the 3 months preceding the study was obtained. Respondents also provided information on the effects of the last incident of bullying on them and whether or not they reported this incident. RESULTS:25.8% of males and 22.1% of females had perpetrated electronic aggression, while 42.7% of females were victims compared to 36.8% of males. More females (58.1%) than males (40.3%) perpetrated electronic aggression via phone calls and more males (33.8%) than females (22.6%) perpetrated electronic aggression via chatrooms. 45.4% of male victims and 39.4% of female victims felt angry following the last cyberbully incident. Findings from the in-depth interviewees corroborated the survey findings and a male victim reported feeling very sad and even tried to stay away from school following repeated episodes of electronic aggression. More female (59.1%) than male (42.7%) victims reported the incident to someone (p=0.035). CONCLUSIONS:Incidents of electronic aggression were common and the experiences of male and female students were comparable, although more female victims reported the incidents they had experienced. Victims, especially males, should be encouraged to report incidents so that the relevant authorities can institute interventions to address the problem.

BACKGROUND:Many adolescents are exposed to a significant amount of sexual content in the media. This has far-reaching effects on their sexual practices as this exposure is occurring at a period when most adolescents are often not sure of the choices to make, and the choices they make during adolescence affect their health when they become adults. The aim of this study was to assess the association between exposure of in-school adolescents to sexual content in the electronic media and their sexual intentions. METHODS:In this cross-sectional study, information was obtained from 750 senior secondary school students in private and public schools using interviewer-administered questionnaire. Sexual media content in the movies, music video and Internet was assessed using a modified version of the sexual media diet tool. The dependent variable was sexual intention; the main independent variable was exposure to sexually explicit content in the media and confounders that were controlled for selected individual (age, sex, religiosity, self-esteem and attachment to parents), family (parents' marital status, parents' type of marriage, hands-on parenting and parent-adolescent communication on sex) and environmental factors (school connectedness and influence from peers) which were previously reported to be associated with sexual intentions of adolescents. Chi-square test was used to determine associations between sexual content of the electronic media and adolescents' sexual intentions, and confounders were controlled for using logistic regression analysis. RESULTS:Thirty-six percent of respondents were exposed to overtly explicit sexual content from all forms of media in the 3 months prior to this study. Twenty-four percent of the adolescents indicated their intention to have sex within 12 months following the study. Predictors of sexual intention were as follows: moderate [odds ratio, OR=2.21 (95% confidence interval, CI: 1.22-3.99)] and high exposure to sexual content in the media [OR=3.02 (95% CI: 1.69-5.43]; attending a public school [OR=2.19 (95% CI: 1.26-3.83)]; moderate peer pressure [OR=2.36 (95% CI: 1.41-3.95)] and high peer pressure [OR=10.32 (95% CI: 2.94-36.31)]; and previous history of sexual intercourse [OR=3.89 (95% CI: 2.25-6.76)]. CONCLUSION/CONCLUSIONS:Many adolescents were exposed to sexually explicit content in the media and this had a strong association with sexual intention. Interventions to censor sexually explicit content in the media are required to protect adolescents from the consequences of early exposure to sex.

PURPOSE/OBJECTIVE:Findings on the influences of the media on the sexual health of adolescents in vulnerable communities in Ibadan are presented. METHODS:Phase I of the WAVE study in Ibadan was conducted among participants purposively selected from disadvantaged communities in Ibadan North Local Government Area (LGA). Qualitative research methods (key informant interviews, in-depth interviews, community mapping and focus group discussions as well as photovoice sessions) were utilized. RESULTS:A total of 132 key informants and adolescents (aged 15-19 years) participated. The key informants were teachers, youth workers, and religious leaders working with adolescents within the LGA. Respondents mentioned a number of media technologies (such as television, cellphones, computers, the Internet as well as online and hard copy novels) that adolescents are exposed to in contemporary times. They said these had positive and negative influences on them. Adolescents often looked up information on the Internet although it was mostly used as a means of meeting and communicating with friends. Respondents stated that the media had a strong influence on adolescents' sexual and reproductive health especially regarding dating, relationships, and sexual practices. It also exposed them to pornography and Internet fraud. CONCLUSIONS:The study highlighted the important role the media plays in the sexual health of adolescents in Ibadan. Intervention programmes need to make use of this medium to reach out to more adolescents and measures should be instituted to prevent adolescents from misusing the media.

PURPOSE:Intimate partner violence (IPV) affects one in three women globally, with adolescent and young adult women at highest risk. Less is known about IPV perpetration. We compare the prevalence and correlates of IPV perpetration among 15- to 19-year-old adolescent males in Baltimore (United States), Johannesburg (South Africa), Delhi (India), and Shanghai (China). METHODS:A cross-sectional survey was conducted in 2013 with males aged 15-19 recruited via respondent-driven sampling from disadvantaged neighborhoods in four cities: Baltimore (United States), New Delhi (India), Johannesburg (South Africa), and Shanghai (China); total n = 751 ever-partnered men. We describe the prevalence of past-year physical and sexual IPV perpetration and evaluate associations with gender norm attitudes, mental health, substance use, victimization experiences, and demographic factors. RESULTS:Past-year physical or sexual IPV perpetration ranged from 9% in Shanghai to 40% in Johannesburg. Factors associated with past-year perpetration across multiple sites included: binge drinking (Johannesburg adjusted odds ratio [AOR] = 2.8, Baltimore AOR = 6.7, and Shanghai AOR = 3.2), depressive symptoms (Johannesburg AOR = 2.4 and Shanghai AOR = 2.2), victimization in the home (Baltimore AOR = 2.5, Shanghai AOR = 2.7, and Johannesburg AOR = 1.7), and community violence victimization (Baltimore AOR = 7.0, Delhi AOR = 4.1, and Johannesburg AOR = 2.8). Equitable gender norm attitudes were protective against IPV perpetration in Johannesburg and Shanghai. Demographic factors (e.g., age, employment, and education) were inconsistently associated with IPV perpetration across sites. CONCLUSIONS:Past-year IPV perpetration was prevalent with differences identified across settings. Findings suggest the need to scale up evidence-based interventions targeting adolescents in disadvantaged urban communities in order to address many modifiable factors associated with IPV perpetration in this study.

Photovoice is a participatory action research method in which people are given cameras and asked to take pictures of specific issues within their community. It is often used among marginalised populations. This method helps people capture specific issues within their community using photographs, critically discuss these issues within a group and present their findings to inform policies within their community. Photovoice has been used in developed countries and among adult participants; however, the extent to which it has been used in developing countries and among adolescent participants is yet to be extensively reported. In this paper, we describe the use of photovoice among male and female adolescents aged 15-19 years who participated in the qualitative phase (phase I) of the Well-being of Adolescents in Vulnerable Environments (WAVE) study in Ibadan, Nigeria. The main study was conducted among adolescents residing in disadvantaged communities within five global cities (Baltimore, USA; Ibadan, Nigeria; Johannesburg, South Africa; New Delhi, India and Shanghai, China). Our findings revealed that adolescents in Ibadan were very eager to participate, remained fully engaged throughout the process and the data obtained were rich and detailed. Some challenges encountered with using this method were that younger adolescents had a tendency to attain saturation when taking pictures much earlier than older adolescents; however, they equally discussed the pictures taken enthusiastically. Overall, our findings affirm that photovoice as a data collection method can be successfully used in research among adolescents in developing countries like Nigeria.

BACKGROUND:The study was conducted to determine the incidence and risk factors associated with injuries among adolescents participating in an amateur soccer tournament in Ibadan, Nigeria. METHODS:A prospective study was conducted among 90 participants (66 players and 24 substitutes) from six all-male teams with each team comprising 11 players. A total of six matches, each lasting 60 minutes (132 player-hours) were played in the tournament. Players were observed during all matches and followed up for up to two weeks after the final match. The association between selected risk factors and injury occurence was assessed using χ2 test. RESULTS:Players mean age was 16.1 (±1.8) years. Twelve (13.3%) of the 90 players were involved in 15 injury events. The injury incidence was 113.6 injuries per 1000 player hours (95% CI: 56.1-171.1) and 12 (80.0%) of all injuries occurred within 15 minutes of the end of each half of the match. Injuries often affected the lower limb 10 (58.8%), and the upper limb 6 (35.3%). Common injuries sustained were abrasions, 11 (64.6%), sprains, 3 (17.6%) and contusions 2 (11.8%). Eighty percent of injuries were due to collision with another player. All injuries were slight to mild as all the injured players returned to practice or games within five days of sustaining the injury. Dominant playing foot (mainly left foot or both feet) was associated with a higher incidence of injuries (χ2=7.321; P=0.018). CONCLUSIONS:Injury incidence was relatively high although injuries were mild. Measures to minimize injuries following player-to-player contact would be beneficial for adolescent soccer players in our study setting.

OBJECTIVE:Cyberharassment/cyberbullying is a global problem that has been inadequately investigated in developing countries. In this paper, we present findings on the prevalence and predictors of perpetration of cyberbullying among in-school adolescents in Oyo state, Nigeria. METHODS:A total of 653 students were selected via multi-stage sampling. Information on history of perpetrating harassment via an electronic medium in the 3-month period preceding the survey was obtained. RESULTS:Respondents' mean age was 14.2±2.2 years and 51.3% were females. All respondents had personal mobile phones and about half had Internet access. About 40% accessed the Internet every day while about 48% accessed it at least once to several times a week and <5% accessed it about once every 2 weeks. One hundred and fifty-six (23.9%) had harassed someone electronically, 260 (39.8%) had been victimized, and 137 (21.0%) were both victims and perpetrators. Common modes of harassment were via phone calls 99 (63.5%), chat rooms 70 (44.9%), and text messages 60 (38.5%). Students who had been victims of cyberbullying (OR=21.76, 95% CI=12.64-37.47) and those with daily Internet access (OR=2.32, 95% CI=1.28-4.19) had significantly higher Oods of being perpetrators. CONCLUSION/CONCLUSIONS:About a quarter of students were perpetrators of cyberbullying, and the correlates of perpetration were history of cyber victimization and daily Internet access. Intervention programs must be instituted for victims as well as frequent users of the Internet to curb the problem in the study area.