Egypt has one of the highest prevalences and burdens of hepatitis C virus (HCV) worldwide, and a large government treatment programme. However, identifying and treating people who are infected in rural communities can be a substantial challenge. We designed and evaluated a comprehensive community-led outreach programme for prevention, testing, and treatment of HCV infection in one village in northern Egypt, with the goal to eliminate HCV infection from all adult villagers, and as a model for potential adoption in rural settings.A community-based education and test-and-treat project was established in Al-Othmanya village. The programme consisted of community mobilisation facilitated by a network of village promoters and establishment of partnerships; an educational campaign to raise awareness and promote behavioural changes; fundraising for public donations in the local community; and comprehensive testing, diagnosis, and treatment. For the educational campaign, we used public awareness events, house-to-house visits, and promotional materials (eg, booklets, cartoons, songs) to raise awareness of HCV and its transmission, and changes in knowledge, attitudes, and practices were measured through the use of a survey done before and after the educational campaign. Comprehensive testing, linkage to care, and treatment was offered to all eligible villagers (ie, those aged 12–80 years who had not previously been treated for HCV). Testing was done by use of HCV antibody and hepatitis B surface antigen (HBsAg) rapid diagnostic tests, with HCV-RNA PCR confirmation of positive cases, and staging of liver disease by use of transient elastography. HCV-RNA-positive participants were offered a 24-week course of sofosbuvir (400 mg orally, daily) and ribavirin (1000–1200 mg orally, daily) with an assessment of cure (sustained virological response) at 12 weeks after completion of treatment (SVR12).Between June 6, 2015, and June 9, 2016, 4215 (89%) of 4721 eligible villagers were screened for HCV antibodies and HBsAg. Of these participants, 530 (13%) were HCV antibody positive and eight (<1%) were HBsAg positive. All HCV-antibody-positive individuals had an HCV-RNA assay, and 312 (59%) were HCV-RNA positive. All 312 completed a full baseline assessment with staging of liver disease, and 300 (96%) were given 24 weeks of sofosbuvir and ribavirin treatment within a median of 2·3 weeks (IQR 0·0–3·7) from serological diagnosis. 293 (98%) of the treated participants achieved SVR12. 42 (13%) HCV-RNA-positive participants had cirrhosis as determined by transient elastography, of whom 12 (29%) were diagnosed with hepatocellular carcinoma on the basis of α-fetoprotein measurement and ultrasound. 3575 (85%) of 4215 eligible villagers completed the baseline and after educational campaign survey, and awareness, knowledge, and adoption of safer practices to prevent HCV transmission all significantly increased (p<0·0001).This community-led educate, test-and-treat demonstration project achieved high uptake of HCV testing, linkage to care and treatment, and attainment of cure in one village, as well as awareness and adoption of practices to prevent transmission in the community. This approach could be an important strategy for adoption in rural settings to complement the national government programme towards the elimination of HCV in Egypt.Egyptian Liver Research Institute and Hospital.

INTRODUCTION:Use of waterpipe tobacco smoking (WTS) is now prevalent among U.S. adolescents. However, the more clinically relevant questions are whether users exhibit sustained patterns of use and whether use is increasing over time relative to other tobacco products. We aimed to examine factors associated with sustained WTS among U.S. adolescents and to compare prevalence trends between WTS and other tobacco products.METHODS:The Monitoring the Future project began assessing WTS among 12th-grade students in 2010. In 2014, we conducted multivariable regression analyses to examine correlates of sustained WTS, which we defined as use at least six times in the past 12 months. We used trend analysis to compare use of WTS and other types of tobacco.RESULTS:Of the 8,737 participants queried from 2010 to 2013, 18.8% (1,639) reported past-year WTS, whereas 7.2% (627) reported sustained use. Sustained WTS was inversely associated with female sex (versus male, OR=0.78, 95% CI=0.63, 0.96); African American race (versus Caucasian, OR=0.26, 95% CI=0.14, 0.48); and increased number of parents in the home (p<0.001). Sustained WTS was positively associated with increased school-level parental education (p=0.002); lower grades (p=0.005); truancy (p<0.001); lower religiosity (p<0.001); more evenings out per week (p<0.001); and dating (p=0.03). Visual inspection and non-overlapping CIs suggest that both past-year and sustained WTS are significantly increasing relative to cigarette use but not small cigar use.CONCLUSIONS:Given the prevalence of sustained WTS and indications of its increase over time, it should be included in efforts related to tobacco surveillance and intervention.

Since their arrival 400 years ago, African Americans have endured 246 years of chattel slavery and 100 years of apartheid followed by decades of systematic racial discrimination and injustice. Nevertheless, Africans and their descendants have contributed significantly to the building of the United States and have greatly influenced every sector of society. To document this tenuous position, we summarize key demographic, economic, and social trends as well as the potential role of macro social work to improve outcomes. Present-day racism in the United States is persistent and frequently underestimated, so combatting anti-Blackness and White supremacy at structural and societal levels is essential.

Objective: Secondary school students' rates of substance use vary significantly by race/ethnicity and by their parents' level of education (a proxy for socioeconomic status). The relationship between students' substance use and race/ethnicity is, however, potentially confounded because parental education also differs substantially by race/ethnicity. This report disentangles the confounding by examining White, African American, and Hispanic students separately, showing how parental education relates to cigarette smoking, heavy drinking, and illicit drug use. Method: Data are from the 1999-2008 Monitoring the Future nationally representative in-school surveys of more than 360,000 students in Grades 8, 10, and 12. Results: (a) High proportions of Hispanic students have parents with the lowest level of education, and the relatively low levels of substance use by these students complicates total sample data linking parental education and substance use. (b) There are clear interactions: Compared with White students, substance use rates among African American and Hispanic students are less strongly linked with parental education (and are lower overall). (c) Among White students, 8th and 1 0th graders show strong negative relations between parental education and substance use, whereas by 12th grade their heavy drinking and marijuana use are not correlated with parental education. Conclusions: Low parental education appears to be much more of a risk factor for White students than for Hispanic or African American students. Therefore, in studies of substance use epidemiology, findings based on predominantly White samples are not equally applicable to other racial/ethnic subgroups. Conversely, the large proportions of minority students in the lowest parental education category can mask or weaken findings that are clearer among White students alone.

Historically, girls have been less delinquent than boys. However, increased justice system involvement among girls and current portrayals of girls in the popular media and press suggest that girls' delinquency, particularly their violence and drug use, is becoming more similar to that of boys. Are girls really becoming more delinquent? To date, this question remains unresolved. Girls' increased system involvement might reflect actual changes in their behavior or changes in justice system policies and practices. Given that girls of color are overrepresented in the justice system, efforts to rigorously examine the gender convergence hypothesis must consider the role of race/ethnicity in girls' delinquency. This study uses self-report data from a large, nationally representative sample of youth to investigate the extent to which the magnitude of gender differences in violence and substance use varies across racial/ethnic groups and explore whether these differences have decreased over time. We find little support for the gender convergence hypothesis, because, with a few exceptions, the data do not show increases in girls' violence or drug use. Furthermore, even when girls' violent behavior or drug use has increased, the magnitude of the increase is not substantial enough to account for the dramatic increases in girls' arrests for violence and drug abuse violations.

Background: This study uses large nationally representative samples of White, Black, Mexican American, Puerto Rican, Other Latina, Asian American, and American Indian 8th-grade girls to examine racial/ethnic differences and similarities in patterns, trends, and socioeconomic correlates of cigarette use.Methods: The data are drawn from the University of Michigan's Monitoring the Future study. Prevalence and trend data (from 1991 to 2007) in girls' cigarette use were examined by racial/ethnic subgroup. Logistic regression analyses were conducted to determine the extent to which socioeconomic factors predict girls' cigarette use, and whether the relationships between socioeconomic status (SES) and smoking differed across racial/ethnic Subgroup.Results: Cigarette use was highest among American Indian girls; at an intermediate level among Mexican American, Puerto Rican, Other Latinas, and White girls; and lowest among Black and Asian American girls, Trend data show that cigarette use has declined for all racial/ethnic subgroups, and that small but consistent racial/ethnic differences in girls' cigarette use have persisted. Generally, girls who did not live in two-parent households, whose parents had lower levels of educational attainment, who attended lower SES schools, and who had more disposable income were more likely than their peers to smoke. That said, however, the relationships between smoking and parental education and school SES were, on average, stronger for White girls than for Black or Hispanic (Mexican American, Other Latina, Puerto Rican) girls.Conclusions: Future research should seek to understand the mechanisms by which low SES impacts smoking. (C) 2009 Elsevier Ireland Ltd. All rights reserved.

The authors used data from the older African American subsample of the National Survey of American Life (n = 837) to examine the sociodemographic and denominational correlates of organizational religious involvement among older African Americans. Six measures of organizational religious participation were used, including two measures of time allocation for organized religious pursuits. Significant gender, regional, marital status, and denominational differences in organizational religiosity were found. Of particular note, although older Black women generally displayed higher levels of religious participation, older Black men spent more hours per week in other activities at their places of worship. The findings are discussed in relation to prior work in the area of religious involvement among older adults. New directions for research on religious time allocation are outlined.

The present study uses large nationally representative samples of White, Black, Hispanic, Asian American, and American Indian students to examine current patterns and recent trends (1991 to 2005) in racial, ethnic, and gender differences in school discipline. We found that Black, Hispanic, and American Indian youth are slightly more likely than White and Asian American youth to be sent to the office and substantially (two to five times) more likely to be suspended or expelled. Although school discipline rates decreased over time for most ethnic groups, among Black students school discipline rates increased between 1991 and 2005. Logistic regression analyses that controlled for racial and ethnic differences in socio-demographic factors suggest racial and ethnic differences in school discipline do not result from racial and ethnic differences in socioeconomic status. Future research and practice efforts should seek to better understand and to eliminate racial, ethnic and gender disproportionality in school discipline.

The incarceration of young people is a growing national problem. Key correlates of incarceration among American youth include mental health problems, substance use, and delinquency. The present study uses a statewide sample of incarcerated youth to examine racial differences in African American and Caucasian juvenile offenders' outcomes related to mental health, substance use, and delinquency. The data indicate that relative to Caucasian offenders, African American offenders report lower levels of mental health problems and substance use but higher levels of delinquent behavior such as violence, weapon carrying, and gang fighting. The data further reveal that African American offenders are more likely than Caucasian offenders to be victims of violence and to experience traumatic events such as witnessing injury and death. Recognition of these patterns may help to improve postrelease services by tailoring or adapting preexisting programs to patterns of risk factors and their relative magnitudes of effect.

For more than three decades scholars have debated about if, when, and under what circumstances religiosity deters delinquency. The present study uses multilevel modeling data analytic techniques (i.e., hierarchical linear model [HLM]) and large nationally representative samples of American public high schools (N = 227) and high school seniors ( N = 16,595) to examine various unresolved issues in the ongoing debate, with a specific focus on the relationships between individual- and contextual-level (i.e., school) religiosity and adolescent's use of tobacco, alcohol, and marijuana. The results indicate first, that the higher adolescents' level of religiosity, the less likely they are to be current tobacco users, to engage in binge drinking, or to have used marijuana in the past year; second, that as the level of religiosity in a school increases, adolescents' frequency of cigarette use, binge drinking, and marijuana use decreases; third, that the religiosity of the school influences students' substance use, over and above their individual religiosity, but that this relationship exists only for marijuana; and fourth, that the strength of the relationship between individual- level religiosity and individual- level substance use varies depending upon the religiosity of the context, such that adolescents who are highly religious and in highly religious contexts are less likely to engage in binge drinking or marijuana use than those who are equally religious but in less religious contexts. Future research should seek to understand the mechanisms through which individual- and contextual-level religiosity influences young people's use of substances and other delinquent behaviors.

We thank McCarthy and colleagues for their interest in our work. We agree that immigrant generational status is important, and we also agree that the various Hispanic groups differ in their status. Indeed, we recognize that there are many differences between the groups; it was for this reason we conducted separate analyses for adolescents of Mexican, Puerto Rican, Cuban, and “other Latin American” ancestries. As McCarthy and colleagues note, we found significant differences by language first spoken for Mexican Americans and “other Latin Americans” in marijuana use and heavy drinking. However, we also found that cocaine use was not significantly associated with language first spoken in any of the Hispanic groups included (see Table 3 of our article). Why would the variable “language first spoken” behave differently for use of different drugs? As suggested by McCarthy and colleagues, our findings highlight the complex nature of drug use among Hispanic populations and the fact that this complexity deserves further attention.

AIMS:This paper examines ethnic differences in licit and illicit drug use among American 8th, 10th and 12th grade students, with a particular focus on girls.DESIGN:The study uses cross-sectional data from large, ethnically diverse, nationally representative samples of 8th, 10th and 12th grade girls.SETTING:Data were collected through questionnaires administered in schools.PARTICIPANTS:A total of 40 416 8th grade girls and 37 977 8th grade boys, 35 451 10th grade girls and 33 188 10th grade boys, and 33 588 12th grade girls and 31 014 12th grade boys took part in the study.FINDINGS:Across ethnic groups, drug use is highest among Native American girls and lowest among black and Asian American girls. Trend data suggest that there have been important changes in girls' drug use over time and that girls' and boys' drug use patterns are converging.CONCLUSIONS:Drug use is widespread among American adolescent girls. Future research should examine further girls' drug use and seek to identify whether risk and protective factors identified in past research, based on predominantly white samples, are also important predictors for drug use among non-white girls.

In this paper we examine whether the physical availability of alcohol is greater in predominantly African American communities compared to predominantly white communities as indicated by the presence of off premises liquor stores. We investigate the extent to which the income status of the residents of a community mediates the relationship between community racial composition and alcohol availability; and explore whether the intersection of race and class places low income African American communities at increased risk to have such stores located in their communities. Multivariate analytic techniques are used to examine the relationship between community racial composition, median income of neighborhood residents and per capita number of alcohol outlets in 194 census tracts in Baltimore, Maryland. The analysis found that liquor stores are disproportionately located in predominantly black census tracts, even after controlling for census tract socioeconomic status. Census tracts that are both low income and predominantly African American have substantially more liquor stores per capita than other census tracts. Although it is beyond the scope of the present study, our data reveal significant associations between the presence of liquor stores and the risk of health-related social problems in low income neighborhoods. More research needs to be done on the impact of alcohol on the social, psychological, and physiological health of low income urban populations.

The number of adolescent females between the ages of 13 and 19 who are contracting sexually transmitted diseases (STDs) is rising at an alarming rate. Although the issue of STDs has been overshadowed by continued public debate over adolescent pregnancy and childbearing, it demands attention. Particularly concerning is the fact that STDs increase the likelihood of transmitting HIV (N.E. MacDonald et al., 1990). To offset the growing incidences of STDs among female adolescents, gender-specific interventions are needed. Following is a description of the theoretical underpinnings that informed and guided the development of a gender-specific intervention titled Girl Talk. A two-stage creation and review process was used to design this 2.5-hr, four-session intervention. An overview of the quasi-experimental design that compared a nonequivalent comparison and two intervention groups (peer led and adult led) is presented. Baseline characteristics of the three groups are reported. Also described is how participant feedback and a design content analysis are used to evaluate the appropriateness of the intervention for adolescent females.

The number of adolescent females between the ages of 13 and 19 who are contracting sexually transmitted diseases (STDs) is rising at an alarming rate. Although the issue of STDs has been overshadowed by continued public debate over adolescent pregnancy and childbearing, it demands attention. Particularly concerning is the fact that STDs increase the likelihood of transmitting HIV (N.E. MacDonald et al., 1990). To offset the growing incidences of STDs among female adolescents, gender-specific interventions are needed. Following is a description of the theoretical underpinnings that informed and guided the development of a gender-specific intervention titled Girl Talk. A two-stage creation and review process was used to design this 2.5-hr, four-session intervention. An overview of the quasi-experimental design that compared a nonequivalent comparison and two intervention groups (peer led and adult led) is presented. Baseline characteristics of the three groups are reported. Also described is how participant feedback and a design content analysis are used to evaluate the appropriateness of the intervention for adolescent females.