John E Ehiri

Interests

Teaching

Global Health; Global Reproductive, Maternal, Newborn, and Child health; Program Planning and Evaluation; Evidence-Based Methods; Policy Analysis

Research

HIV/AIDS; Global Infectious Disease Control; Behavioral Interventions

Courses

Scholarly Contributions

Journals/Publications

• Alaofè, H., Mahdavimanshadi, M., Mizéhoun-Adissoda, C., Okechukwu, A., Hounkpatin, W. A., Bedrick, E. J., Gninkoun, J., Fan, N., & Ehiri, J. (2024). Precision nutrition for type 2 diabetes in Benin: leveraging linear goal programming to optimize diets with emphasis on adequacy, affordability, accessibility, and culture. Frontiers in nutrition, 11, 1400594.
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  Nutrition and diet are critical to managing Type 2 diabetes (T2D). Low-income households often face challenges maintaining a healthy and balanced diet due to food insecurity, availability, and cost. To address this issue, we used a linear goal programming (LGP) model to develop nutritionally adequate, affordable, accessible, and culturally acceptable diets for persons with T2D in Benin, a French-speaking sub-Saharan country. The goal was to help persons with T2D manage their condition more effectively.
• Alaofè, H., Okechukwu, A., Yeo, S., McClelland, J. D., Hounkpatin, W. A., & Ehiri, J. (2024). Social network interventions for dietary adherence among adults with type 2 diabetes: a systematic review and meta-analysis protocol. BMJ open, 14(11), e082946.
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  Optimal adherence to recommended diets is crucial to achieving long-term glycaemic control among individuals with type 2 diabetes (T2D) individuals. However, there is limited evidence on the effectiveness of interventions that target dietary adherence through social networks. Since social networks can influence individuals' health behaviours, it is important to thoroughly evaluate the impact of social network interventions on dietary adherence in adults with T2D. This systematic review protocol aimed to provide insights into future interventions and improve diabetes management strategies.
• Celaya, M., Zahlan, A. I., Rock, C., Nathan, A., Acharya, A., Madhivanan, P., Ehiri, J., Hu, C., Pettygrove, S. D., & Nuño, V. L. (2024). Individual- and community-level risk factors for maternal morbidity and mortality among Native American women in the USA: a systematic review. BMJ open, 14(11), e088380.
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  Maternal morbidity and mortality (MMM) is a public health concern in the USA, with Native American women experiencing higher rates than non-Hispanic White women. Research on risk factors for MMM among Native American women is limited. This systematic review comprehensively synthesizes and critically appraises the literature on risk factors for MMM experienced by Native American women.
• Fingesi, T. S., Kimaru, L. J., Okusanya, B. O., Ehiri, J. E., & Rosales, C. (2024). Nicotine and Alcohol Use as Predictors of Recreational Cannabis Use in Adolescence: A Systematic Review and Narrative Synthesis. Substance use & misuse, 59(9), 1367-1382.
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  The prevalence of recreational cannabis use among adolescents is a growing public health concern due to its link to short- and long-term adverse effects on adolescents' wellbeing, physical health, mental health, and interpersonal behaviors. Five databases were searched from inception to March 17, 2023, for exposure (nicotine product, alcohol) and outcome (recreational cannabis) in adolescents (persons aged 10-19 years). The studies were screened independently by two reviewers, and the quality of the studies was assessed with Newcastle Ottawa and AXIS tool. PRISMA guidelines were employed in this review. Twenty-one (21) studies involving 2,778,406 adolescents were included in the appraisal and heterogeneity was found among these studies. Ascertainment bias was commonly detected in thirteen (13) of the included studies. Among the substances examined as potential exposures, nicotine-product use emerged as a significant factor associated with future cannabis use among adolescents, particularly in mid-adolescence and in places where recreational cannabis use has been legalized. Current evidence suggests an association between nicotine-product use and subsequent recreational cannabis use among adolescents. However, further research is needed to establish causality between exposure to nicotine substances and the use of recreational cannabis within this age demographic. Additionally, there is a need for the development of prevention programs and targeted policies that continuously inform and update this vulnerable sub-population about the risks associated with cannabis use for leisure.
• Kimaru, L. J., Habila, M. A., Mantina, N. M., Madhivanan, P., Connick, E., Ernst, K., & Ehiri, J. (2024). Neighborhood characteristics and HIV treatment outcomes: A scoping review. PLOS global public health, 4(2), e0002870.
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  Recognizing challenges faced by people living with HIV is vital for improving their HIV treatment outcomes. While individual-level interventions play a crucial role, community factors can shape the impact of individual interventions on treatment outcomes. Understanding neighborhood characteristics' association with HIV treatment outcomes is crucial for optimizing effectiveness. This review aims to summarize the research scope on the association between neighborhood characteristics and HIV treatment outcomes. The databases PubMed, CINAHL (EBSCOhost), Embase (Elsevier), and PsychINFO (EBSCOhost) were searched from the start of each database to Nov 21, 2022. Screening was performed by three independent reviewers. Full-text publications of all study design meeting inclusion criteria were included in the review. There were no language or geographical limitations. Conference proceedings, abstract only, and opinion reports were excluded from the review. The search yielded 7,822 publications, 35 of which met the criteria for inclusion in the review. Studies assessed the relationship between neighborhood-level disadvantage (n = 24), composition and interaction (n = 17), social-economic status (n = 18), deprivation (n = 16), disorder (n = 8), and rural-urban status (n = 7) and HIV treatment outcomes. The relationship between all neighborhood characteristics and HIV treatment outcomes was not consistent across studies. Only 7 studies found deprivation had a negative association with HIV treatment outcomes; 6 found that areas with specific racial/ethnic densities were associated with poor HIV treatment outcomes, and 5 showed that disorder was associated with poor HIV treatment outcomes. Three studies showed that rural residence was associated with improved HIV treatment outcomes. There were inconsistent findings regarding the association between neighborhood characteristics and HIV treatment outcomes. While the impact of neighborhood characteristics on disease outcomes is highly recognized, there is a paucity of standardized definitions and metrics for community characteristics to support a robust assessment of this hypothesis. Comparative studies that define and assess how specific neighborhood indicators independently or jointly affect HIV treatment outcomes are highly needed.
• Kimaru, L. J., Hu, C., Nagalingam, S., Magrath, P., Connick, E., Ernst, K., & Ehiri, J. (2024). Perceived neighborhood disorder and achieving HIV viral suppression among adults living with HIV: A cross-sectional study. PLOS global public health, 4(12), e0004060.
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  Adherence to antiretroviral therapy (ART) is crucial for achieving and maintaining viral suppression in people living with HIV (PLWH). While individual factors affecting HIV viral suppression have been extensively studied, there is less attention on community-level factors, specifically perceived neighborhood disorder. This study aims to assess the relationship between perceived neighborhood disorder and achieving virologic suppression among people living with HIV. One hundred and eighty-eight PLWH 18 years of age and older from two HIV clinics completed a cross-sectional study. We assessed perceptions of neighborhood disorder, ART self-efficacy, social support, alcohol and drug use, depression, HIV stigma, provider-patient relationship, demographics, and length at the zip code. HIV viral loads were obtained from the clinical record. The analysis involved the use of Fisher's Exact test, Spearman's Rank test, Wilcoxon rank sum test, and Firth logistic regression. All analyses were conducted using STATA 17. Most participants were male (79%), white (62%), and identified as non-Hispanic (66%). Individuals with no perceived neighborhood disorder had median scores of 10 for integration and perseverance in ART self-efficacy. Those with high perceived disorder displayed decreased scores of 8.4 and 8.3 for integration and perseverance respectively. Both integration and perseverance showed statistically significant negative correlations with perceived neighborhood disorder, (Spearman's rho -0.2966; p
• Luzingu, J., Kilungo, A., Flores, R., Baccam, Z., Turner-Warren, T., Reis, T., Okusanya, B., & Ehiri, J. (2024). Effect of Self-Measuring Blood Pressure Program on Hypertension Control: Analysis by Diabetes Status, Age, Gender, and Race in Rural Arizona. Clinics and practice, 14(6), 2637-2649.
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  Rural areas face numerous health challenges, including workforce shortages, limited training opportunities, and delayed care. These disparities can be mitigated by self-management interventions for diseases such as hypertension. This study assessed the implementation of a Self-Measuring Blood Pressure (SMBP) program in rural Arizona, documenting its barriers and patient experiences.
• Nuño, V., Pettygrove, S., Hu, C., Ehiri, J., Madhivanan, P., Acharya, A., Nathan, A., Rock, C., Zahlan, A., & Celaya, M. (2024). Individual- and community-level risk factors for maternal morbidity and mortality among Native American women in the USA: a systematic review. BMJ open, 14(11). doi:10.1136/bmjopen-2024-088380
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  INTRODUCTION AND OBJECTIVE: Maternal morbidity and mortality (MMM) is a public health concern in the USA, with Native American women experiencing higher rates than non-Hispanic White women. Research on risk factors for MMM among Native American women is limited. This systematic review comprehensively synthesizes and critically appraises the literature on risk factors for MMM experienced by Native American women. METHODS AND ANALYSIS: A systematic search was conducted on 10 October 2022 in PubMed, Embase, CINAHL and Scopus for articles published since 2012. Selection criteria included observational studies set in the USA, involving Native American women in the perinatal period, and examining the relationship between risk factors and MMM outcomes. Three reviewers screened and extracted data from the included studies, with risk of bias assessed using the National Institutes of Health Quality Assessment Tools. Data were analysed descriptively. RESULTS: 15 studies were included. All studies used administrative databases, with settings, including nationwide (seven studies), statewide (four studies) and Indian reservations (four studies). The majority of studies focused on hypertensive disorders of pregnancy (eight studies) and severe maternal morbidity (SMM) (four studies). 26 risk factors were identified. Key risk factors included Native American race (six studies), rural maternal residency (four studies), overweight/obese body mass index (two studies), maternal age (two studies), nulliparity (two studies) and pre-existing medical conditions (one study). CONCLUSION: This review identified risk factors associated with MMM among Native American women, including rural residency, overweight or obesity and advanced maternal age. However, the findings also reveal a scarcity of research specific to this population, limiting the ability to fully understand these risk factors and develop effective interventions. These results emphasise the need for further research and culturally relevant studies to inform public health and address disparities for Native American women, particularly those in rural areas. PROSPERO REGISTRATION NUMBER: CRD42022363405.
• Okechukwu, A., Magrath, P., Alaofe, H., Farland, L. V., Abraham, I., Marrero, D. G., Celaya, M., & Ehiri, J. (2024). Optimizing Postpartum Care in Rural Communities: Insights from Women in Arizona and Implications for Policy. Maternal and child health journal.
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  Optimal postpartum care promotes healthcare utilization and outcomes. This qualitative study investigated the experiences and perceived needs for postpartum care among women in rural communities in Arizona, United States.
• Yeo, S., Kim-Hines, Y., Ehiri, J., Magrath, P., Johnson-Agbakwu, C., Ernst, K., Ibrahimi, S., & Alaofè, H. (2024). A qualitative study exploring the factors influencing maternal healthcare access and utilization among Muslim refugee women resettled in the United States. PloS one, 19(8), e0307192.
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  Although a large number of Muslim refugees have resettled in the United States for the last decades, few studies have looked into maternal healthcare access and utilization among Muslim refugee women in the country. This qualitative study was conducted to explore the factors influencing maternal healthcare access and utilization among Muslim refugee women resettled in the United States. In-depth interviews were conducted among Afghan, Iraqi, and Syrian refugee women (n = 17) using an interview guide informed by Social Cognitive Theory and its key constructs. The interviews were recorded and transcribed verbatim, imported into MAXQDA 2020 (VERBI Software), and analyzed based on qualitative content analysis. Data analysis revealed several themes at the micro, meso, and macro-levels. Micro-level factors included women's attitudes toward hospitals and prenatal care, as well as their life skills and language proficiency. Meso-level factors, such as cultural norms and practices, social support and network, as well as health care provider characteristics, were also identified. Macro-level factors, such as the complex healthcare system and access to insurance, also appeared to influence maternal healthcare access and utilization. This study revealed the complex contextual factors that refugee populations face. Given the population's heterogeneity, a more nuanced understanding of refugee maternal health is required, as are more tailored programs for the most vulnerable groups of refugee women.
• Chebet, J. J., McMahon, S. A., Tarumbiswa, T., Hlalele, H., Maponga, C., Mandara, E., Ernst, K., Alaofe, H., Baernighausen, T., Ehiri, J. E., Geldsetzer, P., & Nichter, M. (2023). Motivations for pre-exposure prophylaxis uptake and decline in an HIV-hyperendemic setting: findings from a qualitative implementation study in Lesotho. AIDS research and therapy, 20(1), 43.
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  Pre-Exposure Prophylaxis (PrEP) has demonstrated clinical efficacy in preventing HIV infection, yet its uptake remains low. This study, conducted in five PrEP implementing districts in Lesotho, examined factors motivating persons at risk of HIV infection to adopt or reject PrEP when offered freely.
• Okusanya, B. O., Nweke, C. I., Akeju, D. O., & Ehiri, J. (2023). Early infant diagnosis of HIV infection: a mixed-method study of uptake and challenges at primary health centers in Lagos State, Nigeria. BMC health services research, 23(1), 1038.
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  Nigeria has a low uptake of early infant diagnosis (EID) of HIV despite its high pediatric HIV infection rate. Efforts to increase the EID of HIV have been limited by many factors. This research assessed EID uptake and challenges service providers experienced in providing routine care for HIV-exposed infants.
• Yeo, S., Park, Y., McClelland, D. J., Ehiri, J., Ernst, K., Magrath, P., & Alaofè, H. (2023). A scoping review of maternal health among resettled refugee women in the United States. Frontiers in public health, 11, 1157098.
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  Globally, refugee women continue to face higher maternity-related risks from preventable complications during pregnancy and childbirth, partly due to high health care costs, unfamiliarity with the healthcare system, language barriers, and discrimination. Nevertheless, there is still a paucity of literature that evaluates the available evidence in the US. This scoping review delineated the body of literature on maternal health among refugee women resettled in the US in order to identify knowledge gaps in the literature and highlight future research priorities and directions for maternal health promotion.
• Alaofè, H., Amoussa Hounkpatin, W., Djrolo, F., Ehiri, J., & Rosales, C. (2022). Factors Associated with Quality of Life in Patients with Type 2 Diabetes of South Benin: A Cross-Sectional Study. International journal of environmental research and public health, 19(4).
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  : Type 2 diabetes (T2D) adversely affects health-related quality of life (QoL). However, little is known about the QoL of diabetic patients in Benin, where the disease is a growing concern. Thus, this study aims to assess the QoL and its associated factors among T2D patients in Cotonou, southern Benin. : A total of 300 T2D patients (age > 18 years) were enrolled, and the diabetes-specific quality of life (DQoL) and Natividad self-care behaviors' (SCB) instruments were used for data collection. DQoL scores were calculated, and factors associated with DQoL explored using logistic regression. : The mean of patients' DQoL was 38.1 ± 4.1, with 43% having low QoL. In terms of DQoL, 56.3% reported a high diabetes impact, followed by low life satisfaction (53%) and high worry about diabetes (32.7%). In the logistic regression analysis, education, marital status, occupation, family history of diabetes, complications, and social support were associated with DQoL. SCB factors, including healthy eating, problem-solving, coping strategies, and risk reduction, were significant predictors of DQoL. : Patients' empowerment, starting with self-management education, is essential to improve the QoL of T2D patients in Cotonou. However, the programs need to target low education, low socioeconomic status, low social support, and overweight patients.
• Alaofè, H., Okechukwu, A., Yeo, S., Magrath, P., Amoussa Hounkpatin, W., Ehiri, J., & Rosales, C. (2022). Formative Qualitative Research: Design Considerations for a Self-Directed Lifestyle Intervention for Type-2 Diabetes Patients Using Human-Centered Design Principles in Benin. International journal of environmental research and public health, 19(18).
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  Given the burgeoning prevalence of Type-2 Diabetes (T2D) in Benin and other sub-Saharan countries, tailored diabetes self-management interventions are urgently needed. Human-centered designs can be useful for identifying beneficiaries' needs while keeping in mind feasibility and viability in a given context. Therefore, this study examined the acceptability and community perceptions of a self-directed lifestyle program for T2D patients in Cotonou, southern Benin. Data were collected using focus group discussions (FDGs) with T2D patients (n = 3; 32 participants), academic partners (n = 2; 16 participants), and community partners (n = 2; 12 participants). All FDG sessions were audio-recorded, transcribed from French into English verbatim, and analyzed using MAXQDA 2020. Most participants found the program to be useful and feasible. However, they preferred pictorial brochures as training materials and suggested community health workers as facilitators, assisted by clinicians or dietitians. They recommended community-based delivery mechanisms and mobile applications like WhatsApp to enhance patient adherence. Participants' characteristics, tangible health benefits, incentives, and simple curriculums were cited as critical to program feasibility, effectiveness, and acceptability. This study provides a deeper understanding of potential diabetes self-management participants' needs and concerns. Moreover, it highlights the need to consider key stakeholders' needs and voices for effective intervention.
• Axon, D. R., Kloster, J., Eckert, B., Morales, S., Riggs, S., Kilungo, A., Ehiri, J., Grieser, M., Turner-Warren, T., Aseret-Manygoats, T., Bingham, J. M., Scovis, N., & Warholak, T. (2022). Evaluation of a Pharmacist-Led Telephonic Medication Therapy Management Program in Rural Arizona: Implications for Community Health Practice. Clinics and practice, 12(3), 243-252.
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  This study evaluated a pharmacist-led telephonic Medication Therapy Management (MTM) program for rural patients in Arizona with poor access to healthcare services. A pharmacist provided telephonic MTM services to eligible adult patients living in rural Arizona communities with a diagnosis of diabetes and/or hypertension. Data were collected and summarized descriptively for demographic and health conditions, clinical values, and medication-related problems (MRPs) at the initial consultation, and follow-up data collected at 1 and 3 months. A total of 33 patients had baseline and one-month follow-up data, while 15 patients also had three-month follow-up data. At the initial consultation, the following MRPs were identified: medication adherence issues, dose-related concerns, adverse drug events (ADE), high-risk medications, and therapeutic duplications. Recommendations were made for patients to have the influenza, herpes zoster, and pneumonia vaccines; and to initiate a statin, angiotensin converting enzyme inhibitor, angiotensin receptor blocker, beta-blocker, and/or rescue inhaler. In conclusion, this study demonstrated that while pharmacists can identify and make clinical recommendations to patients, the value of these interventions is not fully realized due to recommendations not being implemented and difficulties with patient follow-up, which may have been due to the COVID-19 pandemic. Additional efforts to address these shortcomings are therefore required.
• Okusanya, B. O., Lott, B. E., Ehiri, J., McClelland, J., & Rosales, C. (2022). Medical Cannabis for the Treatment of Migraine in Adults: A Review of the Evidence. Frontiers in neurology, 13, 871187.
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  Medical cannabis (MC) has been hypothesized as an alternative therapy for migraines, given the undesirable side effects of current migraine medications. The objective of this review was to assess the effectiveness and safety of MC in the treatment of migraine in adults.
• Okusanya, B., Kimaru, L. J., Mantina, N., Gerald, L. B., Pettygrove, S., Taren, D., & Ehiri, J. (2022). Interventions to increase early infant diagnosis of HIV infection: A systematic review and meta-analysis. PloS one, 17(2), e0258863.
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  Early infant diagnosis (EID) of HIV infection increases antiretroviral therapy initiation, which reduces pediatric HIV-related morbidity and mortality. This review aims to critically appraise the effects of interventions to increase uptake of early infant diagnosis.
• Okusanya, B., Nweke, C., Gerald, L. B., Pettygrove, S., Taren, D., & Ehiri, J. (2022). Are prevention of mother-to-child HIV transmission service providers acquainted with national guideline recommendations? A cross-sectional study of primary health care centers in Lagos, Nigeria. BMC health services research, 22(1), 769.
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  Implementation of interventions for the prevention of mother-to-child transmission (PMTCT) of HIV in low- and middle-income countries, faces several barriers including health systems challenges such as health providers' knowledge and use of recommended guidelines. This study assessed PMTCT providers' knowledge of national PMTCT guideline recommendations in Lagos, Nigeria.
• Alaofè, H., Hounkpatin, W. A., Djrolo, F., Ehiri, J., & Rosales, C. (2021). Knowledge, attitude, practice and associated factors among patients with type 2 diabetes in Cotonou, Southern Benin. BMC public health, 21(1), 339.
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  Type 2 diabetes (T2D) is becoming an epidemic with significant disability and premature death in Sub-Saharan Africa, including Benin. However, little is known about the level of knowledge, attitude, and practice (KAP) necessary for diabetic patients to enhance therapeutic outcomes and prevent diabetes complications. The study aimed to assess patients' KAP levels and identify the factors associated in Cotonou, southern Benin.
• Alaofè, H., Yeo, S., Okechukwu, A., Magrath, P., Amoussa Hounkpatin, W., Ehiri, J., & Rosales, C. (2021). Cultural Considerations for the Adaptation of a Diabetes Self-Management Education Program in Cotonou, Benin: Lessons Learned from a Qualitative Study. International journal of environmental research and public health, 18(16).
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  : Type 2 diabetes (T2D) poses a disproportionate burden on Benin, West Africa. However, no diabetes intervention has yet been developed for Benin's contexts. This study aimed to explore specific cultural beliefs, attitudes, behaviors, and environmental factors to help adapt a diabetes self-management program to patients with T2D from Cotonou, in southern Benin. : Qualitative data were collected through focus group discussions (FDGs) involving 32 patients with T2D, 16 academic partners, and 12 community partners. The FDGs were audio-recorded, transcribed verbatim from French to English, and then analyzed thematically with MAXQDA 2020. : Healthy food was challenging to obtain due to costs, seasonality, and distance from markets. Other issues discussed were fruits and vegetables as commodities for the poor, perceptions and stigmas surrounding the disease, and the financial burden of medical equipment and treatment. Information about local food selections and recipes as well as social support, particularly for physical activity, were identified, among other needs. When adapting the curriculum, gender dynamics and spirituality were suggested. : The study demonstrates the need for culturally sensitive interventions and a motivation-based approach to health (spiritual and emotional support). It also lays the groundwork for addressing T2D contextually in Benin and similar sub-Saharan African countries.
• Asaolu, I., Kram, N., Ajala, C., Aquaisua, E., Asaolu, A., Kato-Lagumbay, K., Abuh, A., Bernand, M., & Ehiri, J. (2021). "Antibiotics Can Work as a Contraceptive:" Contraceptive Knowledge and Use Among University Students in Calabar, Nigeria. Frontiers in reproductive health, 3, 665653.
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  Many sexually active youths who wish to delay pregnancy are not using any form of modern contraceptives. In sub-Saharan Africa, less than 1 in 5 sexually active youth do not use contraceptives. In Nigeria, 48.4% of all sexually active unmarried women have an unmet need for contraception. Although the literature is replete with information on structural barriers to modern contraceptives, there is limited scholarship on contextual factors that may inhibit modern contraceptive use among Nigerian youth. This study uses a qualitative research approach to assess knowledge and use of natural, modern, and folkloric contraceptive methods among a sample of university students in Calabar, Nigeria. This study used data from focus group discussions among women and men in university halls of residence, all of whom were unmarried. Also, three male pharmacists and three female community health workers were interviewed. All focus group discussions and interviews took place in August 2017 and were conducted in Calabar Metropolis, Cross River State, Nigeria. The audio recordings were transcribed into detailed summaries of the interviews and focus group discussions. All data analysis was completed using Atlas.Ti (version 8). University men and women have limited knowledge of and application of natural and modern contraception. Participants listed folkloric methods of contraceptives, including repurposing pharmaceuticals (e.g., antibiotics, quinine, and Andrews Livers Salt-a laxative) as contraceptive agents. Respondents also discussed the use of non-pharmaceuticals such as water, salt solution, and squatting after intercourse as contraceptives. Generally, university students defaulted to withdrawal, calendar method, and emergency contraceptives as preferred methods of contraception. Lastly, condoms were used among participants in causal sexual encounters. In dating relationships, however, both male and female students cited their partners' hesitancy to condom use as such act could indicate distrust. Awareness and use of modern contraceptives are limited among university students in Calabar, Nigeria. The use of folkloric contraceptives could lead to bodily harm and unintended pregnancy. Further research is needed to elucidate factors that promote use of folkloric methods of contraceptives. Integration of contraceptive awareness into health promotion services for young people may help to dispel myths about folkloric methods of contraceptives while promoting awareness and use of safe and effective contraception.
• Chebet, J. J., Ehiri, J. E., McClelland, D. J., Taren, D., & Hakim, I. A. (2021). Effect of d-limonene and its derivatives on breast cancer in human trials: a scoping review and narrative synthesis. BMC cancer, 21(1), 902.
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  D-limonene and its derivatives have demonstrated potential chemopreventive and anticancer activity in preclinical and clinical studies. The aim of this scoping review was to assess and critically appraise current literature on the effect of these bioactive citrus peel compounds on breast cancer in human trials and to identify knowledge gaps for exploration in future studies.
• Ejemot-Nwadiaro, R. I., Ehiri, J. E., Arikpo, D., Meremikwu, M. M., & Critchley, J. A. (2021). Hand-washing promotion for preventing diarrhoea. The Cochrane database of systematic reviews, 12, CD004265.
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  Diarrhoea accounts for 1.8 million deaths in children in low- and middle-income countries (LMICs). One of the identified strategies to prevent diarrhoea is hand washing.
• Kram, N. A., Yesufu, V., Lott, B., Palmer, K. N., Balogun, M., & Ehiri, J. (2021). 'Making the most of our situation': a qualitative study reporting health providers' perspectives on the challenges of implementing the prevention of mother-to-child transmission of HIV services in Lagos, Nigeria. BMJ open, 11(10), e046263.
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  To investigate the challenges of, and opportunities for, effective delivery of prevention of mother-to-child transmission (PMTCT) services from the perspectives of primary healthcare providers in Lagos, Nigeria.
• Lott, B. E., Halkiyo, A., Kassa, D. W., Kebede, T., Dedefo, A., Ehiri, J., Madhivanan, P., Carvajal, S., & Soliman, A. (2021). Health workers' perspectives on barriers and facilitators to implementing a new national cervical cancer screening program in Ethiopia. BMC women's health, 21(1), 185.
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  Cervical cancer disproportionately affects women in sub-Saharan Africa, compared with other world regions. In Ethiopia, a National Cancer Control Plan published in 2015, outlines an ambitious strategy to reduce the incidence and mortality of cervical cancer. This strategy includes widespread screening using visual inspection with acetic acid (VIA). As the national screening program has rolled out, there has been limited inquiry of provider experiences. This study aims to describe cancer control experts' perspectives regarding the cancer control strategy and implementation of VIA.
• Parra, K. L., Alaofe, H. S., Ehiri, J. E., Nuño, V. L., Mazariegos, M., Garcia, B., Martinez, E., Junkins, A., & Jolly, P. (2021). Prevalence and Determinants of Underweight, Overweight, and Obesity: A Cross-Sectional Study of Sociodemographic, Dietary, and Lifestyle Factors Among Adolescent Girls in Jutiapa, Guatemala. Food and nutrition bulletin, 42(4), 502-519.
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  As the incidence of overweight continues to increase among children and adolescents in Guatemala, underweight remains a prominent health problem. However, the prevalence of overweight or underweight and associated risk factors has not been investigated among adolescent girls.
• Peterson, R. L., Butler, E. A., Ehiri, J. E., Fain, M. J., & Carvajal, S. C. (2021). Mechanisms of Racial Disparities in Cognitive Aging: An Examination of Material and Psychosocial Well-Being. The journals of gerontology. Series B, Psychological sciences and social sciences, 76(3), 574-582.
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  We tested the hypothesis that education's effect on cognitive aging operates in part through measures of material and psychosocial well-being.
• Riggs, S. L., Thomson, C. A., Jacobs, E., Cutshaw, C. A., & Ehiri, J. E. (2021). Hispanic Ethnicity and Cervical Cancer Precursors Among Low-Income Women in Arizona. International journal of women's health, 13, 929-937.
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  In the United States, Hispanics are more likely to be diagnosed with cervical cancer compared to Non-Hispanic Whites. Annually, 250,000 to 1 million women are diagnosed with a precursor to CC. The aim of this study was to assess whether Hispanics have a higher prevalence of cervical dysplasia compared to Non-Hispanics Whites among a population of low-income women.
• Alaofe, H., Lott, B., Kimaru, L., Okusanya, B., Okechukwu, A., Chebet, J., Meremikwu, M., & Ehiri, J. (2020). Emergency Transportation Interventions for Reducing Adverse Pregnancy Outcomes in Low- and Middle-Income Countries: A Systematic Review. Annals of global health, 86(1), 147.
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  To assess the effect of emergency transportation interventions on the outcome of labor and delivery in low- and middle-income countries (LMICs).
• Iwelunmor, J., Nwaozuru, U., Obiezu-Umeh, C., Uzoaru, F., Ehiri, J., Curley, J., Ezechi, O., Airhihenbuwa, C., & Ssewamala, F. (2020). Is it time to RE-AIM? A systematic review of economic empowerment as HIV prevention intervention for adolescent girls and young women in sub-Saharan Africa using the RE-AIM framework. Implementation science communications, 1, 53.
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  Economic empowerment (EE) HIV prevention programs for adolescent girls and young women (AGYW) in sub-Saharan Africa are gaining traction as effective strategies to reduce HIV risk and vulnerabilities among this population. While intervention effectiveness is critical, there are numerous factors beyond effectiveness that shape an intervention's impact. The objective of this systematic review was to assess the reporting of implementation outcomes of EE HIV prevention programs for AGYW in SSA, as conceptualized in the RE-AIM (reach, efficacy/effectiveness, adoption, implementation, and maintenance) framework.
• Lott, B. E., Okusanya, B. O., Anderson, E. J., Kram, N. A., Rodriguez, M., Thomson, C. A., Rosales, C., & Ehiri, J. E. (2020). Interventions to increase uptake of Human Papillomavirus (HPV) vaccination in minority populations: A systematic review. Preventive medicine reports, 19, 101163.
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  Minority youth represent a unique population for public health interventions given the social, economic, and cultural barriers they often face in accessing health services. Interventions to increase uptake of Human Papillomavirus (HPV) vaccination in minority youth have the potential to reduce disparities in HPV infection and HPV-related cancers. This systematic review assesses the effectiveness of interventions to increase HPV vaccine uptake, measured as vaccine series initiation and series completion, among adolescents and young adults, aged 9-26 years old, identifying as a racial and ethnic minority or sexual and gender minority (SGM) group in high-income countries. Of the 3013 citations produced by a systematic search of three electronic databases (PubMed, Embase, and Web of Science) in November 2018, nine studies involving 9749 participants were selected for inclusion. All studies were conducted in the United States and were published from 2015 to 2018. Interventions utilized education, vaccine appointment reminders, and negotiated interviewing to increase vaccination. Participants were Black or African American (44.4%), Asian (33.3%), Hispanic or Latinx (22.2%), American Indian or Alaska Native (11.1%), and SGM (22.2%). Studies enrolled parent-child dyads (33.3%), parents alone (11.1%), and youth alone (55.6%). Vaccine series initiation ranged from 11.1% to 84% and series completion ranged from 5.6% to 74.2% post-intervention. Educational and appointment reminder interventions may improve HPV vaccine series initiation and completion in minority youth in the U.S. Given the lack of high quality, adequately powered studies, further research is warranted to identify effective strategies for improving HPV vaccine uptake for minority populations.
• Nwaozuru, U., Blackstone, S., Obiezu-Umeh, C., Conserve, D. F., Mason, S., Uzoaru, F., Gbajabiamila, T., Ezechi, O., Iwelunmor, P., Ehiri, J. E., & Iwelunmor, J. (2020). Psychosocial correlates of safe sex self-efficacy among in-school adolescent girls in Lagos, Nigeria. PloS one, 15(6), e0234788.
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  Adolescent girls in Nigeria are at heightened risk for HIV and other sexually transmitted infections. However, there are limited studies on psychosocial factors that are associated with safe sex intentions among this population. Self-efficacy has been established as an important correlate of behavioral intentions and the actual behavior. The objective of this research was to examine how key psychosocial factors such as social support, parental monitoring, and future orientation influence perceived safe sex self-efficacy among in-school adolescent girls in Nigeria. Furthermore, we assessed the associations between these psychosocial factors and HIV-related knowledge and safe sex self-efficacy.
• Okusanya, B. O., Asaolu, I. O., Ehiri, J. E., Kimaru, L. J., Okechukwu, A., & Rosales, C. (2020). Medical cannabis for the reduction of opioid dosage in the treatment of non-cancer chronic pain: a systematic review. Systematic reviews, 9(1), 167.
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  Medical cannabis (MC) is currently being used as an adjunct to opiates given its analgesic effects and potential to reduce opiate addiction. This review assessed if MC used in combination with opioids to treat non-cancer chronic pain would reduce opioid dosage.

Presentations

• Perez Coronado, M., Ehiri, J. E., Moore-Monroy, M. J., & Soto, S. (2024, Fall). ADHS Title V Assessment Community Forum Presentation. Title V Community Forums. Phoenix, Prescott and Virtual: ADHS.
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  Presentation of results of Qualitative Assessment
• Ehiri, J. E., Valenzuela Cordova, R., Parra Felix, T., Soto, S., & Moore-Monroy, M. J. (2024, Junje). Title V  MCH Qualitative Assessment- River of Life Activity. 9th Annual Arizona Rural Women's Health Symposium. Flagstaff Arizona: Alliance of Arizona Community Health Centers.
• Celaya, M., Okechukwu, A., Butler, S., Palmer, K., Kram, N., Nuno, V. L., Moore-Monroy, M. J., Magrath, P. A., Ehiri, J. E., & Yuan, N. P. (2021, April). “Work with us and not against us”: Creating a safe space for hearing the voices of African-American and refugee parents for a statewide maternal and child health needs assessment. ResilienceCon. Virtual.
• Moore-Monroy, M. J., Carbajal, B., Yuan, N. P., Ehiri, J. E., Nuno, V. L., & Magrath, P. A. (2021, April 9). Community and campus partnerships key role in identifying and addressing social determinants of health impacting MCH. 2021 Resiliency in Maternal and Child Health Populations Conference. Virtual: ASU College of Health Solutions.
• Moore-Monroy, M. J., Yuan, N. P., Ehiri, J. E., Magrath, P. A., & Nuno, V. L. (2021, 4-12-2021). River of Life: Application of a visual method to promote inclusion and build partnerships for a statewide maternal and child health assessment in arizona. Rescon. Virtual: Resilience con.
• Moore-Monroy, M. J., Yuan, N. P., Magrath, P. A., Nuno, V. L., & Ehiri, J. E. (2021, Spring). River of Life: Application of a visual method to promote inclusion and build partnerships for a statewide maternal and child health needs assessment in Arizona.. Resilience ConLife Paths Research.
• Moore-Monroy, M. J., Yuan, N. P., Ehiri, J. E., Magrath, P. A., & Nuno, V. L. (2020, August). Presentation of results of Title V MCH assessment. Arizona Rural Women's Health Symposium. Sedona. Arizona: Arizona Rural Women's Health Department.
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  Present on the Title V MCH assessment unfortunately the conference was canceled.