State and sex-specific trends in the annual incidence of child marriage in the United States since the year 2000

OBJECTIVES

Child marriage, defined as marriage before 18 years of age, is a violation of human rights with harmful consequences for population health, educational attainment, and economic opportunities. Child marriage is legal across most of the United States but how often it happens is challenging to estimate. We measured state and sex-specific trends in the annual incidence of child marriage in 41 states and the District of Columbia.

METHODS

We collected data from marriage certificates filed between 2000 and 2019. These certificates allowed us to identify marriages that occurred within each state and involved a spouse under the age of 18. We divided the number of 15-17-year-olds married in each year by the number of children in that age range living in the state in that year and graphed these annual rates to present trends over time.

RESULTS

The rate of child marriage declined substantially across the United States between 2000 and 2019. Over 75 % of all married children in each state were girls. Girls married men who were an average of 4 years older than they were, and the age gap was substantially larger when girls married than when boys married.

CONCLUSIONS

Child marriage continues across most of the United States and reflects gender inequities in American society. The continued legality of marriage before the age of 18 is at odds with the country's commitment to eliminate child marriage by the year 2030 and violates the human rights of children, primarily girls, across the country.

Nigeria's 2023 presidential election and the future of healthcare in the country

On February 25, 2023, Nigerians took a step forward as a democratic state by voting for a new president. The election is history as the ruling party's candidate, Bola Tinubu, was declared the winner. He polled 37% of the vote, his main rival Abubakar Atiku garnered 29%, and Labour's Peter Obi 25%. Only 27% of registered voters came out to vote. International election observers noted that the election lacked transparency and was marred by logistical challenges and multiple incidents of political violence. The currency and fuel shortages in the country burdened many voters and election officials and therefore marginalised many groups, especially women, who continue to face barriers to political office. The outcome of the election is in contention and inconclusive. The aggrieved parties have taken their case to court, so the nation awaits the outcome of the court decision. In this Editorial, AJRH analyses the prospects and implications of Tinubu's presidency for healthcare in Nigeria.

Beneficial use of dredged sediment as a sustainable practice for restoring coastal marsh habitat

Coastal Louisiana (USA) continues to sustain immense land and habitat losses due to subsidence, sea-level rise, and storm events. Approximately 65 million m³ (85 million cubic yards) of sediment is dredged annually from Gulf Coast federal navigation channels to maintain safe waterway passage. The beneficial use of these sediments continues to increase, and now this sediment is recognized as a critical resource in large-scale (estimated multibillion dollar) ecosystem restoration efforts to mitigate land and habitat losses along the US Gulf Coast. However, the documentation of restoration benefits where dredged sediments are the primary resource is lacking, which limits the potential for future applications. Therefore, this study documents the progress to restore marsh habitat and the resultant benefits in West Bay, Louisiana, and investigates how the restoration practices align with principles of the US Army Corps of Engineers (USACE) Engineering with Nature^® (EWN^® ) and UN Sustainable Development Goals (UN SDGs). West Bay, a 4964-ha subdelta adjacent to the Mississippi River, typifies risks of coastal land loss that also threatens the integrity of the adjacent federal navigation channel. To help restore coastal marsh habitat on a large spatial and temporal scale, the USACE constructed an uncontrolled diversionary channel from the Mississippi River and with subsequent direct and strategic placement of dredged sediment. Restoration performance was assessed through remotely sensed methods using data spanning approximately 70 years. To date, placement of dredged sediment in the bay has facilitated the creation of over 800 ha of new land in the formerly open waters of West Bay. The West Bay restoration project aligns with the principles of the EWN initiative, which supports more sustainable practices to deliver economic, environmental, and social benefits through collaborative processes and meaningfully integrates 10 of the UN SDGs designed to achieve a better and more sustainable future. Integr Environ Assess Manag 2022;18:1162-1173. Published 2021. This article is a U.S. Government work and is in the public domain in the USA.

Urban strategies evaluation for waste management in coastal areas in the framework of area metabolism

Europe is considered one of the most attractive and safe prevalent tourist destinations in the entire world. Approximately half (47.4%) of European tourist visits occurred in coastal regions, defined "on the basis of and consist of local administrative units or municipalities that border the sea, or have at least half of their total surface area within a distance of 10 km from the sea." Destinations such as Malta, Greece, Cyprus, Spain and Croatia presented with an increased level of tourist accommodation establishments, as well as, the overall flow of tourism in the European Union is mostly concentrated on Mediterranean coastal regions (as nine out 10 tourists, in 2015, spent their holidays at coastal areas). This paper, is dealing with the assessment of a tourist area and how the concept of urban metabolism has been affected by touristic activities. Moreover, this research using several key performance indicators such as waste compositional analysis, the clean coast index, the accumulation rate, and accumulation index, etc., tries to measure the level of environmental performance, and furthermore, to assess the existing infrastructures and the waste management plan, that are being implemented. The results are very useful, for any policy-maker, as well as competent authorities and/or tourist organizations which are dealing with tourist activities and aim to propose or re-schedule any waste strategy targeting the goals of United Nations Sustainable Development Goals, European Green Deal, and the new circular economy strategy.

Climate Change and Population Health: Incorporating Stages of Nursing's Political Development

Climate change is the greatest public health threat of the 21^st century and is associated with environmental degradation and deleterious health consequences. In 2019, the Lancet Commission Report on Health and Climate Change: Ensuring that the Health of a Child Born Today Is Not Defined By a Changing Climate (Watts et al., 2019) examined the critical health issues that children will face in the era of climate change. Greenhouse gas emissions (GGEs) are responsible for an alarming increase in the warming of the planet, shifts in weather patterns, loss of arable land, and exacerbations of acute health issues, chronic health problems, and disaster-related health consequences. The purpose of this paper is to provide an overview of climate change and the associated deleterious health consequences in our climate-changing world. The paper will also examine the stages of political development to advance the 21^st century role of the nursing profession in climate and health advocacy and policy.

Global municipal solid waste infrastructure: Delivery and forecast of uncontrolled disposal

Proper management and treatment of municipal solid waste (MSW) plays a central role towards the reduction or elimination of uncontrolled disposal and the achievement of United Nations (UN) Sustainable Development Goals (SDGs) with the reduction of its vast adverse environmental and health impacts. Despite that, till now, there has never been a quantitative analysis of the progress in waste management infrastructure delivery worldwide. In this paper, we provide valuable insights regarding the progress in new MSW infrastructure delivery based on a dataset of 1764 projects from 156 countries, for the period 2014-2019. We also estimate the magnitude of uncontrolled waste disposal practices worldwide by estimating the gap between the current MSW infrastructure delivery and actual changes in MSW generation. Our results show that the new capacity delivered during the six years period amounted to 243 million metric tonnes (Mt) (40 million Mt per year), out of which 45% was delivered in high-income countries, 37.5% in the People's Republic of China and 17.5% in the rest of the world, mainly through thermal treatment (~57%) and landfilling (8%). The average allocated per capita budget of these projects during this period is about US$14, equivalent to US$2.33 (cap*year)^-1. Our main conclusion is that the share of uncontrolled disposal will continue to rise at least until 2028, reaching almost 730 million Mt per year. Evidently, the global community continues to face a serious challenge towards the implementation of the UN SDG 12, target 12.4 by 2020. The analysis demonstrates that infrastructure delivery must increase by four folds to eliminate uncontrolled disposal practices.

How afforestation affects the water cycle in drylands: A process-based comparative analysis

The world's largest afforestation programs implemented by China made a great contribution to the global "greening up." These programs have received worldwide attention due to its contribution toward achieving the United Nations Sustainable Development Goals. However, emerging studies have suggested that these campaigns, when not properly implemented, resulted in unintended ecological and water security concerns at the regional scale. While mounting evidence shows that afforestation causes substantial reduction in water yield at the watershed scale, process-based studies on how forest plantations alter the partitioning of rainwater and affect water balance components in natural vegetation are still lacking at the plot scale. This lack of science-based data prevents a comprehensive understanding of forest-related ecosystem services such as soil conservation and water supply under climate change. The present study represents the first "Paired Plot" study of the water balance of afforestation on the Loess Plateau. We investigate the effects of forest structure and environmental factors on the full water cycle in a typical multilayer plantation forest composed of black locust, one of the most popular tree species for plantations worldwide. We measure the ecohydrological components of a black locust versus natural grassland on adjacent sites. The startling finding of this study is that, contrary to the general belief, the understory-instead of the overstory-was the main water consumer in this plantation. Moreover, there is a strict physiological regulation of forest transpiration. In contrast to grassland, annual seepage under the forest was minor in years with an average rainfall. We conclude that global long-term greening efforts in drylands require careful ecohydrologic evaluation so that green and blue water trade-offs are properly addressed. This is especially important for reforestation-based watershed land management, that aims at carbon sequestration in mitigating climate change while maintaining regional water security, to be effective on a large scale.

The effectiveness and cost-effectiveness of community-based support for adolescents receiving antiretroviral treatment: an operational research study in South Africa

Introduction

Adolescents and youth receiving antiretroviral treatment (ART) in sub‐Saharan Africa have high attrition and inadequate ART outcomes, and evaluations of interventions improving ART outcomes amongst adolescents are very limited. Sustainable Development Goal (SDG) target 3c is to substantially increase the health workforce in developing countries. We measured the effectiveness and cost‐effectiveness of community‐based support (CBS) provided by lay health workers for adolescents and youth receiving ART in South Africa.

Methods

A retrospective cohort study including adolescents and youth who initiated ART at 47 facilities. Previously unemployed CBS‐workers provided home‐based ART‐related education, psychosocial support, symptom screening for opportunistic infections and support to access government grants. Outcomes were compared between participants who received CBS plus standard clinic‐based care versus participants who received standard care only. Cumulative incidences of all‐cause mortality and loss to follow‐up (LTFU), adherence measured using medication possession ratios (MPRs), CD4 count slope, and virological suppression were analysed using multivariable Cox, competing‐risks regression, generalized estimating equations and mixed‐effects models over five years of ART. An expenditure approach was used to determine the incremental cost of CBS to usual care from a provider perspective. Incremental cost‐effectiveness ratios were calculated as annual cost per patient‐loss (through death or LTFU) averted.

Results

Amongst 6706 participants included, 2100 (31.3%) received CBS. Participants who received CBS had reduced mortality, adjusted hazard ratio (aHR) = 0.52 (95% CI: 0.37 to 0.73; p < 0.0001). Cumulative LTFU was 40% lower amongst participants receiving CBS (29.9%) compared to participants without CBS (38.9%), aHR = 0.60 (95% CI: 0.51 to 0.71); p < 0.0001). The effectiveness of CBS in reducing attrition ranged from 42.2% after one year to 35.9% after five years. Virological suppression was similar after three years, but after five years 18.8% CBS participants versus 37.2% non‐CBS participants failed to achieve viral suppression, adjusted odds ratio = 0.24 (95% CI: 0.06 to 1.03). There were no significant differences in MPR or CD4 slope. The cost of CBS was US$49.5/patient/year. The incremental cost per patient‐loss averted was US$600 and US$776 after one and two years, respectively.

Conclusions

CBS for adolescents and youth receiving ART was associated with substantially reduced patient attrition, and is a low‐cost intervention with reasonable cost‐effectiveness that can aid progress towards several health, economic and equality‐related SDG targets.

The Mycotox Charter: Increasing Awareness of, and Concerted Action for, Minimizing Mycotoxin Exposure Worldwide

Mycotoxins are major food contaminants affecting global food security, especially in low and middle-income countries. The European Union (EU) funded project, MycoKey, focuses on “Integrated and innovative key actions for mycotoxin management in the food and feed chains” and the right to safe food through mycotoxin management strategies and regulation, which are fundamental to minimizing the unequal access to safe and sufficient food worldwide. As part of the MycoKey project, a Mycotoxin Charter (charter.mycokey.eu) was launched to share the need for global harmonization of mycotoxin legislation and policies and to minimize human and animal exposure worldwide, with particular attention to less developed countries that lack effective legislation. This document is in response to a demand that has built through previous European Framework Projects—MycoGlobe and MycoRed—in the previous decade to control and reduce mycotoxin contamination worldwide. All suppliers, participants and beneficiaries of the food supply chain, for example, farmers, consumers, stakeholders, researchers, members of civil society and government and so forth, are invited to sign this charter and to support this initiative.

Dietary Strategies to Reduce Environmental Impact: A Critical Review of the Evidence Base

The food system is a major source of environmental impact, and dietary change has been recommended as an important and necessary strategy to reduce this impact. However, assessing the environmental performance of diets is complex due to the many types of foods eaten and the diversity of agricultural production systems and local environmental settings. To assess the state of science and identify knowledge gaps, an integrative review of the broad topic of environment and diet was undertaken, with particular focus on the completeness of coverage of environmental concerns and the metrics used. Compared with the 14 discrete environmental areas of concern identified in the United Nations Sustainable Development Goals, the located journal literature mainly addressed greenhouse gas (GHG) emissions and, to a lesser extent, land and water use. Some relevant concerns were rarely addressed or not addressed at all. In the case of GHG emissions, changes in land use and soil carbon stocks were seldom considered. This represents a disconnect between the science informing strategic climate action in the agricultural sector and the science informing public health nutrition. In the case of land and water use, few studies used metrics that are appropriate in a life-cycle context. Some metrics produce inherently biased results, which misinform about environmental impact. The limited evidence generally points to recommended diets having lower environmental impacts than typical diets, although not in every case. This is largely explained by the overconsumption of food energy associated with average diets, which is also a major driver of obesity. A shared-knowledge framework is identified as being needed to guide future research on this topic. Until the evidence base becomes more complete, commentators on sustainable diets should not be quick to assume that a dietary strategy to reduce overall environmental impact can be readily defined or recommended.

Estimating treatment coverage for people with substance use disorders: an analysis of data from the World Mental Health Surveys

Substance use is a major cause of disability globally. This has been recognized in the recent United Nations Sustainable Development Goals (SDGs), in which treatment coverage for substance use disorders is identified as one of the indicators. There have been no estimates of this treatment coverage cross-nationally, making it difficult to know what is the baseline for that SDG target. Here we report data from the World Health Organization (WHO)'s World Mental Health Surveys (WMHS), based on representative community household surveys in 26 countries. We assessed the 12-month prevalence of substance use disorders (alcohol or drug abuse/dependence); the proportion of people with these disorders who were aware that they needed treatment and who wished to receive care; the proportion of those seeking care who received it; and the proportion of such treatment that met minimal standards for treatment quality ("minimally adequate treatment"). Among the 70,880 participants, 2.6% met 12-month criteria for substance use disorders; the prevalence was higher in upper-middle income (3.3%) than in high-income (2.6%) and low/lower-middle income (2.0%) countries. Overall, 39.1% of those with 12-month substance use disorders recognized a treatment need; this recognition was more common in high-income (43.1%) than in upper-middle (35.6%) and low/lower-middle income (31.5%) countries. Among those who recognized treatment need, 61.3% made at least one visit to a service provider, and 29.5% of the latter received minimally adequate treatment exposure (35.3% in high, 20.3% in upper-middle, and 8.6% in low/lower-middle income countries). Overall, only 7.1% of those with past-year substance use disorders received minimally adequate treatment: 10.3% in high income, 4.3% in upper-middle income and 1.0% in low/lower-middle income countries. These data suggest that only a small minority of people with substance use disorders receive even minimally adequate treatment. At least three barriers are involved: awareness/perceived treatment need, accessing treatment once a need is recognized, and compliance (on the part of both provider and client) to obtain adequate treatment. Various factors are likely to be involved in each of these three barriers, all of which need to be addressed to improve treatment coverage of substance use disorders. These data provide a baseline for the global monitoring of progress of treatment coverage for these disorders as an indicator within the SDGs.