This study uniquely evaluates the prevalence of recreational gambling, and cooccurring conditions prior to gambling expansion in Massachusetts (MA), and assesses associations between gambling and co-occurring behavioral, and mental health disorders. Data are derived from the 2008 MA Behavioral Risk Factor Surveillance System. Logistic regression models to obtain multivariate adjusted odds ratios (ORs) for factors associated with gambling are performed. Prevalence of recreational gambling in MA is 40.2 % (95 % CI 38.2-42.1). Gamblers are more likely to be obese (OR 1.3, 95%CI 1.0-1.7; p<0.05), smoke heavily (OR 2.2, 95%CI 1.1-4.6; p<0.05), use alcohol (OR 1.3, 95%CI 1.0-1.6; p<0.05), and prescription drugs (OR 1.3, 95%CI 1.1-1.6; p<0.05). Gamblers are also more likely to selfreport their health status as good compared to excellent (OR 1.3, 95%CI 1.0-1.7; p<0.05), and Int J Ment Health Addiction

Differing behavioral and mental health risk factors emerge among recreational gamblers by gambling frequency. Gambling frequency may be a better proxy for assessing the risk of developing gambling related behavioral disorders than overall endorsement of gambling participation.

Sexual violence is one of the most common forms of violence against women in Kenya. Recognizing this, the Kenyan government introduced health care sector guidelines for survivors of sexual violence. This study explores the care of rape survivors from the perspective of health-care practitioners and identifies a number of recommendations for improving the quality of care. Qualitative interviews were conducted with 28 health practitioners from eight post-rape care facilities located in Nairobi, Kenya. Data were analyzed using the Colaizzi's 1978 analytical model. The study uncovered a troubling tendency of health practitioners questioning the authenticity of a woman's claim, deeming some not to be genuine rape survivors. Doubts about the veracity of the client's story led to additional emotional drain on health practitioners. This judgment negatively impacted the quality of care for rape survivors and in some cases, leading practitioners to deny services and exposing survivors to secondary victimization.

The 2019 Kenya Violence Against Children Survey highlighted the increased prevalence of sexual violence experienced by girls; 62.6% of girls who have experienced childhood sexual violence reported multiple incidents before age 18. Studies have shown that transactional sex (TS) relationships are a source of sexual violence, particularly age-disparate TS. TS is defined as sex that is a nonmarital, noncommercial relationship driven by the assumption that sex is exchanged for material support or other benefits. TS is common among adolescents and young women in sub-Saharan Africa, with the prevalence varying from as low as 5% to as high as 80%. This qualitative study explored the factors influencing age-disparate TS relationships in two rural districts, Mutomo and Ikutha Wards of Kitui South Sub County, Kenya. Four focus group discussions were conducted with primary (12–14 years of age) and secondary schoolgirls (15–18 years of age). The study results identified several main themes, which were grouped into two major themes: influencing factors and consequences. Influencing factors include material/basic needs, school-related influences, parental influence, peer pressure, and perpetrator access, while consequences include health and social consequences. Our study found that girls’ sense of agency, social pressure, and economic vulnerability impacted their decision to engage in age-disparate TS. These relationships’ power dynamics and exploitative nature increase girls’ risk of experiencing gender-based sexual violence and adverse health and social outcomes. Our study suggests that explicitly addressing individual risk behaviors will not effectively reduce the incidence of TS relationships. Interventions should be focused on understanding the social-cultural beliefs of TS and shifting the narrative that has continued to fuel a patriarchal society in which women and girls have limited decision-making power in relationships.

INTRODUCTION This study assessed the determinants of tobacco use among adults in Nigeria, exploring associations between different types of tobacco products and gender. METHODS Study data were derived from the 2013 Nigerian Demographic and Health Survey (NDHS). The NDHS is a nationally representative household survey of 39 902 women, 17 359 men and 38 522 households. Country weighted data were collected on participants' demographic characteristics and current tobacco use by type. Weighted prevalence estimates and 95% confidence intervals (CI) were performed to examine individual sociodemographic factors and tobacco use. A multivariate logistic regression was also performed to assess the relationship between tobacco use, adjusting for sociodemographic characteristics. RESULTS Overall prevalence of any tobacco use in 2013 was 2.9% (n=1621, 95% CI: 2.8-3.0). The prevalence of any tobacco use was 8.3% (95%CI: 7.8-8.8, p<0.001) in men and 0.4% (95%CI: 0.3-0.5, p<0.001) in women. Cigarettes and snuff were the most commonly used tobacco products in men and women. Dual (smoking and smokeless tobacco products) use was associated with increased odds among men (AOR=26.1, 95%CI: 11.7-58.5, p<0.001), aged 45-59 years (AOR=5.6, 95%CI: 2.1-15.2, p<0.01) and completely/semi-illiterate (AOR=1.8, 95CI: 1.1-2.9, p<0.05). CONCLUSIONS Men and women differed in their preference of type of tobacco product and the associated risk factors. Tobacco control policies need to take these specific differences into consideration for the design and implementation of interventions aimed at addressing tobacco use. INTRODUCTIONTobacco use is the leading cause of preventable death and is responsible for about 6 million deaths each year worldwide 1,2 . The death toll is expected to rise to 8 million by 2030, if current trends continue 2 . Thus, urgent action to curb the consumption of tobacco products is imperative, particularly in developing countries were tobacco use is becoming alarmingly popular3. About 80% of the current 1.3 billion smokers live in low and middle income countries 4 . In 2010, annual tobacco-related deaths in low and middle income countries were estimated at 4.3 million, corresponding to about 25% more deaths than tuberculosis, malaria and HIV/AIDS 5 . The increasing prevalence of tobacco consumption in developing countries is associated with aggressive marketing strategies, employed by the tobacco industry, which explicitly target the youth and women 6,7 . Meanwhile, tobacco consumption, particularly cigarette smoking, is on the decline in many developed countries 1,8 , a result of successful anti-tobacco campaigns and national tobacco control policies. As a consequence, the tobacco industry has targeted new emerging markets, leading to tobacco consumption spreading across the globe 9,10 . The increase in tobacco use in developing AFFILIATION