protective factors


Summary: An aspect of personal behavior or lifestyle, environmental exposure, or inborn or inherited characteristic, which, on the basis of epidemiologic evidence, is known to be associated with prevention or mitigation of a health-related condition considered important to prevent.

Top Publications

  1. Martiskainen H, Herukka S, Stancakova A, Paananen J, Soininen H, Kuusisto J, et al. Decreased plasma ?-amyloid in the Alzheimer's disease APP A673T variant carriers. Ann Neurol. 2017;82:128-132 pubmed publisher
    ..This is the first report to show decreased A? levels in plasma in APP A673T carriers and thus provides evidence that lower A? levels throughout life may be protective against AD. Ann Neurol 2017;82:128-132. ..
  2. Sun K, Hong F, Wang Y, Agopian V, Yan M, Busuttil R, et al. Venovenous Bypass Is Associated With a Lower Incidence of Acute Kidney Injury After Liver Transplantation in Patients With Compromised Pretransplant Renal Function. Anesth Analg. 2017;125:1463-1470 pubmed publisher
    ..Further studies to assess the role of intraoperative VVB in posttransplant AKI are warranted. ..
  3. Hamilton R, Shield C, Laughrun D. Progression of asymptomatic mild carotid artery stenosis: Implications for frequency of surveillance. Vasc Med. 2017;22:411-417 pubmed publisher
    ..One carotid artery (0.2%) progressed from mild CAS to severe CAS. If supported by others, our data may lead to a change in the recommendations regarding appropriate follow-up of asymptomatic CAS...
  4. Kawai S, Yamada T, Matsuura T, Funao T, Nishikawa K. Neuropathic pain attenuates ischemia reperfusion injury through ?2-adrenergic pathway. Life Sci. 2017;187:9-16 pubmed publisher
    ..The underlying mechanisms were possibly regulated by ?2-adrenergic activation and pro-survival kinase expression in cardiomyocytes. ..
  5. Turati F, Bravi F, di Maso M, Bosetti C, Polesel J, Serraino D, et al. Adherence to the World Cancer Research Fund/American Institute for Cancer Research recommendations and colorectal cancer risk. Eur J Cancer. 2017;85:86-94 pubmed publisher
    ..56, 95% CI, 0.42-0.76), limiting alcohol (OR 0.87, 95% CI, 0.77-0.99) and salt intake (OR 0.63, 95% CI, 0.48-0.84). Our study indicated that adherence to the WCRF/AICR recommendations is inversely related to CRC risk. ..
  6. Blood A, Sandoval M, Burger E, Halverson Carpenter K. Risk and Protective Factors Associated with Surgical Infections among Spine Patients. Surg Infect (Larchmt). 2017;18:234-249 pubmed publisher
    The purpose of the study was to identify patient-specific and procedure-specific risk and protective factors associated with post-operative surgical site infections (SSIs) among surgical spine patients...
  7. Burnette C, Roh S, Lee K, Lee Y, Newland L, Jun J. A Comparison of Risk and Protective Factors Related to Depressive Symptoms among American Indian and Caucasian Older Adults. Health Soc Work. 2017;42:e15-e23 pubmed publisher
    ..Although adverse childhood experiences (ACEs) and social support are well-documented risk and protective factors for depression in the general population, little is known about AI/AN populations, especially older adults...
  8. Heffron S, Rockman C, Adelman M, Gianos E, Guo Y, Xu J, et al. Greater Frequency of Fruit and Vegetable Consumption Is Associated With Lower Prevalence of Peripheral Artery Disease. Arterioscler Thromb Vasc Biol. 2017;37:1234-1240 pubmed publisher
    ..These observations suggest the need to further efforts to increase F&V consumption and for more rigorous evaluation of the role of F&V in PAD prevention. ..
  9. Stavroulakis K, Borowski M, Torsello G, Bisdas T. Association between statin therapy and amputation-free survival in patients with critical limb ischemia in the CRITISCH registry. J Vasc Surg. 2017;66:1534-1542 pubmed publisher
    ..38; 95% CI, 0.21-0.68; P = .001). Statin therapy in CLI patients is associated with an increased AFS and lower rates of mortality and MACCEs without improving, however, the salvage rates of the affected limb. ..

More Information


  1. Larsen S, Dehlendorff C, Skriver C, Dalton S, Jespersen C, Borre M, et al. Postdiagnosis Statin Use and Mortality in Danish Patients With Prostate Cancer. J Clin Oncol. 2017;35:3290-3297 pubmed publisher
    ..Conclusion Postdiagnosis statin use was associated with reduced mortality from prostate cancer; however, it remains to be established whether this association is causal. ..
  2. Tran H, Erskine N, Kiefe C, Barton B, Lapane K, Do V, et al. Is low iodine a risk factor for cardiovascular disease in Americans without thyroid dysfunction? Findings from NHANES. Nutr Metab Cardiovasc Dis. 2017;27:651-656 pubmed publisher
    ..If low iodine levels precede CAD, then this potential and modifiable new CAD risk factor might have therapeutic implications. ..
  3. Mehaffey J, Hawkins R, Fashandi A, Cherry K, Kern J, Kron I, et al. Lower extremity bypass for critical limb ischemia decreases major adverse limb events with equivalent cardiac risk compared with endovascular intervention. J Vasc Surg. 2017;66:1109-1116.e1 pubmed publisher
    ..Furthermore, there was no difference in 30-day MACE rate between the groups despite higher inherent risk with open surgical procedures. Therefore, this study supports the effectiveness and primacy of LEB for revascularization in CLI. ..
  4. Myrelid P, Landerholm K, Nordenvall C, Pinkney T, Andersson R. Appendectomy and the Risk of Colectomy in Ulcerative Colitis: A National Cohort Study. Am J Gastroenterol. 2017;112:1311-1319 pubmed publisher
    ..Appendectomy for appendicitis after established UC appears associated with a worse disease course, with an increased rate of subsequent colectomy. ..
  5. Taimour S, Zarrouk M, Holst J, Rosengren A, Groop L, Nilsson P, et al. Aortic diameter at age 65 in men with newly diagnosed type 2 diabetes. Scand Cardiovasc J. 2017;51:202-206 pubmed publisher
    ..Putative protective effects of type 2 diabetes mellitus against aortic dilatation and AAA development therefore probably occur later after diagnosis of diabetes. ..
  6. Parikh N, Fu S, Rao H, Yang M, Li Y, Powell C, et al. Risk Assessment of Hepatocellular Carcinoma in Patients with Hepatitis C in China and the USA. Dig Dis Sci. 2017;62:3243-3253 pubmed publisher
    ..The protective effect of tea consumption on HCC development deserves further validation. ..
  7. Malik V, Li Y, Tobias D, Pan A, Hu F. Dietary Protein Intake and Risk of Type 2 Diabetes in US Men and Women. Am J Epidemiol. 2016;183:715-28 pubmed publisher
    ..In conclusion, higher intake of animal protein was associated with an increased risk of T2D, while higher intake of vegetable protein was associated with a modestly reduced risk. ..
  8. Fresán U, Gea A, Bes Rastrollo M, Basterra Gortari F, Carlos S, Martinez Gonzalez M. Substitution of water or fresh juice for bottled juice and type 2 diabetes incidence: The SUN cohort study. Nutr Metab Cardiovasc Dis. 2017;27:874-880 pubmed publisher
    ..Thus, these substitutions could be useful to tackle the diabetes epidemic. ..
  9. Ware L, Charlton K, Schutte A, Cockeran M, Naidoo N, Kowal P. Associations between dietary salt, potassium and blood pressure in South African adults: WHO SAGE Wave 2 Salt & Tobacco. Nutr Metab Cardiovasc Dis. 2017;27:784-791 pubmed publisher
    ..These preliminary results indicate that high dietary Na:K ratio may lead to a greater increase in BP and hypertension risk with age. Interventions to increase potassium intakes alongside sodium reduction initiatives may be warranted. ..
  10. Bandak M, Jørgensen N, Juul A, Lauritsen J, Oturai P, Mortensen J, et al. Leydig cell dysfunction, systemic inflammation and metabolic syndrome in long-term testicular cancer survivors. Eur J Cancer. 2017;84:9-17 pubmed publisher
    ..Total testosterone at follow-up was significantly associated with MetS. The study is registered at www.clinicaltrials.govNCT02240966. ..
  11. Oza A, Lu N, Schoenfeld S, Fisher M, Dubreuil M, Rai S, et al. Survival benefit of statin use in ankylosing spondylitis: a general population-based cohort study. Ann Rheum Dis. 2017;76:1737-1742 pubmed publisher
    ..The magnitude of the inverse association appears to be larger than that observed in randomised trials of the general population and in population-based cohort studies of patients with rheumatoid arthritis. ..
  12. Qu Y, Chen Y, Yu H, Zhao Y, Chen G, Bai L, et al. Survival and Prognostic Analysis of Primary Nasopharyngeal Carcinoma in North China. Clin Lab. 2015;61:699-708 pubmed
    ..Patient gender, age, smoking status, clinical stages, and T stages all served as prognostic factors of nasopharyngeal carcinoma. ..
  13. Khetarpal S, Zeng X, Millar J, Vitali C, Somasundara A, Zanoni P, et al. A human APOC3 missense variant and monoclonal antibody accelerate apoC-III clearance and lower triglyceride-rich lipoprotein levels. Nat Med. 2017;23:1086-1094 pubmed publisher
    ..This protective mechanism has the potential to be exploited as a new therapeutic approach to reduce apoC-III levels and circulating TRL burden. ..
  14. Ebadi M, Martin L, Ghosh S, Field C, Lehner R, Baracos V, et al. Subcutaneous adiposity is an independent predictor of mortality in cancer patients. Br J Cancer. 2017;117:148-155 pubmed publisher
    ..The effect of sarcopenia on survival was more pronounced in patients with low subcutaneous adiposity. ..
  15. Rossetti M, Tosone A, Stratta P, Collazzoni A, Santarelli V, Guadagni E, et al. Different roles of resilience in depressive patients with history of suicide attempt and no history of suicide attempt. Rev Bras Psiquiatr. 2017;39:216-219 pubmed publisher
    Suicidal ideation is modulated by several risk and protective factors. The aim of this study was to evaluate differences between patients with a history of suicide attempt and those with no such history, with special attention to ..
  16. Russ T, Hannah J, Batty G, Booth C, Deary I, Starr J. Childhood Cognitive Ability and Incident Dementia: The 1932 Scottish Mental Survey Cohort into their 10th Decade. Epidemiology. 2017;28:361-364 pubmed publisher
    ..001) but not in men (1.05; 0.89, 1.24 and 1.01; 0.85, 1.21; 0.44). Childhood intelligence is related to subsequent dementia risk but this association is not the same in men and women. See video abstract at, ..
  17. Johnson A, Parlow J, Whitehead M, Xu J, Rohland S, Milne B. Body Mass Index, Outcomes, and Mortality Following Cardiac Surgery in Ontario, Canada. J Am Heart Assoc. 2015;4: pubmed publisher
    ..This may impact health resource planning, shifting the focus to morbidly obese and underweight patients prior to, during, and after cardiac surgery. ..
  18. Mirmiran P, Bahadoran Z, Ghasemi A, Azizi F. Contribution of dietary amino acids composition to incidence of cardiovascular outcomes: A prospective population-based study. Nutr Metab Cardiovasc Dis. 2017;27:633-641 pubmed publisher
    ..30, 95% CI = 1.03-1.64, and HR = 1.33, 95% CI = 1.10-1.60, respectively). These novel data provide evidence to suggest that amino acid composition of diet may modify the risk of CVD events. ..
  19. Saeed O, Rangasamy S, Selevany I, Madan S, Fertel J, Eisenberg R, et al. Sildenafil Is Associated With Reduced Device Thrombosis and Ischemic Stroke Despite Low-Level Hemolysis on Heart Mate II Support. Circ Heart Fail. 2017;10: pubmed publisher
    ..Accordingly, we investigated the association of sildenafil administration and thrombotic events in patients with LLH during Heart Mate II support...
  20. Wlodarczyk O, Schwarze M, Rumpf H, Metzner F, Pawils S. Protective mental health factors in children of parents with alcohol and drug use disorders: A systematic review. PLoS ONE. 2017;12:e0179140 pubmed publisher
    ..One difference between resilient and maladapted children is the presence of protective factors. The aim of this systematic review is to provide an overview of the current state of the research concerning ..
  21. Niiranen T, Lyass A, Larson M, Hamburg N, Benjamin E, Mitchell G, et al. Prevalence, Correlates, and Prognosis of Healthy Vascular Aging in a Western Community-Dwelling Cohort: The Framingham Heart Study. Hypertension. 2017;70:267-274 pubmed publisher
    ..Although our data are observational, our findings support prevention strategies targeting modifiable factors and behaviors and obesity, in particular, to prevent or delay vascular aging and the associated risk of CVD. ..
  22. Mary A, Hartemann A, Liabeuf S, Aubert C, Kemel S, Salem J, et al. Association between metformin use and below-the-knee arterial calcification score in type 2 diabetic patients. Cardiovasc Diabetol. 2017;16:24 pubmed publisher
    ..Further prospective investigations of metformin's potential ability to inhibit VC in patients with and without type 2 diabetes are now needed to confirm these results. ..
  23. Koolhaas C, Dhana K, Golubic R, Schoufour J, Hofman A, van Rooij F, et al. Physical Activity Types and Coronary Heart Disease Risk in Middle-Aged and Elderly Persons: The Rotterdam Study. Am J Epidemiol. 2016;183:729-38 pubmed publisher
    ..In conclusion, in this long-term follow-up study of older adults, domestic work and cycling were associated with reduced CHD risk. Physical activity should be promoted in this population with the aim to prevent CHD. ..
  24. Qi L, Ma W, Heianza Y, Zheng Y, Wang T, Sun D, et al. Independent and Synergistic Associations of Biomarkers of Vitamin D Status With Risk of Coronary Heart Disease. Arterioscler Thromb Vasc Biol. 2017;37:2204-2212 pubmed publisher
    ..VDBP but not bioavailable 25OHD was independently associated with lower CHD risk. ..
  25. Guasch Ferré M, Salas Salvado J, Ros E, Estruch R, Corella D, Fito M, et al. The PREDIMED trial, Mediterranean diet and health outcomes: How strong is the evidence?. Nutr Metab Cardiovasc Dis. 2017;27:624-632 pubmed publisher
  26. Richards C, Schneider P. Will mesh-covered stents help reduce stroke associated with carotid stent angioplasty?. Semin Vasc Surg. 2017;30:25-30 pubmed publisher
    ..Improvements in stent design that eliminate post-procedural debris embolization will expand the application of CAS for severe internal carotid artery atherosclerotic stenosis. ..
  27. Dougherty R, Schultz S, Boots E, Ellingson L, Meyer J, Van Riper S, et al. Relationships between cardiorespiratory fitness, hippocampal volume, and episodic memory in a population at risk for Alzheimer's disease. Brain Behav. 2017;7:e00625 pubmed publisher
    ..The objective of this study was to determine the association between CRF and both hippocampal volume and episodic memory in a cohort of cognitively healthy older adults with familial and/or genetic risk for Alzheimer's disease (AD)...
  28. Ceppi M, Munnia A, Cellai F, Bruzzone M, Peluso M. Linking the generation of DNA adducts to lung cancer. Toxicology. 2017;390:160-166 pubmed publisher
    ..I.) 1.10-4.73, in overall smokers in respect to non-smokers. The present work provides strengthening of the hypothesis that bronchial adducts are not simply relate to exposure, but are a cause of chemical-induced lung cancer. ..
  29. Dai Z, Niu J, Zhang Y, Jacques P, Felson D. Dietary intake of fibre and risk of knee osteoarthritis in two US prospective cohorts. Ann Rheum Dis. 2017;76:1411-1419 pubmed publisher
    ..02). No apparent association was found with ROA. Findings from two longitudinal studies consistently showed that higher total fibre intake was related to a lower risk of SxOA, while the relation to ROA was unclear. ..
  30. Rader D. Spotlight on HDL biology: new insights in metabolism, function, and translation. Cardiovasc Res. 2014;103:337-40 pubmed publisher
  31. Petrykiv S, Sjöström C, Greasley P, Xu J, Persson F, Heerspink H. Differential Effects of Dapagliflozin on Cardiovascular Risk Factors at Varying Degrees of Renal Function. Clin J Am Soc Nephrol. 2017;12:751-759 pubmed publisher
    ..These effects in conjunction with the finding of similar effects on hematocrit, a proxy for volume contraction, suggest that the effects of dapagliflozin are partly mediated via nonglucosuric-dependent mechanisms. ..
  32. Cooper L, Boukary R, Aseffa A, Mihret W, Collard J, Daugla D, et al. Investigation of correlates of protection against pharyngeal carriage of Neisseria meningitidis genogroups W and Y in the African meningitis belt. PLoS ONE. 2017;12:e0182575 pubmed publisher
  33. Ohn J, Hwang J, Moon M, Ahn H, Kim H, Koo Y, et al. Small heterodimer partner (SHP) deficiency protects myocardia from lipid accumulation in high fat diet-fed mice. PLoS ONE. 2017;12:e0186021 pubmed publisher
    ..We confirmed the reduced expression of PPAR?1 and PPAR? target genes such as CD36, medium-chain acyl-CoA dehydrogenase, long-chain acyl-CoA dehydrogenase, and very long-chain acyl-CoA dehydrogenase by SHP KO after HFD. ..
  34. Nano J, Ghanbari M, Wang W, de Vries P, Dhana K, Muka T, et al. Epigenome-Wide Association Study Identifies Methylation Sites Associated With Liver Enzymes and Hepatic Steatosis. Gastroenterology. 2017;153:1096-1106.e2 pubmed publisher
    ..Our results provide new insights into epigenetic mechanisms associated with markers of liver function and hepatic steatosis, laying the groundwork for future diagnostic and therapeutic applications. ..
  35. Britton A, Grobbee D, den Ruijter H, Anderson T, Desvarieux M, Engstrom G, et al. Alcohol Consumption and Common Carotid Intima-Media Thickness: The USE-IMT Study. Alcohol Alcohol. 2017;52:483-486 pubmed publisher
    ..In this large CIMT consortium, we did not find evidence to support a protective effect of alcohol on CIMT. ..
  36. Fanidi A, Muller D, Yuan J, Stevens V, Weinstein S, Albanes D, et al. Circulating Folate, Vitamin B6, and Methionine in Relation to Lung Cancer Risk in the Lung Cancer Cohort Consortium (LC3). J Natl Cancer Inst. 2018;110: pubmed publisher
  37. Shimomura T, Wakabayashi I. Inverse associations between light-to-moderate alcohol intake and lipid-related indices in patients with diabetes. Cardiovasc Diabetol. 2013;12:104 pubmed publisher
  38. Rong H, He X, Zhu L, Zhu X, Kang L, Wang L, et al. Association between regulator of telomere elongation helicase1 (RTEL1) gene and HAPE risk: A case-control study. Medicine (Baltimore). 2017;96:e8222 pubmed publisher
    ..0025). Our findings provide new evidence for the association between SNPs in RTEL1 and a decreased risk HAPE in the Chinese population. The results need further confirmation. ..
  39. Kanwal F, Kramer J, Asch S, Chayanupatkul M, Cao Y, El Serag H. Risk of Hepatocellular Cancer in HCV Patients Treated With Direct-Acting Antiviral Agents. Gastroenterology. 2017;153:996-1005.e1 pubmed publisher
    ..However, in patients with SVR, the absolute risk of HCC remained high in patients with established cirrhosis. These patients should be considered for ongoing HCC surveillance. ..
  40. Kubota K, Egi M, Mizobuchi S. Haptoglobin Administration in Cardiovascular Surgery Patients: Its Association With the Risk of Postoperative Acute Kidney Injury. Anesth Analg. 2017;124:1771-1776 pubmed publisher
    ..54 [0.31, 0.93]). In this hypothesis-generating, single-center retrospective observational study, intraoperative administration of haptoglobin was independently associated with lower risk of AKI after cardiovascular surgery. ..
  41. Kristensen K, Pottegård A, Hallas J, Rasmussen L, Lindholt J. Metformin treatment does not affect the risk of ruptured abdominal aortic aneurysms. J Vasc Surg. 2017;66:768-774.e2 pubmed publisher
    ..84 (confidence interval, 0.61-1.17). None of the subgroups had ORs deviating substantially from the main result. Metformin use does not increase the risk of RAAA among individuals with diabetes. ..
  42. Wisiol F, Juen B, Unterrainer C. [The Impact of Risk Factors and Effective Factors on Success in Crisis Intervention for Children and Adolescents]. Prax Kinderpsychol Kinderpsychiatr. 2017;66:345-361 pubmed publisher
    ..The crisis intervention must therefore not only focus on its most important function, protection and security, but also on the strengthening of self-esteem and a positive sense of coherence as part of the crisis intervention. ..
  43. Adejumo A, Alliu S, Ajayi T, Adejumo K, Adegbala O, Onyeakusi N, et al. Cannabis use is associated with reduced prevalence of non-alcoholic fatty liver disease: A cross-sectional study. PLoS ONE. 2017;12:e0176416 pubmed publisher
    ..These novel findings suggest additional molecular mechanistic studies to explore the potential role of cannabis use in NAFLD development. ..
  44. Jiang Y, Ma L, Han C, Liu Q, Cong X, Xu Y, et al. Effects of Apolipoprotein E Isoforms in Diabetic Nephropathy of Chinese Type 2 Diabetic Patients. J Diabetes Res. 2017;2017:3560920 pubmed publisher
    ..91% versus 19.96%, P < 0.05). These results suggest ApoE ?2 allele may be a risk factor; however ApoE ?4 allele may play a protective role of DN in Chinese type 2 diabetic patients. ..
  45. Gill D, Del Greco M F, Walker A, Srai S, Laffan M, Minelli C. The Effect of Iron Status on Risk of Coronary Artery Disease: A Mendelian Randomization Study-Brief Report. Arterioscler Thromb Vasc Biol. 2017;37:1788-1792 pubmed publisher
    ..08 per SD unit increase; 95% confidence interval, 1.01-1.16; P=0.034). This Mendelian randomization study supports the hypothesis that higher iron status reduces CAD risk. These findings may highlight a therapeutic target. ..
  46. Budu Aggrey A, Bowes J, Stuart P, Zawistowski M, Tsoi L, Nair R, et al. A rare coding allele in IFIH1 is protective for psoriatic arthritis. Ann Rheum Dis. 2017;76:1321-1324 pubmed publisher
    ..While this association further supports existing evidence for IFIH1 as a causal gene for PsA, mechanistic studies will need to be pursued to confirm that IFIH1 is indeed causal. ..
  47. Martini D, Rossi S, Biasini B, Zavaroni I, Bedogni G, Musci M, et al. Claimed effects, outcome variables and methods of measurement for health claims proposed under European Community Regulation 1924/2006 in the framework of protection against oxidative damage and cardiovascular health. Nutr Metab Cardiovasc Dis. 2017;27:473-503 pubmed publisher
  48. DeCarlo C, Scher L, Shariff S, Phair J, Lipsitz E, Garg K. Statin use and other factors associated with mortality after major lower extremity amputation. J Vasc Surg. 2017;66:216-225 pubmed publisher
    ..Medium-intensity and high-intensity statin therapies were associated with a mortality benefit at 1 year. We have identified initiation of statin therapy in this high-risk population as a gap in patient care. ..
  49. Moeller M, Pink C, Endlich N, Endlich K, Grabe H, Volzke H, et al. Mortality is associated with inflammation, anemia, specific diseases and treatments, and molecular markers. PLoS ONE. 2017;12:e0175909 pubmed publisher
    ..The latter two, together with albumin and fibrinogen, aligned with an"integrated albunemia" model of aging proposed recently. ..
  50. Franco M, Bilal U, Diez Roux A. Preventing non-communicable diseases through structural changes in urban environments. J Epidemiol Community Health. 2015;69:509-11 pubmed publisher
  51. Newman A, Murabito J. The epidemiology of longevity and exceptional survival. Epidemiol Rev. 2013;35:181-97 pubmed publisher
    ..In this review, we consider how these studies are leading to a deeper understanding of the underlying biologic pathways to longevity. ..
  52. Diniz T, Rossi F, Silveira L, Neves L, Fortaleza A, Christofaro D, et al. The role of moderate-to-vigorous physical activity in mediating the relationship between central adiposity and immunometabolic profile in postmenopausal women. Arch Endocrinol Metab. 2017;61:354-360 pubmed publisher
    ..To analyze the role of moderate-to-vigorous physical activity (MVPA) in mediating the relationship between central adiposity and immune and metabolic profile in postmenopausal women...
  53. Ma Q, Jiang J, Pan X, Cai G, Wang H, Zhou X, et al. Consistent condom use and its correlates among female sex workers at hair salons: a cross-sectional study in Zhejiang province, China. BMC Public Health. 2017;17:910 pubmed publisher
    ..Commercial sex is not effectively protected, and behavioural interventions targeting FSWs should take into account the various factors that are correlated to condom use. ..