Medicine and Health Sciences Commons^™

Engaging Antiracist And Decolonial Praxis To Advance Equity In Oregon Public Health Surveillance Practices., Ryan J. Petteway, Daniel López-Cevallos, Mira Mohsini, Andres Lopez, Roberta S. Hunte, Tim Holbert, Kusuma Madamala

OHSU-PSU School of Public Health Faculty Publications and Presentations

Public health surveillance and data systems in the US remain an unnamed facet of structural racism. What gets measured, which data get collected and analyzed, and how and by whom are not matters of happenstance. Rather, surveillance and data systems are productions and reproductions of political priority, epistemic privilege, and racialized state power. This has consequences for how communities of color are represented or misrepresented, viewed, and valued and for what is prioritized and viewed as legitimate cause for action. Surveillance and data systems accordingly must be understood as both an instrument of structural racism and an opportunity to dismantle …

Community Paramedicine In Central Oregon: A Promising Model To Reduce Non-Urgent Emergency Department Utilization Among Medically Complexmedicaid Beneficiaries, Jessica Currier, Neal Wallace, Keshia Bigler, Maggie O’Connor, Paige E. Farris, Jackilen Shannon

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background

Community paramedicine has emerged as a promising model to redirect persons with nonmedically emergent conditions to more appropriate and less expensive community-based health care settings. Outreach through community paramedicine to patients with a history of high hospital emergency department (ED) use and chronic health conditions has been found to reduce ED use. This study examined the effect of community paramedicine implemented in 2 rural counties in reducing nonemergent ED use among a sample of Medicaid beneficiaries with complex medical conditions and a history of high ED utilization.

Methods

A cluster randomized trial approach with a stepped wedge design was …

Engaging Public Health Critical Race Praxis In Local Social Determinants Of Health Research: The Youth Health Equity And Action Research Training Program In Portland, Or—Yheartpdx, Ryan J. Petteway, Lourdes Gonzalez

OHSU-PSU School of Public Health Faculty Publications and Presentations

The social determinants of health (SDH) have long been considered a core mechanism through which racial health inequities are (re)produced and incubated in the U.S. Moreover, scholars have expressly—and appropriately—named structural racism as a precursor to inequities associated with SDH. However, while research on racial health inequities—SDH-related or otherwise—continues to grow, communities of color remain grossly underrepresented as public health researchers and practitioners. Additionally, although SDH are experienced in a very local sense, much research and practice fails to more deeply and thoroughly engage and center local community knowledges. Thus, much work around SDH and racial health inequities presents, ironically, …

2022 Community Needs Assessment Of Klamath County Residential Services And Housing Needs, Karen Cellarius, Aliza Tuttle, Jennifer Blakeslee

Regional Research Institute for Human Services

The PSU Regional Research Institute for Human Services (RRI) was asked by Klamath Basin Behavioral Health (KBBH) and the Oregon Health Authority (OHA) to conduct a community-wide needs assessment focusing on residential services and housing needs for populations that (1) Have behavioral health needs, and (2) Identify with a community experiencing inequities in access to health care resources.

The assessment was conducted in collaboration with KBBH and other community partners. Data sources included key informant interviews, written surveys of individuals impacted by mental health challenges and/or housing needs, and focus groups with representatives from underserved communities in Klamath County, Oregon. …

Examination Of Orthodontic Expenditures And Trends In The United States From 1996 To 2016: Disparities Across Demographics And Insurance Payers, Man Hung, Sharon Su, Eric S. Hon, Edgar Tilly, Alex Macdonald, Evelyn Lauren, Glen Roberson, Martin S. Lipsky

Institute on Aging Publications

Background: Orthodontics prevent and treat facial, dental, and occlusal anomalies. Untreated orthodontic problems can lead to significant dental public health issues, making it important to understand expenditures for orthodontic treatment. This study examined orthodontic expenditures and trends in the United States over 2 decades. Methods: This study used data collected by the Medical Expenditure Panel Survey to examine orthodontic expenditures in the United States from 1996 to 2016. Descriptive statistics for orthodontic expenditures were computed and graphed across various groups. Trends in orthodontic expenditures were adjusted to the 2016 United States dollar to account for inflation and deflation over time. …

Facilitators And Barriers To Healthy Eating Among American Indian And Alaska Native Adults With Type 2 Diabetes: Stakeholder Perspectives, Sarah Stotz, Nertila Bregaj, Kelly Gonzales, Luciana E. Hebert, Kelly R. Moore

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: American Indian and Alaska Native (AI/AN) adults have a higher prevalence of type 2 diabetes (T2D) and related complications than non-AI/AN adults. As healthy eating is a cornerstone of diabetes self-management, nutrition education plays an important role in diabetes self-management education.

Objective: To understand stakeholder perspectives on facilitators and barriers to healthy eating for AI/AN adults with T2D in order to inform the cultural adaptation of an existing diabetes nutrition education curriculum.

Methods: Individual interviews were conducted with 9 national content experts in diabetes nutrition education (e.g. registered dietitians, diabetes educators, experts on AI/AN food insecurity) and 10 community-based …

Understanding Individual And Family Experiences Associated With Dup: Lessons From The Early Assessment And Support Alliance (Easa) Program In Oregon, Usa, Ryan P. Melton, Shannon Blajeski, Diana Glasser

Regional Research Institute for Human Services

Research shows that a longer duration of untreated psychosis (DUP) is associated with worse psychiatric outcomes, with average length of DUP of 73 weeks in the U.S. The aim was to examine the DUP period for first episode psychosis in Oregon, with a focus on the processes between the first positive symptoms and first treatment. To investigate DUP, researchers used methods consistent with grounded theory to collect data from 9 participants and their families about the process between onset of psychotic symptoms and entrance into treatment. Results suggest that recognition of symptoms was the primary driver of help-seeking in this …

The Politics Of Caregiving: Taking Stock Of State-Level Policies To Support Family Caregivers, Walter D. Dawson, Lauren Bangerter, Micheal Splaine

Institute on Aging Publications

The U.S. population is aging rapidly. The changing demographics offer several benefits and opportunities at local, national, and global levels (Kluge, Zagheni, Loichinger, & Vogt, 2014). Yet, living to an advanced age remains a significant risk factor for the need of care and support during one’s lifetime. Half of all adults 65 years of age and older will reach a point where they require a high level of support due to either physical or cognitive challenges (Tumlinson, Juring, & Alkema, 2016). At the same time, the number of older adults living with chronic disease (e.g., diabetes, …

‘Presumptively Initiating Vaccines And Optimizing Talk With Motivational Interviewing’ (Pivot With Mi) Trial: A Protocol For A Luster Randomised Controlled Trial Of A Clinician Vaccine Communication Intervention, Douglas J. Opel, Jeffrey D. Robinson, Heather Spielvogle, Christine Spina, Kathleen Garrett, Amanda F. Dempsey, Cathryn Perreira, Miriam Dickinson, Chuan Zhou, Barbara Pahud, Multiple Additional Authors

Communication Faculty Publications and Presentations

Introduction A key contributor to under immunisation is parental refusal or delay of vaccines due to vaccine concerns. Many clinicians lack confidence in communicating with vaccine-hesitant parents (VHP) and perceive that their discussions will do little to change parents’ minds. Improving clinician communication with VHPs is critical to increasing childhood vaccine uptake.

Methods and analysis We describe the protocol for a cluster randomised controlled trial to test the impact of a novel, multifaceted clinician vaccine communication strategy on child immunisation status. The trial will be conducted in 24 primary care practices in two US states (Washington and Colorado). The strategy …

Annual Wellness Visits And Influenza Vaccinations Among Older Adults In The Us, Terese Sara Hoj Jørgensen, Heather G. Allore, Miriam R. Elman, Corey L. Nagel, Mengran Zhang, Sheila Markwardt, Ana R. Quiñones

OHSU-PSU School of Public Health Faculty Publications and Presentations

Objectives

Investigate whether combinations of sociodemographic factors, chronic conditions, and other health indicators pose barriers for older adults to access Annual Wellness Visits (AWVs) and influenza vaccinations.

Methods

Data on 4999 individuals aged ≥65 years from the 2012 wave of the Health and Retirement Study linked with Medicare claims were analyzed. Conditional Inference Tree (CIT) and Random Forest (CIRF) analyses identified the most important predictors of AWVs and influenza vaccinations. Multivariable logistic regression (MLR) was used to quantify the associations.

Results

Two-year uptake was 22.8% for AWVs and 65.9% for influenza vaccinations. For AWVs, geographical region and wealth emerged as …

Gut Carriage Of Antimicrobial Resistance Genes In Women Exposed To Small-Scale Poultry Farms In Rural Uganda: A Feasibility Study, Ana A. Weil, Meti D. Debela, Daniel M. Muyanja, Bernard Kakuhikire, Charles Baguma, David Bangsberg, Alexander C. Tsai, Peggy S. Lai

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Antibiotic use for livestock is presumed to be a contributor to the acquisition of antimicrobial resistance (AMR) genes in humans, yet studies do not capture AMR data before and after livestock introduction.

Methods: We performed a feasibility study by recruiting a subset of women in a delayed-start randomized controlled trial of small-scale chicken farming to examine the prevalence of clinically-relevant AMR genes. Stool samples were obtained at baseline and one year post-randomization from five intervention women who received chickens at the start of the study, six control women who did not receive chickens until the end of the study, …

Strong Men, Strong Communities: Design Of A Randomized Controlled Trial Of A Diabetes Prevention Intervention For American Indian And Alaska Native Men, Ka‘Imi Sinclair, Cara Carty, Kelly L. Gonzales, Cassandra Nikolaus, Lucas Gillespie, Dedra Buchwald

OHSU-PSU School of Public Health Faculty Publications and Presentations

Type 2 diabetes is a serious global epidemic that disproportionately affects disadvantaged populations. American Indians and Alaska Natives (AIs/ANs) have the highest rates of diabetes in the nation with a prevalence of 14.7% in 2018, more than twice that of non-Hispanic Whites. AI/AN men have the highest prevalence of diagnosed type 2 diabetes (14.5%) compared to non-Hispanic Black (11.4%), non-Hispanic Asian (10.0%), and non-Hispanic White (8.6%) men. Several landmark clinical trials have shown that lifestyle interventions can effectively prevent or delay the onset of diabetes among those at risk, including in AIs/ANs. Despite positive outcomes for AIs/ANs in these studies, …

Using “Remote” Training And Coaching To Increase Providers’ Skills For Working Effectively With Older Youth And Young Adults With Serious Mental Health Conditions, Janet S. Walker, Caitlin Baird

School of Social Work Faculty Publications and Presentations

Since about the turn of the century, a growing awareness of the poor outcomes resulting from “as usual” community mental health care has led to increasing efforts to implement programs and interventions with empirical evidence of effectiveness. However, these efforts have encountered numerous barriers, in particular the high cost of implementation, which has severely limited uptake and sustainment of empiricallysupported programs and interventions. Typically, the largest contributor to cost is the training and coaching required to ensure provider competence and fidelity to the intervention or program model. This paper describes a social innovation that aims to provide high-quality training and …

“Little Tablets Of Gold”: An Examination Of The Psychological And Social Dimensions Of Prep Among Lgbtq Communities, Christina J. Sun, Kirsten M. Anderson, Kim Toevs, Dayna Morrison, Caitlin Wells, Christina Nicolaidis

OHSU-PSU School of Public Health Faculty Publications and Presentations

There are significant psychological, social, and cultural dimensions to the HIV epidemic in the United States, especially among lesbian, gay, bisexual, transgender, and queer (LGBTQ) communities. Biomedical HIV treatment has been shown to impact these dimensions. However, there is little understanding of the real-world psychosocial and sociocultural effects of the latest biomedical HIV prevention strategy, HIV pre-exposure prophylaxis (PrEP). This study explored the psychosocial and sociocultural dimensions of PrEP use among LGBTQ adults. We interviewed 23 LGBTQ adults who were current or former users of PrEP. Results included that PrEP users’ experiences were shaped by multiple forms of stigma. Participants …

When A Little Goes A Long Way: Expanding Home Care Services To Adults With Disabilities, Serena Hasworth, Jaclyn Winfree, Ozcan Tunalilar, Diana L. White

Institute on Aging Publications

Policy makers are increasingly interested in reducing public spending while maintaining quality of life. Since 1975, Oregon Project Independence (OPI) has supported community-based adults aged 60 and older to avoid or delay the need for residential long-term care services by increasing access to personal and home care services. The program also aims to prevent the need for Medicaid by optimizing personal resources and natural supports. In 2014, the OPI Expansion (OPI-E) pilot project began to serve adults aged 18-59 with disabilities in seven of Oregon’s seventeen Area Agencies on Aging (AAAs). This poster describes the evaluation of the expansion using …

Supporting Nursing Home Staff Through Person-Centered Care Practices, Diana White, Sarah Dys, Jaclyn Winfree, Serena Hasworth, Ozcan Tunalilar

Institute on Aging Publications

Policies and practices have increasingly focused on person-centered care (PCC) to improve quality of life for long-term care residents and staff. Adequate staffing has been a consistent barrier to implementing and sustaining PCC practices. The purpose of this paper is to explore the association between job satisfaction and PCC practices. This research was conducted in a stratified random sample of 33 Oregon nursing homes which were representative in terms of quality, profit/nonprofit ownership, and urban/rural location. Data were collected from 415 staff who completed the staff assessment of person-directed care, direct care worker job satisfaction scale, turnover intention, and organizational …

Impacts Of An Opioid Overdose Prevention Intervention Delivered Subsequent To Acute Care, Caleb J. Banta-Green, Phillip O. Coffin, Joseph O. Merrill, Jeanne M. Sears, Chris Dunn, Norbert D. Yanez, Multiple Additional Authors

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background Opioid overdose is a major and increasing cause of injury and death. There is an urgent need for interventions to reduce overdose events among high-risk persons.

Methods Adults at elevated risk for opioid overdose involving heroin or pharmaceutical opioids who had been cared for in an emergency department (ED) were randomised to overdose education combined with a brief behavioural intervention and take-home naloxone or usual care. Outcomes included: (1) time to first opioid overdose-related event resulting in medical attention or death using competing risks survival analysis; and (2) ED visit and hospitalisation rates, using negative binomial regression and adjusting …

Portrayals Of Mental Illness, Treatment, And Relapse And Their Effects On The Stigma Of Mental Illness: Population-Based, Randomized Survey Experiment In Rural Uganda, Justin D. Rasmussen, Bernard Kakuhikire, C. Baguma, Scholastic Ashaba, Christine E. Cooper-Vince, Jessica M. Perkins, David Bangsberg, Alexander C. Tsai

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background

Mental illness stigma is a fundamental barrier to improving mental health worldwide, but little is known about how to durably reduce it. Understanding of mental illness as a treatable medical condition may influence stigmatizing beliefs, but available evidence to inform this hypothesis has been derived solely from high-income countries. We embedded a randomized survey experiment within a whole-population cohort study in rural southwestern Uganda to assess the extent to which portrayals of mental illness treatment effectiveness influence personal beliefs and perceived norms about mental illness and about persons with mental illness.

Methods and findings

Study participants were randomly assigned …

Relative Wealth, Subjective Social Status, And Their Associations With Depression: Cross-Sectional, Population-Based Study In Rural Uganda, Meghan L. Smith, Bernard Kakuhikire, C. Baguma, Justin D. Rasmussen, David Bangsberg, Multiple Additional Authors

OHSU-PSU School of Public Health Faculty Publications and Presentations

Depression is a leading cause of disability worldwide, and has been found to be a consistent correlate of socioeconomic status (SES). The relative deprivation hypothesis proposes that one mechanism linking SES to health involves social comparisons, suggesting that relative SES rather than absolute SES is of primary importance in determining health status. Using data from a whole-population sample of 1,620 participants residing in rural southwestern Uganda, we estimated the independent associations between objective and subjective relative wealth and probable depression, as measured by the depression subscale of the Hopkins Symptom Checklist (HSCLD). Objective relative wealth was measured by an asset …

Exploring The Extent Of The Hikikomori Phenomenon On Twitter: Mixed Methods Study Of Western Language Tweets, Pereira-Sanchez, Miguel Angel Alvarez-Mon, Angel Asunsolo Del Barco, Melchor Alvarez-Mon, Alan R. Teo

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Hikikomori is a severe form of social withdrawal, originally described in Japan but recently reported in other countries. Debate exists as to what extent hikikomori is viewed as a problem outside of the Japanese context. Objective: We aimed to explore perceptions about hikikomori outside Japan by analyzing Western language content from the popular social media platform, Twitter. Methods: We conducted a mixed methods analysis of all publicly available tweets using the hashtag #hikikomori between February 1 and August 16, 2018, in 5 Western languages (Catalan, English, French, Italian, and Spanish). Tweets were first classified as to whether they described …

Barriers And Facilitators To Recruitment And Enrollment Of Hiv-Infected Individuals With Opioid Use Disorder In A Clinical Trial, Kim Hoffman, Robin Baker, Lynn Elizabeth Kunkel, Elizabeth Needham Waddell, Paula J. Lum, Dennis Mccarty, P. Todd Korthuis

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background

The CTN-0067 CHOICES trial tests implementation of extended-release naltrexone (XR-NTX) versus treatment-as-usual (TAU) for opioid use disorders (OUD) in HIV clinics to improve HIV viral suppression. The study team investigated recruitment strategies to elucidate the barriers and facilitators to recruitment and enrollment in the study.

Main text

Methods: Semi-structured, in-depth, digitally recorded interviews were completed with study recruitment-related staff and medical providers (n = 26) from six participating HIV clinics in the fall of 2018. Interviews probed 1) factors that might prevent prospective participants from engaging in study recruitment and enrollment procedures and 2) strategies used by study …

Development And Testing Of An Assessment Of Youth/Young Adult Voice In Agency-Level Advising And Decision Making, Janet S. Walker, Brie Masselli, Jennifer E. Blakeslee, Caitlin Baird, Kristin Thorp

School of Social Work Faculty Publications and Presentations

There is a range of stakeholder benefits when youth- and young adult-serving agencies include service recipient “voice” in advising and decision making regarding agency policies and programming. Yet many agency stakeholders lack awareness of strategic best practices to ensure the consistent and meaningful participation of young people in decision-making processes, and few tools exist to evaluate agency efforts. This paper describes the development and validation of the Youth/Young Adult Voice at the Agency Level (Y-VAL), an assessment of the extent to which agencies have implemented best practices for supporting meaningful participation. The Y-VAL is intended for research purposes, as well …

Internalized Hiv Stigma, Art Initiation And Hiv-1 Rna Suppression In South Africa: Exploring Avoidant Coping As A Longitudinal Mediator, Valerie A. Earnshaw, Laura M. Bogart, Jean-Philippe Laurenceau, Brian T. Chan, Brendan G. Maughan-Brown, Janan Dietrich, Ingrid Courtney, Gugu Tshabalala, Catherine Orrell, Glenda E. Gray, David Bangsberg, Ingrid T. Katz

OHSU-PSU School of Public Health Faculty Publications and Presentations

Introduction: Cross‐sectional evidence suggests that internalized HIV stigma is associated with lower likelihoods of antiretroviral therapy (ART) initiation and HIV‐1 RNA suppression among people living with HIV (PLWH). This study examined these associations with longitudinal data spanning the first nine months following HIV diagnosis and explored whether avoidant coping mediates these associations.

Methods: Longitudinal data were collected from 398 South African PLWH recruited from testing centres in 2014 to 2015. Self‐report data, including internalized stigma and avoidant coping (denying and distracting oneself from stressors), were collected one week and three months following HIV diagnosis. ART initiation at six months and …

Reaching Those At Risk For Psychiatric Disorders And Suicidal Ideation: Facebook Advertisements To Recruit Military Veterans, Alan R. Teo, Samuel B.L. Liebow, Benjamin Chan, Steven K. Dobscha, Amanda L. Graham

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Younger military veterans are at high risk for psychiatric disorders and suicide. Reaching and engaging veterans in mental health care and research is challenging. Social media platforms may be an effective channel to connect with veterans.

Objective: This study tested the effectiveness of Facebook advertisements in reaching and recruiting Iraq and Afghanistan-era military veterans in a research study focused on mental health.

Methods: Facebook ads requesting participation in an online health survey ran for six weeks in 2017. Ads varied imagery and headlines. Validated instruments were used to screen for psychiatric disorders and suicidality. Outcomes included impressions, click-through rate, …

Social Network Correlates Of Ipv Acceptance In Rural Honduras And Rural Uganda, Holly B. Shakya, Jessica M. Perkins, Margaret Traeger, Alexander C. Tsai, David Bangsberg, Bernard Kakuhikire, Nicholas A. Christakis

OHSU-PSU School of Public Health Faculty Publications and Presentations

We investigated the household-level social network correlates of acceptance of intimate partner violence (IPV) in rural, agrarian settings of Honduras and Uganda, two low-income countries with unequal access to resources based upon gender. We collected complete social network data in each location (Honduras in 2014 and Uganda in 2012), across a diverse range of relationships, and then created a measure of household cohesion by calculating the degree to which members of a household nominated each other as important social connections. Our measure of IPV acceptance was based on 4 questions from the Demographic Health Survey to assess the conditions under …

Food Insecurity, Social Networks And Symptoms Of Depression Among Men And Women In Rural Uganda: A Cross-Sectional, Population-Based Study, Jessica M. Perkins, Viola N. Nyakato, Bernard Kakuhikire, Alexander C. Tsai, Sv Subramanian, David Bangsberg, Nicholas A. Christakis

OHSU-PSU School of Public Health Faculty Publications and Presentations

Objective: To assess the association between food insecurity and depression symptom severity stratified by sex, and test for evidence of effect modification by social network characteristics.

Design: A population-based cross-sectional study. The nine-item Household Food Insecurity Access Scale captured food insecurity. Five name generator questions elicited network ties. A sixteen-item version of the Hopkins Symptom Checklist for Depression captured depression symptom severity. Linear regression was used to estimate the association between food insecurity and depression symptom severity while adjusting for potential confounders and to test for potential network moderators.

Setting: In-home survey interviews in south-western Uganda. Subjects: All adult residents …

Diagnostic Performance Of Blood Inflammatory Markers For Tuberculosis Screening In People Living With Hiv, Katherine Farr, Resmi Ravindran, Luke Strnad, Emily Chang, Leah H. Chaisson, Christina Yoon, William Worodria, Alfred Andama, Irene Ayakaka, Priscilla Bbosa Nalwanga, Multiple Additional Authors

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background

Approaches to screening for active tuberculosis (TB) among people living with HIV are inadequate, leading to missed diagnoses and poor implementation of preventive therapy.

Methods

Consecutive HIV-infected adults hospitalized at Mulago Hospital (Kampala, Uganda) between June 2011 and July 2013 with a cough ≥ 2 weeks were enrolled. Patients underwent extensive evaluation for pulmonary TB. Concentrations of 43 cytokines/chemokines were measured at the same time point as C-reactive protein (CRP) in banked plasma samples using commercially-available multiplex kits. Advanced classification algorithms were used to rank cytokines/chemokines for their ability to identify TB, and to model the specificity of the …

Focus Groups To Increase The Cultural Acceptability Of A Contingency Management Intervention For American Indian And Alaska Native Communities, Katherine A. Hirchak, Emily Leickly, Jalene Herron, Jennifer Shaw, Jordan Skalisky, Lisa G. Dirks, Jaedon P. Avey, Multiple Additional Authors

Psychology Faculty Publications and Presentations

Introduction

Many American Indian and Alaska Native (AI/AN) people seek evidence-based, cost-effective, and culturally acceptable solutions for treating alcohol use disorders. Contingency management (CM) is a feasible, low-cost approach to treating alcohol use disorders that uses “reinforcers” to promote and support alcohol abstinence. CM has not been evaluated among AI/AN communities. This study explored the cultural acceptability of CM and adapted it for use in diverse AI/AN communities.

Methods

We conducted a total of nine focus groups in three AI/AN communities: a rural reservation, an urban health clinic, and a large Alaska Native healthcare system. Respondents included adults …

Household Water Insecurity, Missed Schooling, And The Mediating Role Of Caregiver Depression In Rural Uganda, Christine E. Cooper-Vince, Bernard Kakuhikire, Dagmar Vořechovská, Amy Q. Mcdonough, Jessica M. Perkins, Atheendar S. Venkataramani, Rumbidzai Mushavi, Charles Baguma, Scholastic Ashaba, David Bangsberg, Alexander C. Tsai

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: School attendance rates in sub-Saharan Africa are among the lowest worldwide, placing children at heightened risk for poor educational and economic outcomes. One understudied risk factor for missed schooling is household water insecurity, which is linked to depression among women and may increase children’s water-fetching burden at the expense of educational activities, particularly among children of depressed caregivers. In this study conducted in rural Uganda, we assessed the association between household water insecurity and child school participation and the mediating pathways behind these associations.

Method: We conducted a population-based, cross-sectional study of female household heads (N = 257) and …

Measuring Personal Beliefs And Perceived Norms About Intimate Partner Violence: Population-Based Survey Experiment In Rural Uganda, Alexander C. Tsai, Bernard Kakuhikire, Jessica M. Perkins, Dagmar Vořechovská, Amy Q. Mcdonough, Elizabeth L. Ogburn, Jordan M. Downey, David R. Bangsberg

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Demographic and Health Surveys (DHS) conducted throughout sub-Saharan Africa indicate there is widespread acceptance of intimate partner violence, contributing to an adverse health risk environment for women. While qualitative studies suggest important limitations in the accuracy of the DHS methods used to elicit attitudes toward intimate partner violence, to date there has been little experimental evidence from sub-Saharan Africa that can be brought to bear on this issue.

Methods and Findings: We embedded a randomized survey experiment in a population-based survey of 1,334 adult men and women living in Nyakabare Parish, Mbarara, Uganda. The primary outcomes were …