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Sommer M, Schmitt ML. Taking Stock: An Adaptable Research and Partnership Model for Developing Puberty Education in 10 Countries. Glob Health Sci Pract 2023; 11:e2200498. [PMID: 37348938 DOI: 10.9745/ghsp-d-22-00498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 04/04/2023] [Indexed: 06/24/2023]
Abstract
There is a growing global interest in puberty and early adolescence and the importance of ensuring young people have the information and support they need during this critical phase of transition in the life course. This article highlights an adaptable model being used to support the development of contextually appropriate puberty education, in the form of illustrated and often bilingual books, for early adolescent girls and boys in countries around the world. This youth-centered participatory research and design model, which relies on the generation of community and government partnerships, has been employed in 10 countries thus far. Valuable learning has been documented from various contexts, including the approach's flexibility in adapting to the inputs of government and community members, incorporating local buy-in as a key ingredient for sustainability, using in-country experts for social and cultural appropriateness of illustrations and translations, and ensuring that the authentic youth voices captured through the participatory data collection and field-testing shape the educational content. The continuous integration of insights and perceptions of adults who influence young people's lives into the development process is also essential to enabling the uptake of puberty content in each new country. Parents, educators, youth service providers, and government officials are often the gatekeepers to young adolescents receiving puberty content and are thus critical to the process. This review of more than a decade of experience using this model underscores the essentiality of 2 key components-local partnership and participatory data collection-and highlights the importance of flexible approaches that are adapted to the unique sociocultural and environmental conditions in each country context.
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Affiliation(s)
- Marni Sommer
- Mailman School of Public Health, Columbia University, New York, NY, USA.
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Schmitt ML, Dimond K, Maroko AR, Phillips-Howard PA, Gruer C, Berry A, Nash D, Kochhar S, Sommer M. "I stretch them out as long as possible:" U.S. women's experiences of menstrual product insecurity during the COVID-19 pandemic. BMC Womens Health 2023; 23:179. [PMID: 37060006 PMCID: PMC10104689 DOI: 10.1186/s12905-023-02333-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 04/05/2023] [Indexed: 04/16/2023] Open
Abstract
BACKGROUND A growing body of evidence highlights how the COVID-19 pandemic has exacerbated gender inequalities in the US. This resulted in women being more vulnerable to economic insecurity and decreases in their overall well-being. One relevant issue that has been less explored is that of women's menstrual health experiences, including how inconsistent access to menstrual products may negatively impact their daily lives. METHODS This qualitative study, conducted from March through May 2021, utilized in-depth interviews that were nested within a national prospective cohort study. The interviews (n = 25) were conducted with a sub-sample of cis-gender women living across the US who had reported challenges accessing products during the first year of the pandemic. The interviews sought to understand the barriers that contributed to experiencing menstrual product insecurity, and related coping mechanisms. Malterud's 'systematic text condensation', an inductive thematic analysis method, was utilized to analyze the qualitative transcripts. RESULTS Respondents came from 17 different states across the U.S. Three key themes were identified: financial and physical barriers existed to consistent menstrual product access; a range of coping strategies in response to menstrual product insecurity, including dependence on makeshift and poorer quality materials; and heightened experiences of menstrual-related anxiety and shame, especially regarding the disclosure of their menstruating status to others as a result of inadequate menstrual leak protection. CONCLUSIONS Addressing menstrual product insecurity is a critical step for ensuring that all people who menstruate can attain their most basic menstrual health needs. Key recommendations for mitigating the impact of menstrual product insecurity require national and state-level policy reform, such as the inclusion of menstrual products in existing safety net basic needs programs, and the reframing of menstrual products as essential items. Improved education and advocacy are needed to combat menstrual stigma.
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Affiliation(s)
- Margaret L Schmitt
- Mailman School of Public Health, Columbia University, 722 W 168Th St, New York, NY, 10032, USA.
| | - Katie Dimond
- Mailman School of Public Health, Columbia University, 722 W 168Th St, New York, NY, 10032, USA
| | - Andrew R Maroko
- Institute for Implementation Science in Population Health, City University of New York (CUNY), New York City, NY, USA
| | | | - Caitlin Gruer
- Mailman School of Public Health, Columbia University, 722 W 168Th St, New York, NY, 10032, USA
| | - Amanda Berry
- Institute for Implementation Science in Population Health, City University of New York (CUNY), New York City, NY, USA
| | - Denis Nash
- Institute for Implementation Science in Population Health, City University of New York (CUNY), New York City, NY, USA
| | - Shivani Kochhar
- Institute for Implementation Science in Population Health, City University of New York (CUNY), New York City, NY, USA
| | - Marni Sommer
- Mailman School of Public Health, Columbia University, 722 W 168Th St, New York, NY, 10032, USA
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Schmitt ML, Hagstrom C, Gruer C, Nowara A, Keeley K, Adenu-Mensah NE, Sommer M. “Girls May Bleed Through Pads Because of Demerits”: Adolescent Girls’ Experiences With Menstruation and School Bathrooms in the U.S.A. Journal of Adolescent Research 2022. [DOI: 10.1177/07435584221139342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The aim of this study was to better understand the role of school bathrooms in shaping the menstrual experiences of adolescents in the U.S.A. The participants were Black and Latina, low-income adolescent girls (15–19) and adults interacting closely with youth in three U.S.A. cities (Chicago, Los Angeles, New York City). Data collection methods included: (1) Participatory Methodologies (PM) sessions with adolescent girls ( n = 73); (2) In-depth interviews (IDI) with adolescent girls ( n = 12); and (3) Key Informant Interviews (KII) with adults ( n = 23). Malterud’s “systematic text condensation,” an inductive thematic analysis method, was utilized to analyze the various data types (field notes, in-depth interviews, drawings). Key findings include, one, that menstruating girls experience embarrassment and a need for secrecy when accessing school bathrooms; two, the social and physical environments of school bathrooms, including poor design and maintenance, heighten girls’ discomfort, especially while menstruating; and three, school policies restricting students’ bathroom access are problematic for many menstruating students, especially those experiencing heavy and/or unpredictable bleeding. Schools and policymakers need to consider holistic approaches when addressing the menstrual needs of adolescents in U.S.A. schools, including better prioritizing issues related to menstrual stigma, school bathroom design and bathroom access policies.
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Affiliation(s)
| | | | | | | | - Katie Keeley
- Ann & Robert H. Lurie Children’s Hospital of Chicago, IL, USA
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Schmitt ML, Gruer C, Hagstrom C, Ekua Adenu-Mensah N, Nowara A, Keeley K, Sommer M. “It always gets pushed aside:” Qualitative perspectives on puberty and menstruation education in U.S.A. schools. Front Reprod Health 2022; 4:1018217. [PMID: 36339773 PMCID: PMC9635341 DOI: 10.3389/frph.2022.1018217] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 09/28/2022] [Indexed: 11/06/2022] Open
Abstract
Adolescent girls in the U.S.A. often lack sufficient education on pubertal and menstrual health topics. This educational gap may be growing given the current decline in American elementary and middle schools' delivery of sexual health education. Furthermore, little is known about the actual scope and quality of existing menstruation and puberty education in U.S.A. schools. This paper provides insights into some of the challenges with the delivery of menstruation and puberty education in schools. Qualitative and participatory research methodologies were utilized with Black and Latina girls ages 15–19 and adults working with youth in three U.S.A. cities (Chicago, Los Angeles, and New York City), exploring experiences of menstruation within school and family contexts. Findings revealed tension between school responsibility and family authority in providing menstruation and puberty education in schools, school- and teacher-related delivery challenges, and inadequate and disengaging menstruation and puberty content. Further research is needed on the effectiveness and best practices for providing this education in schools, including improved understanding on student and parent preferences, delivery mediums and the scope of content.
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Affiliation(s)
- Margaret L. Schmitt
- Mailman School of Public Health, Columbia University, New York City, NY, United States
- Correspondence: Margaret L. Schmitt
| | - Caitlin Gruer
- Mailman School of Public Health, Columbia University, New York City, NY, United States
| | - Christine Hagstrom
- Mailman School of Public Health, Columbia University, New York City, NY, United States
| | | | - Azure Nowara
- Mailman School of Public Health, Columbia University, New York City, NY, United States
| | - Katie Keeley
- Office of Clinical and Community Trials, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Marni Sommer
- Mailman School of Public Health, Columbia University, New York City, NY, United States
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Sommer M, Phillips-Howard PA, Gruer C, Schmitt ML, Nguyen AM, Berry A, Kochhar S, Gorrell Kulkarni S, Nash D, Maroko AR. Menstrual Product Insecurity Resulting From COVID-19‒Related Income Loss, United States, 2020. Am J Public Health 2022; 112:675-684. [PMID: 35319956 PMCID: PMC8961817 DOI: 10.2105/ajph.2021.306674] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To identify key effects of the pandemic and its economic consequences on menstrual product insecurity with implications for public health practice and policy. Methods. Study participants (n = 1496) were a subset of individuals enrolled in a national (US) prospective cohort study. Three survey waves were included (March‒October 2020). Menstrual product insecurity outcomes were explored with bivariate associations and logistic regression models to examine the associations between outcomes and income loss. Results. Income loss was associated with most aspects of menstrual product insecurity (adjusted odds ratios from 1.34 to 3.64). The odds of not being able to afford products for those who experienced income loss was 3.64 times (95% confidence interval [CI] = 2.14, 6.19) that of those who had no income loss and 3.95 times (95% CI = 1.78, 8.79) the odds for lower-income participants compared with higher-income participants. Conclusions. Pandemic-related income loss was a strong predictor of menstrual product insecurity, particularly for populations with lower income and educational attainment. Public Health Implications. Provision of free or subsidized menstrual products is needed by vulnerable populations and those most impacted by pandemic-related income loss.(Am J Public Health. 2022;112(4):675-684. (https://doi.org/10.2105/AJPH.2021.306674).
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Affiliation(s)
- Marni Sommer
- Marni Sommer, Caitlin Gruer, and Margaret L. Schmitt are with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Penelope A. Phillips-Howard is with the Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK. Angela-Maithy Nguyen is with the Interdisciplinary Division, School of Public Health, University of California‒Berkeley. Amanda Berry, Shivani Kochhar, Sarah Gorrell Kulkarni, and Denis Nash are with the Institute for Implementation Science in Population, City University of New York (CUNY), New York. Andrew R. Maroko is with the Department of Environmental, Occupational, and Geospatial Health Sciences, Graduate School of Public Health and Health Policy, CUNY
| | - Penelope A Phillips-Howard
- Marni Sommer, Caitlin Gruer, and Margaret L. Schmitt are with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Penelope A. Phillips-Howard is with the Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK. Angela-Maithy Nguyen is with the Interdisciplinary Division, School of Public Health, University of California‒Berkeley. Amanda Berry, Shivani Kochhar, Sarah Gorrell Kulkarni, and Denis Nash are with the Institute for Implementation Science in Population, City University of New York (CUNY), New York. Andrew R. Maroko is with the Department of Environmental, Occupational, and Geospatial Health Sciences, Graduate School of Public Health and Health Policy, CUNY
| | - Caitlin Gruer
- Marni Sommer, Caitlin Gruer, and Margaret L. Schmitt are with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Penelope A. Phillips-Howard is with the Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK. Angela-Maithy Nguyen is with the Interdisciplinary Division, School of Public Health, University of California‒Berkeley. Amanda Berry, Shivani Kochhar, Sarah Gorrell Kulkarni, and Denis Nash are with the Institute for Implementation Science in Population, City University of New York (CUNY), New York. Andrew R. Maroko is with the Department of Environmental, Occupational, and Geospatial Health Sciences, Graduate School of Public Health and Health Policy, CUNY
| | - Margaret L Schmitt
- Marni Sommer, Caitlin Gruer, and Margaret L. Schmitt are with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Penelope A. Phillips-Howard is with the Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK. Angela-Maithy Nguyen is with the Interdisciplinary Division, School of Public Health, University of California‒Berkeley. Amanda Berry, Shivani Kochhar, Sarah Gorrell Kulkarni, and Denis Nash are with the Institute for Implementation Science in Population, City University of New York (CUNY), New York. Andrew R. Maroko is with the Department of Environmental, Occupational, and Geospatial Health Sciences, Graduate School of Public Health and Health Policy, CUNY
| | - Angela-Maithy Nguyen
- Marni Sommer, Caitlin Gruer, and Margaret L. Schmitt are with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Penelope A. Phillips-Howard is with the Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK. Angela-Maithy Nguyen is with the Interdisciplinary Division, School of Public Health, University of California‒Berkeley. Amanda Berry, Shivani Kochhar, Sarah Gorrell Kulkarni, and Denis Nash are with the Institute for Implementation Science in Population, City University of New York (CUNY), New York. Andrew R. Maroko is with the Department of Environmental, Occupational, and Geospatial Health Sciences, Graduate School of Public Health and Health Policy, CUNY
| | - Amanda Berry
- Marni Sommer, Caitlin Gruer, and Margaret L. Schmitt are with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Penelope A. Phillips-Howard is with the Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK. Angela-Maithy Nguyen is with the Interdisciplinary Division, School of Public Health, University of California‒Berkeley. Amanda Berry, Shivani Kochhar, Sarah Gorrell Kulkarni, and Denis Nash are with the Institute for Implementation Science in Population, City University of New York (CUNY), New York. Andrew R. Maroko is with the Department of Environmental, Occupational, and Geospatial Health Sciences, Graduate School of Public Health and Health Policy, CUNY
| | - Shivani Kochhar
- Marni Sommer, Caitlin Gruer, and Margaret L. Schmitt are with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Penelope A. Phillips-Howard is with the Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK. Angela-Maithy Nguyen is with the Interdisciplinary Division, School of Public Health, University of California‒Berkeley. Amanda Berry, Shivani Kochhar, Sarah Gorrell Kulkarni, and Denis Nash are with the Institute for Implementation Science in Population, City University of New York (CUNY), New York. Andrew R. Maroko is with the Department of Environmental, Occupational, and Geospatial Health Sciences, Graduate School of Public Health and Health Policy, CUNY
| | - Sarah Gorrell Kulkarni
- Marni Sommer, Caitlin Gruer, and Margaret L. Schmitt are with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Penelope A. Phillips-Howard is with the Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK. Angela-Maithy Nguyen is with the Interdisciplinary Division, School of Public Health, University of California‒Berkeley. Amanda Berry, Shivani Kochhar, Sarah Gorrell Kulkarni, and Denis Nash are with the Institute for Implementation Science in Population, City University of New York (CUNY), New York. Andrew R. Maroko is with the Department of Environmental, Occupational, and Geospatial Health Sciences, Graduate School of Public Health and Health Policy, CUNY
| | - Denis Nash
- Marni Sommer, Caitlin Gruer, and Margaret L. Schmitt are with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Penelope A. Phillips-Howard is with the Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK. Angela-Maithy Nguyen is with the Interdisciplinary Division, School of Public Health, University of California‒Berkeley. Amanda Berry, Shivani Kochhar, Sarah Gorrell Kulkarni, and Denis Nash are with the Institute for Implementation Science in Population, City University of New York (CUNY), New York. Andrew R. Maroko is with the Department of Environmental, Occupational, and Geospatial Health Sciences, Graduate School of Public Health and Health Policy, CUNY
| | - Andrew R Maroko
- Marni Sommer, Caitlin Gruer, and Margaret L. Schmitt are with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Penelope A. Phillips-Howard is with the Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK. Angela-Maithy Nguyen is with the Interdisciplinary Division, School of Public Health, University of California‒Berkeley. Amanda Berry, Shivani Kochhar, Sarah Gorrell Kulkarni, and Denis Nash are with the Institute for Implementation Science in Population, City University of New York (CUNY), New York. Andrew R. Maroko is with the Department of Environmental, Occupational, and Geospatial Health Sciences, Graduate School of Public Health and Health Policy, CUNY
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Schmitt ML, Booth K, Sommer M. A Policy for Addressing Menstrual Equity in Schools: A Case Study From New York City, U.S.A. Front Reprod Health 2022; 3:725805. [PMID: 36303999 PMCID: PMC9580679 DOI: 10.3389/frph.2021.725805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 12/22/2021] [Indexed: 12/03/2022] Open
Abstract
There has been a growth in menstrual equity policy advancements in the U.S.A. in recent years; with much of the new legislation prioritizing the needs of adolescent girls in schools. New York City, a predecessor of this movement, was the first U.S.A. locality to pass such legislation in 2016. The aim of this case study was to better understand the various factors which led to the development, passage and initial implementation of New York City's Menstrual Equity in Schools Policy. Data collection methods included a desk review and qualitative assessment with several actors involved across the policy and introduction phases. Key findings included (1) the utility of community narratives and a pilot project as a means for overcoming initial skepticisms, proving feasibility, and generating support; (2) the importance of policy champions for overcoming fiscal objections and navigating political discourse; and (3) lessons learned from early implementation efforts, including variance in awareness and distribution models. This case study yields valuable insights into the practical considerations when designing or implementing policies aimed at tackling issues of menstrual equity within school settings.
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Affiliation(s)
- Margaret L. Schmitt
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
- *Correspondence: Margaret L. Schmitt
| | - Kathleen Booth
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Marni Sommer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
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Awoonor-Williams JK, Phillips JF, Aboba M, Vadrevu L, Azasi E, Tiah JAY, Schmitt ML, Patel S, Sheff MC, Kachur SP. Supporting the Utilization of Community-Based Primary Health Care Implementation Research in Ghana. Health Policy Plan 2022; 37:420-427. [PMID: 34984450 DOI: 10.1093/heapol/czab156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 12/07/2021] [Accepted: 01/01/2022] [Indexed: 11/13/2022] Open
Abstract
Ever since the 1990s, implementation research in Ghana has guided the development of policies and practices that are essential to establishing community-based primary health care. In response to evidence emerging from this research, the Community-based Health Planning and Services (CHPS) policy was promulgated in 1999 to scale-up results. However, during the first decade of CHPS operation, national monitoring showed that its pace of coverage expansion was unacceptably slow. In 2010, the Ghana Health Service launched a five-year plausibility trial of CHPS reform for testing ways to accelerate scale-up. This initiative, known as the Ghana Essential Health Intervention Program (GEHIP), included a knowledge management component for establishing congruence of knowledge generation and flow with the operational system that GEHIP evidence was intended to reform. Four Upper East Region districts served as trial areas while seven districts were comparison areas. Interventions tested means of developing the upward flow of information based on perspectives of district managers, sub-district supervisors, and community-level workers. GEHIP also endeavored to improve procedures for the downward flow and utilization of policy guidelines. Field exchanges were convened for providing national, regional, and district leaders with opportunities for participatory learning about GEHIP implementation innovations. This systems approach facilitated the process of augmenting the communication of evidence with practical field experience. Scientific rigor associated with the production of evidence was thereby integrated into management decision-making processes in ways that institutionalized learning at all levels. The GEHIP knowledge management system functioned as a prototype for guiding the planning of a national knowledge management strategy. A follow-up project transferred its mechanisms from the Upper East Regional Health Administration to the Policy Planning Monitoring and Evaluation Division of the Ghana Health Service in Accra.
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Affiliation(s)
| | - James F Phillips
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University
| | - Mathias Aboba
- Policy Planning Monitoring and Evaluation Division, Ghana Health Service, Private Mail Bag, Accra, Ghana
| | - Lalitha Vadrevu
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University
| | - Esther Azasi
- Queen Margaret University, Edinburgh, Scotland, EH21 6UU, UK
| | | | - Margaret L Schmitt
- Department of Sociomedical Science, Mailman School of Public Health, Columbia University
| | - Sneha Patel
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University
| | - Mallory C Sheff
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University
| | - S Patrick Kachur
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University
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Gruer C, Goss T, Schmitt ML, Sommer M. Menstrual Equity Initiatives at USA Universities: A Multiple Case Study of Common Obstacles and Enabling Factors. Front Reprod Health 2021; 3:787277. [PMID: 36304028 PMCID: PMC9580624 DOI: 10.3389/frph.2021.787277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/15/2021] [Indexed: 11/13/2022] Open
Abstract
Background: In recent years there has been growing momentum in the USA around addressing issues of “menstrual equity” and “period poverty,” including a proliferation of university-level initiatives seeking to provide access to free menstrual products. This multiple case study examined four such efforts at a diversity of tertiary institutions to identify the factors that facilitated or impeded success. Methods: We conducted a qualitative multiple case study, including a desk review and key informant interviews with student and administrative actors from universities with free menstrual product initiatives. We sought to identify key learning regarding common challenges and obstacles, enabling factors which supported success and sustainability, and practical learning for future initiatives. From the desk review, four schools (n = 4) were purposively selected to represent a range of geographic regions, student population size, and university type. Purposive sampling was used to identify students and administrators engaged in the menstrual equity initiatives on each campus (n = 20; 4–6 per school). Data from the desk review and interviews were analyzed using thematic analysis. Results: Key themes included (1) the critical role of champions, (2) the importance of social and financial support, (3) challenges diffusing menstrual equity from pilot to scale, and (4) recommendations for future initiatives. University initiatives varied greatly in terms of their scope, funding, and implementation strategy. Conclusion: This multiple case study provides valuable insights regarding the facilitating factors and obstacles faced by initiatives providing free menstrual products at universities. To date, these initiatives have proven successful across the four case studies; however, in most cases, the scope of the initiatives was constrained by limited resources and sustainability concerns. Future campus menstrual equity strategies would benefit from cross-institutional learning and dialogue highlighting design and implementation successes and challenges.
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Affiliation(s)
- Caitlin Gruer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
- *Correspondence: Caitlin Gruer
| | - Taylor Goss
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Margaret L. Schmitt
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Marni Sommer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
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Schmitt ML, Wood OR, Clatworthy D, Rashid SF, Sommer M. Innovative strategies for providing menstruation-supportive water, sanitation and hygiene (WASH) facilities: learning from refugee camps in Cox's bazar, Bangladesh. Confl Health 2021; 15:10. [PMID: 33637096 PMCID: PMC7912835 DOI: 10.1186/s13031-021-00346-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 02/15/2021] [Indexed: 11/16/2022] Open
Abstract
Background There is growing attention to addressing the menstrual hygiene management (MHM) needs of the over 21 million displaced adolescent girls and women globally. Current approaches to MHM-related humanitarian programming often prioritize the provision of menstrual materials and information. However, a critical component of an MHM response includes the construction and maintenance of water, sanitation and hygiene (WASH) facilities, including more female-friendly toilets. This enables spaces for menstruating girls and women to change, dispose, wash and dry menstrual materials; all of which are integral tasks required for MHM. A global assessment identified a number of innovations focused on designing and implementing menstruation-supportive WASH facilities in the Rohingya refugee camps located in Cox’s Bazar (CXB), Bangladesh. These pilot efforts strove to include the use of more participatory methodologies in the process of developing the new MHM-supportive WASH approaches. This study aimed to capture new approaches and practical insights on innovating menstrual disposal, waste management and laundering in emergency contexts through the conduct of a qualitative assessment in CXB. Methods The qualitative assessment was conducted in the Rohingya refugee camps in CXB in September of 2019 to capture new approaches and practical insights on innovating for menstrual disposal, waste management and laundering. This included Key Informant Interviews with 19 humanitarian response staff from the WASH and Protection sectors of a range of non-governmental organizations and UN agencies; Focus Group Discussions with 47 Rohingya adolescent girls and women; and direct observations of 8 WASH facilities (toilets, bathing, and laundering spaces). Results Key findings included: one, the identification of new female-driven consultation methods aimed at improving female beneficiary involvement and buy-in during the design and construction phases; two, the design of new multi-purpose WASH facilities to increase female beneficiary usage; three, new menstrual waste disposal innovations being piloted in communal and institutional settings, with female users indicating at least initial acceptability; and four, novel strategies for engaging male beneficiaries in the design of female WASH facilities, including promoting dialogue to generate buy-in regarding the importance of these facilities and debate about their placement. Conclusions Although the identified innovative participatory methodologies and design approaches are promising, the long term viability of the facilities, including plans to expand them, may be dependent on the continued engagement of girls and women, and the availability of resources.
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Affiliation(s)
- Margaret L Schmitt
- Columbia University, Mailman School of Public Health, 722 W. 168th Street, New York, NY, 10032, USA.
| | - Olivia R Wood
- Columbia University, Mailman School of Public Health, 722 W. 168th Street, New York, NY, 10032, USA
| | - David Clatworthy
- International Rescue Committee, 122 E 42nd St, New York, NY, 10168, USA
| | - Sabina Faiz Rashid
- James P Grant School of Public Health, BRAC University, 68 Shahid Tajuddin Ahmed Sharani, Mohakhali, Dhaka, Bangladesh
| | - Marni Sommer
- Columbia University, Mailman School of Public Health, 722 W. 168th Street, New York, NY, 10032, USA.
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Schmitt ML, Hagstrom C, Nowara A, Gruer C, Adenu-Mensah NE, Keeley K, Sommer M. The intersection of menstruation, school and family: Experiences of girls growing up in urban cities in the U.S.A. International Journal of Adolescence and Youth 2021. [DOI: 10.1080/02673843.2020.1867207] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Margaret L. Schmitt
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Christine Hagstrom
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Azure Nowara
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Caitlin Gruer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Nana Ekua Adenu-Mensah
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Katie Keeley
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, United States
| | - Marni Sommer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
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Sommer M, Zulaika G, Schmitt ML, Khandakji S, Phillips-Howard PA. : Advancing the measurement agenda for menstrual health and hygiene interventions in low- and middle-income countries. J Glob Health 2021; 10:010323. [PMID: 32257146 PMCID: PMC7100917 DOI: 10.7189/jogh.10.010323] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Marni Sommer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Garazi Zulaika
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Margaret L Schmitt
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Samantha Khandakji
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
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Sommer M, Zulaika G, Schmitt ML, Khandakji S, Neudorf K, Gellis L, Phillips-Howard PA. Improving the impact of menstrual health innovations in low- and middle-income countries: a theory of change and measurement framework. Journal of Global Health Reports 2020. [DOI: 10.29392/001c.12105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Marni Sommer
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Garazi Zulaika
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Margaret L Schmitt
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Samantha Khandakji
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Kristin Neudorf
- Grand Challenges Canada/Grands Défis Canada, Toronto, Ontario, Canada
| | - Leeat Gellis
- Grand Challenges Canada/Grands Défis Canada, Toronto, Ontario, Canada
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Schmitt ML, Clatworthy D, Ratnayake R, Klaesener-Metzner N, Roesch E, Wheeler E, Sommer M. Understanding the menstrual hygiene management challenges facing displaced girls and women: findings from qualitative assessments in Myanmar and Lebanon. Confl Health 2017; 11:19. [PMID: 29046714 PMCID: PMC5641996 DOI: 10.1186/s13031-017-0121-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 08/24/2017] [Indexed: 12/04/2022] Open
Abstract
Background There is a significant gap in empirical evidence on the menstrual hygiene management (MHM) challenges faced by adolescent girls and women in emergency contexts, and on appropriate humanitarian response approaches to meet their needs in diverse emergency contexts. To begin filling the gap in the evidence, we conducted a study in two diverse contexts (Myanmar and Lebanon), exploring the MHM barriers facing girls and women, and the various relevant sectoral responses being conducted (e.g. water, sanitation and hygiene (WASH), Protection, Health, Education and Camp Management). Methods Two qualitative assessments were conducted: one in camps for internally displaced populations in Myanmar, and one with refugees living in informal settlements and host communities in Lebanon. Key informant interviews were conducted with emergency response staff in both sites, and focus group discussion and participatory mapping activities conducted with adolescent girls and women. Results Key findings included that there was insufficient access to safe and private facilities for MHM coupled with displacement induced shifts in menstrual practices by girls and women. Among staff, there was a narrow interpretation of what an MHM response includes, with a focus on supplies; significant interest in understanding what an improved MHM response would include and acknowledgement of limited existing MHM guidance across various sectors; and insufficient consultation with beneficiaries, related to discomfort asking about menstruation, and limited coordination between sectors. Conclusions There is a significant need for improved guidance across all relevant sectors for improving MHM response in emergency context, along with increased evidence on effective approaches for integrating MHM into existing responses.
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Affiliation(s)
- Margaret L Schmitt
- Mailman School of Public Health, Columbia University, New York, NY 10032 USA
| | - David Clatworthy
- International Rescue Committee, 122 W. 42nd Street, New York, NY 10168 USA
| | - Ruwan Ratnayake
- International Rescue Committee, 122 W. 42nd Street, New York, NY 10168 USA
| | | | - Elizabeth Roesch
- International Rescue Committee, 122 W. 42nd Street, New York, NY 10168 USA
| | - Erin Wheeler
- International Rescue Committee, 122 W. 42nd Street, New York, NY 10168 USA
| | - Marni Sommer
- Mailman School of Public Health, Columbia University, New York, NY 10032 USA
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Patel S, Koku Awoonor-Williams J, Asuru R, Boyer CB, Awopole Yepakeh Tiah J, Sheff MC, Schmitt ML, Alirigia R, Jackson EF, Phillips JF. Benefits and Limitations of a Community-Engaged Emergency Referral System in a Remote, Impoverished Setting of Northern Ghana. Glob Health Sci Pract 2016; 4:552-567. [PMID: 28031297 PMCID: PMC5199174 DOI: 10.9745/ghsp-d-16-00253] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 10/11/2016] [Indexed: 11/15/2022]
Abstract
Although Ghana has a well-organized primary health care system, it lacks policies and guidelines for developing or providing emergency referral services. In 2012, an emergency referral pilot-the Sustainable Emergency Referral Care (SERC) initiative-was launched by the Ghana Health Service in collaboration with community stakeholders and health workers in one subdistrict of the Upper East Region where approximately 20,000 people reside. The pilot program was scaled up in 2013 to a 3-district (12-subdistrict) plausibility trial that served a population of approximately 184,000 over 2 years from 2013 to 2015. The SERC initiative was fielded as a component of a 6-year health systems strengthening and capacity-building project known as the Ghana Essential Health Intervention Program. Implementation research using mixed methods, including quantitative analysis of key process and health indicators over time in the 12 intervention subdistricts compared with comparison districts, a survey of health workers, and qualitative systems appraisal with community members, provided data on effectiveness of the system as well as operational challenges and potential solutions. Monitoring data show that community exposure to SERC was associated with an increased volume of emergency referrals, diminished reliance on primary care facilities not staffed or equipped to provide surgical care, and increased caseloads at facilities capable of providing appropriate acute care (i.e., district hospitals). Community members strongly endorsed the program and expressed appreciation for the service. Low rates of adherence to some care protocols were noted: referring facilities often failed to alert receiving facilities of incoming patients, not all patients transported were accompanied by a health worker, and receiving facilities commonly failed to provide patient outcome feedback to the referring facility. Yet in areas where SERC worked to bypass substandard points of care, overall facility-based maternal mortality as well as accident-related deaths decreased relative to levels observed in facilities located in comparison areas.
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Affiliation(s)
- Sneha Patel
- New York City Department of Health and Mental Hygiene, New York, NY, USA
| | | | - Rofina Asuru
- University of Basel, Swiss Tropical and Public Health Institute, and Ghana Health Service, Accra, Ghana
| | | | | | - Mallory C Sheff
- Columbia University Mailman School of Public Health, New York, NY, USA
| | | | | | | | - James F Phillips
- Columbia University Mailman School of Public Health, New York, NY, USA.
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Sommer M, Schmitt ML, Clatworthy D, Bramucci G, Wheeler E, Ratnayake R. What is the scope for addressing menstrual hygiene management in complex humanitarian emergencies? A global review. ACTA ACUST UNITED AC 2016. [DOI: 10.3362/1756-3488.2016.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Marni Sommer
- Marni Sommer is Associate Professor of Sociomedical Sciences at the Columbia University, Mailman School of Public Health, New York
| | - Margaret L. Schmitt
- Margaret L. Schmitt is Program Manager in Sociomedical Sciences at the Columbia University, Mailman School of Public Health, New York
| | - David Clatworthy
- David Clatworthy is Environmental Health Technical Advisor at the International Rescue Committee, New York
| | - Gina Bramucci
- Gina Bramucci is Women’s Protection and Empowerment Senior Technical Advisor at the International Rescue Committee, New York
| | - Erin Wheeler
- Erin Wheeler is Family Planning and Post-abortion Care Technical Advisor at the International Rescue Committee, New York
| | - Ruwan Ratnayake
- Ruwan Ratnayake is Epidemiology Technical Advisor at the International Rescue Committee, New York
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Awoonor-Williams JK, Schmitt ML, Tiah J, Ndago J, Asuru R, Bawah AA, Phillips JF. A qualitative appraisal of stakeholder reactions to a tool for burden of disease-based health system budgeting in Ghana. Glob Health Action 2016; 9:30448. [PMID: 27246868 PMCID: PMC4887521 DOI: 10.3402/gha.v9.30448] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 04/29/2016] [Accepted: 04/29/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In 2010, the Ghana Health Service launched a program of cooperation with the Tanzania Ministry of Health and Social Welfare that was designed to adapt Tanzania's PLANREP budgeting and reporting tool to Ghana's primary health care program. The product of this collaboration is a system of budgeting, data visualization, and reporting that is known as the District Health Planning and Reporting Tool (DiHPART). OBJECTIVE This study was conducted to evaluate the design and implementation processes (technical, procedures, feedback, maintenance, and monitoring) of the DiHPART tool in northern Ghana. DESIGN This paper reports on a qualitative appraisal of user reactions to the DiHPART system and implications of pilot experience for national scale-up. A total of 20 health officials responsible for financial planning operations were drawn from the national, regional, and district levels of the health system and interviewed in open-ended discussions about their reactions to DiHPART and suggestions for systems development. RESULTS The findings show that technical shortcomings merit correction before scale-up can proceed. The review makes note of features of the software system that could be developed, based on experience gained from the pilot. Changes in the national system of financial reporting and budgeting complicate DiHPART utilization. This attests to the importance of pursuing a software application framework that anticipates the need for automated software generation. CONCLUSIONS Despite challenges encountered in the pilot, the results lend support to the notion that evidence-based budgeting merits development and implementation in Ghana.
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Affiliation(s)
- John Koku Awoonor-Williams
- Regional Health Directorate, Ghana Health Service PMB, Bolgatanga, Ghana.,Swiss Tropical and Public Health Institute, Department of Epidemiology and Public Health, Basel, Switzerland.,Faculty of Sciences, University of Basel, Basel, Switzerland;
| | | | - Janet Tiah
- Regional Health Directorate, Ghana Health Service PMB, Bolgatanga, Ghana
| | - Joyce Ndago
- Regional Health Directorate, Ghana Health Service PMB, Bolgatanga, Ghana
| | - Rofina Asuru
- Regional Health Directorate, Ghana Health Service PMB, Bolgatanga, Ghana
| | - Ayaga A Bawah
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - James F Phillips
- Mailman School of Public Health, Columbia University, New York, NY, USA
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Awoonor-Williams JK, Sory EK, Nyonator FK, Phillips JF, Wang C, Schmitt ML. Lessons learned from scaling up a community-based health program in the Upper East Region of northern Ghana. Glob Health Sci Pract 2013; 1:117-33. [PMID: 25276522 PMCID: PMC4168550 DOI: 10.9745/ghsp-d-12-00012] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 01/08/2013] [Indexed: 11/18/2022]
Abstract
The original CHPS model deployed nurses to the community and engaged local leaders, reducing child mortality and fertility substantially. Key scaling-up lessons: (1) place nurses in home districts but not home villages, (2) adapt uniquely to each district, (3) mobilize local resources, (4) develop a shared project vision, and (5) conduct “exchanges” so that staff who are initiating operations can observe the model working in another setting, pilot the approach locally, and expand based on lessons learned. Ghana's Community-Based Health Planning and Service (CHPS) initiative is envisioned to be a national program to relocate primary health care services from subdistrict health centers to convenient community locations. The initiative was launched in 4 phases. First, it was piloted in 3 villages to develop appropriate strategies. Second, the approach was tested in a factorial trial, which showed that community-based care could reduce childhood mortality by half in only 3 years. Then, a replication experiment was launched to clarify appropriate activities for implementing the fourth and final phase—national scale up. This paper discusses CHPS progress in the Upper East Region (UER) of Ghana, where the pace of scale up has been much more rapid than in the other 9 regions of the country despite exceedingly challenging economic, ecological, and social circumstances. The UER employed 5 strategies that facilitated scale up: (1) nurse recruitment from their home districts to improve worker morale and cultural grounding, balanced with some social distance from the village community to ensure client confidentiality, particularly regarding family planning use; (2) prioritization of CHPS planning and continuous review in management meetings to make necessary modifications to the initiative's approach; (3) community engagement and advocacy to local politicians to mobilize resources for financing start-up costs; (4) a shared and consistent vision about CHPS among health administration leaders to ensure appropriate resources and commitment to the initiative; and (5) knowledge exchange visits between new and advanced CHPS implementers to facilitate learning and scale up within and between districts.
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Affiliation(s)
| | | | | | - James F Phillips
- Columbia University, Mailman School of Public Health , New York City, New York , USA
| | - Chen Wang
- Columbia University, Mailman School of Public Health , New York City, New York , USA
| | - Margaret L Schmitt
- Columbia University, Mailman School of Public Health , New York City, New York , USA
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Schmitt ML, Coelho W, Lopes-de-Souza AS, Guimarães FS, Carobrez AP. Anxiogenic-like effect of glycine and D-serine microinjected into dorsal periaqueductal gray matter of rats. Neurosci Lett 1995; 189:93-6. [PMID: 7609926 DOI: 10.1016/0304-3940(95)11459-a] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The glutamatergic system of the dorsal periaqueductal gray matter (DPAG) has been implicated in anxiety. This study shows that microinjections of glycine (GLY) or D-serine (D-SER), into the DPAG of rats, dose-dependently reduced the number of entries and the time spent on open arms of an elevated plus-maze (EPM), an established animal model for measuring anxiety-related behavior. This anxiogenic-like effect was greatest following DPAG application of either 80 nmol GLY or 160 and 320 nmol D-SER. Microinjections of these same amino acid doses outside the DPAG, or of L-serine (320 nmol) inside the DPAG, produced neither of these pro-anxiety effects. The current results suggest that, in vivo, the GLY modulatory site of N-methyl-D-aspartate receptors is not fully saturated, and further substantiate a role for the DPAG excitatory amino acid system in anxiety.
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Affiliation(s)
- M L Schmitt
- Departamento de Farmacologia/CCB, Universidade Federal de Santa Catarina, Florianópolis, Brazil
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Abstract
We have compared the performance of male and female Wistar rats at different ages (45, 60, 90, 120 and 150 days) in the elevated plus-maze test, a reliable animal model of anxiety. Up to 60 days of age, rats of both sexes exhibited a high number of entries and of time spent on open arms (50% or above). At 120 days of age or more, rats of both sexes characteristically exhibited a reduction in the number of entries and of the time spent on open arms (below 50%). Within the range of 60 and 120 days there are statistically significant sex differences. At 90 days of age male rats showed a marked switch in their performance in the apparatus, reaching levels of the latter stage, whereas in females it happened around 120 days. These results suggest an ontogenetic difference in rats that accounts for at least two distinct performances for rats placed in an elevated plus-maze. Gender effects were found in a certain range, suggesting caution on interpreting data obtained in rats within 60 and 120 days old. Also, the results obtained highlight the importance of carefully controlling animal age in studies using the elevated plus-maze.
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Affiliation(s)
- J T Imhof
- Departamento de Farmacologia, Universidade Federal de Santa Catarina, Florianopolis, Brazil
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