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Karuga R, Kabaria C, Chumo I, Okoth L, Njoroge I, Otiso L, Muturi N, Karki J, Dean L, Tolhurst R, Steege R, Ozano K, Theobald S, Mberu B. Voices and challenges of marginalized and vulnerable groups in urban informal settlements in Nairobi, Kenya: building on a spectrum of community-based participatory research approaches. Front Public Health 2023; 11:1175326. [PMID: 38074741 PMCID: PMC10701261 DOI: 10.3389/fpubh.2023.1175326] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 11/06/2023] [Indexed: 12/18/2023] Open
Abstract
Urbanization is rapidly increasing across Africa, including in Nairobi, Kenya. Many people, recent migrants and long-term residents, live within dense and dynamic urban informal settlements. These contexts are fluid and heterogeneous, and deepening the understanding of how vulnerabilities and marginalization are experienced is important to inform pointed action, service delivery and policy priorities. The aim of this paper is to explore vulnerabilities and marginalization within Korogocho and Viwandani informal settlements in Nairobi and generate lessons on the value of a spectrum of community based participatory research approaches for understanding health and well-being needs and pinpointing appropriate interventions. In the exploratory stages of our ARISE consortium research, we worked with co-researchers to use the following methods: social mapping, governance diaries, and photo voice. Social mapping (including the use of Focus Group Discussions) identified key vulnerable groups: marginalized and precarious child heads of households (CHHs), Persons with disability who face multiple discrimination and health challenges, and often isolated older adults; and their priority needs, including health, education, water and sanitation. The governance diaries generated an understanding of the perceptions of the particularly vulnerable and marginalized informal settlement residents regarding the various people and institutions with the power to influence health and wellbeing; while photo voice highlighted the lived experiences of vulnerability and marginality. Understanding and responding to fluid and intersecting marginalities and vulnerabilities within growing urban informal settlements is particularly critical to achieving inclusive urbanization, where no one is left behind, a theme central to the Sustainable Development Goals and Kenya's Vision 2030.
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Affiliation(s)
- Robinson Karuga
- Department of Research and Strategic Information, LVCT Health, Nairobi, Kenya
| | - Caroline Kabaria
- Urbanization and Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Ivy Chumo
- Urbanization and Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Linet Okoth
- Department of Research and Strategic Information, LVCT Health, Nairobi, Kenya
| | - Inviolata Njoroge
- Department of Research and Strategic Information, LVCT Health, Nairobi, Kenya
| | - Lilian Otiso
- Department of Research and Strategic Information, LVCT Health, Nairobi, Kenya
| | - Nelly Muturi
- Airbel Impact Lab, International Rescue Committee, Nairobi, Kenya
| | - Jiban Karki
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Laura Dean
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Rachel Tolhurst
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Rosie Steege
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kim Ozano
- The SCL Agency, Wales, United Kingdom
| | - Sally Theobald
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Blessing Mberu
- Urbanization and Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya
- Department of Demography and Population Studies, University of Witwatersrand, Johannesburg, South Africa
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Seth R, Dhaliwal BK, Miller E, Best T, Sullivan A, Thankachen B, Qaiyum Y, Shet A. Leveling the Research Playing Field: Decolonizing Global Health Research Through Web-Based Platforms. J Med Internet Res 2023; 25:e46897. [PMID: 37906225 PMCID: PMC10646667 DOI: 10.2196/46897] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/17/2023] [Accepted: 07/27/2023] [Indexed: 11/02/2023] Open
Abstract
Global health research has traditionally been rooted in colonialism, with some investigators in high-income countries leading and managing research and investigators in low- and middle-income countries serving as implementing partners. The Community Health Worker-Led Intervention for Vaccine Information and Confidence (CIVIC) Project, conducted in India and led jointly by India- and US-based investigators, leveraged web-based platforms to facilitate a more horizontal, inclusive, and balanced approach to partnerships between researchers and the community. Using web-based platforms to conduct research was found to be an effective strategy to engage researchers at all levels and combat systemic barriers associated with in-person activities such as power, economic, social, and gender dynamics. Connecting online for research meetings created a more equitable environment for community members to engage meaningfully with research. Further, by conducting research through web-based platforms, we found that we were able to strengthen the diversity of participants, provide a space for more marginalized groups to speak up, and minimize logistical barriers to attendance. Harnessing web-based approaches in research provides a pathway toward opportunities to promote equity and contribute to the decolonization of global health spaces.
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Affiliation(s)
| | - Baldeep K Dhaliwal
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Emily Miller
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Tyler Best
- Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Alexis Sullivan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | | | | | - Anita Shet
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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Khanna R, Khanna R, Larson AR. Implications of the Dobbs decision on marginalized populations: Letter in reply to "The Supreme Court abortion ban impact on dermatology". J Am Acad Dermatol 2022; 88:e287-e288. [PMID: 36528269 DOI: 10.1016/j.jaad.2022.10.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/05/2022] [Accepted: 10/05/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Rayva Khanna
- Department of Internal Medicine, Medstar Washington Hospital Center, Washington, District of Columbia.
| | - Raveena Khanna
- Department of Dermatology, Howard University College of Medicine, Washington, District of Columbia
| | - Allison R Larson
- Department of Dermatology, Medstar Washington Hospital Center, Georgetown University Hospital, Washington, District of Columbia
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Leung T, Jamieson G, Murray CV, Lock MJ, Doyle D. Recasting Jung Through an Indigenist Approach to Deepen Shared Knowledges of Well-being and Healing on Australian Soils: Protocol for a Qualitative Landscape Research Study. JMIR Res Protoc 2022; 11:e36328. [PMID: 36480249 PMCID: PMC9782316 DOI: 10.2196/36328] [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: 01/20/2022] [Revised: 09/18/2022] [Accepted: 09/20/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The colonization of Australia is responsible for complex layers of trauma for the First Nations peoples of the continent. First Nations Australians' well-being is irrevocably tied to the well-being of the land. The application of a landscape-based approach to collaborative research shows promise in enabling genuine relationships that yield rich and informative data. However, there is a lack of practical evidence in the field of landscape research-research tied to First Nations Australians' worldviews of landscape. OBJECTIVE This study aims to deepen shared knowledges of well-being and healing on Australian soils. We aim to examine ritual co-design as a novel method for deepening these shared knowledges. METHODS This research comprises a qualitative and participatory action research design operationalized through an Indigenist approach. It is a 2-phase project that is co-designed with First Nations Australians. Phase 1 of this project is a relational study that endeavors to deepen the theory underpinning the project, alongside the development of meaningful and reciprocal community connections. Phase 2 is a series of 3 participatory action research cycles to co-design a new communal ritual. This process seeks to privilege First Nations Australians' voices and ways of knowing, which are themselves communal, ritual, and symbolic. The framework developed by psychiatrist Carl Jung informs the psychological nature of the enquiry. An Indigenist approach to landscape research recasts the Jungian frame to enable a culturally safe, context-specific, and landscape-based method of qualitative research. RESULTS The research is in the preliminary stages of participant recruitment. It is expected that data collection will commence in late 2022. CONCLUSIONS It is expected that this qualitative and co-designed project will strengthen the cross-cultural co-designer relationships and that the data gathered from these relationships, and the accompanying practical outcomes, will provide new insight into the interaction between human and landscape well-being. The field of landscape research is in an embryonic phase. This new field is embedded in the understanding that First Nations Australians' well-being is irrevocably tied to the well-being of the land, and this study seeks to build on this evidence base. A strength of this research is the relational methodology, in which First Nations Peoples' needs and desires will inform future research directions. It is limited by its context specific nature; however, it is expected that findings will be usable in guiding future research directions in the multidisciplinary field of landscape research. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/36328.
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Affiliation(s)
| | - Graham Jamieson
- School of Psychology, Faculty of Medicine and Health, University of New England, Armidale, Australia
| | - Clara V Murray
- School of Psychology, Faculty of Medicine and Health, University of New England, Armidale, Australia
| | - Mark J Lock
- School of Health & Social Development, Faculty of Health, Deakin University, Melbourne, Australia
| | - David Doyle
- Royal Flying Doctor Service, Broken Hill, Australia
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Rigby MJ. A commitment to marginalized children in the European Union: The hope and challenges of the EU Child Guarantee. Child Care Health Dev 2022; 48:170-174. [PMID: 34388279 DOI: 10.1111/cch.12907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 07/28/2021] [Accepted: 08/04/2021] [Indexed: 11/28/2022]
Abstract
While children in general are usually seen as a societal priority, many children are disadvantaged by marginalization, with adverse effects on health and development. Following feasibility studies, the European Commission has now adopted a formal Child Guarantee of service access. This paper links the Feasibility Studies to other reports on the need to address marginalized and institutionalized children. The problems in identifying and quantifying such children are outlined, as are the challenges of planning for these groups of children and the difficulty of finding universal definitions and data. This European Union initiative is timely, given that around a quarter of European children are marginalized, while the effects of Covid-19 will add to this marginalization.
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Affiliation(s)
- Michael J Rigby
- School of Social, Political and Global Studies and School of Primary, Community and Social Care, Keele University, Keele, UK
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Bloom M, Verma S, Ram D, Roberton T, Pacheco C, Goldman RE, Lima K, Faith Vera Cruz M, Szkwarko D. COVID-19 Vaccine Concerns and Acceptability by Language in a Marginalized Population in Rhode Island. J Prim Care Community Health 2021; 12:21501327211058976. [PMID: 34854328 PMCID: PMC8646824 DOI: 10.1177/21501327211058976] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION We need to understand the continued concerns and acceptability of COVID-19 vaccines within marginalized communities in the United States. Our study explores the concerns and acceptability of COVID-19 vaccines, by language group, at a Federally Qualified Health Center (FQHC) in Rhode Island. METHODS We conducted an exploratory, mixed data collection telephone survey in languages spoken in the community (Spanish, Cape Verdean (CV) Creole/Portuguese, and English). Participants were asked about their COVID-19 vaccination status, as well as vaccine concerns and acceptability via 9 closed-ended and 2 open-ended questions. Chi squared and multivariate analysis was used to compare concerns and acceptability across languages. Coding and immersion/crystallization techniques were used to identify qualitative data themes. RESULTS The overall response rate was 58%. Side effects were cited as the most frequent (66%) concern among all language groups. Concern about the speed of vaccine development, vaccine ingredients, and being in a research trial varied significantly by language. Qualitative findings included concerns about chronic medical conditions and generalized fear of vaccine safety. English speakers were the most likely to report concerns and CV Creole/Portuguese speakers were the least likely to report concerns about the vaccine. Spanish and CV Creole/Portuguese participants who were not yet vaccinated reported higher acceptability to receive the vaccine compared to English speakers, with odds ratios of 2.00 (95% CI: 1.00-4.00) and 1.27 (95% CI: 0.62-2.60), respectively. CONCLUSION To mitigate the effects of the COVID-19 pandemic and prepare for future pandemics, strategies must be based on understanding the beliefs and perceptions of marginalized communities.
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Affiliation(s)
- Molly Bloom
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Shelly Verma
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Deepika Ram
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Timothy Roberton
- Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA
| | | | - Roberta E Goldman
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Kevin Lima
- Blackstone Valley Community Health Care, Pawtucket, RI, USA
| | | | - Daria Szkwarko
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
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Williams SE, Ross AH. Ethical dilemmas in skeletal collection utilization: Implications of the Black Lives Matter movement on the anatomical and anthropological sciences. Anat Rec (Hoboken) 2021; 305:860-868. [PMID: 34854566 DOI: 10.1002/ar.24839] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 07/12/2021] [Revised: 10/14/2021] [Accepted: 11/01/2021] [Indexed: 11/10/2022]
Abstract
The Black Lives Matter (BLM) movement has brought to the public eye longstanding issues of social and racial injustice which have permeated the experiences of individuals of African ancestry in the United States and abroad for centuries. Motivated by a desire to disassemble a framework of systemic racism, the BLM movement has infiltrated numerous social and political arenas including the sciences, demanding change. The impact of the BLM movement is evident in the attention recently garnered by protests of museum skeletal collections' acquisition and handling of African/African American human remains. It is from this vantage point that we explore the ethical issues pervasive within United States skeletal collections and forensically relevant issues surrounding the unclaimed decedents of marginalized populations; colonial/imperial ideological formations, which construct and sustain power differentials in anatomization; and conceive of a path forward that prioritizes personhood.
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Affiliation(s)
- Shanna E Williams
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, South Carolina, USA
| | - Ann H Ross
- Department of Biological Sciences, Human Identification & Forensic Analysis Laboratory, North Carolina State University, Raleigh, North Carolina, USA
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Lamberti-Castronuovo A, Pine JA, Brogiato G, Kinkel HF. Agricultural Migrants' Health and Ability to Access Care: A Case Study in Southern Italy. Int J Environ Res Public Health 2021; 18:ijerph182312615. [PMID: 34886339 PMCID: PMC8656562 DOI: 10.3390/ijerph182312615] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/21/2021] [Accepted: 11/24/2021] [Indexed: 11/16/2022]
Abstract
Although a large amount of research exists about migration into the European Union (EU) and the role of migrants in European society, relatively little information is available on the health status of migrants after arriving in the EU. This is particularly true in the case of the most marginalised migrants, migrants from sub-Saharan Africa, who work as itinerant laborers harvesting fruits and vegetables in southern Italy. This study analyzes demographic and health data gathered by a non-governmental organization-run primary healthcare clinic in order to understand the challenges these migrants face when trying to maintain their health. Results show that their health suffers greatly due to substandard living and working conditions, partially due to the fact that these individuals experience many barriers when trying to access care from the national health system. The health status of this population cannot improve without broad reforms to the welfare system and the agricultural sector. Government action is needed to ensure that such individuals are not denied their basic human rights and freedoms, including the right to health.
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Affiliation(s)
- Alessandro Lamberti-Castronuovo
- CRIMEDIM—Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, 28100 Novara, Italy;
- iNGO EMERGENCY, 20122 Milan, Italy;
| | | | | | - Hans-Friedemann Kinkel
- Institute of Tropical Medicine and International Health, Charité–Universitätsmedizin Berlin, 13353 Berlin, Germany
- Correspondence:
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Abstract
Background Recruitment in health and social science research is a critically important but often
overlooked step in conducting successful research. The challenges associated with
recruitment pertain to multiple factors such as enrolling groups with vulnerabilities,
obtaining geographic, cultural, and ethnic representation within study samples,
supporting the participation of less accessible populations such as older adults, and
developing networks to support recruitment. Purpose This paper presents the experiences of two early career researchers in recruiting
community-based samples of older adults, their caregivers, and associated health
providers. Methods Challenges and facilitators in recruiting two community-based qualitative research
samples are identified and discussed in relation to the literature. Results Challenges included: identifying potential participants, engaging referral partners,
implementing multi-methods, and achieving study sample diversity. Facilitators included:
making connections in the community, building relationships, and drawing on existing
networks. Conclusions Findings suggest the need for greater recognition of the importance of having clear
frameworks and strategies to address recruitment prior to study commencement as well as
the need to have clear outreach strategies to optimize inclusion of marginalized groups.
Recommendations and a guide are provided to inform the development of recruitment
approaches of early career researchers in health and social science research.
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Affiliation(s)
- Anna Garnett
- Arthur Labatt School of Nursing, 6221Western University, London, Ontario, Canada
| | - Melissa Northwood
- School of Nursing, 3710McMaster University, Hamilton, Ontario, Canada
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Were N, Hikuam F, Lakhani I, D Nibogora B, Mkhatshwa M. An investment case: the role of advocacy in addressing discrimination of vulnerable and marginalized populations at risk for HIV in sub-Saharan Africa. J Int AIDS Soc 2021; 24 Suppl 3:e25719. [PMID: 34189854 PMCID: PMC8242971 DOI: 10.1002/jia2.25719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 04/09/2021] [Indexed: 11/10/2022] Open
Affiliation(s)
- Nerima Were
- Kenya Legal and Ethical Issues Network on HIV and AIDS (KELIN) and School of LawCollege of Humanities and Social Sciences at the University of NairobiNairobiKenya
| | - Felicita Hikuam
- AIDS and Rights Alliance for Southern Africa (ARASA)WindhoekNamibia
| | | | - Berry D Nibogora
- African Men for Sexual Health and Rights (AMSHeR)JohannesburgSouth Africa
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Gozum IEA, Capulong HGM, Gopez JMW, Galang JRF. Philippine community pantries as a way of helping the marginalized during the COVID-19 pandemic. J Public Health (Oxf) 2021; 44:e264-e265. [PMID: 33982104 PMCID: PMC8194662 DOI: 10.1093/pubmed/fdab151] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 04/23/2021] [Accepted: 04/26/2021] [Indexed: 11/23/2022] Open
Abstract
In a previous correspondence, the author tried to establish the crucial relationship of the country’s public health with the government officials’ economic decisions and actions. Understanding such, we look at the perspective of the handling of the pandemic, in terms of economic decisions and actions, in the Philippines. In the country, complaints from the citizens surfaced because the government failed in providing an appropriate response to the economic imbalance generated by the pandemic. Thus, in this paper, we surveyed the sudden engenderment of community pantries in the Philippines as a way of filling the gaps of the government.
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Affiliation(s)
- Ivan Efreaim A Gozum
- Center for Christian Formation and Praxis, Angeles University Foundation, Angeles City 2009, Philippines
| | - Harvey Gain M Capulong
- Center for Christian Formation and Praxis, Angeles University Foundation, Angeles City 2009, Philippines
| | - Jose Ma W Gopez
- Center for Christian Formation and Praxis, Angeles University Foundation, Angeles City 2009, Philippines
| | - Joseph Renus F Galang
- Theology and Religious Education Department, De La Salle University, 2401 Taft Avenue, 0922 Manila, Philippines
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Standley CJ, Foster-Fishman P. Intersectionality, social support, and youth suicidality: A socioecological approach to prevention. Suicide Life Threat Behav 2021; 51:203-211. [PMID: 33876493 DOI: 10.1111/sltb.12695] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 07/03/2020] [Accepted: 07/14/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study examined the relationship between social support and suicidality among youth from a public health perspective by using (1) a socioecological framework and (2) an intersectional approach to social identity. METHODS Secondary analysis of cross-sectional survey data (N = 5058) involved means comparisons and a series of standard and hierarchical regression analyses. RESULTS Youth with intersecting marginalized identities (i.e., females and racial and sexual minority youth) were significantly more likely to report higher suicidality scores. Social support at the family, school, and community levels was significantly associated with lower suicidality scores, and the combination of family and school support was associated with the lowest suicidality scores. Finally, family support significantly reduced the relationship between intersecting marginalized identities and suicidality. CONCLUSIONS Findings highlight the importance of protective factors in every context in which youth live, learn, and play. Measuring and reporting social identities as well as their intersections add to our understanding of both risk and prevention.
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Beltran RS, Marnocha E, Race A, Croll DA, Dayton GH, Zavaleta ES. Field courses narrow demographic achievement gaps in ecology and evolutionary biology. Ecol Evol 2020; 10:5184-5196. [PMID: 32607142 PMCID: PMC7319162 DOI: 10.1002/ece3.6300] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [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: 12/17/2019] [Revised: 03/06/2020] [Accepted: 03/30/2020] [Indexed: 11/23/2022] Open
Abstract
Disparities remain in the representation of marginalized students in STEM. Classroom-based experiential learning opportunities can increase student confidence and academic success; however, the effectiveness of extending learning to outdoor settings is unknown. Our objectives were to examine (a) demographic gaps in ecology and evolutionary biology (EEB) major completion, college graduation, and GPAs for students who did and did not enroll in field courses, (b) whether under-represented demographic groups were less likely to enroll in field courses, and (c) whether under-represented demographic groups were more likely to feel increased competency in science-related tasks (hereafter, self-efficacy) after participating in field courses. We compared the relationships among academic success measures and demographic data (race/ethnicity, socioeconomic status, first-generation, and gender) for UC Santa Cruz undergraduate students admitted between 2008 and 2019 who participated in field courses (N = 941 students) and who did not (N = 28,215 students). Additionally, we administered longitudinal surveys to evaluate self-efficacy gains during field-based versus classroom-based courses (N = 570 students). We found no differences in the proportion of students matriculating at the university as undecided, proposed EEB, or proposed other majors across demographic groups. However, five years later, under-represented students were significantly less likely to graduate with EEB degrees, indicating retention rather than recruitment drives disparities in representation. This retention gap is partly due to a lower rate of college completion and partly through attrition to other majors. Although under-represented students were less likely to enroll in field courses, field courses were associated with higher self-efficacy gains, higher college graduation rates, higher EEB major retention, and higher GPAs at graduation. All demographic groups experienced significant increases in self-efficacy during field-based but not lecture-based courses. Together, our findings suggest that increasing the number of field courses and actively facilitating access to students from under-represented groups can be a powerful tool for increasing STEM diversity.
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Affiliation(s)
| | - Erin Marnocha
- Natural Reserve SystemUniversity of CaliforniaOaklandCAUSA
| | | | - Donald A. Croll
- Ecology and Evolutionary BiologyUniversity of CaliforniaSanta CruzCAUSA
| | - Gage H. Dayton
- Natural Reserve SystemUniversity of CaliforniaSanta CruzCAUSA
| | - Erika S. Zavaleta
- Ecology and Evolutionary BiologyUniversity of CaliforniaSanta CruzCAUSA
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McGready R, Paw MK, Wiladphaingern J, Min AM, Carrara VI, Moore KA, Pukrittayakamee S, Nosten FH. The overlap between miscarriage and extreme preterm birth in a limited-resource setting on the Thailand-Myanmar border: a population cohort study. Wellcome Open Res 2018; 1:32. [PMID: 30607368 PMCID: PMC6305214 DOI: 10.12688/wellcomeopenres.10352.3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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] [Accepted: 11/28/2018] [Indexed: 02/05/2023] Open
Abstract
Background: No universal demarcation of gestational age distinguishes miscarriage and stillbirth or extreme preterm birth (exPTB). This study provides a synopsis of outcome between 22 to <28 weeks gestation from a low resource setting. Methods: A retrospective record review of a population on the Thailand-Myanmar border was conducted. Outcomes were classified as miscarriage, late expulsion of products between 22 to < 28 weeks gestation with evidence of non-viability (mostly ultrasound absent fetal heart beat) prior to 22 weeks; or exPTB (stillbirth/live born) between 22 to < 28 weeks gestation when the fetus was viable at ≥22 weeks. Termination of pregnancy and gestational trophoblastic disease were excluded. Results: From 1995-2015, 80.9% (50,046/ 61,829) of registered women had a known pregnancy outcome, of whom 99.8% (49,931) had a known gestational age. Delivery between 22 to <28 weeks gestation included 0.9% (472/49,931) of pregnancies after removing 18 cases (3.8%) who met an exclusion criteria. Most pregnancies had an ultrasound: 72.5% (n=329/454); 43.6% (n=197) were classified as miscarriage and 56.4% (n=257) exPTB. Individual record review of miscarriages estimated that fetal death had occurred at a median of 16 weeks, despite late expulsion between 22 to <28 weeks. With available data (n=252, 5 missing) the proportion of stillbirth was 47.6% (n=120), congenital abnormality 10.5% (24/228, 29 missing) and neonatal death was 98.5% (128/131, 1 missing). Introduction of ultrasound was associated with a 2-times higher odds of classification of outcome as exPTB rather than miscarriage. Conclusion: In this low resource setting few (<1%) pregnancy outcomes occurred in the 22 to <28 weeks gestational window; four in ten were miscarriage (late expulsion) and neonatal mortality approached 100%. In the scale-up to preventable newborns deaths (at least initially) greater benefits will be obtained by focusing on the viable newborns of ≥ 28 weeks gestation.
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Affiliation(s)
- Rose McGready
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Mae Sot, Thailand.,Centre for Tropical Medicine and Global health, Nuffield Department of Medicine Research Building, University of Oxford, Oxford, UK
| | - Moo Kho Paw
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Mae Sot, Thailand
| | - Jacher Wiladphaingern
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Mae Sot, Thailand
| | - Aung Myat Min
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Mae Sot, Thailand
| | - Verena I Carrara
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Mae Sot, Thailand.,Department of Medicine, Swiss Tropical and Public Health Institute, 4002 Basel, Switzerland
| | - Kerryn A Moore
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.,Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne, Australia
| | | | - François H Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Mae Sot, Thailand.,Centre for Tropical Medicine and Global health, Nuffield Department of Medicine Research Building, University of Oxford, Oxford, UK
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15
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McGready R, Paw MK, Wiladphaingern J, Min AM, Carrara VI, Moore KA, Pukrittayakamee S, Nosten FH. The overlap between miscarriage and extreme preterm birth in a limited-resource setting on the Thailand-Myanmar border: a population cohort study. Wellcome Open Res 2018; 1:32. [PMID: 30607368 DOI: 10.12688/wellcomeopenres.10352.2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2018] [Indexed: 12/21/2022] Open
Abstract
Background : No universal demarcation of gestational age distinguishes miscarriage and stillbirth or extreme preterm birth (exPTB). This study provides a synopsis of outcome between 22 to <28 weeks gestation from a low resource setting. Methods : A retrospective record review of a population on the Thailand-Myanmar border was conducted. Outcomes were classified as miscarriage, late expulsion of products between 22 to < 28 weeks gestation with evidence of non-viability (mostly ultrasound absent fetal heart beat) prior to 22 weeks; or exPTB (stillbirth/live born) between 22 to < 28 weeks gestation when the fetus was viable at ≥22 weeks. Termination of pregnancy and gestational trophoblastic disease were excluded. Results : From 1995-2015, 80.9% (50,046/ 61,829) of registered women had a known pregnancy outcome, of whom 99.8% (49,931) had a known gestational age. Delivery between 22 to <28 weeks gestation included 0.9% (472/49,931) of pregnancies after removing 18 cases (3.8%) who met an exclusion criteria. Most pregnancies had an ultrasound: 72.5% (n=329/454); 43.6% (n=197) were classified as miscarriage and 56.4% (n=257) exPTB. Individual record review of miscarriages estimated that fetal death had occurred at a median of 16 weeks, despite late expulsion between 22 to <28 weeks. With available data (n=252, 5 missing) the proportion of stillbirth was 47.6% (n=120), congenital abnormality 10.5% (24/228, 29 missing) and neonatal death was 98.5% (128/131, 1 missing). Introduction of ultrasound was associated with a 2-times higher odds of classification of outcome as exPTB rather than miscarriage. Conclusion : In this low resource setting few (<1%) pregnancy outcomes occurred in the 22 to <28 weeks gestational window; four in ten were miscarriage (late expulsion) and neonatal mortality approached 100%. In the scale-up to preventable newborns deaths (at least initially) greater benefits will be obtained by focusing on the viable newborns of ≥ 28 weeks gestation.
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Affiliation(s)
- Rose McGready
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Mae Sot, Thailand.,Centre for Tropical Medicine and Global health, Nuffield Department of Medicine Research Building, University of Oxford, Oxford, UK
| | - Moo Kho Paw
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Mae Sot, Thailand
| | - Jacher Wiladphaingern
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Mae Sot, Thailand
| | - Aung Myat Min
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Mae Sot, Thailand
| | - Verena I Carrara
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Mae Sot, Thailand.,Department of Medicine, Swiss Tropical and Public Health Institute, 4002 Basel, Switzerland
| | - Kerryn A Moore
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.,Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne, Australia
| | | | - François H Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Mae Sot, Thailand.,Centre for Tropical Medicine and Global health, Nuffield Department of Medicine Research Building, University of Oxford, Oxford, UK
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16
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Choudhry FR, Khan TM, Park MSA, Golden KJ. Mental Health Conceptualization and Resilience Factors in the Kalasha Youth: An Indigenous Ethnic and Religious Minority Community in Pakistan. Front Public Health 2018; 6:187. [PMID: 30065918 PMCID: PMC6056674 DOI: 10.3389/fpubh.2018.00187] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 06/13/2018] [Indexed: 11/13/2022] Open
Abstract
The Kalasha are a religious, ethnic, and linguistic minority community in Pakistan. They are indigenous people living in remote valleys of the Hindu Kush Mountains in northern Pakistan, neighboring Afghanistan. The Kalasha are pastoral, as well as agricultural people to some extent, although they are increasingly facing pressures from globalization and social change, which may be influencing youth and community development. Their traditional world view dichotomizes and emphasizes on the division of the pure (Onjeshta) and the impure (Pragata). There remains a scarcity of literature on mental health and resilience of indigenous communities in South Asia and Pakistan generally, and the polytheistic Kalasha community specifically. Thus, the current study was conducted with the aim to explore the cultural protective factors (resilience) of the Kalasha youth (adolescents and emerging adults) and to explore their perceived etiological understandings and preferred interventions for mental health support systems. The theoretical framework of Bronfenbrenner's (1, 2) ecological systems model was used. Interpretative Phenomenological Analysis (IPA) was conducted, considering the advantage of its idiographic approach and the “double hermeneutic” analytic process. This methodology was consistent with the aim to understand and make sense of mental health and resilience from the Kalasha indigenous perspective. A total of 12 in-depth interviews were conducted with adolescents and emerging adults (5 males, 7 females), along with ethnographic observations. The analysis revealed 3 superordinate themes of mental health perceptions and interventions, each with more specific emergent themes: (1) Psychological Resilience/Cultural Protective Factors Buffering Against Mental Health Problems (Intra-Communal Bonding & Sharing; Kalasha Festivals & Traditions; Purity Concept; Behavioral Practice of Happiness and Cognitive Patterns); (2) Perceived Causes of Mental Health Issues (Biological & Psychosocial; Supernatural & Spiritual; Environmental); and (3) Preferred Interventions [Shamanic Treatment; Ta'awiz (Amulets); Communal Sharing & Problem Solving; Medical Treatment; Herbal Methods]. The overall findings point to the need for developing culturally-sensitive and indigenous measures and therapeutic interventions. The findings highlighted the Kalasha cultural practices which may promote resilience. The findings also call for indigenous sources of knowledge to be considered when collaboratively designing public health programs.
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Affiliation(s)
- Fahad R Choudhry
- Department of Psychology, Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Bandar Sunway, Malaysia.,National Institute of Psychology, Quaid-i-Azam University, Islamabad, Pakistan
| | - Tahir M Khan
- Institute of Pharmaceutical Science, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Miriam Sang-Ah Park
- Department of Psychology, Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Bandar Sunway, Malaysia.,School of Social and Health Sciences, Leeds Trinity University, Leeds, United Kingdom
| | - Karen J Golden
- Department of Psychology, Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Bandar Sunway, Malaysia
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