Risk, power, and knowledge: exploring adolescent girls’ sexual and reproductive health in Kenya

Helping adolescent girls grow up to be healthy, resilient women is an ongoing mission around the world. Adolescence is a period marked by rapid physical, emotional, and social changes. Research shows that when young receive proper support and access to education and health services, it can be a time of immense opportunity during this life phase. In my dissertation, I discuss factors that shape adolescent girls’ transition to adulthood and those that might predispose them to risky behaviors or lifestyles. I shed light on these influences by looking at a wide range of factors operating at multiple levels--individual, peer, family, school, community, and society. The aim of this dissertation, I will highlight three papers that describe the link between social and behavioral risk and reproductive health outcomes among adolescent girls living in low-income areas. The first paper is The Determinants of Sexual Risk Factors among Adolescent Girls in Kenya Using a Social-Ecological Model. In this paper, I focus on predicting cumulative risk using each social dimension (i.e., individual, peer, family, community, and society) to show how these social factors surrounding adolescent girls can lead to higher risk for contracting HIV or unplanned pregnancy. I use a multi-level, social-ecological model developed by Bronfenbrenner (1979) to evaluate the association between each level and cumulative risk. I propose a new level for measuring the influence and opportunities created by virtual networks or connections established by technology. In this paper, I show that the probability of a girl being defined as at-risk for adverse health outcomes is (i) negatively associated with factors at the family level and (ii) positively associated with a girl's physical and virtual network. The second paper is The Determinants of and Associations with Power in the Sexual Relationships of Adolescent Girls in an Urban and Informal Settlement in Nairobi, Kenya. I investigate economic empowerment as a mechanism for increasing sexual relationship power among adolescent girls. I show that a higher sexual relationship power score is associated with (i) fewer reports of intimate partner violence, (ii) greater financial knowledge and savings behavior, and (iii) increased self-efficacy. The evidence suggests that building economic empowerment is an effective approach for increasing sexual relationship power. The third paper is Game Changer? Phones and Sexual and Reproductive Health Knowledge among Adolescent Girls in Kenya. Mobile phone ownership among adolescent girls is growing rapidly in Kenya, yet, documentation or evidence about their virtual life is largely undocumented. The United Nation's suggests that mobile phones could be a game-changer for adolescent girls in low-to-middle income countries, allowing them to become more independent in their choices and control of information. I explore some of the benefits to adolescent girls who own a mobile phone. I show that mobile phone ownership is associated with (i) higher levels of sexual and reproductive health knowledge measured by contraceptive and HIV knowledge scores and (ii) a higher probability of testing for HIV. All three papers use data from the Population Council's Adolescent Girls' Initiative in Kenya, a 2-year intervention focused on empowering girls and reducing the rate of irreversible events related to sex, such as HIV infection and unplanned pregnancy. A cohort of 3,052 adolescent girls was enrolled and interviewed in 2015 and followed up in 2017 and 2019. Participants completed a survey that included questions about their sexual behaviors and reproductive health knowledge at each time point. In my dissertation, I provide perspective on the impact of knowledge, power, and risk on sexual and reproductive health outcomes among adolescent girls in Kibera and Huruma, Kenya

Evaluation of the Baltimore Health Corps Pilot: An Economic and Public Health Response to the Coronavirus

The Bal­ti­more Health Corps was a city-run pilot launched in June 2020 and concluding in December, 2021. The pilot simul­ta­ne­ous­ly addressed two issues: the spread of COVID-19 and the result­ing employ­ment cri­sis faced by Bal­ti­more res­i­dents.The Bal­ti­more City Health Depart­ment and the Mayor's Office of Employ­ment Devel­op­ment led the Bal­ti­more Health Corps, draw­ing on their expe­ri­ences with equi­table recruit­ment and hir­ing prac­tices, work­force-sup­port­ing activ­i­ties and pub­lic health work­er train­ing. Togeth­er, they led a team of pub­lic and pri­vate part­ners that includ­ed the Bal­ti­more Civic Fund, Bal­ti­more Corps, Health­Care Access Mary­land (HCAM), Jhpiego and the Mayor's Office of Per­for­mance and Inno­va­tion.The ini­tia­tive tracked those who con­tract­ed the virus at the height of the pan­dem­ic and con­nect­ed COVID-19-pos­i­tive indi­vid­u­als with test­ing, resources and oth­er assis­tance. In doing so, the Bal­ti­more Health Corps also placed unem­ployed work­ers on a path to high-qual­i­ty, last­ing careers via tem­po­rary posi­tions as com­mu­ni­ty health work­ers with the Bal­ti­more City Health Depart­ment and Health­Care Access Mary­land (HCAM). The pro­gram hired from a pool of Bal­ti­more res­i­dents who reflect­ed the city's racial and eth­nic demo­graph­ics and were unem­ployed, under­em­ployed or fur­loughed because of the pandemic. By Sep­tem­ber 2021, 336 health work­ers had received train­ing and took on roles with­in either the Health Corps' con­tact trac­ing and out­reach pro­gram or the care coor­di­na­tion and access program.While these health work­er posi­tions were intend­ed to last just eight months, as the pan­dem­ic per­sist­ed, the jobs were extend­ed thanks to fund­ing from the Amer­i­can Res­cue Plan Act. As of May 2022, 126 Bal­ti­more Health Corps work­ers remain employed with either the health depart­ment or HCAM, while 119 for­mer staff mem­bers have since moved on to oth­er employ­ment opportunities.This is the Final Report to follow the Early Lessons Report for the Baltimore Health Corps Pilot Study. Readers are encouraged to review the Early Lessons Report for a detailed description of the formation of the Pilot Study, the role of each partner, as well as findings from the first year of the Pilot Study

Leveraging Breadth and Depth: Strategies to Characterize Population Diversity to Address Cancer Disparities in the DF/HCC Catchment Area

Abstract Background: NCI-Designated Cancer Centers provide key cancer research, prevention, and treatment services to members of their catchment area. Characterization of these areas may be complex given the diverse needs of the populations within, particularly those from low socioeconomic position (SEP). The purpose of this paper is to describe the characterization of the Dana-Farber/Harvard Cancer Center (DF/HCC) catchment area through using a two-pronged approach. Methods: Participants (n = 1,511) were recruited through (i) an online, probability-based survey (n = 1,013) and (ii) a supplementary, in-person survey from priority groups (African Americans, Latinos, blue-collar workers, low SEP, homeless; n = 498) within Massachusetts. Study staff worked closely with community partners across the state to reach individuals who may not usually be included in online surveys. Results: There were several differences across samples, with the community-based sample having a higher percentage of low SEP, low education, African Americans, and Latinos compared with the online sample. Differences were also noted in the cancer-related behaviors of the samples, with the community-based sample having higher rates of smoking, particularly within those who were homeless or make less than $20,000 per year. Fewer community-based subgroups were current with cancer screenings, and more showed more indication of potential communication inequalities compared with statewide estimates. Conclusions: The sampling strategy used to characterization of the DF/HCC catchment area provided broad, statewide estimates and additional focus on vulnerable populations, highlighting several potential areas for intervention. Impact: This study provides data to highlight the value of using multiple sampling strategies when characterizing cancer center catchment areas

Adolescent Girls Initiative–Kenya: Endline evaluation report

Early pregnancy is a challenge for girls in Kenya that often has immediate effects on their educational opportunities, future implications for their social, health, and economic outcomes, and negative impacts on their children. For girls to achieve well-being in early and late adolescence, no single-sector intervention—whether education, health, wealth creation, or prevention of violence—will be adequate. The Adolescent Girls Initiative–Kenya (AGI-K) delivered multisectoral interventions to over 6,000 girls aged 11–15 in two marginalized areas of Kenya: the Kibera informal settlement in Nairobi and Wajir County in Northeastern Kenya. These interventions were carried out for two years (2015–17) and comprised a combination of girl-level, household-level, and community-level interventions. The two-year follow-up results largely confirmed the AGI-K theory of change and held up the view that an investment in early adolescents among the right groups of marginalized girls would have short-term benefits on asset accumulation, educational attainment, and household economic status that translated into longer-term impact on delaying childbearing. This report describes the intervention and research design of AGI-K, and presents the impact findings from the two-year follow-up data

Effective knowledge translation approaches and practices in Indigenous health research: A systematic review protocol

Background: Effective knowledge translation (KT) is critical to implementing program and policy changes that require shared understandings of knowledge systems, assumptions, and practices. Within mainstream research institutions and funding agencies, systemic and insidious inequities, privileges, and power relationships inhibit Indigenous peoples' control, input, and benefits over research. This systematic review will examine literature on KT initiatives in Indigenous health research to help identify wise and promising Indigenous KT practices and language in Canada and abroad. Methods: Indexed databases including Aboriginal Health Abstract Database, Bibliography of Native North Americans, CINAHL, Circumpolar Health Bibliographic Database, Dissertation Abstracts, First Nations Periodical Index, Medline, National Indigenous Studies Portal, ProQuest Conference Papers Index, PsycInfo, Social Services Abstracts, Social Work Abstracts, and Web of Science will be searched. A comprehensive list of non-indexed and grey literature sources will also be searched. For inclusion, documents must be published in English; linked to Indigenous health and wellbeing; focused on Indigenous people; document KT goals, activities, and rationale; an

Genome-Wide Transcriptional Response of Silurana (Xenopus) tropicalis to Infection with the Deadly Chytrid Fungus

Emerging infectious diseases are of great concern for both wildlife and humans. Several highly virulent fungal pathogens have recently been discovered in natural populations, highlighting the need for a better understanding of fungal-vertebrate host-pathogen interactions. Because most fungal pathogens are not fatal in the absence of other predisposing conditions, host-pathogen dynamics for deadly fungal pathogens are of particular interest. The chytrid fungus Batrachochytrium dendrobatidis (hereafter Bd) infects hundreds of species of frogs in the wild. It is found worldwide and is a significant contributor to the current global amphibian decline. However, the mechanism by which Bd causes death in amphibians, and the response of the host to Bd infection, remain largely unknown. Here we use whole-genome microarrays to monitor the transcriptional responses to Bd infection in the model frog species, Silurana (Xenopus) tropicalis, which is susceptible to chytridiomycosis. To elucidate the immune response to Bd and evaluate the physiological effects of chytridiomycosis, we measured gene expression changes in several tissues (liver, skin, spleen) following exposure to Bd. We detected a strong transcriptional response for genes involved in physiological processes that can help explain some clinical symptoms of chytridiomycosis at the organismal level. However, we detected surprisingly little evidence of an immune response to Bd exposure, suggesting that this susceptible species may not be mounting efficient innate and adaptive immune responses against Bd. The weak immune response may be partially explained by the thermal conditions of the experiment, which were optimal for Bd growth. However, many immune genes exhibited decreased expression in Bd-exposed frogs compared to control frogs, suggesting a more complex effect of Bd on the immune system than simple temperature-mediated immune suppression. This study generates important baseline data for ongoing efforts to understand differences in response to Bd between susceptible and resistant frog species and the effects of chytridiomycosis in natural populations

Minimal information for studies of extracellular vesicles (MISEV2023): from basic to advanced approaches

Extracellular vesicles (EVs), through their complex cargo, can reflect the state of their cell of origin and change the functions and phenotypes of other cells. These features indicate strong biomarker and therapeutic potential and have generated broad interest, as evidenced by the steady year-on-year increase in the numbers of scientific publications about EVs. Important advances have been made in EV metrology and in understanding and applying EV biology. However, hurdles remain to realising the potential of EVs in domains ranging from basic biology to clinical applications due to challenges in EV nomenclature, separation from non-vesicular extracellular particles, characterisation and functional studies. To address the challenges and opportunities in this rapidly evolving field, the International Society for Extracellular Vesicles (ISEV) updates its ‘Minimal Information for Studies of Extracellular Vesicles’, which was first published in 2014 and then in 2018 as MISEV2014 and MISEV2018, respectively. The goal of the current document, MISEV2023, is to provide researchers with an updated snapshot of available approaches and their advantages and limitations for production, separation and characterisation of EVs from multiple sources, including cell culture, body fluids and solid tissues. In addition to presenting the latest state of the art in basic principles of EV research, this document also covers advanced techniques and approaches that are currently expanding the boundaries of the field. MISEV2023 also includes new sections on EV release and uptake and a brief discussion of in vivo approaches to study EVs. Compiling feedback from ISEV expert task forces and more than 1000 researchers, this document conveys the current state of EV research to facilitate robust scientific discoveries and move the field forward even more rapidly

Minimal Information for Studies of Extracellular Vesicles (MISEV2023): From Basic to Advanced Approaches

Extracellular vesicles (EVs), through their complex cargo, can reflect the state of their cell of origin and change the functions and phenotypes of other cells. These features indicate strong biomarker and therapeutic potential and have generated broad interest, as evidenced by the steady year-on-year increase in the numbers of scientific publications about EVs. Important advances have been made in EV metrology and in understanding and applying EV biology. However, hurdles remain to realising the potential of EVs in domains ranging from basic biology to clinical applications due to challenges in EV nomenclature, separation from non-vesicular extracellular particles, characterisation and functional studies. To address the challenges and opportunities in this rapidly evolving field, the International Society for Extracellular Vesicles (ISEV) updates its \u27Minimal Information for Studies of Extracellular Vesicles\u27, which was first published in 2014 and then in 2018 as MISEV2014 and MISEV2018, respectively. The goal of the current document, MISEV2023, is to provide researchers with an updated snapshot of available approaches and their advantages and limitations for production, separation and characterisation of EVs from multiple sources, including cell culture, body fluids and solid tissues. In addition to presenting the latest state of the art in basic principles of EV research, this document also covers advanced techniques and approaches that are currently expanding the boundaries of the field. MISEV2023 also includes new sections on EV release and uptake and a brief discussion of in vivo approaches to study EVs. Compiling feedback from ISEV expert task forces and more than 1000 researchers, this document conveys the current state of EV research to facilitate robust scientific discoveries and move the field forward even more rapidly

Minimal information for studies of extracellular vesicles (MISEV2023): From basic to advanced approaches

Extracellular vesicles (EVs), through their complex cargo, can reflect the state of their cell of origin and change the functions and phenotypes of other cells. These features indicate strong biomarker and therapeutic potential and have generated broad interest, as evidenced by the steady year-on-year increase in the numbers of scientific publications about EVs. Important advances have been made in EV metrology and in understanding and applying EV biology. However, hurdles remain to realising the potential of EVs in domains ranging from basic biology to clinical applications due to challenges in EV nomenclature, separation from non-vesicular extracellular particles, characterisation and functional studies. To address the challenges and opportunities in this rapidly evolving field, the International Society for Extracellular Vesicles (ISEV) updates its 'Minimal Information for Studies of Extracellular Vesicles', which was first published in 2014 and then in 2018 as MISEV2014 and MISEV2018, respectively. The goal of the current document, MISEV2023, is to provide researchers with an updated snapshot of available approaches and their advantages and limitations for production, separation and characterisation of EVs from multiple sources, including cell culture, body fluids and solid tissues. In addition to presenting the latest state of the art in basic principles of EV research, this document also covers advanced techniques and approaches that are currently expanding the boundaries of the field. MISEV2023 also includes new sections on EV release and uptake and a brief discussion of in vivo approaches to study EVs. Compiling feedback from ISEV expert task forces and more than 1000 researchers, this document conveys the current state of EV research to facilitate robust scientific discoveries and move the field forward even more rapidly

Minimal information for studies of extracellular vesicles (MISEV2023): From basic to advanced approaches

Extracellular vesicles (EVs), through their complex cargo, can reflect the state of their cell of origin and change the functions and phenotypes of other cells. These features indicate strong biomarker and therapeutic potential and have generated broad interest, as evidenced by the steady year-on-year increase in the numbers of scientific publications about EVs. Important advances have been made in EV metrology and in understanding and applying EV biology. However, hurdles remain to realising the potential of EVs in domains ranging from basic biology to clinical applications due to challenges in EV nomenclature, separation from non-vesicular extracellular particles, characterisation and functional studies. To address the challenges and opportunities in this rapidly evolving field, the International Society for Extracellular Vesicles (ISEV) updates its 'Minimal Information for Studies of Extracellular Vesicles', which was first published in 2014 and then in 2018 as MISEV2014 and MISEV2018, respectively. The goal of the current document, MISEV2023, is to provide researchers with an updated snapshot of available approaches and their advantages and limitations for production, separation and characterisation of EVs from multiple sources, including cell culture, body fluids and solid tissues. In addition to presenting the latest state of the art in basic principles of EV research, this document also covers advanced techniques and approaches that are currently expanding the boundaries of the field. MISEV2023 also includes new sections on EV release and uptake and a brief discussion of in vivo approaches to study EVs. Compiling feedback from ISEV expert task forces and more than 1000 researchers, this document conveys the current state of EV research to facilitate robust scientific discoveries and move the field forward even more rapidly