HIV risk among young Ghanaians in high school: validation of a multidimensional attitude towards condom use scale

Condom use remains low among sexually active youth in sub-Saharan Africa. Theoretical and empirical evidence suggests that attitudes towards condom use are important predictors of actual condom use. However, few attempts have been made to systematically develop a valid scale that measures attitudes towards condom use among youth, particularly high school students in sub-Saharan Africa. Using the health belief model, we developed an instrument that measures such attitudes. We analysed survey data collected from 6252 Ghanaian junior high school students. We assessed construct validity using confirmatory factor analysis. Results indicate that attitudes towards condom use among young Ghanaians are best represented by a multidimensional construct. Young Ghanaians differentiate constructs related to perception of benefits and barriers to condom use, as well as perception of severity and susceptibility to HIV. This instrument offers a valid tool for assessing high school students' attitudes towards condom use and their HIV risk

Conducting Measurement Invariance Tests with Ordinal Data: A Guide for Social Work Researchers

Objective: The validity of measures across groups is a major concern for social work researchers and practitioners. Many social workers use scales, or sets of questionnaire items, with ordinal response options. However, a review of social work literature indicates the appropriate treatment of ordinal data in measurement invariance tests is rare; only 3 of 57 articles published in 26 social work journals over the past 12 years used proper testing procedures. This article synthesizes information from the literature and provides recommendations for appropriate measurement invariance procedures with ordinal data. Method: We use data from the Cebu Longitudinal Health and Nutrition Survey to demonstrate applications of invariance testing with ordinal data. Using a robust weighted least squares estimator and polychoric correlation matrix, we examine invariance of a 10-item Perceived Stress Scale (PSS) across 2 young adult groups defined by health status. We describe 2 competing approaches: a 4-step approach, in which factor loadings and thresholds are tested and constrained separately; and a 3-step approach, in which loadings and thresholds are tested and constrained in tandem. Results: Both approaches lead to the same conclusion that the 2 dimensions of the PSS are noninvariant across health status. In the absence of invariance, mean scores on the PSS factors cannot be validly compared across groups, nor should latent variables be used in the hypothesis testing across the 2 groups. Readers are directed to online resources. Conclusions: Careful examination of social work scales is likely to reveal fit or noninvariance problems across some groups. Use of appropriate methods for invariance testing will reduce misuse of measures in practice and improve the rigor and quality of social work publications

Overview of Child Development Accounts in Developing Countries

Child Development Accounts (CDAs) as a matter of policy have existed for some time, though predominantly in developed countries. While there are at least a few government social programs with CDA components in the developing world, such policies have yet to gain significant traction. This paper finds that despite this lack of policy movement, CDAs do exist in developing countries in a variety of forms and delivered by a diverse group of institutions. Government-linked institutions (such as savings and post banks); non-governmental institutions (such as credit unions and NGOs); and commercial financial institutions are all innovating in CDA design and delivery. This paper offers a review of how CDAs exist in developing countries, including the types of institutions offering CDAs, and design features and delivery mechanisms common among such accounts. The paper concludes with implications of this analysis for policymakers and researchers

Walking and perceived lack of safety: Correlates and association with health outcomes for people living with HIV in rural Zambia

Introduction: Geographic inaccessibility disproportionately affects health outcomes of rural populations due to lack of suitable transport, prolonged travel time, and poverty. Rural patients are left with few transport options to travel to a health facility. One common option is to travel by foot, which may present additional challenges, such as perceived lack of safety while transiting. We examined the correlates of perceived lack of safety when walking to a health facility and its association with treatment and psychosocial outcomes among adults living with HIV. Methods: Data were collected from 101 adults living with HIV in Eastern Province, Zambia. All participants were receiving antiretroviral therapy at one of two health clinics. Perceived lack of safety was measured by asking respondents whether they felt unsafe traveling to and from the health facility in which they were receiving their HIV care. Outcomes included medication adherence, perceived stress, hope for the future, and barriers to pill taking. Linear and logistic regression methods were used to examine the correlates of perceived safety and its association with health outcomes. Results: Being older, a woman, having a primary education, living farther from a health facility, traveling longer to reach a health facility, and owing money were associated with higher likelihood of feeling unsafe when traveling by foot to health facility. Perceived lack of safety was associated with medication nonadherence, higher level of stress, lower level of agency, and more barriers to pill taking. Conclusions: Perceived lack of safety when traveling by foot to a health facility may be a barrier to better treatment and psychosocial outcomes, especially among rural patients. Practitioners and policymakers should consider implementation of differentiated HIV service delivery models to reduce frequent travel to health facilities and to alleviate ART patients' worry about lack of safety when traveling by foot to a health facility

Parental Involvement\u27s Effects on Academic Performance: Evidence From the YouthSave Ghana Experiment

Research in developed countries suggests that parental involvement is associated with youth academic success, but little is known about this relationship in developing countries. Further, it is unclear which type of parental involvement may impact the academic performance of youth from developing countries. This study examines whether (a) parental involvement at home and in school are meaningfully different constructs in a population of Ghanaian youth and their parents and (b) parental involvement predicts academic performance. Results suggest that parental involvement is a bidimensional construct consists of home and school involvement. The effect of parental involvement on youth academic performance appears to be a function of the type of involvement. Home-based parental involvement is associated positively with academic performance, while school-based parental involvement has a negative association. Parents can model positive attitudes and behaviors toward school and convey the importance of school

The Association of Perceived, Internalized, and Enacted HIV Stigma With Medication Adherence, Barriers to Adherence, and Mental Health Among Young People Living With HIV in Zambia

Few studies have examined the independent effects of different manifestations of HIV stigma experiences on health outcomes among youth living with HIV in low- and middle-income countries. We examined the association of internalized, enacted, and perceived HIV stigmas with medication adherence, self-esteem, depression, and barriers to adherence. Young people living with HIV aged 18-21 years (N = 120) were purposively sampled from two health facilities in Eastern Province, Zambia, and completed self-report measures. Results indicated heterogeneous associations. Internalized HIV stigma was positively associated with depression and negatively associated with adherence, adherence motivation, behavioral adherence skills, and self-esteem. Perceived stigma was negatively associated with self-esteem. No significant association was observed between enacted stigma and health outcomes. The complexity of HIV stigma requires a precise explication of the associations among different HIV stigma experiences and outcomes, which can inform the development of stigma reduction interventions targeting one or more stigma experiences

How Do Student and School Characteristics Influence Youth Academic Performance in Ghana? A Hierarchical Linear Modeling of Baseline Data From the YouthSave Ghana Experiment

Student and school characteristics are associated with academic performance of high school students. However, few attempts have been made to examine the simultaneous influence of student and school factors on academic performance of youth in sub-Saharan Africa. Using hierarchical linear modeling, we examine student- and school- level predictors of academic performance of Ghanaian junior high school students. As other researchers have found, we note that age and gender are significant predictors of academic performance. Student traits, including academic self-efficacy and commitment to school, are positively associated with math and English scores. Class size and presence of a toilet facility are significant predictors of English scores. No school-level characteristic is significantly associated with math performance. Through this study, we suggest that student characteristics have more impact on youth’s academic performance than school characteristics

The Impact of Household Possessions on Youth\u27s Academic Achievement in the Ghana YouthSave Experiment

Households play an important role in youth’s academic achievement. Household assets as part of youth’s family background have been found to have a significant impact on youth’s academic achievement. In this study, the impact of household possessions on youth’s academic achievement in the Ghana YouthSave experiment is investigated. Findings support the hypothesized positive direction of the impact of household possessions on academic achievement of youth. Using propensity score optimal matching and matching estimators, results show youth from households that reported owning at least one of the five household items measured scored almost 1 unit higher on English than their peers from households that do not own any. However, results indicate ownership of household possessions do not have a statistically significant impact on Math scores of youth in the Ghana YouthSave experiment. Although the impact of ownership of household possessions on English scores is consistent across different tests used in this study, the impact of ownership of household possessions on Math scores is less conclusive. Policy implications are discussed

Prevalence and contributing factors to recurrent binge eating and obesity among black adults with food insufficiency: findings from a cross-sectional study from a nationally-representative sample

Background: Living in a food-insecure or food insufficient household may increase risk for binge eating and obesity. Because racial disparities in food access, obesity, and access to treatment for disordered eating exist, it is important to examine these relationships in Black populations. Methods: We conducted a secondary analysis of data from the National Survey of American Life (N = 4553), a nationally- representative sample of Black Americans, including African Americans and Afro-Caribbeans. Logistic regression was used to explore the association of food insufficiency with obesity and binge eating. Results: In the total sample of Black Americans, the prevalence of food insufficiency was 10.9% (95% CI 10.0–11.8%). Food insufficiency was not significantly associated with obesity in Black Americans, but when associations were explored in analyses stratified by ethnicity and sex, food insufficiency significantly predicted an increased odds of obesity in Afro-Caribbeans (odds ratio [OR] = 1.47, 95% CI 1.01, 2.13). Individuals experiencing food insufficiency were more likely to report recurrent binge eating in the last 12 months (3% v 2%, P = 0.02) and a lifetime history of binge eating (6% v 3%, P = 0.004) compared to those who were food sufficient. After adjusting for socio-demographic factors, food insufficiency was not significantly associated with recurrent binge eating in Black Americans or in sex- and ethnicity-stratified analyses. Conclusion: The present study reveals a more complex relation between food insufficiency and binge eating than previously thought—although an association existed, it was attenuated by an array of sociodemographic factors. Our results also underscore the importance of considering ethnicity as different patterns emerged between African American and Afro-Caribbean participant

Determinants of saving among low-income individuals in rural Uganda: Evidence from AssetsAfrica.

Although research has shown that poor people in sub-Saharan Africa (SSA), including those living in rural areas save, little is known about the factors that influence saving and asset accumulation among this population. Using three theoretical perspectives on saving and asset accumulation, this study examines the broader determinants of saving and asset accumulation among low-income individuals in rural Uganda. Compared with the individual-oriented and sociological perspectives, institutional theory explains a large part of the variance in saving outcome among rural, low-income households. Wealth, proximity to financial institutions, financial education, and financial incentives are positively associated with higher saving performance. Findings suggest that poor people can and do save, particularly when institutional barriers to saving are removed. Institutional structures, which encourage low-income individuals to save, may contribute to a poverty reduction policy that shifts from just income supplementation to a more inclusive wealth promotion policy that assists people in creating their own pathways out of poverty