The long-term impact of the MEMA kwa Vijana adolescent sexual and reproductive health intervention: effect of dose and time since intervention exposure.

BACKGROUND: Despite recent decreases in HIV incidence in many sub-Saharan African countries, there is little evidence that specific behavioural interventions have led to a reduction in HIV among young people. Further and wider-scale decreases in HIV require better understanding of when behaviour change occurs and why. The MEMA kwa Vijana adolescent sexual and reproductive health intervention has been implemented in rural Mwanza, Tanzania since 1999. A long-term evaluation in 2007/8 found that the intervention improved knowledge, attitudes to sex and some reported risk behaviours, but not HIV or HSV2 prevalence. The aim of this paper was to assess the differential impact of the intervention according to gender, age, marital status, number of years of exposure and time since last exposure to the intervention. METHODS: In 2007, a cross-sectional survey was conducted in the 20 trial communities among 13,814 young people (15-30 yrs) who had attended intervention or comparison schools between 1999 and 2002. Outcomes for which the intervention had an impact in 2001 or 2007 were included in this subgroup analysis. Data were analysed using cluster-level methods for stratified cluster-randomised trials, using interaction tests to determine if intervention impact differed by subgroup. RESULTS: Taking into account multiplicity of testing, concurrence with a priori hypotheses and consistency within the results no strong effect-modifiers emerged. Impact on pregnancy knowledge and reported attitudes to sex increased with years of exposure to high-quality intervention. CONCLUSIONS: The desirable long-term impact of the MEMA kwa Vijana intervention did not vary greatly according to the subgroups examined. This suggests that the intervention can have an impact on a broad cross-section of young people in rural Mwanza. TRIAL REGISTRATION: ClinicalTrials.gov NCT00248469

Building community resilience in a context of climate change : The role of social capital

Acknowledgements This research was funded by the UK Research and INNOVATION Economic and Social Research Council award number ES/J500136/1.Peer reviewedPublisher PD

Healthy country, healthy people: the relationship between Indigenous health status and "caring for country"

Objective: To investigate associations between “caring for country” — an activity that Indigenous peoples assert promotes good health — and health outcomes relevant to excess Indigenous morbidity and mortality.Design, setting and participants: Cross-sectional study involving 298 Indigenous adults aged 15–54 years in an Arnhem Land community, recruited from March to September 2005.Main outcome measures: Self-reported involvement in caring for country, health behaviours and clinically measured body mass index (BMI), waist circumference, blood pressure, type 2 diabetes status, albumin to creatinine ratio (ACR), levels of glycated haemoglobin (HbA1c) and high-density lipoprotein (HDL) cholesterol, lipid ratio, score on the five-item version of the Kessler Psychological Distress Scale (K5), and 5-year cardiovascular disease (CVD) risk.Results: Controlling for sociodemographic characteristics and health behaviours, multivariate regression revealed significant and substantial associations between caring for country and health outcomes. An interquartile range rise in the weighted composite caring-for-country score was significantly associated with more frequent physical activity, better diet, lower BMI (regression coefficient [b] = − 2.83; 95% CI, − 4.56 to − 1.10), less abdominal obesity (odds ratio [OR], 0.43; 95% CI, 0.26–0.72), lower systolic blood pressure (b = − 7.59; 95% CI, − 12.01 to − 3.17), less diabetes (OR, 0.12; 95% CI, 0.03–0.52), lower HbA1c level (b = − 0.45; 95% CI, − 0.79 to − 0.11), non-elevated ACR (OR, 0.28; 95% CI, 0.13–0.60), higher HDL cholesterol level (b = 0.06; 95% CI, 0.01–0.12), lower K5 score (b = − 0.97; 95% CI, − 1.64 to − 0.31) and lower CVD risk (b = − 0.77; 95% CI, − 1.43 to − 0.11).Conclusions: Greater Indigenous participation in caring for country activities is associated with significantly better health. Although the causal direction of these associations requires clarification, our findings suggest that investment in caring for country may be a means to foster sustainable economic development and gains for both ecological and Indigenous peoples’ health

Improving response rates using a monetary incentive for patient completion of questionnaires: an observational study

Background: Poor response rates to postal questionnaires can introduce bias and reduce the statistical power of a study. To improve response rates in our trial in primary care we tested the effect of introducing an unconditional direct payment of 5 pound for the completion of postal questionnaires. Methods: We recruited patients in general practice with knee problems from sites across the United Kingdom. An evidence-based strategy was used to follow-up patients at twelve months with postal questionnaires. This included an unconditional direct payment of 5 pound to patients for the completion and return of questionnaires. The first 105 patients did not receive the 5 pound incentive, but the subsequent 442 patients did. We used logistic regression to analyse the effect of introducing a monetary incentive to increase the response to postal questionnaires. Results: The response rate following reminders for the historical controls was 78.1% ( 82 of 105) compared with 88.0% ( 389 of 442) for those patients who received the 5 pound payment (diff = 9.9%, 95% CI 2.3% to 19.1%). Direct payments significantly increased the odds of response ( adjusted odds ratio = 2.2, 95% CI 1.2 to 4.0, P = 0.009) with only 12 of 442 patients declining the payment. The incentive did not save costs to the trial - the extra cost per additional respondent was almost 50 pound. Conclusion: The direct payment of 5 pound significantly increased the completion of postal questionnaires at negligible increase in cost for an adequately powered study

How social capital influences community support for alternative water sources

Ensuring future water security requires broad community support for changes in policy, practice, and technology, such as those involved in delivering alternative water schemes. Building community support for alternative water sources may involve a suite of engagement activities, ranging from information campaigns, through to grassroots and participatory approaches. There is increasing recognition that ‘social capital’—the degree of social connectedness, trust, and shared values within a community—is important for building support for pro-environmental policies. However, little research has examined how social capital might influence support for alternative water schemes. We surveyed a representative sample of Australian adults (n\ua0=\ua05194). Support for alternative water sources was examined using a series of questions focusing on stormwater harvesting, desalination, and recycled water. Involvement in community organisations (defined as participation or membership) was used as an indicator of social capital. Using a series of mediation analyses, we identified that community involvement is associated with support for alternative water sources, and that this effect is mediated by (i) stronger water-related social norms, (ii) greater water-related knowledge, and (iii) increased recall of water-related information. Our results also suggest that these indirect effects can be conditional upon location, employment status, life satisfaction, and language spoken within the home. These findings highlight the importance of social capital in building engagement in water-related issues, and specifically, building support for alternative water sources. In addition they highlight potential pathways for the association between social capital and support for alternative water sources for different social groups and communities

On the move: Twentieth anniversary editorial of the European Journal of Cultural Studies

Twenty years of the European Journal of Cultural Studies is a cause for celebration. We do so with a festive issue that comes together with our first free open access top articles in three areas that readers have sought us out for: postfeminism, television beyond textual analysis and cultural labour in the creative industries. The issue opens with freshly commissioned introductory essays to these three thematic areas by key authors in those fields. In addition, the issue offers new articles showcasing the range of the broad field of cultural studies today, including pieces on the politics of co-working, punk in China, Black British women on YouTube, trans-pedagogy and fantasy sports gameplay, featuring work by emerging as well as established scholars. Our editorial introduction to this celebratory issue offers reflections on how both the journal and the field of cultural studies have developed, and on our thoughts and ambitions for the future within the current conjuncture as we ‘move on’ as a new editorial team