Three Essays Analyzing the Impact of Community and Neighborhood Factors on Intimate Partner Violence against Women in Uganda

The overall aim of the proposed dissertation is to enhance understanding of the impact of the community and neighborhood in preventing violence against women, and how women who have been displaced from their communities may be at increased risk of violence. This three-paper dissertation utilized secondary data sources from two studies of IPV against women in Uganda: the SASA! Study and the Ugandan Demographic and Health Study (UDHS). The first paper used quantitative data from the baseline of the SASA! study (a cluster randomized controlled trial of a community-based intervention to prevent violence against women and HIV/AIDS, called SASA!), a representative sample of community members in two districts in Kampala. This study hypothesized that women who live in neighborhoods with higher levels of collective efficacy to prevent IPV would be at decreased risk of experiencing male-perpetrated IPV. Using a multi-level logistics model, there was no significant neighborhood effect on intimate partner violence related to collective efficacy or otherwise. However, women with higher levels of self-efficacy to prevent IPV against others were significantly less likely to experience physical IPV themselves. Other fixed effect factors, including younger age, no education, higher number of children, having no electricity, not earning an income, and partner's daily alcohol use significantly predicted women's risk of IPV. Potential research and practice implications will be discussed. The second paper utilized secondary analyses of the impact of displacement on IPV against women from the Demographic and Health Survey, a representative community sample of women throughout Uganda. Using propensity score matching, this study attempts to determine the causal effect of displacement on women's experiences of intimate partner violence. Given that assumptions hold, the results indicate that women who are displaced in northern Uganda are less likely to experience IPV than if they had not been displaced. Potential explanations for these findings, such as the renegotiation of gender during displacement and the impact of the humanitarian Cluster Approach, will be discussed. The third paper is an in-depth qualitative study using secondary analysis of focus groups with community leaders in Kampala Uganda, also from the baseline of the SASA! study. Key findings using framework analysis of focus group discussions with religious leaders, sengas/traditional aunties, health care workers, police and local council leaders suggest a widely held justification for violence against women based on an underlying cultural belief in men's authority over women and expectations on women. The belief in men's power over women manifests in three, interrelated themes: men's authority, blaming women, and controlling women's sexuality. Few dissenting voices argued against violence against women for reasons related to the impact on the children and the need for women and men to live with peace and happiness in the home. Overall, despite numerous justifications for violence against women, community leaders expressed a strong sense of responsibility in responding to violence against women, particularly in life threatening situations. Suggested strategies for intervening in situations of violence against women in the home included recruiting elders, talking to the men about the violence, calling upon help from local council leaders, and reporting to the police. These suggested strategies were not, however, without underlying sentiments of men's authority and associated risks faced by community leaders. Community leaders also expressed a sense of responsibility in helping organize community members for prevention activities, although they did not see their role as leaders or facilitators of these efforts

Mental Health Research in the Global Era: Training the Next Generation

Psychiatric disorders are among the leading cause of disability worldwide, yet fewer than 25 % of affected individuals are estimated to have access to treatment. In many low-income settings, it is estimated that less than 10 % of affected individuals are able to access basic mental health care and, even when they do, it is often below minimum ethical and clinical standards. The discipline of global mental health is dedicated to reducing mental health disparities within and between countries by preventing mental disorders and improving access to psychiatric treatment, particularly in low-resource settings. The global partnership model for mental health research is based on the idea that investigators from high- and low-resource settings work collaboratively to identify and address barriers and facilitators to mental well-being across diverse settings

The “Batman Effect”: Improving Perseverance in Young Children

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138336/1/cdev12695.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/138336/2/cdev12695_am.pd

The impact of a microsavings intervention on reducing violence against women engaged in sex work: a randomized controlled study

Background Women who engage in sex work are at risk for experiencing violence from numerous perpetrators, including paying partners. Empirical evidence has shown mixed results regarding the impact of participation in microfinance interventions on women’s experiences of violence, with some studies demonstrating reductions in intimate partner violence (IPV) and others showing heightened risk for IPV. The current study reports on the impact of participation in a microsavings intervention on experiences of paying partner violence among women engaged in sex work in Mongolia. Methods Between 2011 and 2013, we conducted a two-arm, non-blinded randomized controlled trial (RCT) comparing an HIV/STI risk reduction intervention (HIVSRR) (control condition) to a combined microsavings and HIVSRR intervention (treatment condition). Eligible women (aged 18 or older, reported having engaged in unprotected sex with paying partner in past 90 days, expressed interest in microsavings intervention) were invited to participate. One hundred seven were randomized, including 50 in the control and 57 in the treatment condition. Participants completed assessments at baseline, immediate post-test following HIVSRR, and at 3-months and 6-months after completion of the treatment group intervention. Outcomes for the current study include any violence (physical and/or sexual), sexual violence, and physical violence from paying partners in the past 90 days. Results An intention-to-treat approach was utilized. Linear growth models revealed significant reductions over time in both conditions for any violence (β = −0.867, p < 0.001), physical violence (β = −0.0923, p < 0.001), and sexual violence (β = −1.639, p = 0.001) from paying partners. No significant differences between groups were found for any violence (β = 0.118, p = 0.389), physical violence (β = 0.091, p = 0.792), or sexual violence (β = 0.379, p = 0.114) from paying partners. Conclusions Microsavings participation did not significantly impact women’s risk for paying partner violence. Qualitative research is recommended to understand the cause for reductions in paying partner violence in both study conditions

Reducing Intimate and Paying Partner Violence Against Women Who Exchange Sex in Mongolia

Women who exchange sex for money or other goods, that is, female sex workers, are at increased risk of experiencing physical and sexual violence from both paying and intimate partners. Exposure to violence can be exacerbated by alcohol use and HIV/STI risk. The purpose of this study is to examine the efficacy of a HIV/STI risk reduction and enhanced HIV/STI risk reduction intervention at decreasing paying and intimate partner violence against Mongolian women who exchange sex and engage in harmful alcohol use. Women are recruited and randomized to either (a) four sessions of a relationship-based HIV/STI risk reduction intervention (n = 49), (b) the same HIV/STI risk reduction intervention plus two additional motivational interviewing sessions (n = 58), or (c) a four session control condition focused on wellness promotion (n = 59). All the respondents complete assessments at baseline (preintervention) as well as at immediate posttest, 3 and 6 months postintervention. A multilevel logistic model finds that women who participated in the HIV/STI risk reduction group (OR = 0.14, p < .00), HIV/STI risk reduction and motivational interview group (OR = 0.46, p = .02), and wellness (OR = 0.20, p < .00) group reduced their exposure to physical and sexual violence in the past 90 days. No significant differences in effects are observed between conditions. This study demonstrates the efficacy of a relationship-based HIV/STI risk reduction intervention, a relationship-based HIV/STI risk reduction intervention combined with motivational interviewing, and a wellness promotion intervention in reducing intimate and paying partner violence against women who exchange sex in Mongolia. The findings have significant implications for the impact of minimal intervention and the potential role of peer networks and social support in reducing women’s experiences of violence in resource poor settings

Physical and sexual violence, childhood sexual abuse and HIV/STI risk behaviour among alcohol-using women engaged in sex work in Mongolia

Although the prevalence of human immunodeficiency virus (HIV) in Mongolia is low, it could increase without strategic prevention strategies. Female sex workers (FSWs) often experience barriers to prevention, including interpersonal violence. This study investigated if childhood sexual abuse (CSA) or recent physical or sexual violence was associated with HIV sexual risk behaviours and if CSA modified associations between recent violence and HIV sexual risk behaviours. Two-hundred twenty-two women who (1) were at least 18 years old and clients at the National AIDS Foundation; (2) reported vaginal or anal sex in the past 90 days in exchange for money or goods and (3) met criteria for harmful alcohol use in the past year were enrolled. In-person interviews assessed sexual risk behaviours and violence in childhood and adulthood. Negative binomial regression, ordinary least squares regression and modified Poisson regression were performed. Sexual risk with paying partners was associated with penetrative CSA and sexual violence by paying partners. CSA and recent violence were not associated with sexual risk behaviours with intimate partners. CSA modified the association between recent sexual violence and unprotected sex with intimate partners. Findings highlight the need for integrated violence and sexual risk reduction services to ensure safe and effective prevention for FSWs

Experiences and Perspectives of Polycystic Kidney Disease Patients following a Diet of Reduced Osmoles, Protein, and Acid Precursors Supplemented with Water:A Qualitative Study

Background Salt, protein, acid precursors, and fluid intake have been identified as factors that influence cyst growth in ADPKD. Unfortunately, the feasibility of following these dietary restrictions/enhancements from a patient's point-of-view has yet to be studied. The purpose of this study is to understand better the experiences of patients following a relatively complex dietary prescription targeting these factors. Methods Twelve adults with ADPKD and kidney function >30ml/min/1.73m(2) were recruited from the University of Kansas Medical Center Polycystic Kidney Disease clinic. In a qualitative design, semi-structured interviews of participants were conducted following a four week dietary intervention (experimental diet lower in sodium, protein, and acid precursors, and supplemented with water) either face-to-face or by telephone. All interviews were recorded, transcribed verbatim, and checked for accuracy. Transcripts were analyzed thematically for emerging themes. Results Participants reported that eating less meat and more fruits and vegetables were the easiest components of the diet, whereas reaching the daily goal amount of fruits and vegetables and tracking the diet constantly were the most difficult components. Participants had little difficulty with fluid intake and reported the prescribed fluid goal as achievable. The tracking system for fruits and vegetables and protein was reported to be both helpful and intuitive, but tracking their intake on paper was tedious. Eating out was the most significant barrier to following the diet with some individuals avoiding restaurants in order to comply with the dietary prescription. Conclusion Participants on the experimental diet heightened their awareness of the consumption of dietary salt, protein, acid precursors, and fluid intake. Additionally, most participants believed adherence to the prescribed diet was feasible. However, participants wanted less cumbersome ways to track and monitor the diet, especially given that the prescribed diet is designed for lifelong adherence. Future studies should focus on targeting these specific dietary factors in larger groups of more ethnically and culturally diverse populations to help inform clinicians and how best to help diverse populations adhere to the dietary intervention

Finishing a whole-genome shotgun: Release 3 of the Drosophila melanogaster euchromatic genome sequence

BACKGROUND: The Drosophila melanogaster genome was the first metazoan genome to have been sequenced by the whole-genome shotgun (WGS) method. Two issues relating to this achievement were widely debated in the genomics community: how correct is the sequence with respect to base-pair (bp) accuracy and frequency of assembly errors? And, how difficult is it to bring a WGS sequence to the accepted standard for finished sequence? We are now in a position to answer these questions. RESULTS: Our finishing process was designed to close gaps, improve sequence quality and validate the assembly. Sequence traces derived from the WGS and draft sequencing of individual bacterial artificial chromosomes (BACs) were assembled into BAC-sized segments. These segments were brought to high quality, and then joined to constitute the sequence of each chromosome arm. Overall assembly was verified by comparison to a physical map of fingerprinted BAC clones. In the current version of the 116.9 Mb euchromatic genome, called Release 3, the six euchromatic chromosome arms are represented by 13 scaffolds with a total of 37 sequence gaps. We compared Release 3 to Release 2; in autosomal regions of unique sequence, the error rate of Release 2 was one in 20,000 bp. CONCLUSIONS: The WGS strategy can efficiently produce a high-quality sequence of a metazoan genome while generating the reagents required for sequence finishing. However, the initial method of repeat assembly was flawed. The sequence we report here, Release 3, is a reliable resource for molecular genetic experimentation and computational analysis