Mahua Mandal

From Family to Friends: Does Witnessing Interparental Violence Affect Young Adults' Relationships With Friends?

PURPOSE Childhood exposure to violence in ones family of origin has been closely linked to subsequent perpetration and victimization of intimate partner violence. There is, however, little research on the relationship between witnessing violence and subsequent peer violence. This study investigates the effects of witnessing interparental violence among Filipino young adults on their use and experience of psychological aggression with friends. METHODS The data source for this study was the Cebu Longitudinal Health and Nutrition Survey. Recent perpetration and victimization of friend psychological aggression among young adults ages 21-22 years was assessed through self-reports from the 2005 survey; witnessing interparental violence during childhood was assessed through self-reports from the 2002 survey. Multinomial logistic regression was used to examine the effects of witnessing interparental violence on subsequent use and experience of friend psychological aggression. Analyses were stratified by gender. RESULTS About 13% of females and 4% of males perpetrated psychological aggression toward close friends, and about 4% of females and males were victims. Fourteen percent of females and 3% of males experienced bidirectional psychological aggression. About 44% of females and 47% of males had, during childhood, witnessed their parents physically hurt one another. Witnessing maternal and reciprocal interparental violence during childhood significantly predicted bidirectional friend psychological aggression among males. Among females, witnessing interparental violence did not significantly predict involvement with friend psychological aggression. CONCLUSIONS Violence prevention programs should consider using family-centered interventions, and apply a gendered lens to their application. Further research on gender differences in friend aggression is recommended.

Changes in state policies related to oral health in the United States, 2002‐2009

OBJECTIVES Examining state policies in oral health, including changes over time, helps inform the degree to which states fulfill public health dentistry functions and deliver essential services. This study examines changes in state policies affecting oral health in the United States between 2002 and 2009. METHODS We reviewed 43 oral health policies in three domains (public dental insurance; workforce capacity; and infrastructure, programs, and surveillance). Data sources included federal, state, and private foundation reports and databases. Fifteen of 43 policies had data available for both time points and were analyzed. We examined national and regional changes over time using McNemars test and Wilcoxon matched pairs signed ranks test. RESULTS Between 2002 and 2009, the number of states offering Medicaid reimbursement to nondental professionals increased, more states had 12-month continuous coverage in CHIP, income eligibility for children on Medicaid expanded, and the number of licensed dentists per 10,000 population per state increased. However, the percent of public and private state health expenditures going toward dental services declined. Though nationally no other state policies significantly changed, the proportion of population on public water system with fluoridated water increased in Western states, and administration of needs assessments or oral health surveys decreased in the Northeast. CONCLUSION Efforts are needed to systematically track the status of state policies to promote the publics oral health. Further research can determine if changes in state policies have led to improvements in the provision of oral health services and oral health status and reductions in disparities.

Gender counts: A systematic review of evaluations of gender-integrated health interventions in low- and middle-income countries

ABSTRACT As a result of new global priorities, there is a growing need for high-quality evaluations of gender-integrated health programmes. This systematic review examined 99 peer-reviewed articles on evaluations of gender-integrated (accommodating and transformative) health programmes with regard to their theory of change (ToC), study design, gender integration in data collection, analysis, and gender measures used. Half of the evaluations explicitly described a ToC or conceptual framework (n = 50) that guided strategies for their interventions. Over half (61%) of the evaluations used quantitative methods exclusively; 11% used qualitative methods exclusively; and 28% used mixed methods. Qualitative methods were not commonly detailed. Evaluations of transformative interventions were less likely than those of accommodating interventions to employ randomised control trials. Two-thirds of the reviewed evaluations reported including at least one specific gender-related outcome (n = 18 accommodating, n = 44 transformative). To strengthen evaluations of gender-integrated programmes, we recommend use of ToCs, explicitly including gender in the ToC, use of gender-sensitive measures, mixed-method designs, in-depth descriptions of qualitative methods, and attention to gender-related factors in data collection logistics. We also recommend further research to develop valid and reliable gender measures that are globally relevant.

Evaluations of Structural Interventions for HIV Prevention: A Review of Approaches and Methods

Structural interventions alter the social, economic, legal, political, and built environments that underlie processes affecting population health. We conducted a systematic review of evaluations of structural interventions for HIV prevention in low- and middle-income countries (LMICs) to better understand methodological and other challenges and identify effective evaluation strategies. We included 27 peer-reviewed articles on interventions related to economic empowerment, education, and substance abuse in LMICs. Twenty-one evaluations included clearly articulated theories of change (TOCs); 14 of these assessed the TOC by measuring intermediary variables in the causal pathway between the intervention and HIV outcomes. Although structural interventions address complex interactions, no evaluation included methods designed to evaluate complex systems. To strengthen evaluations of structural interventions, we recommend clearly articulating a TOC and measuring intermediate variables between the predictor and outcome. We additionally recommend adapting study designs and analytic methods outside traditional epidemiology to better capture complex results, influences external to the intervention, and unintended consequences.

Methodology and baseline results from the evaluation of a sexuality education activity in mpumalanga and KwaZulu-Natal, South Africa

In South Africa, adolescents and young adults (ages 15-24) are at risk of HIV, sexually transmitted infections, and unintended pregnancies. Recently, the Department of Basic Education has revised its sexuality education content and teaching strategies (using scripted lessons plans) as part of its life orientation curriculum. This paper presents the methodology and baseline results from the evaluation of the scripted lesson plans and supporting activities. A rigorous cluster-level randomized design with random assignment of schools as clusters is used for the evaluation. Baseline results from grade 8 female and male learners and grade 10 female learners demonstrate that learners are at risk of HIV and early and unintended pregnancies. Multivariable analyses demonstrate that household-level food insecurity and living with an HIV-positive person are associated with sexual experience and pregnancy experience. Implications are discussed for strengthening the current life orientation program for future scale-up by the government of South Africa.

A review of measures of women’s empowerment and related gender constructs in family planning and maternal health program evaluations in low- and middle-income countries

BackgroundEvidence suggests that gender-integrated interventions, which actively seek to identify and integrate activities that address the role of gender norms and dynamics, improve family planning (FP) and maternal health (MH). To understand the link between the gender components of interventions and FP and MH outcomes, it is critical to examine the gender measures used in evaluations.MethodsWe conducted a systematic review of evaluations of gender-integrated FP and MH interventions in low- and middle-income countries. We examine characteristics of the interventions and their evaluations, and summarize women’s empowerment and related gender measures.ResultsOut of 16 evaluation articles, five reported the theoretical or conceptual model that guided the intervention. Twelve described how gender was quantitatively measured and identified 13 women’s empowerment and related gender constructs. Gender scales or indexes were used in five evaluations, three of which noted that their scales had been validated. Less than one third of articles reported examining the effect of gender on FP or MH.ConclusionsEvaluations of gender-integrated FP and MH interventions do not consistently describe how gender influences FP and MH outcomes or include validated gender measures within their studies. As a result, examining the pathways through which interventions empower women and the manner in which women’s empowerment leads to changes in FP and MH outcomes remains a challenge. Valid measures of commonly reported women’s empowerment and gender constructs, such as gender-equitable attitudes and women’s decision-making power, must be adapted and used within evaluations to examine how empowerment and improvements in gender-related factors can produce positive FP and MH outcomes.