Balancing Belligerents or Feeding the Beast: Transforming Conflict Traps

Since the end of the Cold War, recurring civil conflicts have been the dominant form of violent armed conflict in the world, accounting for 70% of conflicts active between 2000-2013. Duration and intensity of episodes within recurring conflicts in Africa exhibit four behaviors characteristic of archetypal dynamic system structures. The overarching questions asked in this study are whether these patterns are robustly correlated with fundamental concepts of resiliency in dynamic systems that scale from micro-to macro levels; are they consistent with theoretical risk factors and causal mechanisms; and what are the policy implications. Econometric analysis and dynamic systems modeling of 36 conflicts in Africa between 1989 -2014 are combined with process tracing in a case study of Somalia to evaluate correlations between state characteristics, peace operations and foreign aid on the likelihood of observed conflict patterns, test hypothesized causal mechanisms across scales, and develop policy recommendations for increasing human security while decreasing resiliency of belligerents. Findings are that observed conflict patterns scale from micro to macro levels; are strongly correlated with state characteristics that proxy a mix of cooperative (e.g., gender equality) and coercive (e.g., security forces) conflict-balancing mechanisms; and are weakly correlated with UN and regional peace operations and humanitarian aid. Interactions between peace operations and aid interventions that effect conflict persistence at micro levels are not seen in macro level analysis, due to interdependent, micro-level feedback mechanisms, sequencing, and lagged effects. This study finds that the dynamic system structures associated with observed conflict patterns contain tipping points between balancing mechanisms at the interface of micro-macro level interactions that are determined as much by factors related to how intervention policies are designed and implemented, as what they are. Policy implications are that reducing risk of conflict persistence requires that peace operations and aid interventions (1) simultaneously increase transparency, promote inclusivity (with emphasis on gender equality), and empower local civilian involvement in accountability measures at the local levels; (2) build bridges to horizontally and vertically integrate across levels; and (3) pave pathways towards conflict transformation mechanisms and justice that scale from the individual, to community, regional, and national levels.

The relationship of early social, mental, and behavioral experiences with adult obesity and Alcohol Use Disorder

Stressful life events early in life, including symptoms of mental disorders or childhood maltreatment, may increase risk for worse mental and physical health outcomes in adulthood. The purpose of this dissertation was to examine the effects of childhood Attention Deficit Hyperactivity Disorder (ADHD) symptoms and maltreatment experience on two adult outcomes: obesity and alcohol use disorder (AUD). Mediational effects of adolescent characteristics were explored. This dissertation used Waves I, III, and IV of the National Longitudinal Study of Adolescent to Adult Health. In Paper 1 (Chapter 3), we investigated the association between multiple types of child maltreatment and adult objective (body mass index; BMI) and subjective (self-rated) obesity, as well as mediating effects by adolescent characteristics including depressive symptoms and BMI. Results showed that after adjusting for sex, race/ethnicity, and maternal education, physical maltreatment was moderately associated with adulthood obesity as measured by BMI and self-reported obesity, while sexual maltreatment was more strongly associated with the objective measure but not the subjective measure. The indirect effects of mediation of adolescent BMI and depressive symptoms were statistically significant. In Paper 2 (Chapter 4), the objective was to examine mediation by adolescent depressive symptoms, alcohol consumption, peer alcohol consumption, and delinquency in the relationship between ADHD symptoms and adult AUD. The indirect effects of mediation of adolescent delinquency, alcohol consumption, and peer alcohol consumption were statistically significant in single and multiple mediator models. In Paper 3 (Chapter 5), the objective was to assess the joint effects of maltreatment/neglect on adult AUD. After adjusting for sex, race/ethnicity, child maltreatment, and parental AUD, ADHD symptoms were significantly associated with increased odds of AUD. There was no strong evidence of multiplicative interaction by maltreatment. This association was stronger for males than females, although the interaction term was not statistically significant. This dissertation adds to the literature by examining relationships between several major public health problems: ADHD symptoms, childhood maltreatment, AUD, depressive symptoms, and obesity. This project has implications for understanding how early life stress increases risk for later physical and mental health problems, and identifying potential intervention targets for adolescents.

CERVIXCHECK: A SPIRITUALLY-BASED SMS TEXT MESSAGING PILOT INTERVENTION TO INCREASE CERVICAL CANCER AWARENESS AND PAP TEST SCREENING INTENTION AMONG AFRICAN AMERICAN WOMEN

African American women account for a disproportionate burden of cervical cancer incidence and mortality rate when compared to non-Hispanic White women. Cervical cancer is one of the most preventable types of cancer, and women can be screened for it with a routine Pap test. Given that religion occupies an essential place in African American lives, framing health messages with important spiritual themes and delivering them through a popular communication delivery channel may allow for a more culturally-relevant and accessible technology-based approach to promoting cervical cancer educational content to African American women. Using community-engaged research as a framework, the purpose of this multiple methods study was to develop, pilot test, and evaluate the feasibility, acceptability, and initial efficacy of a spiritually-based SMS text messaging intervention to increase cervical cancer awareness and Pap test screening intention among African American women. The study recruited church-attending African American women ages 21-65 and was conducted in three phases. Phases 1 and 2 consisted of a series of focus group discussions (n=15), cognitive response interviews (n=8), and initial usability testing that were conducted to inform the intervention development and modifications. Phase 3 utilized a non-experimental one-group pretest-posttest design to pilot test the 16-day text messaging intervention (n=52). Of the individuals enrolled, forty-six completed the posttest (retention rate=88%). Findings provided evidence for the early feasibility, high acceptability, and some initial efficacy of the CervixCheck intervention. There were significant pre-post increases observed for knowledge about cervical cancer and the Pap test (p = .001) and subjective norms (p = .006). Additionally, results post-intervention revealed that 83% of participants reported being either “satisfied” or “very satisfied” with the program and 85% found the text messages either “useful” or “very useful”. 85% of the participants also indicated that they would “likely” or “very likely” share the information they learned from the intervention with the women around them, with 39% indicating that they had already shared some of the information they received with others they knew. A spiritually-based SMS text messaging intervention could be a culturally appropriate and cost-effective method of promoting cervical cancer early detection information to African American women.