The increasing impact of human immunodeficiency virus infections, sexually transmitted diseases, and viral hepatitis in Durham County, North Carolina: a call for coordinated and integrated services.

BACKGROUND: Durham County, North Carolina, faces high rates of human immunodeficiency virus (HIV) infection (with or without progression to AIDS) and sexually transmitted diseases (STDs). We explored the use of health care services and the prevalence of coinfections, among HIV-infected residents, and we recorded community perspectives on HIV-related issues. METHODS: We evaluated data on diagnostic codes, outpatient visits, and hospitalizations for individuals with HIV infection, STDs, and/or hepatitis B or C who visited Duke University Hospital System (DUHS). Viral loads for HIV-infected patients receiving care were estimated for 2009. We conducted geospatial mapping to determine disease trends and used focus groups and key informant interviews to identify barriers and solutions to improving testing and care. RESULTS: We identified substantial increases in HIV/STDs in the southern regions of the county. During the 5-year period, 1,291 adults with HIV infection, 4,245 with STDs, and 2,182 with hepatitis B or C were evaluated at DUHS. Among HIV-infected persons, 13.9% and 21.8% were coinfected with an STD or hepatitis B or C, respectively. In 2009, 65.7% of HIV-infected persons receiving care had undetectable viral loads. Barriers to testing included stigma, fear, and denial of risk, while treatment barriers included costs, transportation, and low medical literacy. LIMITATIONS: Data for health care utilization and HIV load were available from different periods. Focus groups were conducted among a convenience sample, but they represented a diverse population. CONCLUSIONS: Durham County has experienced an increase in the number of HIV-infected persons in the county, and coinfections with STDs and hepatitis B or C are common. Multiple barriers to testing/treatment exist in the community. Coordinated care models are needed to improve access to HIV care and to reduce testing and treatment barriers.

Increasing Motorcycle Taxi Driver Conspicuity in Tanzania

Motorcycle crash related injuries and deaths are increasing rapidly in many African nations. Utilizing conspicuity measures, such as wearing reflective, fluorescent safety vests, are effective as crash prevention strategies. Furthermore, use of some conspicuity measures is mandated by law among motorcycle-taxi drivers in Tanzania. Nonetheless, uptake remains low. Locally appropriate strategies to improve crash preventative behaviors are needed.

To explore whether use of conspicuity measures could be improved through eliminating cost-barriers, we tested a distribution strategy involving the provision of free motorcycle safety vests among a population of motorcycle-taxi drivers in Moshi, Tanzania. We conducted a cluster randomized controlled trial among 180 motorcycle-taxi drivers in which half of the participants (90) were randomized to the intervention arm and received a free reflective vest. The other half of the participants (90) were randomized to the control arm and did not receive free vests. Whether motorcycle taxi drivers used the reflective vest was then unobtrusively observed on city streets over a period of three months.

Mixed-effects logistic regression was used to estimate differential uptake of the vests between trial arms. At baseline, 3.3% of individuals in both arms used a reflective vest. In three months of follow-up, 79 drivers in the intervention arm and 82 drivers in the control arm were able to be observed. In the intervention arm the average proportion of observations during which drivers were observed to be using a reflective vest was 9.5%, compared to 2.0% in the control arm (odds ratio: 5.5, 95% confidence interval: 1.1-26.9, p-value: 0.04). Distribution of free reflective vests did lead to an increase in vest usage, however, the increase was minimal. Removing economic barriers alone appears insufficient to adequately improve adherence to conspicuity measures.

Increasing arousal enhances inhibitory control in calm but not excitable dogs

© 2015, Springer-Verlag Berlin Heidelberg.The emotional-reactivity hypothesis proposes that problem-solving abilities can be constrained by temperament, within and across species. One way to test this hypothesis is with the predictions of the Yerkes–Dodson law. The law posits that arousal level, a component of temperament, affects problem solving in an inverted U-shaped relationship: Optimal performance is reached at intermediate levels of arousal and impeded by high and low levels. Thus, a powerful test of the emotional-reactivity hypothesis is to compare cognitive performance in dog populations that have been bred and trained based in part on their arousal levels. We therefore compared a group of pet dogs to a group of assistance dogs bred and trained for low arousal (N = 106) on a task of inhibitory control involving a detour response. Consistent with the Yerkes–Dodson law, assistance dogs, which began the test with lower levels of baseline arousal, showed improvements when arousal was artificially increased. In contrast, pet dogs, which began the test with higher levels of baseline arousal, were negatively affected when their arousal was increased. Furthermore, the dogs’ baseline levels of arousal, as measured in their rate of tail wagging, differed by population in the expected directions. Low-arousal assistance dogs showed the most inhibition in a detour task when humans eagerly encouraged them, while more highly aroused pet dogs performed worst on the same task with strong encouragement. Our findings support the hypothesis that selection on temperament can have important implications for cognitive performance.

Peer-Informed Learning on Increasing Contraceptive Knowledge Among Women in Rural Haiti

Contraceptive prevalence in Haiti remains low despite extensive foreign aid targeted at improving family planning. [1] Earlier studies have found that peer-informed learning have been successful in promoting sexual and reproductive health. [2-5] This pilot project was implemented as a three-month, community-based, educational intervention to assess the impact of peer education in increasing contraceptive knowledge among women in Fondwa, Haiti. Research investigators conducted contraceptive information trainings to pre-identified female leaders of existing women’s groups in Fondwa, who were recruited as peer educators (n=4). Later, these female leaders shared the knowledge from the training with the test participants in the women’s group (n=23) through an information session. Structured surveys measuring knowledge of contraceptives were conducted with all participants before the intervention began, at the end of the intervention, and four weeks after the intervention. The surveys measured general contraceptive knowledge, knowledge about eight selected types of modern contraceptives and contraceptive preferences and attitudes. Only test participants showed significant improvement in their general contraceptive knowledge score (p<0.001), but both test participants and peer educators showed significant improvement in overall knowledge scores for identifying the types and uses of modern contraceptive methods. Assessment for knowledge retention remained significantly higher four weeks after the intervention than prior to the intervention. Therefore, a one-time, three-hour peer-based educational intervention using existing social structures is effective, and might be valuable in a population with minimal access to education and little to no knowledge about contraceptives.

Making Good Citizens: Policy Approaches to Increasing Civic Participation

In this dissertation, I explore the impact of several public policies on civic participation. Using a unique combination of school administrative and public–use voter files and methods for causal inference, I evaluate the impact of three new, as of yet unexplored, policies: one informational, one institutional, and one skill–based. Chapter 2 examines the causal effect of No Child Left Behind’s performance-based accountability school failure signals on turnout in school board elections and on individuals’ use of exit. I find that failure signals mobilize citizens both at the ballot box and by encouraging them to vote with their feet. However, these increases in voice and exit come primarily from citizens who already active—thus exacerbating inequalities in both forms of participation. Chapter 3 examines the causal effect of preregistration—an electoral reform that allows young citizens to enroll in the electoral system before turning 18, while also providing them with various in-school supports. Using data from the Current Population Survey and Florida Voter Files and multiple methods for causal inference, I (with my coauthor listed below) show that preregistration mobilizes and does so for a diverse set of citizens. Finally, Chapter 4 examines the impact of psychosocial or so called non-cognitive skills on voter turnout. Using information from the Fast Track intervention, I show that early– childhood investments in psychosocial skills have large, long-run spillovers on civic participation. These gains are widely distributed, being especially large for those least likely to participate. These chapters provide clear insights that reach across disciplinary boundaries and speak to current policy debates. In placing specific attention not only on whether these programs mobilize, but also on who they mobilize, I provide scholars and practitioners with new ways of thinking about how to address stubbornly low and unequal rates of citizen engagement.

Mothers but not wives: The increasing lag between nonmarital births and marriage

This study analyzed trends in marital behavior for unwed mothers who gave birth between 1960 and 2004. With nationally representative data on 15,353 White and Black unmarried mothers, results indicated that mothers who gave birth after 1989 were waiting much longer to marry than were mothers giving birth before 1968. The most pronounced delays were found immediately after a birth. Over the study period, the cumulative proportion of women who married within three years of a birth decreased for Whites by 27% and for Blacks by 60%. Findings underscore the separation that has developed between first births and first marriages in the United States, and they highlight the older ages at which children are experiencing a transition to marriage. © National Council on Family Relations, 2011.