In defence of amateurism:on not professionalizing ethnic and racial studies

This piece suggests that the field of ethnic and racial studies is too diverse in theoretical and methodological approach and subject of study to constitute its own discipline. Instead, ethnic and racial studies remains a loosely defined space of interdisciplinary exchange. There is a sense of community among researchers in this field, but teaching continues to be organized to meet the imperatives of different home disciplines. This article argues that in these times of increasing bureaucracy, standardization and managerial intrusion into academic life, there is a positive benefit in retaining a relatively open space of inquiry where we can consider the construction of contemporary social boundaries.

A developmental intervention science outreach research approach to promoting positive youth development

Recent intervention efforts in promoting positive identity in troubled adolescents have begun to draw on the potential for an integration of the self-construction and self-discovery perspectives in conceptualizing identity processes, as well as the integration of quantitative and qualitative data analytic strategies. This study reports an investigation of the Changing Lives Program (CLP), using an Outcome Mediation (OM) evaluation model, an integrated model for evaluating targets of intervention, while theoretically including a Self-Transformative Model of Identity Development (STM), a proposed integration of self-discovery and self-construction identity processes. This study also used a Relational Data Analysis (RDA) integration of quantitative and qualitative analysis strategies and a structural equation modeling approach (SEM), to construct and evaluate the hypothesized OM/STM model. The CLP is a community supported positive youth development intervention, targeting multi-problem youth in alternative high schools in the Miami Dade County Public Schools (M-DCPS). The 259 participants for this study were drawn from the CLP’s archival data file. The model evaluated in this study utilized three indices of core identity processes (1) personal expressiveness, (2) identity conflict resolution, and (3) informational identity style that were conceptualized as mediators of the effects of participation in the CLP on change in two qualitative outcome indices of participants’ sense of self and identity. Findings indicated the model fit the data (χ2 (10) = 3.638, p = .96; RMSEA = .00; CFI = 1.00; WRMR = .299). The pattern of findings supported the utilization of the STM in conceptualizing identity processes and provided support for the OM design. The findings also suggested the need for methods capable of detecting and rendering unique sample specific free response data to increase the likelihood of identifying emergent core developmental research concepts and constructs in studies of intervention/developmental change over time in ways not possible using fixed response methods alone.

Living positive: Life in community among Puerto Rican men living with HIV in Boston

Negative experiences of stigmatization, discrimination, and rejection are common among people living with HIV in the United States, and particularly when they are also members of a minority group. Some three decades after the first cases of AIDS were identified, people infected with HIV continue to be perceived and characterized negatively. While an HIV/AIDS diagnosis is typically associated with negativity, this study investigates the extent to which collective experiences among HIV-positive people result in healthy responses and positive social adjustment. This study is focused on the ways in which HIV-positive Puerto Rican men in Boston live positive despite being diagnosed with HIV. Rather than wrapping themselves in the social stigma of HIV and the isolation that entails, they participate in processes that affirm themselves and their peers. In so doing, they help generate both healthy and meaningful lives for themselves and others. The study examines the process in which Puerto Rican men living with HIV in Boston participate, promote, and reaffirm an HIV community, la comunidad, as a social entity with a unique culture and identity. This study also investigates how this community influences, supports, and encourages the adoption of positive transformations for living long term with HIV. On the basis of nine months of field research, this qualitative study employed both focus groups and interviews with fifty HIV-positive Puerto Rican men in Boston. These men were recruited, using convenience sampling, from different community-based organizations (CBOs) that provide HIV/AIDS services in Boston. The study finds that HIV-positive Puerto Rican men in Boston build community, not in response to social exclusion, but built on shared positive practices and strategies for living healthy with HIV. These men come together to negotiate and form a unique cultural community expressed in norms, beliefs, and practices that, although centered on HIV, are designed for living healthy. These expressions reaffirm a sense of community in everyday settings and transform the lives of these men with positive behaviors and healthy lifestyles. The findings reveal that this transformation takes place in the context of a community, with the support, encouragement, and at times, policing of others. La comunidad is where the lives of these men are transformed as they learn, adopt, and experience living positive with HIV.

Interrole Conflicts in the Hospitality Industry: The Role of Positive Affectivity as an Antidote

This study investigates the role of positive affectivity as a buffer against the detrimental effects of interrole conflicts on frontline hotel employees’ job performance and turnover intentions. Data collected from a sample of frontline hotel employees in Turkey serve as the study setting. Results and their implications are discussed, and directions for future research are offered.

The utility of an Integrated Qualitative /Quantitative Data Analytic Strategy (IQ -DAS) to evaluate the impact of youth development interventions to positive qualitative change in the life course

This study reports one of the first controlled studies to examine the impact of a school based positive youth development program (Lerner, Fisher, & Weinberg, 2000) on promoting qualitative change in life course experiences as a positive intervention outcome. The study built on a recently proposed relational developmental methodological metanarrative (Overton, 1998) and advances in use of qualitative research methods (Denzin & Lincoln, 2000). The study investigated the use the Life Course Interview (Clausen, 1998) and an integrated qualitative and quantitative data analytic strategy (IQ-DAS) to provide empirical documentation of the impact the Changing Lives Program on qualitative change in positive identity in a multicultural population of troubled youth in an alternative public high school. The psychosocial life course intervention approach used in this study draws its developmental framework from both psychosocial developmental theory (Erikson, 1968) and life course theory (Elder, 1998) and its intervention strategies from the transformative pedagogy of Freire's (1983/1970). ^ Using the 22 participants in the Intervention Condition and the 10 participants in the Control Condition, RMANOVAs found significantly more positive qualitative change in personal identity for program participants relative to the non-intervention control condition. In addition, the 2X2X2X3 mixed design RMANOVA in which Time (pre, post) was the repeated factor and Condition (Intervention versus Control), Gender, and Ethnicity the between group factors, also found significant interactions for the Time by Gender and Time by Ethnicity. ^ Moreover, the directionality of the basic pattern of change was positive for participants of both genders and all three ethnic groups. The pattern of the moderation effects also indicated a marked tendency for participants in the intervention group to characterize their sense of self as more secure and less negative at the end of the their first semester in the intervention, that was stable across both genders and all three ethnicities. The basic differential pattern of an increase in the intervention condition of a positive characterization of sense of self relative to both pre test and relative to the directionality of the movement of the non-intervention controls, was stable across both genders and all three ethnic groups. ^

The effect of active student responding in computer -assisted instruction on social -studies learning by students with learning disabilities

The purpose of this study was to compare the effects of three student response conditions during computer-assisted instruction on the acquisition and maintenance of social-studies facts. Two of the conditions required active student responding (ASR), whereas the other required an on-task (OT) response. Participants were five fifth-grade students, with learning disabilities enrolled in a private school. An alternating treatments design with a best treatments phase was used to compare the effects of the response procedures on three major dependent measures: same-day tests, next-day tests, and maintenance tests. ^ Each week for six weeks, participants were provided daily one-to-one instruction on sets of 21 unknown social-studies facts using a hypermedia computer program, with a new set of facts being practiced each week. Each set of 21 facts was divided randomly into three conditions: Clicking-ASR, Repeating-ASR, and Listening-OT. Hypermedia lesson began weekly with the concept introduction lesson, followed by practice and testing. Practice and testing occurred four days per week, per set. During Clicking-ASR, student practice involved the selection of a social-studies response by clicking on an item with the mouse on the hypermedia card. Repeating-ASR instruction required students to orally repeat the social-studies facts when prompted by the computer. During Listening-OT, students listened to the social-studies facts being read by the computer. During weeks seven and eight, instruction occurred with seven unknown facts using only the best treatment. ^ Test results show that all for all 5 students, the Repeating-ASR practice procedure resulted in more social-studies facts stated correctly on same-day tests, next-day tests, and one-and two-week maintenance tests. Clicking-ASR was the next most effective procedure. During the seventh and eighth week of instruction when only the best practice condition was implemented, Repeating-ASR produced higher scores than all conditions (including Repeating-ASR) during the first six weeks of the study. ^ The results lend further support to the growing body of literature that demonstrates the positive relation between ASR and student achievement. Much of the ASR literature has focused on the effects of increased ASR during teacher-led or peer-mediated instruction. This study adds a dimension to that research in that it demonstrated the importance of ASR during computer-assisted instruction and further suggests that the type of ASR used during computer-assisted instruction may influence learning. Future research is needed to investigate the effectiveness of other types of ASR during computer-assisted instruction and to identify other fundamental characteristics of an effective computer-assisted instruction. ^

A meta -analysis of empirical research studies on resilience among students at -risk for school failure

Being at-risk is a growing problem in the U.S. because of disturbing societal trends such as unemployment, divorce, substance abuse, child abuse and neglect, and the new threat of terrorist violence. Resilience characterizes individuals who rebound from or adapt to adversities such as these, and academic resilience distinguishes at-risk students who succeed in school despite hardships. ^ The purpose of this research was to perform a meta-analysis to examine the power of resilience and to suggest ways educators might improve academic resilience, which was operationalized by satisfactory test scores and grades. In order to find all studies that were relevant to academic resilience in at-risk kindergarten through 12th-grade students, extensive electronic and hardcopy searches were conducted, and these resulted in a database of 421 articles. Two hundred eighty seven of these were rejected quickly, because they were not empirical research. Upon further examination, another 106 were rejected for not meeting study protocol criteria. Ultimately, 28 studies were coded for study level descriptors and effect size variables. ^ Protective factors for resilience were found to originate in physical, psychological, and behavioral domains on proximal/intraindividual, transitional/intrafamilial, or distal/extrafamilial levels. Effect sizes (ESs) for these were weighted and the means for each level or category were interpreted by commonly accepted benchmarks. Mean effect sizes for proximal (M = .27) and for transitional (M = .15) were small but significant. The mean effect size for the distal level was insignificant. This supported the hypotheses that the proximal level was the source of most protective factors for academic resilience in at-risk students followed by the transitional level. The distal effect size warranted further research particularly in light of the small number of studies (n = 11) contributing effect sizes to that category. A homogeneity test indicated a search for moderators, i.e., study variables affecting outcomes, was justified. “Category” was the largest moderator. Graphs of weighted mean effect sizes in the physical, psychological, and behavioral domains were plotted for each level to better illustrate the findings of the meta-analysis. Suggestions were made for combining resilience development with aspects of positive psychology to promote resilience in the schools. ^

The effect of reciprocal mapping on high-risk sixth-grade students' social studies achievement

Reading deficits in students in Grades 4 to 12 are evident in American schools. Informational text is particularly difficult for students. This quasi-experimental study (N=138) investigated sixth-grade students' achievement in social studies using the Reciprocal Mapping instructional routine, compared to sixth-grade students' achievement taught with a traditional approach. The Reciprocal Mapping instructional routine incorporated explicit instruction in text structure using graphic organizers. Students created their own graphic organizers and used them to write about social studies content. The comparison group used a traditional approach, students' reading the textbook and answering questions. Students for this study included sixth-graders in the seven sixth-grade classrooms in two public schools in a small, rural south Florida school district. A focus of this study was to determine the helpfulness of the intervention for at-risk readers. To determine students considered to be at-risk, the researcher used data from the reading portion of the Florida Comprehensive Assessment Test (FCAT), 2011-2012, that considers Level 1 and 2 as at-risk readers. The quasi-experimental study used a pretest-posttest control group design, with students assigned to treatment groups by class. Two teachers at the two rural sites were trained on the Reciprocal Mapping instructional routine and taught students in both the experimental and control groups for an equivalent amount of time over a 5-week period. Results of the 3 x 2 factorial ANCOVA found a significant positive difference favoring the experimental group's social studies achievement as compared to that of the comparison group as measured by the pre/post unit test from the social studies series (McGraw-Hill, 2013), when controlling for initial differences in students' reading FCAT scores. Interactions for high-risk struggling readers were investigated using the significance level p < .05. Due to no significant interaction the main effects of treatment were interpreted. The pretest was used as a covariate and the multivariate analysis was found to be significant. Therefore, analysis of covariance was run on each of the dependent variable as a follow-up. Reciprocal Mapping was found to be significant in posttest scores, independent of gender and level of risk, and while holding the pretest scores constant. Findings showed there was a significant difference in the performance of the high-risk reading students taught with the Reciprocal Mapping intervention who scored statistically better than students in the control group. Further study findings showed that teacher fidelity of implementation of the treatment had a statistically significant relationship in predicting posttest scores when controlling for pretest scores. Study results indicated that improving students' use of text structure through the Reciprocal Mapping instructional routine positively supported sixth-grade students' social studies achievement.

The utility of an integrated qualitative/quantitative data analytic strategy (IQ-DAS) to evaluate the impact of youth development interventions on positive qualitative change in the life course

This study reports one of the first controlled studies to examine the impact of a school based positive youth development program (Lerner, Fisher, & Weinberg, 2000) on promoting qualitative change in life course experiences as a positive intervention outcome. The study built on a recently proposed relational developmental methodological metanarrative (Overton, 1998) and advances in use of qualitative research methods (Denzin & Lincoln, 2000). The study investigated the use the Life Course Interview (Clausen, 1998) and an integrated qualitative and quantitative data analytic strategy (IQDAS) to provide empirical documentation of the impact the Changing Lives Program on qualitative change in positive identity in a multicultural population of troubled youth in an alternative public high school. The psychosocial life course intervention approach used in this study draws its developmental framework from both psychosocial developmental theory (Erikson, 1968) and life course theory (Elder, 1998) and its intervention strategies from the transformative pedagogy of Freire's (1983/1970). Using the 22 participants in the Intervention Condition and the 10 participants in the Control Condition, RMANOVAs found significantly more positive qualitative change in personal identity for program participants relative to the non-intervention control condition. In addition, the 2X2X2X3 mixed design RMANOVA in which Time (pre, post) was the repeated factor and Condition (Intervention versus Control), Gender, and Ethnicity the between group factors, also found significant interactions for the Time by Gender and Time by Ethnicity. Moreover, the directionality of the basic pattern of change was positive for participants of both genders and all three ethnic groups. The pattern of the moderation effects also indicated a marked tendency for participants in the intervention group to characterize their sense of self as more secure and less negative at the end of the their first semester in the intervention, that was stable across both genders and all three ethnicities. The basic differential pattern of an increase in the intervention condition of a positive characterization of sense of self relative to both pre test and relative to the directionality of the movement of the non-intervention controls, was stable across both genders and all three ethnic groups.

Independent Projects Environmental Studies 2010: From Climate Change Laggard to Leader: Policy recommedations for Newfoundland and Labrador

Dyer, along with many others reflecting international consensus in the scientific community, argues that countries must be carbon neutral by 2050 to avoid the worst impacts of climate change (Dyer, 2008, p. xii). to accomplish this by 2050, we need to act now: governments need to cooperate with the scientific community to ensure our society makes the changes to combat climate change. How is Canada reacting to this situation? As describes by the Sierra Club of Canada, "federal government continues to drag its feet, and delay any action to reduce emissions" (2008, p. 18). Given this federal reluctance, individual provinces must act to reduce emissions. While some provinces take a required action, primarily Quebec and British Columbia, others, like Newfoundland and Labrador, contribute little in terms of emissions reductions. Newfoundland and Labrador is ranked as "poor"-among the worst performers regarding climate change policy in the country-by the David Suzuki Foundation in a cross Canada evaluation of various provincial climate change policies (David Suzuki Foundation, 2008, p. 9). The Province of Newfoundland is not doing enough to address climate change. In this paper I argue that to improve this situation, the province could follow the example of the two leading jurisdictions, Quebec and British Columbia, to refine and introduce its own hybrid policy that directly affects decision making processes. But, this can be complicated when convincing the government that it is important to accept stronger policy. The government must consider what climate change impacts Newfoundland and Labrador experiences and willconinue to experience and what Newfoundland and Labrador is contributing to the problem of climate change. To evaluate these issues of climate change, I first survey the positive policies Newfoundland and Labrador is currently implementing/ discussing and then outline action taken by the provincial environment leaders, Quebec and British Columbia.Then I describe the strong pieces in the Quebec and British Columbia climate change action plan that Newfoundland and Labrador can emulate. Finally, I consider if thes polices are politically feasible for the government of Newfoundland and labrador. Hence, this paper aims to give a blueprint of what Newfoundland and Labrador has to act on to make itself an environmental leader.

Student Independent Projects Environmental Studies 2011: Creating Federal Policies to Support Environmental Education in Canada.

Environmental Education is an essential component of childhood education and can play a vital role in the development of positive environmental attitudes, community involvement and environmental awareness. One of the main challenges faced by Canadian educators is the lack of support and funding to fully engage and participate in Environmental Education programs that are locally available. To better understand the viewpoint and challenges of educators and Environmental Education programs, this paper includes an interview series with three Environmental Education leaders, followed by a discussion section on significant commonalities. Through the research of peer-reviewed literature, federal documents, and environmental networks, this research paper aims to interpret the development and challenges of K-12 environmental education in North America as well as to review the established programs, networks, and resources availble to Canadian educators.

Barriers and facilitators to asthma self-management in adolescents:a systematic review of qualitative and quantitative studies

BACKGROUND: Many adolescents have poor asthma control and impaired quality of life despite the availability of modern pharmacotherapy. Research suggests that poor adherence to treatment and limited engagement in self-management could be contributing factors. OBJECTIVE: To conduct a systematic review of the barriers and facilitators to self-management of asthma reported by adolescents using a narrative synthesis approach to integrate the findings. DESIGN: MEDLINE, EMBASE, CINAHL, and PsycINFO were searched for all types of study design. Full papers were retrieved for study abstracts that included data from participants aged 12-18 years referring to barriers or facilitators of asthma self-management behaviors. RESULTS: Sixteen studies (5 quantitative and 11 qualitative) underwent data extraction, quality appraisal, and thematic analysis. Six key themes were generated that encompassed barriers and/or facilitators to self-management of asthma in adolescents: Knowledge, Lifestyle, Beliefs and Attitudes, Relationships, Intrapersonal Characteristics, and Communication. CONCLUSIONS: There is a pressing need to prepare adolescents for self-management, using age-appropriate strategies that draw on the evidence we have synthesized. Current clinical practice should focus on ensuring adolescents have the correct knowledge, beliefs, and positive attitude to self-manage their illness. This needs to be delivered in a supportive environment that facilitates two-way communication, fosters adolescents' self-efficacy to manage their disease, and considers the wider social influences that impinge on self-management. Pediatr Pulmonol. 2016; 9999:XX-XX. © 2016 Wiley Periodicals, Inc.

Biochemical and Structural Studies on PrfA, the Transcriptional Regulator of Virulence in Listeria monocytogenes

Abstract

Listeria monocytogenes is a gram-positive soil saprophytic bacterium that is capable of causing fatal infection in humans. The main virulence regulator PrfA, a member of the Crp/FNR family of transcriptional regulators, activates the expression of essential proteins required for host cell invasion and cell-to-cell spread. The mechanism of PrfA activation and the identity of its small molecule coactivator have remained a mystery for more than 20 years, but it is hypothesized that PrfA shares mechanistic similarity to the E. coli cAMP binding protein, Crp. Crp activates gene expression by binding cAMP, increasing the DNA binding affinity of the protein and causing a significant DNA bend that facilitates RNA polymerase binding and downstream gene activation. Our data suggests PrfA activates virulence protein expression through a mechanism distinct from the canonical Crp activation mechanism that involves a combination of cysteine residue reduction and glutathione (GSH) binding.

Listeria lacking glutathione synthase (ΔgshF) is avirulent in mice; however virulence is rescued when the bacterium expresses the constitutively active PrfA mutant G145S. Interestingly, Listeria expressing a PrfA mutant in which its four cysteines are mutated to alanine (Quad PrfA), demonstrate a 30-fold decrease in virulence. The Quad and ΔgshF double mutant strains are avirulent. DNA-binding affinity, measured through fluorescence polarization assays, indicate reduction of the cysteine side chains is sufficient to allow PrfA to binds its physiological promoters Phly and PactA with low nanomolar affinity. Oxidized PrfA binds the promoters poorly.

Unexpectedly, Quad also binds promoter DNA with nanomolar affinity, suggesting that the cysteines play a role in transcription efficiency in addition to DNA binding. Both PrfA and Quad bind GSH at physiologically relevant and comparable affinities, however GSH did not affect DNA binding in either case. Thermal denaturation assays suggest that Quad and wild-type PrfA differ structurally upon binding GSH, which supports the in vivo difference in infection between the regulator and its mutant.

Structures of PrfA in complex with cognate DNA, determined through X-ray crystallography, further support the disparity between PrfA and Crp activation mechanisms as two structures of reduced PrfA bound to Phly (PrfA-Phly30 and PrfA-Phly24) suggest the DNA adopts a less bent DNA conformation when compared to Crp-cAMP- DNA. The structure of Quad-Phly30 confirms the DNA-binding data as the protein-DNA complex adopts the same overall conformation as PrfA-Phly.

From these results, we hypothesize a two-step activation mechanism wherein PrfA, oxidized upon cell entry and unable to bind DNA, is reduced upon its intracellular release and binds DNA, causing a slight bend in the promoter and small increase in transcription of PrfA-regulated genes. The structures of PrfA-Phly30 and PrfA-Phly24 likely visualize this intermediate complex. Increasing concentrations of GSH shift the protein to a (PrfA-GSH)-DNA complex which is fully active transcriptionally and is hypothesized to resemble closely the transcriptionally active structure of the cAMP-(Crp)-DNA complex. Thermal denaturation results suggest Quad PrfA is deficient in this second step, which explains the decrease in virulence and implicates the cysteine residues as critical for transcription efficiency. Further structural and biochemical studies are on-going to clarify this mechanism of activation.

Screening for Sexual Trauma, Intimate Partner Violence and Mental Health Symptoms among HIV Positive South African Women

Background: The psychological sequelae of sexual trauma and physical intimate partner violence (IPV) exposure can lead to poor HIV care outcomes, including poor treatment adherence. This study aimed to estimate the prevalence of and factors associated with mental health symptoms and trauma among HIV positive women. Additionally, the study aimed to assess the feasibility and acceptability of screening for trauma and mental health symptoms among HIV positive South African women. Finally, the study aimed to elicit healthcare workers’ perceptions related to sexual trauma and the provision of care and services for HIV positive women with trauma histories.

Methods: The study utilized a mixed-methods approach that included a cross-sectional survey of 70 HIV positive women recruited through referral sampling and key informant interviews with seven healthcare workers (HCWs). A study-screening instrument consisting of 24 items from standard measures was used to screen women for sexual trauma, physical intimate partner violence (IPV), depression and PTSD. Sexual trauma and IPV were assessed across the lifetime, while depression and PTSD were current assessments. Logistic regression models were used to explore the relationship between trauma exposure and mental health symptoms, while controlling for age and education. Interview transcripts were coded and analyzed for emergent themes on HCWs perceptions on sexual trauma and HIV care.

Results: Among participants, 51% had sexual trauma experience and 75% had intimate partner violence (IPV) experience. Among participants, 36% met screening criteria for major depression; among those with traumatic experiences (n=57), 70% met screening criteria for post-traumatic stress disorder (PTSD). Compared to having no sexual trauma or IPV exposure, having both sexual trauma and IPV was significantly associated with higher odds of depression (OR = 8.11; 95% CI 1.48-44.34), while having either IPV or sexual trauma individually was not significantly associated with increased odds of depression. Compared to having either IPV or sexual trauma, having both sexual trauma and IPV was not significantly associated with PTSD. Responses from participants’ feedback on screening process suggest that screening was feasible and acceptable to participants. Some of the health care workers (HCWs) did not perceive dealing with trauma to be part of their duties, but instead viewed social workers or psychologists as the appropriate health cadre to provide care related to trauma and mental health.

Conclusions: High levels of sexual trauma, IPV and mental health distress were reported among HIV positive women in this setting. Screening for trauma and mental health symptoms was acceptable to the participants, but several challenges were encountered in implementing screening. Given the potential impact of trauma and mental health on HIV care engagement, interventions to address trauma and its psychological sequelae are needed.

Cervical cancer precursors and hormonal contraceptive use in HIV-positive women: application of a causal model and semi-parametric estimation methods.

OBJECTIVE: To demonstrate the application of causal inference methods to observational data in the obstetrics and gynecology field, particularly causal modeling and semi-parametric estimation. BACKGROUND: Human immunodeficiency virus (HIV)-positive women are at increased risk for cervical cancer and its treatable precursors. Determining whether potential risk factors such as hormonal contraception are true causes is critical for informing public health strategies as longevity increases among HIV-positive women in developing countries. METHODS: We developed a causal model of the factors related to combined oral contraceptive (COC) use and cervical intraepithelial neoplasia 2 or greater (CIN2+) and modified the model to fit the observed data, drawn from women in a cervical cancer screening program at HIV clinics in Kenya. Assumptions required for substantiation of a causal relationship were assessed. We estimated the population-level association using semi-parametric methods: g-computation, inverse probability of treatment weighting, and targeted maximum likelihood estimation. RESULTS: We identified 2 plausible causal paths from COC use to CIN2+: via HPV infection and via increased disease progression. Study data enabled estimation of the latter only with strong assumptions of no unmeasured confounding. Of 2,519 women under 50 screened per protocol, 219 (8.7%) were diagnosed with CIN2+. Marginal modeling suggested a 2.9% (95% confidence interval 0.1%, 6.9%) increase in prevalence of CIN2+ if all women under 50 were exposed to COC; the significance of this association was sensitive to method of estimation and exposure misclassification. CONCLUSION: Use of causal modeling enabled clear representation of the causal relationship of interest and the assumptions required to estimate that relationship from the observed data. Semi-parametric estimation methods provided flexibility and reduced reliance on correct model form. Although selected results suggest an increased prevalence of CIN2+ associated with COC, evidence is insufficient to conclude causality. Priority areas for future studies to better satisfy causal criteria are identified.