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Open Access Publications from the University of California

Scholarly Works (21 results)

  • Article
  • Peer Reviewed
Berkeley Undergraduate Journal of Classics, Volume 3, Issue 2 (2015)
Catullus 51, “Ille mi par,” is Catullus’ translation and adaptation of Sappho’s poem “φαίνεταί μοι” (Sappho 31 by the Lobel and Voigt numbering). After translating Catullus 51 in a Latin Lyric class, I became very interested in comparing the two poems and investigating how Catullus used Sappho’s framework to express his own desire and longing for Lesbia. Here I submit a translation of Catullus 51 and one of Sappho 31, specifically intended to be read side by side. I have attempted to render a translation of each poem that will demonstrate both the areas in which Catullus nearly literally translates the Sappho, and the lines which are Catullus’ own invention. Of particular interest are the last four lines of Catullus’ poem, which end the poem on a restrained, dispassionate note that contrasts sharply with the strong emotion of the first three stanzas. The Sappho poem, by contrast, ends with a culmination of Sappho’s passion and a resolve for action. I present both poems for comparison, so that a reader may appreciate the depth of emotion in both poems, and the differing conclusion of each poem.
    Cover page: Translation of Catullus 51 and Sappho 31
    • Thesis
    • Peer Reviewed
    UC Berkeley Electronic Theses and Dissertations (2022)

    Adolescence and emerging adulthood are critical life stages that shape the trajectory of future health. However, adolescents and young adults are underserved by existing health services, which often fail to overcome the unique barriers to care they face. Achieving universal access to healthcare requires moving beyond service availability to understand and address the myriad interconnected structural, sociocultural, and demographic factors that determine individuals’ level of engagement with health services. Each chapter of this dissertation shares the unifying objective of informing real-world implementation strategies to improve access to essential health services among adolescents and young adults.

    In Chapter 1, I present the preliminary impacts of a multifaceted loyalty program intervention on the provision of sexual and reproductive health products and health facility referrals to adolescent girls and young women (AGYW, ages 15-24 years) at drug shops in Tanzania. The intervention was evaluated through a 4-month randomized trial at 20 drug shops in 2019. By the end of the study, the rate of patronage by AGYW customers was four times higher at shops that implemented the intervention than comparison shops. Intervention shops also distributed more HIV self-test kits, contraceptives, and health facility referrals to AGYW than comparison shops over the study period. These results suggest that enhancing private sector drug shops with specialized programs designed around the needs and preferences of AGYW may be an effective strategy to reach them with sexual and reproductive health services.

    In Chapter 2, I describe the findings of an integrated COVID-19 symptom and exposure monitoring and testing system piloted in a longitudinal cohort of 2,918 university students and employees in California in 2020. At baseline and endline, participants were tested for active SARS-CoV-2 infection via quantitative polymerase chain reaction (qPCR) test and provided blood samples for antibody testing. Throughout the study, participants who self-reported certain symptoms or exposures in daily surveys were automatically notified to return for additional qPCR testing. Analyses reveal that undergraduate students who were 18-19 years old were more likely than other participants to be diagnosed with SARS-CoV-2 infection via qPCR test, in part due to a superspreader event identified among those living in congregate housing. Test positivity was also higher among participants who recently reported symptoms or household exposures that triggered notifications to test than those without recent symptoms or exposures. Among participants with newly developed antibodies for SARS-CoV-2 at endline, 91% had been diagnosed with incident infection via qPCR test over the study period. These results demonstrate that integrated monitoring systems can successfully identify and link at-risk students to COVID-19 testing when combined with low-barrier entry points to services.

    In Chapter 3, I assess HIV knowledge and condom-related beliefs and their associations with HIV testing and condom use in a cross-sectional sample of 6,079 Rwandan secondary school students (ages 12-19 years) surveyed in 2021. Participants’ level of HIV knowledge was high overall, with 74% answering at least 6 of 7 HIV knowledge questions correctly. In contrast, beliefs about condoms were mixed, with participants responding favorably to 4 of 8 condom-related statements on average. Most participants endorsed misconceptions about condoms or did not believe that condom use was appropriate in casual or serious relationships. In multivariable models, having high HIV knowledge was associated with recent HIV testing but not condom use. However, participants with supportive or middling condom beliefs were more likely to report condom use than those with prohibitive beliefs. These results motivate renewed attention to educational gaps about condoms’ value in prevention and school-based interventions to create supportive social norms around condom use among youth.

    In summary, this dissertation provides rigorous evidence demonstrating the benefits of tailored, multipronged approaches to reduce barriers to health services experienced by adolescents and young adults. This research also underscores the importance of epidemiologic data analysis as a tool to identify disparities, evaluate impact, and enable evidence-based decision-making to reduce inequities experienced by youth and support health and well-being across the life span.

      Cover page: Reaching adolescents and young adults with accessible health services: Applications to HIV, contraception, and COVID-19
      • Article
      • Peer Reviewed
      UC Berkeley Previously Published Works (2018)
      Just as the ability to remember prior events is critical for guiding our decision-making, so too is the ability to recognize the limitations of our memory. Indeed, we hypothesize that neural signaling of retrieval failure promotes more accurate memory judgments over time. To test this hypothesis, we collected longitudinal functional magnetic resonance imaging data from 8 to 9 years olds, 10 to 12 years olds, and adults, with two time points spaced approximately 1.4 years apart (198 scan sessions in total). Participants performed an episodic memory retrieval task in which they could either select a response or report uncertainty about the target memory detail. Children who engaged anterior insula more strongly during inaccurate or uncertain responses exhibited greater longitudinal increases in anterior prefrontal cortex activation for decisions to report uncertainty; both of these neural variables predicted improvements in episodic memory. Together, the results suggest that the brain processes supporting effective cognitive control and decision-making continue to develop in middle childhood and play an important role for memory development.
        • Article
        • Peer Reviewed
        UC Berkeley Previously Published Works (2021)
        Transportation cost is a barrier to HIV treatment, yet no studies have examined its association with contraceptive use among women living with HIV. We analyzed cross-sectional data from women attending three public healthcare facilities in Shinyanga, Tanzania where they initiated antiretroviral therapy for HIV infection in the previous 90 days; all facilities offered free contraception. Women self-reported current contraceptive use and the round-trip cost of transportation to the facility. Among 421 women aged 18-49, 86 (20.4%) were using any modern contraceptive method, of which half were using modern methods other than condoms. Women who paid more than 2,000 Tanzanian shillings for transportation had a significantly lower prevalence of any modern method use than women who paid nothing (9.1% vs. 21.3%; adjusted difference: -12.9; 95% confidence interval: -21.3, -4.4). A similar difference was observed for non-condom modern method use. We conclude that high transportation cost may impede contraceptive use even among women accessing HIV treatment.
          Cover page: Transportation cost as a barrier to contraceptive use among women initiating treatment for HIV in Tanzania.
          • Article
          • Peer Reviewed
          UC San Francisco Previously Published Works (2018)

          Context

          Recent legislation in states across the United States has required governmental health agencies to take on new and different roles in relation to abortion. While there has been media attention to health department roles in regulating abortion providers, there has been no systematic investigation of the range of activities in which state and local health departments are engaged.

          Objective

          To systematically investigate health department activities related to abortion.

          Methods

          We searched state health department Web sites of the 50 states and District of Columbia using key words such as "abortion" and "pregnancy termination". Two trained coders categorized 6093 documents using the 10 Essential Public Health Services (EPHS) framework. We then applied these methods to 671 local health department documents.

          Setting

          State and local health department Web sites.

          Participants

          N/A.

          Results

          On average, states engaged in 5.1 of 10 Essential Services related to abortion. Most (76%-98%) state health departments engaged in activities to Monitor Health Status (EPHS1), Enforce Laws (EPHS6), and Evaluate Effectiveness, Accessibility, and Quality (EPHS9). Many (47%-69%) engaged in activities to Inform and Educate (EPHS3), Develop Policies (EPHS5), and Link to Services (EPHS7). A minority (4%-29%) engaged in activities to Diagnose and Investigate Health Problems (EPHS2), Mobilize Community Partnerships (EPHS4), and Assure Competent Workforce (EPHS8). No state engaged in Innovative Research (EPHS10). Few local health departments engaged in abortion-related activities.

          Conclusions

          While most state health departments engage in abortion-related activities, they appear to reflect what the law requires rather than the range of core public health activities. Additional research is needed to assess whether these services meet quality standards for public health services and determine how best to support governmental health agencies in their growing tasks. These findings raise important questions about the role of public health agencies and professionals in defining how health departments should be engaging with abortion.
            Cover page: State and Local Health Department Activities Related to Abortion
            • Article
            • Peer Reviewed
            UC Berkeley Previously Published Works (2021)

            Background

            Public health initiatives must look for ways to cost-effectively scale critical interventions to achieve high coverage. Private sector distribution channels, can potentially distribute preventive healthcare products to hard-to-reach populations, decongest public healthcare systems, and increase the sustainability of programs by getting customers to share costs. However, little is known about how sellers set prices for new products. By introducing a new product, HIV self-test kits, to local drug shops, we observed whether shops experimented with pricing, charged different buyers different prices, and whether prices converged within the local market over our study period.

            Methods

            From August to December 2019, we provided free HIV self-test kits, a new product, to 26 drug shops in Shinyanga, Tanzania to sell to the local community. We measured sales volume, price, customer age and sex using shop records. Using a multiple linear regression model, we conducted F-tests to determine whether shop, age, sex, and time (week) respectively were associated with price. We measured willingness-to-pay to restock test kits at the end of the study.

            Results

            514 test kits were sold over 18 weeks; 69% of buyers were male, 40% were aged 25-34 and 32% aged 35-44. Purchase prices ranged from 1000 to 6000 Tsh (median 3000 Tsh; ~$1.30 USD). Within shops, prices were 11.3% higher for 25-34 and 12.7% higher for 45+ year olds relative to 15-19-year olds (p = 0.029) and 13.5% lower for men (p = 0.023) on average. Although prices varied between shops, prices varied little within shops over time, and did not converge over the study period or cluster geospatially. Mean maximum willingness-to-pay to restock was 2000 Tsh per kit.

            Conclusions

            Shopkeepers charged buyers different prices depending on buyers' age and sex. There was limited variation in prices within shops over time and low demand among shopkeepers to restock at the end of the study. Given the subsidized global wholesale price ($2 USD or ~ 4600 Tsh), further demand creation and/or cost-reduction is required before HIV self-test kits can become commercially viable in drug shops in this setting. Careful consideration is needed to align the motivations of retailers with public health priorities while meeting their private for-profit needs.
              Cover page: Sales and pricing decisions for HIV self-test kits among local drug shops in Tanzania: a prospective cohort study.
              • Article
              • Peer Reviewed
              UC San Francisco Previously Published Works (2023)
              Adolescent girls and young women (AGYW; ages 15-24) in sub-Saharan Africa face many barriers to accessing preventive sexual and reproductive health (SRH) services. We drew upon the strengths of two complementary approaches, human-centered design and behavioral economics, to craft a holistic, highly-tailored, and empathetic intervention to motivate AGYW to seek contraception and HIV self-test kits at community drug shops. To encourage engagement, we embedded "nudge" strategies at different opportunity points (uncovered during our design research) along the care-seeking and service delivery journey. Our Malkia Klabu intervention is a loyalty program designed to enhance drug shops' role as SRH providers through which AGYW earned punches for shop purchases redeemable for small prizes; free SRH products could be requested at any time. From our 4-month pilot in Shinyanga, Tanzania, we assess the extent to which different behavioral nudge strategies motivated behaviors as predicted by synthesizing findings from (1) in-depth interviews with AGYW and shopkeepers, (2) shop program records, (3) shop observations, and (4) customer exit surveys. Overall, we find that AGYW and shopkeepers were motivated by many intervention features as intended and consistent with hypothesized mechanisms. We found strong evidence of social norms for helping to spread awareness of Malkia Klabu among peers, prize incentives for drawing AGYW back to shops, and the opt-out default membership gift of an HIV self-test kit for encouraging testing uptake and exploration of contraceptives. Shopkeepers in both arms noted increased community status from distributing HIV self-testing kits (ego). Malkia Klabu shopkeepers experienced increased customer traffic and business revenues (incentives), which reduced shopkeepers' gatekeeping tendencies and earned them additional recognition as champions of AGYW well-being. Integrating human-centered design and behavioral economics was effective for developing an innovative and effective intervention that simultaneously met the different needs of economic actors in support of public health priorities.
                Creative Commons 'BY-NC-ND' version 4.0 license
                • Article
                • Peer Reviewed
                UC Berkeley Previously Published Works (2023)

                Purpose

                Understanding the timing of sexual debut is critical for informing sexual and reproductive health interventions. We investigated sexual behavior and early sexual debut among Rwandan youth.

                Methods

                We conducted a cross-sectional analysis of data from a cluster-randomized trial with 6079 students ages 12-19 years in Rwanda. We examined predictors of early sexual debut (<15 years) using logistic regression to estimate odds ratios and factors associated with the timing of first sex using Cox models to estimate hazard ratios. Interpretations of sex were also explored.

                Results

                Participants were 15 years and 51.5% female on average; 1723 (28.3%) reported sexual activity. Among the 1320 participants who provided an age of sexual debut, 51.4% reported sex at ≤12 years and 75.7% at<15 years. Males had a higher odds of early sexual debut (adjusted odds ratio: 2.40; 95% CI: 1.99, 2.90) and a higher hazard of sex occuring at an earlier age than females (adjusted hazard ratio: 1.91; 95% CI: 1.67, 2.20). One-third of participants considered "sexual intercourse" to include kissing, touching, or masturbation.

                Conclusions

                Sex at ≤12 years was frequently reported, indicating that interventions facilitating access to youth-friendly sexual and reproductive health services are necessary before age 12. Validation studies are needed to evaluate how interpretations of sexual intercourse influence the assessment of sexual activity.

                Clinical trial

                NCT04198272.
                  Cover page: Measuring sexual behavior among in-school youth in Rwanda: a cross-sectional analysis of self-reported timing of first sex and correlates of early sexual debut.Creative Commons 'BY-NC-ND' version 4.0 license
                  • Article
                  UC San Francisco Previously Published Works (2020)
                  Abstract Background: HIV risk remains high among adolescent girls and young women (AGYW, ages 15-24) in Tanzania. Many AGYW experience stigma and provider bias at health facilities, deterring their use of HIV prevention services. Privately-owned drug shops, ubiquitous in many communities, may be an effective and accessible channel to deliver HIV prevention products to AGYW, including oral pre-exposure prophylaxis (PrEP) and the dapivirine vaginal ring. Methods: In July-August 2019, we enrolled 26 drug shops in Shinyanga, Tanzania in an ongoing study to create “girl-friendly” drug shops where AGYW can access HIV self-testing and contraception. At baseline, all shop dispensers were given basic information about oral PrEP and the dapivirine ring and were asked about their interest in stocking each. During the next 3-5 months, we surveyed AGYW (n=56) customers about their interest in oral PrEP and the ring. Results: Among dispensers, the median age was 42 years and 77% were female. Overall, 42% of dispensers had heard of a medication for HIV prevention. Almost all dispensers reported some interest in stocking oral PrEP (92%) and the dapivirine ring (96%). Most (85%) reported they would provide oral PrEP to AGYW who requested it. Among AGYW customers, the median age was 17 years; 18% of AGYW were married and 7% had children. Only 20% of AGYW had heard of a medication to prevent HIV, yet 64% and 43% expressed some interest in using oral PrEP and the dapivirine ring, respectively, after receiving information about the products. PrEP interest was higher among AGYW who were partnered and had children.Conclusions: Despite low prior awareness of PrEP among shop dispensers and AGYW, we found high levels of interest in oral PrEP and the dapivirine ring in both groups. Community-based drug shops represent a promising strategy to make HIV prevention more accessible to AGYW.
                    • Article
                    • Peer Reviewed
                    UC San Francisco Previously Published Works (2021)

                    Background

                    HIV risk remains high among adolescent girls and young women (AGYW, ages 15-24) in Tanzania. Many AGYW experience stigma and provider bias at health facilities, deterring their use of HIV prevention services. Privately-owned drug shops, ubiquitous in many communities, may be an effective and accessible channel to deliver HIV prevention products to AGYW, including oral pre-exposure prophylaxis (PrEP) and the dapivirine vaginal ring.

                    Methods

                    In July-August 2019, we enrolled 26 drug shops in Shinyanga, Tanzania in an ongoing study to create "girl-friendly" drug shops where AGYW can access HIV self-testing and contraception. At baseline, all shop dispensers were given basic information about oral PrEP and the dapivirine ring and were asked about their interest in stocking each. During the next 3-5 months, we surveyed AGYW (n = 56) customers about their interest in oral PrEP and the ring.

                    Results

                    Among dispensers, the median age was 42 years and 77% were female. Overall, 42% of dispensers had heard of a medication for HIV prevention. Almost all dispensers reported some interest in stocking oral PrEP (92%) and the dapivirine ring (96%). Most (85%) reported they would provide oral PrEP to AGYW who requested it. Among AGYW customers, the median age was 17 years; 29% of AGYW were married or had a steady partner and 18% had children. Only 20% of AGYW had heard of a medication to prevent HIV, yet 64% and 43% expressed some interest in using oral PrEP and the dapivirine ring, respectively, after receiving information about the products. PrEP interest was higher among AGYW who were partnered and had children.

                    Conclusions

                    Despite low prior awareness of PrEP among shop dispensers and AGYW, we found high levels of interest in oral PrEP and the dapivirine ring in both groups. Community-based drug shops represent a promising strategy to make HIV prevention more accessible to AGYW.
                      Cover page: HIV prevention at drug shops: awareness and attitudes among shop dispensers and young women about oral pre-exposure prophylaxis and the dapivirine ring in Shinyanga, Tanzania.
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