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Open Access Publications from the University of California

Scholarly Works (17 results)

  • Thesis
  • Peer Reviewed
UC San Francisco Electronic Theses and Dissertations (2016)

Social capital is features embedded in social networks, such as social norms and trust. This dissertation aimed to deepen understanding of the effect of social capital on health outcomes among people living with HIV (PLWH) in the context of global health.

Chapter two scrutinized the complexity of the concept of social capital to find out which aspects of the concepts play a major role in relation to better health outcomes. Then chapter three reviewed application of the concept in clinical practice; a meta-analysis examining efficacy of mobile phone reminders on improving HIV patients’ return to care. Chapter four applied social capital theoretical framework for PLWH in a resource limited, clinical setting and to inform future studies.

Chapter two identified the importance of social connections over other aspects of social capital such as community participation, trust, and feeling of safety. The findings suggest that social networks to promote health related quality of life among PLWH needed to be strengthened. Also, this study found a mediating effect of engagement with health care providers between social capital and health related quality of life.

Chapter three included nine studies into the systematic meta-analysis and found that PLWH who received mobile phone reminders for their follow-up appointments were two times more likely to return to the care than those who did not received the reminders; however, this estimate was not statistically significant (pooled odd ratio (OR)=2.04, 95% confidence interval (CI): 0.97-4.27). Sensitivity analysis drew stronger evidence of the efficacy of mobile phone reminders on retention in care based on five randomized controlled studies (OR=2.04, 95% CI: 1.11-3.74).

Chapter four found that social capital was an independent predictor of higher quality of life based on a cross-sectional study of 163 PLWH in Dar es Salaam, Tanzania. Women were more likely to have less social capital and report lower quality of life compared to men.

This dissertation contributed to socio-behavioral and nursing research by elucidating the importance of social capital and suggesting clinical implications of social capital to improve health outcomes among PLWH in a global perspective.

    Cover page: Social Capital and Social Networks Improve HIV Health Outcomes: A Global Perspective
    • Thesis
    • Peer Reviewed
    UC San Francisco Electronic Theses and Dissertations (2016)

    Women and men’s preferences for delivery services in rural Ethiopia

    Nancy Beam

    Aims: This study aims to determine the combination of facility-based delivery care attributes preferred by women and men; if gender differences exist in attribute preferences; and key demographic factors associated with attribute preferences.

    Background: Despite programs to promote facility-based delivery, which has been shown to decrease maternal and neonatal mortality, 80% of women in rural Ethiopia deliver at home without a skilled birth attendant.

    A review of the Ethiopian literature on factors associated with delivery location revealed several weaknesses in research methods that need to be addressed. First, research participants were almost exclusively women, although male partners often make decisions about delivery location. Second, most quantitative study designs are similar in content to the Ethiopian Demographic Health Survey, limiting the generation of new knowledge. Third, cultural practices identified in qualitative studies as barriers to facility-based delivery have not been included in quantitative studies. This study addressed these weaknesses by using discrete choice experiment methodology to elicit preferences for delivery service attributes, including support persons in the delivery room, staff training and attitude, cost, distance and transportation availability.

    Methods: A cross-sectional, discrete choice experiment was conducted in 109 randomly selected households in rural Ethiopia in September-October 2015. Women, who were pregnant or who had a child < 2 years old, and their male partners were interviewed. After completing a demographic questionnaire, male and female respondents were asked separately to choose between facility-based scenarios that reflected various attributes for delivering their next baby. Data were analyzed using a multilevel mixed-effects logistic regression model.

    Results: Both women and men preferred health facilities where medications and supplies were available, a support person was allowed in the delivery room, cost was low, and doctors performed the delivery. Women also valued free ambulance service, while men favored nearby facilities with friendly providers. Men are disproportionately involved in making household decisions, including decisions about whether their wives seek health care. Yet, men are often unaware of their partners’ prenatal care attendance.

    Implications: The Ethiopian government and health facilities could increase facility births in rural areas by responding to families’ delivery service preferences.

      Cover page: Women and men's preferences for delivery services in rural Ethiopia
      • Article
      • Peer Reviewed
      UC San Francisco Previously Published Works (2016)
      Relative position in a social hierarchy, or subjective social status, has been associated with indicators of socioeconomic status and may be influenced by social connectedness. The primary purpose of this study is to explore the relationship between health insurance status and subjective social status, using the MacArthur Scale of Subjective Social Status (SSS, community version), in the state of Hawai'i with its highly insured population. The secondary purpose is to examine other social determinants that influence social status, including social connectedness. Data were drawn from a convenience sample of 728 O'ahu residents in 2011-12. Social connectedness was measured if participants stated that family, friends, or community were strengths that could address their social and health concerns. In the final adjusted linear regression model, those with Medicaid/Quest insurance (β -0.40; P<.05), those who had not completed high-school (β -0.51; P<.01), adults of working age (27-64 years) (β -0.59; P<.01), and Native Hawaiians (β -0.57; P<.05) ranked themselves lower on the SSS ladder. Social connectedness was highly valued, with over 30% of participants stating strong community and family ties as one of Hawai'i's greatest strengths. However, these strengths were not found to be statistically associated with subjective social status in our sample. Future studies should assess whether reinforcing social connectedness through public health and educational interventions improves subjective social status among low-income and ethnically diverse communities in Hawai'i.
        Cover page: Exploring the Relationship between Health Insurance, Social Connectedness, and Subjective Social Status among Residents of O'ahu.
        • Article
        • Peer Reviewed
        UCSF Open Access Publishing Fund (2018)
          • Article
          • Peer Reviewed
          UC San Francisco Previously Published Works (2018)

          Background

          By 2030, the Sub-Saharan African region is projected to be the epicenter of the tobacco epidemic. While smoking prevalence is currently low among women (< 2%), the prevalence among men (7.7% overall and up to 27% depending on region) makes exposure to secondhand smoke a pressing concern for women and children. To prevent the uptake of smoking among women and address tobacco-related risks, including secondhand smoke exposure, a greater understanding of women's related perceptions is needed. The purpose of this study was to explore Ethiopian women's knowledge, attitudes, and beliefs related to tobacco use and secondhand smoke exposure, and the potential influence of contextual factors including; khat use, exposure to pro- and anti-tobacco messaging, and religious affiliation.

          Methods

          A cross-sectional study using a systematic household sampling technique and an adapted interviewer-administered survey was conducted in Southern Ethiopia. The survey was administered to 353 women, 18-55 years of age, in Aleta Wondo town and surrounding districts between August-October 2014 (95.2% cooperation rate).

          Results

          General awareness of harm associated with personal tobacco use and exposure to secondhand smoke was high (> 94%); however, specific knowledge of associated health-risks was limited. More than 96% perceived female tobacco use as socially unacceptable. At the same time, more than 70% were able to name potential benefits of using tobacco for both personal consumption and non-personal use. Respondents reported greater experimentation with khat versus tobacco and 73% reported that their religion significantly influenced their tobacco-related attitudes. Overall, there were higher reports of exposure to anti-tobacco (70%) versus pro-tobacco (49%) messaging, in the last 30 days.

          Conclusions

          The high level of awareness of health risks associated with tobacco use and SHS exposure and the high exposure to anti-tobacco messaging are community-level strengths that can proactively be built on to prevent the projected disease burden associated with tobacco. Findings have implications for the development of contextualized gender-specific tobacco control interventions, particularly in relation to the promotion of smoke-free homes.
            Cover page: An exploratory study of knowledge, attitudes, and beliefs related to tobacco use and secondhand smoke among women in Aleta Wondo, Ethiopia
            • Article
            • Peer Reviewed
            UC San Francisco Previously Published Works (2020)

            Background

            Household air pollution from solid fuels is a leading risk factor for morbidity and mortality worldwide. Pregnant women's exposure to polycyclic aromatic hydrocarbons (PAHs) and volatile organic compounds (VOCs), two components of solid-fuel smoke, is associated with adverse birth outcomes. Even with improved solid-fuel stoves, exposure to PAHs and VOCs remains high. Therefore, cleaner cooking fuels need to be prioritized.

            Objective

            We aimed to quantify exposure reduction to PAHs and VOCs among pregnant women in rural Guatemala with a liquefied petroleum gas (LPG) stove intervention.

            Materials and methods

            Urine from pregnant women (N = 50) was collected twice: at <20 weeks gestation, when women cooked exclusively with wood, and 6-8 weeks after receiving an LPG stove. Metabolites of four PAHs and eight VOCs were analyzed. Concurrent with urine collection, personal 48-h PM2.5 exposure was measured.

            Results

            Women cooking exclusively with wood were exposed to high levels of particulate matter (PM2.5), which was reduced by 57% with the LPG stove. Urinary concentrations of total PAH metabolites (-37%), PMA (benzene metabolite; -49%), and CNEMA (acrylonitrile metabolite; -51%) were reduced. However, recent use of a wood-fired sauna bath led to large increases in excretion of urinary toxicant metabolites (+66-135%).

            Conclusions

            This is the first study to report PAH and VOC reductions from an LPG stove intervention introduced during pregnancy. However, other sources of air pollution minimized the gains seen from using an LPG stove. Thus, all sources of air pollution must be addressed in concert to reduce exposures to levels that protect health.
              Cover page: Reductions in urinary metabolites of exposure to household air pollution in pregnant, rural Guatemalan women provided liquefied petroleum gas stoves
              • Article
              • Peer Reviewed
              UC San Francisco Previously Published Works (2020)

              Background

              Household air pollution from solid fuels is a leading risk factor for morbidity and mortality worldwide. Pregnant women's exposure to polycyclic aromatic hydrocarbons (PAHs) and volatile organic compounds (VOCs), two components of solid-fuel smoke, is associated with adverse birth outcomes. Even with improved solid-fuel stoves, exposure to PAHs and VOCs remains high. Therefore, cleaner cooking fuels need to be prioritized.

              Objective

              We aimed to quantify exposure reduction to PAHs and VOCs among pregnant women in rural Guatemala with a liquefied petroleum gas (LPG) stove intervention.

              Materials and methods

              Urine from pregnant women (N = 50) was collected twice: at <20 weeks gestation, when women cooked exclusively with wood, and 6-8 weeks after receiving an LPG stove. Metabolites of four PAHs and eight VOCs were analyzed. Concurrent with urine collection, personal 48-h PM2.5 exposure was measured.

              Results

              Women cooking exclusively with wood were exposed to high levels of particulate matter (PM2.5), which was reduced by 57% with the LPG stove. Urinary concentrations of total PAH metabolites (-37%), PMA (benzene metabolite; -49%), and CNEMA (acrylonitrile metabolite; -51%) were reduced. However, recent use of a wood-fired sauna bath led to large increases in excretion of urinary toxicant metabolites (+66-135%).

              Conclusions

              This is the first study to report PAH and VOC reductions from an LPG stove intervention introduced during pregnancy. However, other sources of air pollution minimized the gains seen from using an LPG stove. Thus, all sources of air pollution must be addressed in concert to reduce exposures to levels that protect health.
                Creative Commons 'BY-NC-SA' version 4.0 license
                • Article
                • Peer Reviewed
                UC San Francisco Previously Published Works (2011)

                Background

                A growing body of evidence indicates a relationship between household indoor air pollution from cooking fires and adverse neonatal outcomes, such as low birth weight (LBW), in resource-poor countries.

                Objective

                We examined the effect of reduced wood smoke exposure in pregnancy on LBW of Guatemalan infants in RESPIRE (Randomized Exposure Study of Pollution Indoors and Respiratory Effects).

                Methods

                Pregnant women (n = 266) either received a chimney stove (intervention) or continued to cook over an open fire (control). Between October 2002 and December 2004 we weighed 174 eligible infants (69 to mothers who used a chimney stove and 105 to mothers who used an open fire during pregnancy) within 48 hr of birth. Multivariate linear regression and adjusted odds ratios (ORs) were used to estimate differences in birth weight and LBW (< 2,500 g) associated with chimney-stove versus open-fire use during pregnancy.

                Results

                Pregnant women using chimney stoves had a 39% reduction in mean exposure to carbon monoxide compared with those using open fires. LBW prevalence was high at 22.4%. On average, infants born to mothers who used a stove weighed 89 g more [95% confidence interval (CI), -27 to 204 g] than infants whose mothers used open fires after adjusting for maternal height, diastolic blood pressure, gravidity, and season of birth. The adjusted OR for LBW was 0.74 (95% CI, 0.33-1.66) among infants of stove users compared with open-fire users. Average birth weight was 296 g higher (95% CI, 109-482 g) in infants born during the cold season (after harvest) than in other infants; this unanticipated finding may reflect the role of maternal nutrition on birth weight in an impoverished region.

                Conclusions

                A chimney stove reduced wood smoke exposures and was associated with reduced LBW occurrence. Although not statistically significant, the estimated effect was consistent with previous studies.
                  Cover page: Impact of Reduced Maternal Exposures to Wood Smoke from an Introduced Chimney Stove on Newborn Birth Weight in Rural Guatemala
                  • Article
                  • Peer Reviewed
                  UC San Francisco Previously Published Works (2015)

                  Objective

                  To describe childhood trauma and depressive symptoms in Mexican women and to explore the relationships between number and type of childhood traumatic events and depressive symptoms.

                  Methods

                  A community-based sample of 100 women was interviewed using a demographic questionnaire, the Life Stressor Checklist-Revised (LSC-R), and the Center for Epidemiologic Studies Depression Scale (CES-D). Childhood trauma (trauma at or before 16 years of age) and depressive symptoms were described, and logistic and linear regressions were used to analyze the relationship between childhood traumatic events and current depressive symptoms.

                  Results

                  Participants reported a mean of 9.46 (standard deviation (SD): 4.18) lifetime traumas and 2.76 (SD: 2.34) childhood traumas. The mean CES-D score was 18.9 (SD: 12.0) and 36.0% of participants had clinically significant depression (CES-D > 24). Depression scores were correlated with lifetime trauma, childhood trauma, education level, employment status, and number of self-reported current medical conditions. Depression scores were not significantly correlated with age, marital status, number of children, or socioeconomic status. For every additional childhood trauma experienced, the odds of clinically significant depressive symptoms (CES-D > 24) increased by 50.0% (adjusted odds ratio (OR): 1.50; 95% confidence interval: 1.14-1.96), after controlling for number of children, age, education level, employment status, and number of self-reported medical conditions.

                  Conclusions

                  The results indicated that the number of childhood trauma exposures is associated with current depression among urban Mexican women, suggesting a need for trauma-informed care in this setting.
                    Cover page: Childhood trauma is associated with depressive symptoms in Mexico City women.
                    • Article
                    • Peer Reviewed
                    UC San Francisco Previously Published Works (2014)
                    Low birth weight is associated with exposure to air pollution during pregnancy. The purpose of this study was to evaluate whether null polymorphisms of Glutathione S-transferases (GSTs), specifically GSTM1 and GSTT1 genes in infants or mothers, modify the association between high exposures to household air pollution (HAP) from cooking fires and birth weight. Pregnant women in rural Guatemala were randomized to receive a chimney stove or continue to use open fires for cooking. Newborns were measured within 48 h of birth. 132 mother-infant pairs provided infant genotypes (n=130) and/or maternal genotypes (n=116). Maternal null GSTM1 was associated with a 144 g (95% CI, -291, 1) and combined maternal/infant null GSTT1 was associated with a 155 g (95% CI, -303, -8) decrease in birth weight. Although there was a trend toward higher birth weights with increasing number of expressed GST genes, the effect modification by chimney stove use was not demonstrated.
                      Cover page: Genetic modification of the effect of maternal household air pollution exposure on birth weight in Guatemalan newborns
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