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| Publications of Eve S. Puffer :chronological alphabetical combined listing:
%% Journal Articles
@article{fds221855,
Author = {Puffer, E. S. and Pian, J. and Sikkema, K. J. and Ogwang-Odhiambo, R.
A. and Broverman, S. A.},
Title = {Developing a family-based HIV prevention intervention in
rural Kenya: Ethical challenges in community based
participatory research},
Journal = {The Journal of Empirical Research on Human Research
Ethics},
Volume = {8},
Pages = {119-128},
Year = {2013},
Abstract = {http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3743433/
Community-based participatory research (CBPR) introduces new
ethical challenges for HIV prevention studies in
low-resource international settings. We describe a CBPR
study in rural Kenya to develop and pilot a family-based HIV
prevention and mental health promotion intervention.
Academic partners (APs) worked with a community},
Key = {fds221855}
}
@article{fds221869,
Author = {Matthews, E. J. and Puffer, E. S. and Meade, C. S. and Broverman,
S. A.},
Title = {Implementation of a school-based HIV prevention program in
rural Kenya after national dissemination},
Journal = {East African Medical Journal},
Volume = {in press},
Year = {2013},
Abstract = {Objective: Primary School Action for Better Health (PSABH)
became the national HIV prevention curriculum of Kenya in
2007. This study examined implementation of PSABH and
student risk behaviors. Setting: The study was conducted in
Muhuru, a rural division of Nyanza Province. Subjects: Six
of nine public schools in Muhuru reported implementing
PSABH. Participants were 1146 students aged 9-21 years.
Measures: Anonymous surveys were administered to assess
students’ exposure to PSABH program components, their
sexual activity, condom use, and self-efficacy for engaging
in lower risk behaviors. Results: The 6 schools with PSABH
were not implementing the full program. Fifty-five percent
of males and 44% of females reported a history of sexual
activity. Boys who reported higher self-efficacy and
learning about abstinence strategies engaged in lower risk
behavior, while exposure to HIV education in assemblies and
communication with relatives about HIV increased their
likelihood to engage in riskier behavior. For females,
condom self-efficacy was related to lower risk behavior,
while HIV education during pastoral instruction was
associated with higher risk. Conclusions: Previous studies
in Kenya documented benefits of PSABH. However, it is
unclear how effective the program is after national
scale-up. In this community, PSABH was implemented at a low
level, with some program components associated with higher
risk behavior, calling into question how PSABH is being
delivered. Implementation barriers should be examined, and
studies should test strategies for ongoing support,
monitoring and evaluation to increase effectiveness during
program scale-up.},
Key = {fds221869}
}
%% Papers Published
@article{fds376853,
Author = {Rasmussen, JM and Johnson, SL and Ochieng, Y and Jaguga, F and Green, E and Puffer, E},
Title = {Congregation leader and member discussions in a church-based
family strengthening, mental health promotion, and HIV
prevention trial: Intervention},
Journal = {Cambridge Prisms: Global Mental Health},
Pages = {1-36},
Publisher = {Cambridge University Press (CUP)},
Year = {2024},
Month = {April},
url = {http://dx.doi.org/10.1017/gmh.2024.44},
Doi = {10.1017/gmh.2024.44},
Key = {fds376853}
}
@article{fds371466,
Author = {Johnson, SL and Rasmussen, JM and Mansoor, M and Ibrahim, H and Rono, W and Goel, P and Vissoci, JRN and Von Isenburg and M and Puffer,
ES},
Title = {Correlates of Intimate Partner Violence Victimization and
Perpetration in Adolescents and Young Adults in Sub-Saharan
Africa: A Systematic Review.},
Journal = {Trauma, violence & abuse},
Volume = {25},
Number = {2},
Pages = {1168-1183},
Year = {2024},
Month = {April},
url = {http://dx.doi.org/10.1177/15248380231173428},
Abstract = {Intimate partner violence (IPV) is a global public health
crisis with long-term adverse consequences for both victims
and perpetrators. Patterns of violence often begin during
adolescence, yet most interventions target adult
relationships. A systematic review was conducted to identify
correlates of IPV victimization and perpetration among
adolescents and young adults in sub-Saharan Africa (SSA).
Eligible studies included participants 10 to 24 years old,
took place in SSA, and tested a statistical association
between a correlate and an IPV outcome. Correlates were
defined as any condition or characteristic associated with
statistically significant increased or decreased risk of IPV
victimization or perpetration. PsycInfo, PubMed, Embase, and
African Index Medicus were searched and included studies
published between January 1, 2000 and February 4, 2022. The
search resulted in 3,384 original studies, of which 55 met
inclusion criteria and were analyzed. Correlates were first
qualitatively synthesized by developmental period (e.g.,
early adolescence, older adolescence, and young adulthood)
and then organized in a conceptual framework by correlate
type (e.g., socio-demographic; health, behavior, and
attitudes; relational; or contextual). Over two decades of
literature reveals variability in evidence by developmental
period but also substantial overlap in the correlates of
victimization and perpetration. This review identifies
multiple points for intervention and results suggest the
urgent need for earlier, developmentally appropriate
prevention efforts among younger adolescents as well as
combined approaches that target both victimization and
perpetration of IPV.},
Doi = {10.1177/15248380231173428},
Key = {fds371466}
}
@article{fds376689,
Author = {Johnson, SL and Rieder, AD and Rasmussen, JM and Mansoor, M and Quick,
KN and Proeschold-Bell, RJ and Coping Together Team, and Boone, WJ and Puffer, ES},
Title = {A Pilot Study of the Coping Together Virtual Family
Intervention: Exploring Changes in Family Functioning and
Individual Well-Being.},
Journal = {Research on child and adolescent psychopathology},
Year = {2024},
Month = {March},
url = {http://dx.doi.org/10.1007/s10802-024-01183-z},
Abstract = {In this pilot study, we tested a virtual family
strengthening and mental health promotion intervention,
Coping Together (CT), during the COVID-19 pandemic. We
explored changes at the family and individual levels, as
well as mechanisms of change. Participants included 18
families (24 caregivers, 24 youth) with children aged 7 to
18 years. Community health workers delivered the 8-session
CT intervention using videoconferencing software. We used
qualitative semi-structured interviews with 14 of the
families to explore changes and mechanisms of change using a
thematic content analysis approach. We also administered
pre-post surveys with the 18 families to explore the
direction of changes, using only descriptive statistics in
this small sample. Qualitative findings supported positive
changes across family and individual level outcomes
including family functioning, relationship quality, and
individual psychosocial well-being. Results also confirmed
several hypothesized mechanisms of change with improved
communication providing the foundation for increased hope
and improved problem solving and coping. Pre-post survey
results were mixed, showing positive, but very small,
changes in family closeness, caregiver-child communication,
and levels of hope; almost no change was observed on
measures of caregiver and child mental health. Families
reported few problems at baseline quantitatively despite
qualitative descriptions of pre-intervention difficulties.
Results provide preliminary support for benefits of CT with
the most consistent improvements seen across family
relationships. Findings were mixed related to
individual-level mental health benefits. Results have
implications for revising content on mental health coping
strategies and suggest the need to revise the quantitative
measurement strategy for this non-clinical
sample.},
Doi = {10.1007/s10802-024-01183-z},
Key = {fds376689}
}
@article{fds369073,
Author = {Giusto, A and Jack, HE and Magidson, JF and Ayuku, D and Johnson, S and Lovero, K and Hankerson, SH and Sweetland, AC and Myers, B and Fortunato
Dos Santos and P and Puffer, ES and Wainberg, ML},
Title = {Global Is Local: Leveraging Global Mental-Health Methods to
Promote Equity and Address Disparities in the United
States.},
Journal = {Clinical psychological science : a journal of the
Association for Psychological Science},
Volume = {12},
Number = {2},
Pages = {270-289},
Publisher = {SAGE Publications},
Year = {2024},
Month = {March},
url = {http://dx.doi.org/10.1177/21677026221125715},
Abstract = {Structural barriers perpetuate mental health disparities for
minoritized US populations; global mental health (GMH) takes
an interdisciplinary approach to increasing mental health
care access and relevance. Mutual capacity building
partnerships between low and middle-income countries and
high-income countries are beginning to use GMH strategies to
address disparities across contexts. We highlight these
partnerships and shared GMH strategies through a case series
of said partnerships between Kenya-North Carolina, South
Africa-Maryland, and Mozambique-New York. We analyzed case
materials and narrative descriptions using document review.
Shared strategies across cases included: qualitative
formative work and partnership-building; selecting and
adapting evidence-based interventions; prioritizing
accessible, feasible delivery; task-sharing; tailoring
training and supervision; and mixed-method, hybrid designs.
Bidirectional learning between partners improved the use of
strategies in both settings. Integrating GMH strategies into
clinical science-and facilitating learning across
settings-can improve efforts to expand care in ways that
consider culture, context, and systems in low-resource
settings.},
Doi = {10.1177/21677026221125715},
Key = {fds369073}
}
@article{fds365795,
Author = {Puffer, ES and Johnson, SL and Quick, KN and Rieder, AD and Mansoor, M and Proeschold-Bell, RJ and Jones, S and Moore-Lawrence, S and Rasmussen,
JD and Cucuzzella, C and Burwell, F and Dowdy, L and Moore, F and Rosales,
N and Sanyal, A and Ramachandran, P and Duerr, E and Tice, L and Ayuku, D and Boone, WJ},
Title = {Family Strengthening in the Context of COVID-19: Adapting a
Community-Based Intervention from Kenya to the United
States.},
Journal = {Prevention science : the official journal of the Society for
Prevention Research},
Volume = {25},
Number = {2},
Pages = {267-278},
Year = {2024},
Month = {February},
url = {http://dx.doi.org/10.1007/s11121-022-01418-9},
Abstract = {COVID-19 led to widespread disruption of services that
promote family well-being. Families impacted most were those
already experiencing disparities due to structural and
systemic barriers. Existing support systems faded into the
background as families became more isolated. New approaches
were needed to deliver evidence-based, low-cost
interventions to reach families within communities. We
adapted a family strengthening intervention developed in
Kenya ("Tuko Pamoja") for the United States. We tested a
three-phase participatory adaptation process. In phase 1, we
conducted community focus groups including 11 organizations
to identify needs and a community partner. In phase 2, the
academic-community partner team collaboratively adapted the
intervention. We held a development workshop and trained
community health workers to deliver the program using an
accelerated process combining training, feedback, and
iterative revisions. In phase 3, we piloted Coping Together
with 18 families, collecting feedback through
session-specific surveys and participant focus groups.
Community focus groups confirmed that concepts from Tuko
Pamoja were relevant, and adaptation resulted in a
contextualized intervention-"Coping Together"-an 8-session
virtual program for multiple families. As in Tuko Pamoja,
communication skills are central and applied for developing
family values, visions, and goals. Problem-solving and
coping skills then equip families to reach goals, while
positive emotion-focused activities promote openness to
change. Sessions are interactive, emphasizing skills
practice. Participants reported high acceptability and
appropriateness, and focus groups suggested that most
content was understood and applied in ways consistent with
the theory of change. The accelerated reciprocal adaptation
process and intervention could apply across
resource-constrained settings.},
Doi = {10.1007/s11121-022-01418-9},
Key = {fds365795}
}
@article{fds373397,
Author = {Jaguga, F and Ott, MA and Kwobah, EK and Apondi, E and Giusto, A and Barasa, J and Kosgei, G and Rono, W and Korir, M and Puffer,
ES},
Title = {Adapting a substance use screening and brief intervention
for peer-delivery and for youth in Kenya.},
Journal = {SSM. Mental health},
Volume = {4},
Pages = {100254},
Year = {2023},
Month = {December},
url = {http://dx.doi.org/10.1016/j.ssmmh.2023.100254},
Abstract = {<h4>Background</h4>Substance use is a major problem among
youth in sub-Saharan Africa, yet interventions that address
this problem are scarce within the region. Screening and
brief intervention is a cost-effective, efficacious, and
easy to scale public health approach to addressing substance
use problems. We conducted a pilot study to evaluate the
feasibility of implementing a peer delivered screening and
brief intervention program for youth in Kenya. The goal of
this paper is to report on the process of adapting the
Alcohol Smoking and Substance Involvement Screening Test for
Youth- linked Brief Intervention (ASSIST-Y-linked BI)
program for peer delivery and for the Kenyan context prior
to the pilot.<h4>Methods</h4>The adaptation process was led
by a multi-disciplinary team comprised of psychiatrists,
pediatricians, and psychologists. We utilized the ADAPT-ITT
framework to adapt the ASSIST-Y-linked BI. The ADAPT-ITT
framework consists of 8 phases including Assessment,
Decision making, Adaptation, Production, Topical Experts,
Integration, Training, and Testing the evidence-based
intervention. Here, we report on phases 1-7 of the
framework. The results of the pilot testing have been
published elsewhere.<h4>Results</h4>Overall, we made surface
level adaptations to the ASSIST-Y-linked BI program such as
simplifying the language to enhance understandability. We
maintained the core components of the program i.e.,
Feedback, Responsibility, Advice, Menu of Options, Empathy,
Self-efficacy (FRAMES).<h4>Conclusions</h4>Our paper
provides information which other stakeholders planning to
implement the ASSIST-Y-linked BI for youth in sub-Saharan
Africa, could use to adapt the intervention.},
Doi = {10.1016/j.ssmmh.2023.100254},
Key = {fds373397}
}
@article{fds372411,
Author = {Knettel, BA and Oliver-Steinberg, A and Lee, MJ and Rubesin, H and Duke,
NN and Esmaili, E and Puffer, E},
Title = {Clinician and academic perspectives on expressive arts
therapy for refugee children and families: a qualitative
study},
Journal = {International Journal of Migration, Health and Social
Care},
Volume = {19},
Number = {3-4},
Pages = {260-272},
Year = {2023},
Month = {November},
url = {http://dx.doi.org/10.1108/IJMHSC-11-2021-0110},
Abstract = {Purpose: The refugee journey is fraught with challenges
before, during and after resettlement. There is a critical
need for mental health support upon arrival, and refugees
face language, cultural and logistical barriers. Arts-based
therapies are a promising approach to mitigating such
barriers. The purpose of this study was to elicit
professional stakeholder perspectives on mental health
challenges among refugees, the value of arts-based programs
and future directions. Design/methodology/approach: The
authors conducted three 90-min focus groups with 19
professional stakeholders in North Carolina, USA. This
included mental health professionals, professors and
community services/resettlement workers. Participants were
identified from professional networks and snowball sampling.
Each group was held by videoconference, audio recorded and
transcribed. Data were analyzed through a team-based
approach using applied thematic qualitative analysis.
Findings: Interviewees described a need for targeted,
culturally compatible mental health services for refugee
families, including trauma-informed, family-focused services
with language interpretation. Arts-based therapies were
viewed as highly acceptable and culturally responsive
approaches for understanding distress and building
resilience and less stigmatizing than traditional mental
health services. Services in schools and community settings
would further reduce stigma and minimize logistical
barriers. Participants identified needing strong, culturally
sensitive assessment tools to measure treatment progress as
a key future direction. Originality/value: The study offers
novel insights into the value of arts-based approaches and
considerations for program development. The next phase of
the project will obtain the perspectives of refugee parents
and children to understand client preferences for arts-based
therapies.},
Doi = {10.1108/IJMHSC-11-2021-0110},
Key = {fds372411}
}
@article{fds365454,
Author = {Puffer, ES and Finnegan, A and Schenk, K and Langhaug, L and Rusakaniko,
S and Choi, Y and Mahaso, S and Simmons, R and Green,
EP},
Title = {Comparing fears about paediatric HIV disclosure to the lived
experiences of parents and guardians: a prospective cohort
study.},
Journal = {Psychology & health},
Volume = {38},
Number = {12},
Pages = {1587-1605},
Year = {2023},
Month = {November},
url = {http://dx.doi.org/10.1080/08870446.2022.2041637},
Abstract = {<h4>Objective</h4>We aimed to: (1) follow parents and
guardians through the process of paediatric HIV disclosure
to understand how often pre-disclosure worries are realised;
and (2) estimate the effects of disclosure on child,
caregiver, and family well-being.<h4>Design</h4>We conducted
a 12-month prospective cohort study in Zimbabwe with 123
primary caregivers of children ages 9 to 15 years who were
HIV positive but did not know their serostatus at baseline.
By the end of the study period 65 caregivers reported that
their child learned his or her HIV-positive status.<h4>Main
outcome measures</h4>We used three waves of data to compare
caregivers' pre-disclosure worries to post-disclosure
reports and to characterise associations between disclosure
and well-being of the child (Strengths and Difficulties
Questionnaire), caregiver (Patient Health Questionnaire-9),
and family (Family Relationship Quality) over
time.<h4>Results</h4>Caregivers' pre-disclosure worries and
fears about how their child would react to disclosure of
their HIV status largely went unrealised. Furthermore, we
did not find strong evidence of clinically-important
increases in problems on average following
disclosure.<h4>Conclusion</h4>Findings support the call to
identify supportive intervention strategies that address
caregiver fears at the beginning of the disclosure
process.},
Doi = {10.1080/08870446.2022.2041637},
Key = {fds365454}
}
@article{fds374235,
Author = {Jaguga, F and Kwobah, EK and Giusto, A and Apondi, E and Barasa, J and Korir, M and Rono, W and Kosgei, G and Puffer, E and Ott,
M},
Title = {Feasibility and acceptability of a peer provider delivered
substance use screening and brief intervention program for
youth in Kenya.},
Journal = {BMC public health},
Volume = {23},
Number = {1},
Pages = {2254},
Year = {2023},
Month = {November},
url = {http://dx.doi.org/10.1186/s12889-023-17146-w},
Abstract = {<h4>Background</h4>Youth in sub-Saharan Africa are at high
risk of substance use yet lack access to substance use
interventions. The goal of this project was to evaluate the
feasibility and acceptability of a peer-delivered,
single-session substance use screening and brief
intervention program for youth in Kenya.<h4>Methods</h4>This
was a convergent parallel mixed methods study utilizing both
quantitative and qualitative approaches. Two trained peer
providers administered the screening and brief intervention
program to 100 youth aged 15-24 years. To evaluate the
implementation of the intervention, we collected
quantitative and qualitative data. Feasibility and
acceptability were quantitatively assessed using the
Dissemination and Implementation Measures. Fidelity was
assessed by rating all 100 audio-recorded sessions using a
checklist. To obtain qualitative feedback on the
intervention, we conducted five focus group discussions with
25 youths and six semi-structured interviews with two peer
providers and four clinic leaders. The semi-structured
interviews were guided by the Consolidated Framework for
Implementation Research. Quantitative data was analyzed via
descriptive statistics using STATA. Qualitative data was
analyzed using thematic analysis with NVIVO.<h4>Results</h4>The
lifetime prevalence of any substance use was 50%. The mean
level of acceptability of the intervention from the
perspective of the youth was 3.53 (SD 0.15), meaning that
the youth found the intervention to be acceptable "a lot" of
the time. Mean levels of implementation outcomes
(acceptability, adoption, Acceptability, Appropriateness,
Feasibility, Reach/access, Organizational climate, General
leadership skills, and Sustainability) as rated by peer
providers and clinic staff ranged between 2.61 ("a moderate
amount") and 4.0 ("a lot"). In qualitative data, youth
reported that the intervention was helpful and useful in
enabling them to stop or reduce substance use. The peer
providers felt that the intervention was easy to implement,
while the clinic leaders felt that available resources were
adequate, and that the intervention aligned well with the
goals of the clinic.<h4>Conclusion</h4>Our findings suggest
that the peer-delivered screening and brief intervention
program was perceived as acceptable to the youth and
feasible to implement.<h4>Trial registration</h4>NCT04998045
Registration date: 10/08/2021.},
Doi = {10.1186/s12889-023-17146-w},
Key = {fds374235}
}
@article{fds372412,
Author = {Quick, KN and Vissoci, JRN and Green, EP and Chase, RM and Puffer,
ES},
Title = {Adaptation and Evaluation of a Picture-Based Measure of
Parent Discipline},
Journal = {Journal of Child and Family Studies},
Volume = {32},
Number = {10},
Pages = {2901-2914},
Year = {2023},
Month = {October},
url = {http://dx.doi.org/10.1007/s10826-023-02640-x},
Abstract = {Harsh parenting behaviors are some of the most commonly used
discipline practices in the United States but are often
difficult to measure. Self-report instruments are the most
used method of assessing parenting behaviors, but likely
result in response biases due to their methodological
shortcomings. This study aimed to provide a viable
alternative to traditional self-report surveys used to
evaluate parenting practices with lower social desirability
and lower literacy requirements. Our primary objectives were
to adapt the Harsh Discipline Preference Discrete Choice
Experiment (HDP-DCE), a picture-based measure originally
developed for Liberia, for use with an American population,
and evaluate its psychometric evidence of reliability and
validity. We first adapted items through an iterative
process of collecting feedback from 97 parents and 10
experts through focus groups and surveys to generate clear
and acceptable images to elicit preferences for discipline
strategies. We then administered the measure to 439 parents
to explore the internal structure of the measure and
evaluate multiple indicators of reliability and validity. An
exploratory factor analysis resulted in three potential
factor-solutions, with the three-factor solution explaining
the most variance and being the most theoretically sound.
Analyses also demonstrated that the HDP-DCE has excellent
internal consistency, good test-retest reliability, and good
convergent and discriminant validity. Given these results
the HDP-DCE could be a useful alternative or complement to
traditional self-report tools in research and clinical
work.},
Doi = {10.1007/s10826-023-02640-x},
Key = {fds372412}
}
@article{fds373561,
Author = {Venturo-Conerly, K and Osborn, TL and Puffer, ES and Weisz, J and van
der Markt, A},
Title = {RE: Do no harm: can school mental health interventions cause
iatrogenic harm?},
Journal = {BJPsych bulletin},
Volume = {47},
Number = {5},
Pages = {300-301},
Year = {2023},
Month = {October},
url = {http://dx.doi.org/10.1192/bjb.2023.65},
Doi = {10.1192/bjb.2023.65},
Key = {fds373561}
}
@article{fds373562,
Author = {Johnson, S and Quick, KN and Rieder, AD and Rasmussen, JD and Sanyal, A and Green, EP and Duerr, E and Nagy, GA and Puffer, ES},
Title = {Social Vulnerability, COVID-19, Racial Violence, and
Depressive Symptoms: a Cross-sectional Study in the Southern
United States.},
Journal = {Journal of racial and ethnic health disparities},
Year = {2023},
Month = {October},
url = {http://dx.doi.org/10.1007/s40615-023-01831-y},
Abstract = {<h4>Background</h4>In March 2020, the novel 2019 coronavirus
disease (COVID-19) was declared a pandemic. In May 2020,
George Floyd was murdered, catalyzing a national racial
reckoning. In the Southern United States, these events
occurred in the context of a history of racism and high
rates of poverty and discrimination, especially among
racially and ethnically minoritized populations.<h4>Objectives</h4>In
this study, we examine social vulnerabilities, the perceived
impacts of COVID-19 and the national racial reckoning, and
how these are associated with depression symptoms in the
South.<h4>Methods</h4>Data were collected from 961 adults
between June and November 2020 as part of an online survey
study on family well-being during COVID-19. The sample was
majority female (87.2%) and consisted of 661 White
participants, 143 Black participants, and 157 other racial
and ethnic minoritized participants. Existing social
vulnerability, perceived impact of COVID-19 and racial
violence and protests on families, and depressive symptoms
were assessed. Hierarchical regression analysis was used to
predict variance in depressive symptoms.<h4>Results</h4>Half
of the sample (52%) reported a negative impact of COVID-19,
and 66% reported a negative impact of national racial
violence/protests. Depressive symptoms were common with
49.8% meeting the cutoff for significant depressive
symptoms; Black participants had lower levels of depressive
symptoms. Results from the hierarchical regression analysis
indicate social vulnerabilities and the perceived negative
impact of COVID-19 and racial violence/protests each
contribute to variance in depressive symptoms. Race-specific
sensitivity analysis clarified distinct patterns in
predictors of depressive symptoms.<h4>Conclusion</h4>People
in the South report being negatively impacted by the
confluence of the COVID-19 pandemic and the emergence of
racial violence/protests in 2020, though patterns differ by
racial group. These events, on top of pre-existing social
vulnerabilities, help explain depressive symptoms in the
South during 2020.},
Doi = {10.1007/s40615-023-01831-y},
Key = {fds373562}
}
@article{fds371128,
Author = {Kim, AW and Rieder, AD and Cooper-Vince, CE and Kakuhikire, B and Baguma, C and Satinsky, EN and Perkins, JM and Kiconco, A and Namara,
EB and Rasmussen, JD and Ashaba, S and Bangsberg, DR and Tsai, AC and Puffer, ES},
Title = {Maternal adverse childhood experiences, child mental health,
and the mediating effect of maternal depression: A
cross-sectional, population-based study in rural,
southwestern Uganda.},
Journal = {American journal of biological anthropology},
Volume = {182},
Number = {1},
Pages = {19-31},
Year = {2023},
Month = {September},
url = {http://dx.doi.org/10.1002/ajpa.24758},
Abstract = {<h4>Objectives</h4>This study aimed to examine the
intergenerational effects of maternal adverse childhood
experiences (ACEs) and child mental health outcomes in rural
Uganda, as well as the potentially mediating role of
maternal depression in this pathway. Additionally, we sought
to test the extent to which maternal social group membership
attenuated the mediating effect of maternal depression on
child mental health.<h4>Methods</h4>Data come from a
population-based cohort of families living in the Nyakabare
Parish, a rural district in southwestern Uganda. Between
2016 and 2018, mothers completed surveys about childhood
adversity, depressive symptoms, social group membership, and
their children's mental health. Survey data were analyzed
using causal mediation and moderated-mediation
analysis.<h4>Results</h4>Among 218 mother-child pairs, 61
mothers (28%) and 47 children (22%) showed symptoms meeting
cutoffs for clinically significant psychological distress.
In multivariable linear regression models, maternal ACEs had
a statistically significant association with severity of
child conduct problems, peer problems, and total child
difficulty scores. Maternal depression mediated the
relationship between maternal ACEs and conduct problems,
peer problems, and total difficulty, but this mediating
effect was not moderated by maternal group
membership.<h4>Conclusions</h4>Maternal depression may act
as a potential mechanism linking maternal childhood
adversity with poor child mental health in the next
generation. Within a context of elevated rates of
psychiatric morbidity, high prevalence of childhood
adversity, and limited healthcare and economic
infrastructures across Uganda, these results emphasize the
prioritization of social services and mental health
resources for rural Ugandan families.},
Doi = {10.1002/ajpa.24758},
Key = {fds371128}
}
@article{fds371129,
Author = {Giusto, A and Vander Missen and MR and Kosgei, G and Njiriri, F and Puffer,
E and Kamaru Kwobah and E and Barasa, J and Turissini, M and Rasmussen, J and Ott, M and Binayo, J and Rono, W and Jaguga, F},
Title = {Peer-delivered Problem-solving Therapy for Adolescent Mental
Health in Kenya: Adaptation for Context and Training of
Peer-counselors.},
Journal = {Research on child and adolescent psychopathology},
Volume = {51},
Number = {9},
Pages = {1243-1256},
Year = {2023},
Month = {September},
url = {http://dx.doi.org/10.1007/s10802-023-01075-8},
Abstract = {Peer-delivered interventions for adolescent mental health
can help address poor access to mental health interventions.
Questions remain about how interventions can be adapted for
peer delivery and whether peers can be trained. In this
study, we adapted problem solving therapy (PST) for
peer-delivery with adolescents in Kenya and explored whether
peer counselors can be trained in PST. We adapted treatment
prior to and during training using the Cultural Adaptation
and Contextualization for Implementation framework. Nine
peer counselors (Ages 20-24) were selected and trained over
10 days. Peer competencies and knowledge were measured
pre-post using a written exam, a written case study, and
role plays rated using a standardized competency measure. We
chose a version of PST used in India with secondary school
adolescents originally delivered by teachers. All materials
were translated into Kiswahili. Language and format were
adapted to Kenyan adolescents as well as for delivery by
peers with a focus on understandability and relevance (e.g.,
noting shared experience). Metaphors, examples, and visual
materials were adapted for the context to reflect the
culture and vernacular of Kenyan youth. Peer counselors were
able to be trained in PST. Pre-post competencies and
understanding of content showed improvements with peers
minimally meeting patient needs (pre) on average to
moderate/fully meeting patient needs (post). Post-training
written exam score showed an average 90% correct. There is
an adapted version of PST for Kenyan adolescents and peer
delivery. Peer counselors can be trained to deliver a
5-session PST in a community context.},
Doi = {10.1007/s10802-023-01075-8},
Key = {fds371129}
}
@article{fds372672,
Author = {Kaiser, BN and Kaufman, J and Wall, JT and Healy, EAF and Ayuku, D and Aarons, GA and Puffer, ES},
Title = {Assessing ad-hoc adaptations' alignment with therapeutic
goals: a qualitative study of lay counselor-delivered family
therapy in Eldoret, Kenya.},
Journal = {Implementation science communications},
Volume = {4},
Number = {1},
Pages = {105},
Year = {2023},
Month = {August},
url = {http://dx.doi.org/10.1186/s43058-023-00477-5},
Abstract = {<h4>Background</h4>A key question in implementation science
is how to balance adaptation and fidelity in translating
interventions to new settings. There is growing consensus
regarding the importance of planned adaptations to deliver
interventions in contextually sensitive ways. However, less
research has examined ad-hoc adaptations, or those that
occur spontaneously in the course of intervention delivery.
A key question is whether ad-hoc adaptations ultimately
contribute to or detract from intervention goals. This study
aimed to (a) identify ad-hoc adaptations made during
delivery of a family therapy intervention and (b) assess
whether they promoted or interrupted intervention
goals.<h4>Methods</h4>Tuko Pamoja (Swahili: "We are
Together") is an evidence-informed family therapy
intervention aiming to improve family dynamics and mental
health in Kenya. Tuko Pamoja employs a task-shifting model,
delivered by lay counselors who are afforded a degree of
flexibility in presenting content and in practices they use
in sessions. We used transcripts of therapy sessions with 14
families to examine ad-hoc adaptations used by counselors.
We first identified and characterized ad-hoc adaptations
through a team-based code development, coding, and code
description process. Then, we evaluated to what extent
ad-hoc adaptations promoted the principles and strategies of
the intervention ("TP-promoting"), disrupted them
("TP-interrupting"), or neither ("TP-neutral"). To do this,
we first established inter-coder agreement on application of
these categories with verification by the intervention
developer. Then, coders categorized ad-hoc adaptation text
segments as TP-promoting, TP-interrupting, or
TP-neutral.<h4>Results</h4>Ad-hoc adaptations were frequent
and included (in decreasing order): incorporation of
religious content, exemplars/role models, community dynamics
and resources, self-disclosure, and metaphors/proverbs.
Ad-hoc adaptations were largely TP-promoting (49%) or
neutral (39%), but practices were TP-interrupting 12% of the
time. TP-interrupting practices most often occurred within
religious content and exemplars/role models, which were also
the most common practices overall.<h4>Conclusion</h4>Extra
attention is needed during planned adaptation, training, and
supervision to promote intervention-aligned use of common
ad-hoc adaptation practices. Discussing them in trainings
can provide guidance for lay providers on how best to
incorporate ad-hoc adaptations during delivery. Future
research should evaluate whether well-aligned ad-hoc
adaptations improve therapeutic outcomes.<h4>Trial
registration</h4>Pilot trial registered at
clinicaltrials.gov (C0058).},
Doi = {10.1186/s43058-023-00477-5},
Key = {fds372672}
}
@article{fds372673,
Author = {Joshi, D and Aschner, A and Atkinson, L and Halili-Sychangco, D and Duku, E and Puffer, ES and Rieder, A and Tonmyr, L and Gonzalez,
A},
Title = {Predictors of harsh parenting practices and inter-partner
conflict during the COVID-19 pandemic in Ontario, Canada: a
cross-sectional analysis from the Ontario Parent
Survey.},
Journal = {BMJ open},
Volume = {13},
Number = {8},
Pages = {e066840},
Year = {2023},
Month = {August},
url = {http://dx.doi.org/10.1136/bmjopen-2022-066840},
Abstract = {<h4>Objectives</h4>Guided by the bioecological model, the
purpose of this study was to examine the associations of (1)
individual level factors (sociodemographic, health behaviour
and mental health), (2) family (micro) level COVID-19
experiences (difficulty with household management, managing
child mood and behaviour, and pandemic-related positive
experiences) and (3) community (macro) level factors
(residential instability, ethnic concentration, material
deprivation and dependency, an indicator of age and labour
force) with harsh parenting practices and inter-partner
conflict during the early lockdown of the COVID-19 pandemic
in Ontario, Canada.<h4>Design</h4>A cross-sectional analysis
of data from the Ontario Parent Survey.<h4>Setting</h4>A
convenience sample of 7451 caregivers living in Ontario,
Canada, at the time of baseline data collection (May-June
2020).<h4>Participants</h4>Caregivers aged 18 years and
older with children 17 years or younger.<h4>Outcome
measures</h4>Parenting practices over the past 2 months
was assessed using a published modification of the Parenting
Scale. The frequency of inter-partner conflict over the past
month was assessed using the Marital Conflict
scale.<h4>Results</h4>Individual (sociodemographic factors,
alcohol use, and higher depressive and anxiety symptoms) and
family (difficulties with managing the household and child
mood and behaviour) level factors were positively associated
with inter-partner conflict and harsh parenting practices.
Having fewer positive experiences (eg, performing activities
with children), and economic adversity at the family level
were positively associated with inter-partner conflict but
inversely associated with harsh parenting. At the community
level, residential instability was negatively associated
with harsh parenting practices.<h4>Conclusions</h4>Individual
and family level factors were associated with harsh
parenting and inter-partner conflict. The associations of
fewer positive experiences and economic hardship with harsh
parenting practices may be more complex than initially
thought. Efforts that raise awareness and address caregiver
mental health concerns are needed as part of the pandemic
response to promote positive inter-partner and parent-child
interactions.},
Doi = {10.1136/bmjopen-2022-066840},
Key = {fds372673}
}
@article{fds368902,
Author = {Johnson, SL and Rieder, A and Green, EP and Finnegan, A and Chase, RM and Zayzay, J and Puffer, ES},
Title = {Parenting in a conflict-affected setting: Discipline
practices, parent-child interactions, and parenting stress
in Liberia.},
Journal = {Journal of family psychology : JFP : journal of the Division
of Family Psychology of the American Psychological
Association (Division 43)},
Volume = {37},
Number = {3},
Pages = {283-294},
Year = {2023},
Month = {April},
url = {http://dx.doi.org/10.1037/fam0001041},
Abstract = {Children in conflict-affected settings are at increased risk
for exposure to violence, placing particular importance on
caregiving environments. This study first describes
parenting in urban Liberia by evaluating parent-child
interactions, the use and acceptance of harsh and nonharsh
discipline, discipline preferences, and the co-occurrence of
positive interactions and harsh discipline. The relationship
between parenting stress and harsh discipline attitudes and
behaviors is then tested. Participants included 813 parents
with a child aged 3 or 4 years old. A quantitative survey
battery assessed parent-child interactions; discipline
practices, preferences, and attitudes; and parenting stress.
Parents reported frequent use and high acceptance of
nonharsh discipline, as well as frequent positive
interactions with their child. Though parents reported less
frequent use and low acceptance of harsh discipline,
preference for harsh discipline-based on hypothetical
situations rather than self-report-was common. There was
co-occurrence of frequent positive interactions and frequent
harsh discipline, with one third reporting high frequency of
both. Regression analysis revealed greater parenting stress
(β = .15, <i>t</i> = 4.49, <i>p</i> < .001) and stronger
acceptance of harsh discipline (β = .47, <i>t</i> = 15.49,
<i>p</i> < .001) were associated with more frequent harsh
discipline. Acceptance of harsh discipline interacted with
parenting stress to predict the use of harsh discipline (β
= -.09, <i>t</i> = -3.09, <i>p</i> < .01). Among parents
with lowest average acceptance of harsh practices, stress
predicted more frequent harsh discipline, but acceptance did
not moderate the association for those who are most
accepting of harsh practices. Building on existing parenting
strengths and addressing parenting stress could promote
nurturing caregiving in conflict-affected settings.
(PsycInfo Database Record (c) 2023 APA, all rights
reserved).},
Doi = {10.1037/fam0001041},
Key = {fds368902}
}
@article{fds369706,
Author = {Sim, A and Puffer, E and Ahmad, A and Hammad, L and Georgiades,
K},
Title = {Resettlement, mental health, and coping: a mixed methods
survey with recently resettled refugee parents in
Canada.},
Journal = {BMC public health},
Volume = {23},
Number = {1},
Pages = {386},
Year = {2023},
Month = {February},
url = {http://dx.doi.org/10.1186/s12889-023-15300-y},
Abstract = {<h4>Background</h4>Resettlement experiences of refugee
parents are under-researched despite evidence indicating
higher risk of poor mental health. The current study
integrates family systems and social determinants of refugee
mental health frameworks to examine: (1) Refugee parents'
experiences of resettlement stressors and mental health; (2)
Perceived impacts of resettlement stressors on individual
and family indicators of well-being; and (3) Refugee
parents' coping strategies and resources.<h4>Methods</h4>The
study draws on data from a mixed methods survey conducted
with 40 Government-Assisted Refugee parents who had
resettled to Hamilton, Canada within the past 4 years.
Quantitative and qualitative data were analyzed separately
and then integrated at the results stage using a weaving
approach.<h4>Results</h4>Results indicate significant
exposure to economic and social stressors across multiple
domains of daily life, as well as high levels of parental
psychological distress. Parents drew linkages between
resettlement stressors and negative mental health impacts
that were compounded by intersecting risk factors of ill
health, caregiving burden, single parenthood, and low levels
of education and literacy. Most parents rated themselves as
coping well or very well and described various coping
strategies such as positive reframing, problem solving,
planning, and turning to religion. Quantitative and
qualitative findings indicate high frequency of positive
parent-child interaction and low frequency of family
conflict, and highlight the importance of family as a
protective resource for coping with adversity. Exploratory
regression analyses suggest that longer stay in Canada,
poorer self-rated health, higher levels of resettlement
stressors, and more conflict between adults in the household
may be associated with greater psychological
distress.<h4>Conclusion</h4>Study findings highlight both
the resilience of refugee parents and the psychological toll
of navigating their families through a new and challenging
environment. Policies and programs to provide comprehensive
social and economic supports to refugees beyond the first
one to two years after arrival are necessary to mitigate the
mental health impacts of displacement over time and
strengthen individual and family resilience. Such programs
should include culturally responsive and family-based models
of mental health care that acknowledge collective
experiences and impacts of adversity, as well as harness
family resources to overcome past and present
challenges.},
Doi = {10.1186/s12889-023-15300-y},
Key = {fds369706}
}
@article{fds373960,
Author = {Sim, A and Jirapramukpitak, T and Eagling-Peche, S and Lwin, KZ and Melendez-Torres, GJ and Gonzalez, A and Oo, NN and Castello Mitjans,
I and Soan, M and Punpuing, S and Lee, C and Chuenglertsiri, P and Moo, T and Puffer, E},
Title = {A film-based intervention to reduce child maltreatment among
migrant and displaced families from Myanmar: Protocol of a
pragmatic cluster randomized controlled trial.},
Journal = {PloS one},
Volume = {18},
Number = {10},
Pages = {e0293623},
Year = {2023},
Month = {January},
url = {http://dx.doi.org/10.1371/journal.pone.0293623},
Abstract = {<h4>Background</h4>Child maltreatment is a global public
health crisis with negative consequences for physical and
mental health. Children in low- and middle-income countries
(LMIC)-particularly those affected by poverty, armed
conflict, and forced migration-may be at increased risk of
maltreatment due to heightened parental distress and
disruptions to social support networks. Parenting
interventions have been shown to reduce the risk of child
maltreatment as well as improve a range of caregiver and
child outcomes, yet large-scale implementation remains
limited in low-resource displacement settings. This study
will examine the impact of an entertainment-education
narrative film intervention on reducing physical and
emotional abuse and increasing positive parenting among
migrant and displaced families from Myanmar living in
Thailand.<h4>Method</h4>The study is a pragmatic,
superiority cluster randomized controlled trial with
approximately 40 communities randomized to the intervention
or treatment as usual arms in a 1:1 ratio. Participating
families in the intervention arm will be invited to attend a
community screening of the film intervention and a
post-screening discussion, as well as receive a poster
depicting key messages from the film. Primary outcomes are
changes in physical abuse, emotional abuse, and positive
parenting behaviour. Secondary outcomes include caregiver
knowledge of positive parenting, caregiver attitudes towards
harsh punishment, caregiver psychological distress, and
family functioning. Outcomes will be assessed at 3 time
points: baseline, 4 weeks post-intervention, and 4-month
follow up. A mixed methods process evaluation will be
embedded within the trial to assess intervention delivery,
acceptability, perceived impacts, and potential mechanisms
of change.<h4>Discussion</h4>To our knowledge, this study
will be the first randomized controlled trial evaluation of
a film-based intervention to reduce child maltreatment among
migrant and displaced families in a LMIC. An integrated
knowledge translation approach will inform uptake of study
findings and application to potential scale up pending
evaluation results.<h4>Trial registration</h4>The study was
prospectively registered with the Thai Clinical Trials
Registry on 22 February 2023 (TCTR20230222005).},
Doi = {10.1371/journal.pone.0293623},
Key = {fds373960}
}
@article{fds370315,
Author = {Satinsky, EN and Kakuhikire, B and Baguma, C and Cooper-Vince, CE and Rasmussen, JD and Ashaba, S and Perkins, JM and Ahereza, P and Ayebare,
P and Kim, AW and Puffer, ES and Tsai, AC},
Title = {Caregiver preferences for physically harsh discipline of
children in rural Uganda},
Journal = {Journal of Family Violence},
Year = {2023},
Month = {January},
url = {http://dx.doi.org/10.1007/s10896-023-00536-4},
Abstract = {Purpose: Physically harsh discipline is associated with poor
developmental outcomes among children. These practices are
more prevalent in areas experiencing poverty and resource
scarcity, including in low- and middle-income countries.
Designed to limit social desirability bias, this
cross-sectional study in rural Uganda estimated caregiver
preferences for physically harsh discipline; differences by
caregiver sex, child sex, and setting; and associations with
indicators of household economic stress and insecurity.
Method: Three-hundred-fifty adult caregivers were shown six
hypothetical pictographic scenarios depicting children
whining, spilling a drink, and kicking a caregiver. Girls
and boys were depicted engaging in each of the three
behaviors. Approximately half of the participants were shown
scenes from a market setting and half were shown scenes from
a household setting. For each scenario, caregivers reported
the discipline strategy they would use (time out, beating,
discussing, yelling, ignoring, slapping). Results: Two
thirds of the participants selected a physically harsh
discipline strategy (beating, slapping) at least once. Women
selected more physically harsh discipline strategies than
men (b = 0.40; 95% confidence interval [CI], 0.26 to 0.54).
Participants shown scenes from the market selected fewer
physically harsh discipline strategies than participants
shown scenes from the household (b = -0.51; 95% CI, -0.69 to
-0.33). Finally, caregivers selected more physically harsh
discipline strategies in response to boys than girls.
Indicators of economic insecurity were inconsistently
associated with preferences for physically harsh discipline.
Conclusions: The high prevalence of physically harsh
discipline preferences warrant interventions aimed at
reframing caregivers’ approaches to discipline.},
Doi = {10.1007/s10896-023-00536-4},
Key = {fds370315}
}
@article{fds371298,
Author = {Barnett, ML and Puffer, ES and Ng, LC and Jaguga,
F},
Title = {Effective training practices for non-specialist providers to
promote high-quality mental health intervention delivery: A
narrative review with four case studies from Kenya,
Ethiopia, and the United States.},
Journal = {Global mental health (Cambridge, England)},
Volume = {10},
Pages = {e26},
Publisher = {Cambridge University Press (CUP)},
Year = {2023},
Month = {January},
url = {http://dx.doi.org/10.1017/gmh.2023.19},
Abstract = {Mental health needs and disparities are widespread and have
been exacerbated by the COVID-19 pandemic, with the greatest
burden being on marginalized individuals worldwide. The
World Health Organization developed the Mental Health Gap
Action Programme to address growing global mental health
needs by promoting task sharing in the delivery of
psychosocial and psychological interventions. However,
little is known about the training needed for
non-specialists to deliver these interventions with high
levels of competence and fidelity. This article provides a
brief conceptual overview of the evidence concerning the
training of non-specialists carrying out task-sharing
psychosocial and psychological interventions while utilizing
illustrative case studies from Kenya, Ethiopia, and the
United States to highlight findings from the literature. In
this article, the authors discuss the importance of
tailoring training to the skills and needs of the
non-specialist providers and their roles in the delivery of
an intervention. This narrative review with four case
studies advocates for training that recognizes the expertise
that non-specialist providers bring to intervention
delivery, including how they promote culturally responsive
care within their communities.},
Doi = {10.1017/gmh.2023.19},
Key = {fds371298}
}
@article{fds375963,
Author = {Maloney, CA and Wall, T and Giusto, AM and Chase, RM and Finnegan, A and Sim, A and Zayzay, JO and Puffer, ES},
Title = {Early Childhood Parenting Programs and Community
Peacebuilding Behaviors: A Case Study From Postconflict
Liberia},
Journal = {Peace and Conflict},
Year = {2023},
Month = {January},
url = {http://dx.doi.org/10.1037/pac0000717},
Abstract = {Despite the connection between early childhood development
(ECD) and later behavioral outcomes, peacebuilding
frameworks have only recently begun to explore pathways
through which ECD programs promote peace in community
contexts. Recent literature theorizes that ECD interventions
may spill over from family to community interactions, which
is particularly important in areas affected by conflict. The
current case study explored qualitative outcomes associated
with peacebuilding behaviors across a randomized controlled
trial of Parents Make the Difference, a parenting program in
postconflict Liberia. Parents or primary caregivers of
children aged 3–5 years (N = 813) attended 10 weekly
sessions, with 75 completing follow-up interviews.
Participants described engaging in prosocial behaviors in
the context of their community following program completion,
such as decreased personal conflict and empowerment to
mediate conflict between peers. Findings highlight improved
community relationships in promoting peace among adults and
modeling these behaviors for children during a critical
period of development.},
Doi = {10.1037/pac0000717},
Key = {fds375963}
}
@article{fds358021,
Author = {Schmidt, CN and Puffer, ES and Broverman, S and Warren, V and Green,
EP},
Title = {Is social-ecological risk associated with individual HIV
risk beliefs and behaviours?: An analysis of Kenyan
adolescents' local communities and activity
spaces.},
Journal = {Global public health},
Volume = {17},
Number = {12},
Pages = {3670-3685},
Year = {2022},
Month = {December},
url = {http://dx.doi.org/10.1080/17441692.2021.1951801},
Abstract = {The places where adolescents live, learn, and play are
thought to influence behaviours and health, but we have
limited tools for measuring environmental risk on a
hyperlocal (e.g. neighbourhood) level. Working with 218
adolescents and their parents/guardians in rural western
Kenya, we combined participatory mapping activities with
satellite imagery to identify adolescent activity spaces and
create a novel measure of social-ecological risks. We then
examined the associations between social-ecological risk and
individual HIV risk beliefs and behaviours. We found support
for the conjecture that social-ecological risks may be
associated with individual beliefs and behaviours. As
social-ecological risk increased for a sample of Kenyan
adolescents, so did their reports of riskier sex beliefs and
behaviours, as well as unsupervised outings at night. This
study reinforces calls for disease prevention approaches
that go beyond emphasising individual behaviour
change.},
Doi = {10.1080/17441692.2021.1951801},
Key = {fds358021}
}
@article{fds366201,
Author = {Zewdie, HY and Whetten, K and Dubie, ME and Kenea, B and Bekele, T and Temesgen, C and Molla, W and Puffer, ES and Ostermann, J and Hobbie, AM and Gray, CL},
Title = {The association between urban greenspace and psychological
health among young adults in Addis Ababa,
Ethiopia.},
Journal = {Environmental research},
Volume = {215},
Number = {Pt 1},
Pages = {114258},
Year = {2022},
Month = {December},
url = {http://dx.doi.org/10.1016/j.envres.2022.114258},
Abstract = {<h4>Introduction</h4>Psychological disorders are emerging as
health priorities in Sub-Saharan Africa, specifically
Ethiopia. Urban greenspace - parks, trees, and other
vegetation integrated into urban form - may facilitate
population psychological health, but is largely understudied
outside high-income countries. We explore greenspace in
relation to psychological health among young adults in Addis
Ababa, Ethiopia.<h4>Method</h4>Greenspace exposure was
calculated using the normalized difference vegetation index
(NDVI) derived from publicly available satellite imagery
(2018-2019). We used tests of spatial clustering to
characterize greenspace distribution. Derived NDVI values
were linked to Positive Outcomes for Orphans study
participants to explore cross-sectional associations between
greenspace exposure and psychological health (measured
2019-2021). Two continuous scores of psychological health
were examined: total difficulties from the Strengths and
Difficulties Questionnaire and depressive symptoms from the
8-item Patient Health Questionnaire. Multilevel generalized
linear regression, nested by administrative units, was used
to estimate the association between greenspace and
psychological health. We also explored effect modification
by gender and having income.<h4>Results</h4>We found
greenspace is spatially clustered in Addis Ababa, with high
greenspace density in the northeast region and low
greenspace density in the center of the city. Our findings
suggest residing in greener areas is associated with fewer
emotional and behavioral difficulties (β = -1.89; 95% CI:
-3.50, -0.29), but not significantly associated with
depressive symptomology (β = -0.61; 95% CI: -2.33, 1.11).
We observed stronger associations between greenspace and
total difficulties among those reporting any income and
among males, and for the association between greenspace and
depression symptomology among males.<h4>Conclusion</h4>We
offer initial exploration into the role of greenspace in
psychological well-being in Addis Ababa, with potential
implications for urban communities across Sub-Saharan
Africa. Further research should continue to explore how the
built and natural environment could be leveraged in similar
settings to promote population psychological
health.},
Doi = {10.1016/j.envres.2022.114258},
Key = {fds366201}
}
@article{fds367414,
Author = {Giusto, A and Friis-Healy, EA and Kaiser, BN and Ayuku, D and Rono, W and Puffer, ES},
Title = {Mechanisms of change for a family intervention in Kenya: An
Integrated Clinical and Implementation Mapping
approach.},
Journal = {Behaviour research and therapy},
Volume = {159},
Pages = {104219},
Year = {2022},
Month = {December},
url = {http://dx.doi.org/10.1016/j.brat.2022.104219},
Abstract = {To increase cultural relevance and maximize access for
historically underserved populations, there is a need to
explore mechanisms underlying treatment outcomes during
piloting. We developed a mixed-method approach, Integrated
Clinical and Implementation Mapping (ICIM), to explore
clinical and implementation mechanisms to inform
improvements in content and delivery. We applied ICIM in a
pilot of Tuko Pamoja, a lay counselor-delivered family
intervention in Kenya (10 families with adolescents ages
12-17). ICIM is a 3-phase process to triangulate data
sources to analyze how and why change occurs within
individual cases and across cases. We synthesized data from
session and supervision transcripts, fidelity and clinical
skills ratings, surveys, and interviews. Outputs included a
comprehensive narrative and visual map depicting how content
and implementation factors influenced change. For Tuko
Pamoja, ICIM results showed common presenting problems,
including financial strain and caregivers' distress,
triggering negative interactions and adolescent distress.
ICIM demonstrated that active treatment ingredients included
communication skills and facilitated, prescribed time
together. Families improved communication, empathy, and
hope, facilitated improved family functioning and mental
health. Key implementation mechanisms included provider
clinical competencies, alliance-building, treatment-aligned
adaptations, and consistent attendance. Results guided
manual and training refinements and generated hypotheses
about mechanisms to test in larger trials.},
Doi = {10.1016/j.brat.2022.104219},
Key = {fds367414}
}
@article{fds370411,
Author = {Johnson, SL and Kim, ET and Rieder, AD and Green, EP and Finnegan, A and Chase, RM and Zayzay, J and Puffer, ES},
Title = {Pathways from parent mental health to child outcomes in
Liberia: Testing cross-sectional and longitudinal serial
mediation models},
Journal = {SSM - Mental Health},
Volume = {2},
Year = {2022},
Month = {December},
url = {http://dx.doi.org/10.1016/j.ssmmh.2022.100147},
Abstract = {Children in humanitarian settings face complex adversities
that impact development. The interplay of caregiver mental
health, couples' relationship quality, and parenting
practices can both protect against adversity and contribute
to it. The purpose of the study was to examine whether
caregiver depressive symptoms are associated with increased
couples' distress, in turn predicting fewer positive
parent-child interactions and then worse child emotional and
behavioral outcomes. This study took place in four urban
settlements in Monrovia, Liberia. Participants (N = 569)
included parents or caregivers of children three- or
four-years-old. Using structural equation modeling, the
serial mediation pathway from depressive symptoms to child
outcomes through couples' distress and reduced positive
parent-child interactions was tested cross-sectionally and
longitudinally across three time points. In the
cross-sectional model, two statistically significant, but
very small, indirect effects were found: 1) a serial
mediation from parent depressive symptoms to child problems
through increased couples' distress and reduced positive
parent-child interactions and 2) a specific mediation effect
through couples’ distress. The longitudinal model yielded
null direct and indirect effects. These mixed results
suggest that, while these processes may be related, the
specific pathways linking these family indicators are not
well understood, especially over time and in humanitarian
settings.},
Doi = {10.1016/j.ssmmh.2022.100147},
Key = {fds370411}
}
@article{fds362518,
Author = {Venturo-Conerly, KE and Wasil, AR and Osborn, TL and Puffer, ES and Weisz, JR and Wasanga, CM},
Title = {Designing Culturally and Contextually Sensitive Protocols
for Suicide Risk in Global Mental Health: Lessons From
Research With Adolescents in Kenya.},
Journal = {Journal of the American Academy of Child and Adolescent
Psychiatry},
Volume = {61},
Number = {9},
Pages = {1074-1077},
Year = {2022},
Month = {September},
url = {http://dx.doi.org/10.1016/j.jaac.2022.02.005},
Abstract = {In cross-cultural psychological treatment research,
investigators must ensure that protocols for addressing risk
are culturally tailored and feasible, while also protecting
against harm. Guidelines including the Belmont
Report<sup>1</sup> and the Declaration of
Helsinki<sup>2</sup> emphasize respecting participants'
autonomy and right to equitable treatment, minimizing harm
and maximizing benefit, while considering unique
circumstances, local laws and regulations, and cultures.
They highlight the importance of supervision from qualified
health professionals,<sup>2</sup> and special protections
for children.<sup>1</sup> Suicide risk poses distinctive
challenges for cross-cultural research; actions that protect
participants in one cultural context may harm participants
in another. For example, because suicide attempts are
illegal in many countries (eg, Kenya, Gambia, Nigeria),
involving law enforcement, or others who may report to them,
can generate penalties and incriminate those at risk.
Upholding the Belmont and Helsinki principles can therefore
require adapting strategies for different cultural contexts.
This Commentary outlines strategies for applying principles
of ethical risk management<sup>3,4</sup> that prioritize
sensitivity to context. We focus on addressing participant
suicide risk during clinical research in low-resource and
high-stigma settings, presenting the example of risk among
adolescents in Kenya.<sup>5,6</sup>.},
Doi = {10.1016/j.jaac.2022.02.005},
Key = {fds362518}
}
@article{fds363242,
Author = {Puffer, ES and Ayuku, D},
Title = {A Community-Embedded Implementation Model for Mental-Health
Interventions: Reaching the Hardest to Reach.},
Journal = {Perspectives on psychological science : a journal of the
Association for Psychological Science},
Volume = {17},
Number = {5},
Pages = {1276-1290},
Year = {2022},
Month = {September},
url = {http://dx.doi.org/10.1177/17456916211049362},
Abstract = {The mental-health-care treatment gap remains very large in
low-resource communities, both within high-income countries
and globally in low- and middle-income countries. Existing
approaches for disseminating psychological interventions
within health systems are not working well enough, and
hard-to-reach, high-risk populations are often going
unreached. Alternative implementation models are needed to
expand access and to address the burden of mental-health
disorders and risk factors at the family and community
levels. In this article, we present empirically supported
implementation strategies and propose an implementation
model-the community-embedded model (CEM)-that integrates
these approaches and situates them within social settings.
Key elements of the model include (a) embedding in an
existing, community-based social setting; (b) delivering
prevention and treatment in tandem; (c) using multiproblem
interventions; (d) delivering through lay providers within
the social setting; and (e) facilitating relationships
between community settings and external systems of care. We
propose integrating these elements to maximize the benefits
of each to improve clinical outcomes and sustainment of
interventions. A case study illustrates the application of
the CEM to the delivery of a family-based prevention and
treatment intervention within the social setting of
religious congregations in Kenya. The discussion highlights
challenges and opportunities for applying the CEM across
contexts and interventions.},
Doi = {10.1177/17456916211049362},
Key = {fds363242}
}
@article{fds365155,
Author = {Liu, T and Broverman, S and Puffer, ES and Zaltz, DA and Thorne-Lyman,
AL and Benjamin-Neelon, SE},
Title = {Dietary Diversity and Dietary Patterns in School-Aged
Children in Western Kenya: A Latent Class
Analysis.},
Journal = {International journal of environmental research and public
health},
Volume = {19},
Number = {15},
Pages = {9130},
Year = {2022},
Month = {July},
url = {http://dx.doi.org/10.3390/ijerph19159130},
Abstract = {Inadequate diet among children has both immediate and
long-term negative health impacts, but little is known about
dietary diversity and dietary patterns of school-aged
children in rural Kenya. We assessed dietary diversity and
identified dietary patterns in school-aged children in
Western Kenya using a latent class approach. We collected
dietary intake using a 24 h dietary recall among students in
elementary schools in two rural villages (hereafter village
A and B) in Western Kenya in 2013. The mean (SD) age was
11.6 (2.2) years in village A (<i>n</i> = 759) and 12.6
(2.2) years in village B (<i>n</i> = 1143). We evaluated
dietary diversity using the 10-food-group-based women's
dietary diversity score (WDDS) and found a mean (SD) WDDS of
4.1 (1.4) in village A and 2.6 (0.9) in village B. We
identified three distinct dietary patterns in each village
using latent class analysis. In both villages, the most
diverse pattern (28.5% in A and 57.8% in B) had high
consumption of grains, white roots and tubers, and
plantains; dairy; meat, poultry, and fish; and other
vegetables. Despite variation for some children, dietary
diversity was relatively low for children overall,
supporting the need for additional resources to improve the
overall diet of children in western Kenya.},
Doi = {10.3390/ijerph19159130},
Key = {fds365155}
}
@article{fds363997,
Author = {Venturo-Conerly, KE and Johnson, NE and Osborn, TL and Puffer, ES and Rusch, T and Ndetei, DM and Wasanga, CM and Mutiso, V and Musyimi, C and Weisz, JR},
Title = {Long-term health outcomes of adolescent character strength
interventions: 3- to 4-year outcomes of three randomized
controlled trials of the Shamiri program.},
Journal = {Trials},
Volume = {23},
Number = {1},
Pages = {443},
Year = {2022},
Month = {May},
url = {http://dx.doi.org/10.1186/s13063-022-06394-7},
Abstract = {<h4>Background</h4>Adolescents in low- and middle-income
countries in need of mental health care often do not receive
it due to stigma, cost, and lack of mental health
professionals. Culturally appropriate, brief, and low-cost
interventions delivered by lay-providers can help overcome
these barriers and appear effective at reducing symptoms of
depression and anxiety until several months
post-intervention. However, little is known about whether
these interventions may have long-term effects on health,
mental health, social, or academic outcomes.<h4>Methods</h4>Three
previous randomized controlled trials of the Shamiri
intervention, a 4-week, group-delivered, lay-provider-led
intervention, have been conducted in Kenyan high schools.
Shamiri teaches positively focused intervention elements
(i.e., growth mindset and strategies for growth, gratitude,
and value affirmation) to target symptoms of depression and
anxiety and to improve academic performance and social
relationships, by fostering character strengths. In this
long-term follow-up study, we will test whether these mental
health, academic, social, and character-strength outcomes,
along with related health outcomes (e.g., sleep quality,
heart-rate variability and activity level measured via
wearables, HIV risk behaviors, alcohol and substance use),
differ between the intervention and control group at
3-4-year follow-up. For primary analyses
(N<sub>anticipated</sub> = 432), youths who participated
in the three previous trials will be contacted again to
assess whether outcomes at 3-4-year-follow-up differ for
those in the Shamiri Intervention group compared to those in
the study-skills active control group. Multi-level models
will be used to model trajectories over time of primary
outcomes and secondary outcomes that were collected in
previous trials. For outcomes only collected at 3-4-year
follow-up, tests of location difference (e.g., t-tests) will
be used to assess group differences in metric outcomes and
difference tests (e.g., odds ratios) will be used to assess
differences in categorical outcomes. Finally, standardized
effect sizes will be used to compare groups on all
measures.<h4>Discussion</h4>This follow-up study of
participants from three randomized controlled trials of the
Shamiri intervention will provide evidence bearing on the
long-term and health and mental health effects of brief,
lay-provider-delivered character strength interventions for
youth in low- and middle-income countries.<h4>Trial
registration</h4>PACTR Trial ID: PACTR202201600200783 .
Approved on January 21, 2022.},
Doi = {10.1186/s13063-022-06394-7},
Key = {fds363997}
}
@article{fds362847,
Author = {Dawson-Squibb, J-J and Davids, EL and Chase, R and Puffer, E and Rasmussen, JDM and Franz, L and de Vries, PJ},
Title = {Bringing Parent-Child Interaction Therapy to South Africa:
Barriers and Facilitators and Overall Feasibility-First
Steps to Implementation.},
Journal = {Int J Environ Res Public Health},
Volume = {19},
Number = {8},
Year = {2022},
Month = {April},
url = {http://dx.doi.org/10.3390/ijerph19084450},
Abstract = {There is a large assessment and treatment gap in child and
adolescent mental health services, prominently so in low-
and middle-income countries, where 90% of the world's
children live. There is an urgent need to find
evidence-based interventions that can be implemented
successfully in these low-resource contexts. This pre-pilot
study aimed to explore the barriers and facilitators to
implementation as well as overall feasibility of
Parent-Child Interaction Therapy (PCIT) in South Africa. A
reflective and consensus building workshop was used to
gather South African PCIT therapist (N = 4) perspectives on
barriers, facilitators, and next steps to implementation in
that country. Caregiver participants (N = 7) receiving the
intervention in South Africa for the first time were also
recruited to gather information on overall feasibility.
Facilitators for implementation, including its strong
evidence base, manualisation, and training model were
described. Barriers relating to sustainability and
scalability were highlighted. Largely positive views on
acceptability from caregiver participants also indicated the
promise of PCIT as an intervention in South Africa. Pilot
data on the efficacy of the treatment for participating
families are a next step. These initial results are
positive, though research on how implementation factors
contribute to the longer-term successful dissemination of
PCIT in complex, heterogeneous low-resource settings is
required.},
Doi = {10.3390/ijerph19084450},
Key = {fds362847}
}
@article{fds363191,
Author = {Brown, FL and Bosqui, T and Elias, J and Farah, S and Mayya, A and Abo
Nakkoul, D and Walsh, B and Chreif, S and Einein, A and Meksassi, B and Abi
Saad, R and Naal, H and Ghossainy, ME and Donnelly, M and Betancourt,
TS and Carr, A and Puffer, E and El Chammay and R and Jordans,
MJD},
Title = {Family systemic psychosocial support for at-risk adolescents
in Lebanon: study protocol for a multi-site randomised
controlled trial.},
Journal = {Trials},
Volume = {23},
Number = {1},
Pages = {327},
Year = {2022},
Month = {April},
url = {http://dx.doi.org/10.1186/s13063-022-06284-y},
Abstract = {<h4>Background</h4>Adolescents growing up in communities
characterised by adversity face multiple risk factors for
poor mental health and wellbeing. There is currently a
scarcity of research on effective approaches for preventing
and treating psychological distress in this population,
particularly in humanitarian settings. The powerful impact
of the home environment and family support is well known;
however, approaches targeting the family are seldom
developed or evaluated in such settings. We developed a
brief family systemic psychosocial support intervention to
be delivered through existing child protection systems with
non-specialist facilitators. This paper outlines the study
protocol for a randomised controlled trial of the
intervention in Lebanon.<h4>Methods</h4>We will conduct a
single-blind hybrid effectiveness-implementation multi-site
RCT comparing the locally developed systemic family
intervention to a waitlist control group for families
residing in vulnerable regions in North Lebanon and Beqaa
governorates (including families of Syrian, Palestinian, and
Lebanese backgrounds). Outcomes on a range of family,
adolescent, and caregiver measures will be assessed at
baseline (T0) and post-intervention (T1), and at a 3-month
follow-up for the treatment arm (T2). Families will be
eligible for the trial if they are identified by
implementing organisations as being medium-to-high risk for
child protection concerns and have one or more adolescent
aged 12-17 who demonstrates significant psychological
distress on a self-report brief screening tool. Families
will be randomly assigned to a treatment or a waitlist
control condition. Families in the waitlist condition will
receive a group version of the programme after completion of
the study, to allow us to assess feasibility, acceptability,
and preliminary indications of intervention effects of this
modality. The primary outcome is reduction in overall
adolescent-reported psychological distress over time, with
post-intervention (T1) as the primary endpoint. Secondary
adolescent-reported outcomes include family functioning,
psychosocial wellbeing, and emotional regulation
difficulties. Secondary caregiver-reported outcomes include
parenting style, family functioning, psychological distress,
and emotional regulation difficulties.<h4>Discussion</h4>This
trial will provide the first assessment of the effectiveness
of the family systemic psychosocial support intervention for
use in Lebanon, with important implications for the use of
systemic, low-cost, non-specialist interventions for this
age range.<h4>Trial registration</h4>Local registry:
National Mental Health Program, Ministry of Public Health,
Lebanese Republic. Registered on 19 October 2021 Lebanese
Clinical Trial Registry LBCTR2021104870 . Registered on 13
October 2021 Global registry: ISRCTN ISRCTN13751677 .
Registered on 1 November 2021.},
Doi = {10.1186/s13063-022-06284-y},
Key = {fds363191}
}
@article{fds362517,
Author = {Giusto, AM and Ayuku, D and Puffer, ES},
Title = {Learn, Engage, Act, Dedicate (LEAD): development and
feasibility testing of a task-shifted intervention to
improve alcohol use, depression and family engagement for
fathers.},
Journal = {International journal of mental health systems},
Volume = {16},
Number = {1},
Pages = {16},
Year = {2022},
Month = {March},
url = {http://dx.doi.org/10.1186/s13033-022-00522-1},
Abstract = {<h4>Background</h4>Men's depression, alcohol use, and family
problems commonly co-occur to create of cluster of mental
health problems. Yet, few treatments exist to address these
problems, especially in low and middle-income countries
(LMICs). This paper describes the development and initial
feasibility and acceptability of a novel task-shifted
intervention to address this cluster of men's mental health
problems with a focus on engaging and retaining men in
treatment.<h4>Methods</h4>The intervention, Learn, Engage,
Act, Dedicate (LEAD), is based in behavioral activation
blended with motivational interviewing and was pilot tested
in Kenya. To develop LEAD, we engaged in a community-engaged
multi-step, collaborative process with local Kenyan
stakeholders. LEAD was piloted with nine fathers reporting
problem drinking. To assess initial feasibility and
acceptability, recruitment and participation were tracked
and descriptive statistics were generated given engagement
of men was key for proof of concept. Semi-structured
interviews were conducted with participants and analyzed
using thematic content analysis.<h4>Results</h4>The
development process resulted in a weekly 5-session
intervention rooted in behavioral activation, motivational
interviewing, and masculinity discussion strategies. These
approaches were combined and adapted to fit contextually
salient constructs, such as the importance of the man as
provider, and streamlined for lay providers. Feasibility and
acceptability results were promising with high attendance,
acceptability of delivery and intervention content, and
perceived intervention helpfulness.<h4>Conclusion</h4>Results
describe an acceptable task-shifted treatment that may
engage men in care and addresses a cluster of common mental
health problems among men in ways that consider social
determinants like masculinity. Findings set the stage for a
larger trial. Trial registration ISRCTN, ISRCTN130380278.
Registered 7 October 2019-Retrospectively registered,
http://www.isrctn.com/ISRCTN13038027.},
Doi = {10.1186/s13033-022-00522-1},
Key = {fds362517}
}
@article{fds362671,
Author = {Leocata, AM and Kaiser, BN and Puffer, ES},
Title = {Flexible protocols and paused audio recorders: The
limitations and possibilities for technologies of care in
two global mental health interventions.},
Journal = {SSM. Mental health},
Volume = {1},
Pages = {100036},
Year = {2021},
Month = {December},
url = {http://dx.doi.org/10.1016/j.ssmmh.2021.100036},
Abstract = {Lay-counselors have become a key human resource in the field
of global mental health, aiming to address the estimated
one-million-person shortage of mental healthcare providers.
However, the role of lay-counselors is ambiguous and in
tension: their role is quasi-professional, with specific
training and skills that set them apart within communities,
yet their role is also defined in contrast to professional
mental healthcare providers. We explore how these tensions
manifest through the material technologies for protocolizing
and evaluating lay-counselor roles. We draw on our
ethnographic fieldwork within two global mental health
interventions that represent different ends of the spectrum
of lay-counselor involvement, in order to explore the
possibilities and limitations of such material technologies.
Thinking Healthy Program-Peer delivered is a cognitive
behavioral therapy-based intervention for women with
perinatal depression delivered in Goa, India, and Tuko
Pamoja (Swahili: "We are Together") is a family therapy
intervention to improve mental health and family functioning
in Eldoret, Kenya. First, we explore how intervention
manuals - the step-by-step protocols that guide therapy
delivery - can both constrain counselors to a script and
enable their novel contributions to therapeutic encounters.
Then, we examine assessment tools used to evaluate
interventions writ large and lay-counselors specifically. We
describe how, even where lay-counselors are encouraged to
bring their own expertise into therapy delivery, this
expertise is not often reflected in evaluation tools.
Instead, the focus tends toward fidelity checklists, which
require adherence to the manualized intervention and can
penalize counselors for "going off book." Even though
lay-counselors are often recruited specifically because of
their existing roles and "local expertise," we argue that
the material technologies of interventions can at times
limit how their expertise is enabled and valued. We offer
recommendations for global mental health programs to
facilitate greater recognition and valuing of lay-counselor
expertise.},
Doi = {10.1016/j.ssmmh.2021.100036},
Key = {fds362671}
}
@article{fds370412,
Author = {Giusto, A and Mootz, JJ and Korir, M and Jaguga, F and Mellins, CA and Wainberg, ML and Puffer, ES},
Title = {"When my children see their father is sober, they are
happy": A qualitative exploration of family system
impacts following men's engagement in an alcohol misuse
intervention in peri-urban Kenya.},
Journal = {SSM. Mental health},
Volume = {1},
Pages = {100019},
Year = {2021},
Month = {December},
url = {http://dx.doi.org/10.1016/j.ssmmh.2021.100019},
Abstract = {<h4>Background</h4>Men's alcohol misuse does not occur in a
vacuum but has a cascade of consequences for families and
children, with ties to violence, poor parenting, and poor
partner and child mental health. Despite the intersection of
individual and interpersonal problems associated with men's
alcohol use, studies exploring the impact of men's
completion of alcohol misuse treatment on family and family
member outcomes are scarce. Here we begin to explore this
question.<h4>Methods</h4>We conducted qualitative interviews
(N = 13) with female partners and children (8-17 years) of
men with problem drinking who completed individual treatment
targeting alcohol misuse, depressed mood, and family-focused
efforts in Eldoret, Kenya. Interviews and thematic content
analysis were guided by ecological-transactional systems
theory.<h4>Results</h4>Findings highlighted positive
perceived changes for men, families, women and children that
interacted together in a bi-directional pathway. Partners
and children described men's reduced drinking, reduced
spending, increased family-focused effort (e.g., coming home
early), as well as increased emotion regulation, and
openness to and communication with family. These changes
were tied to perceived improvements in the couple and
father-child relationship, including improved trust and time
together, which were tied to improvements in women and
children's emotional well-being (e.g., hope). Concurrently,
reports noted men's increased effort to share money earned
with the family which alleviated financial stress and helped
ensure basic needs were met. Results aligned with the
ecological transactional systems frame, with individuals in
the family, family relationships, and economic climate each
dynamically shaping each other.<h4>Conclusions</h4>Although
larger studies are needed, results provide promising signals
regarding the potential downstream effects of individual
treatment on family systems and members, which may in turn
help maintain men's changes in drinking.},
Doi = {10.1016/j.ssmmh.2021.100019},
Key = {fds370412}
}
@article{fds352303,
Author = {Greene, MC and Kane, JC and Bolton, P and Murray, LK and Wainberg, ML and Yi, G and Sim, A and Puffer, E and Ismael, A and Hall,
BJ},
Title = {Assessing trauma and related distress in refugee youth and
their caregivers: should we be concerned about iatrogenic
effects?},
Journal = {European child & adolescent psychiatry},
Volume = {30},
Number = {9},
Pages = {1437-1447},
Year = {2021},
Month = {September},
url = {http://dx.doi.org/10.1007/s00787-020-01635-z},
Abstract = {Assessment of potentially traumatic events and related
psychological symptoms in refugee youth is common in
epidemiological and intervention research. The objective of
this study is to characterize reactions to assessments of
trauma exposure and psychological symptoms, including
traumatic stress, in refugee youth and their caregivers.
Eighty-eight Somali youth and their caregivers participated
in a screening and baseline interview for a psychological
intervention in three refugee camps in Ethiopia.
Participants were asked about their levels of distress prior
to, immediately after, and approximately two weeks after
completing the interview. Other quantitative and qualitative
questions inquired about specific reactions to interview
questions and procedures. Children and caregivers became
increasingly relaxed over the course of the interview, on
average. Few children (5.3%) or caregivers (6.5%) who
reported being relaxed at the beginning of the interview
became upset by the end of the interview. Some children and
caregivers reported that certain assessment questions were
upsetting and that feeling upset interfered with their
activities. Despite some participants reporting persistent
negative reactions, most reported liking and benefitting
from the interview. While the majority of refugee youth and
their caregivers reported positive experiences associated
with completing trauma-related assessments, some reported
negative reactions. Researchers and practitioners must
consider the necessity, risks, and benefits of including
questions about potentially traumatic events and related
symptoms that are particularly upsetting in screening,
survey research, and clinical assessment. When included, it
is important that researchers and practitioners monitor
negative reactions to these assessments and connect
participants who become distressed with appropriate
services.},
Doi = {10.1007/s00787-020-01635-z},
Key = {fds352303}
}
@article{fds357324,
Author = {Giusto, A and Johnson, SL and Lovero, KL and Wainberg, ML and Rono, W and Ayuku, D and Puffer, ES},
Title = {Building community-based helping practices by training
peer-father counselors: A novel intervention to reduce
drinking and depressive symptoms among fathers through an
expanded masculinity lens.},
Journal = {The International journal on drug policy},
Volume = {95},
Pages = {103291},
Year = {2021},
Month = {September},
url = {http://dx.doi.org/10.1016/j.drugpo.2021.103291},
Abstract = {<h4>Background</h4>Problem drinking and co-occurring
depression symptoms affect men at high rates and are
associated with increased risk of family violence. In low-
and middle-income countries, there is a large treatment gap
for services due to a lack of human resources. Moreover,
masculine norms are a barrier to men seeking treatment for
drinking and depression in healthcare settings. We examined
an approach for engaging peer-fathers to deliver an
intervention to reduce alcohol use, improve depressive
symptoms, and increase family involvement among fathers in
Kenya with problem drinking. The intervention-LEAD (Learn,
Engage, Act, Dedicate)-combines motivational interviewing,
behavioral activation, and masculinity discussion
strategies.<h4>Methods</h4>Community and religious leaders
nominated fathers with no mental health training to serve as
counselors (N=12); clients were recruited through community
referrals. Nominated fathers completed a 10-day training
beginning with treatment principles followed by manualized
content. Three counselors were selected after training based
on quantitative and qualitative assessments of communication
skills, intervention knowledge, willingness to learn,
ability to use feedback, and empathy. Supervision was tiered
with local supervisors and clinical psychologist
consultation. During LEAD delivery, counselor fidelity,
delivery quality, and general and intervention-specific
competencies were assessed. To evaluate acceptability,
qualitative interviews were conducted with lay-counselors
and clients (N=11). Descriptive statistics were calculated
for quantitative outcomes; interviews were analyzed using
thematic analysis.<h4>Results</h4>Peer-father lay counselors
treated nine clients, with eight completing treatment.
Counselors reached high rates of fidelity (93.8%) and high
to optimal ratings on quality of delivery, clinical
competency, and intervention-specific competencies.
Qualitative results suggested high acceptability, with
counselors expressing satisfaction and empowerment in their
roles. Clients likewise described positive experiences with
counselors.<h4>Conclusions</h4>Findings provide initial
support for the acceptability and feasibility of
recruitment, selection, and training processes for
peer-father lay counselors to deliver LEAD through a lens of
masculinity that aligned with clients help-acceptance
practices.},
Doi = {10.1016/j.drugpo.2021.103291},
Key = {fds357324}
}
@article{fds358691,
Author = {Ives, LT and Stein, K and Rivera-Cancel, AM and Nicholas, JK and Caldwell, K and Datta, N and Mauro, C and Egger, H and Puffer, E and Zucker, NL},
Title = {Children's Beliefs about Pain: An Exploratory
Analysis.},
Journal = {Children (Basel)},
Volume = {8},
Number = {6},
Pages = {452},
Year = {2021},
Month = {May},
url = {http://dx.doi.org/10.3390/children8060452},
Abstract = {Functional abdominal pain (FAP) is one of the most common
childhood medical complaints, associated with significant
distress and impairment. Little is known about how children
understand their pain. Do they attribute it to personal
weakness? Do they perceive pain as having global impact,
affecting a variety of activities? How do they cope with
pain? We explored the pain beliefs of 5- to 9-year-old
children with FAP using a novel Teddy Bear Interview task in
which children answered questions about a Teddy bear's pain.
Responses were analyzed quantitatively and qualitatively.
Results indicate that the majority of young children with
FAP are optimistic about pain outcomes. Children generated
many types of coping strategies for Teddy's pain and
adjusted their calibration of Teddy's pain tolerance
dependent on the activity being performed. Early warning
signs also emerged: a subset of children were pessimistic
about Teddy's pain, and several children identified coping
strategies that, while developmentally appropriate, could
lead to excessive help seeking if not intervened upon (e.g.,
physician consultation and shot). The Teddy Bear Interview
allows children to externalize their pain, making it a
useful tool to access cognitive pain constructs in younger
children. Thus, these findings highlight the importance of
early intervention for childhood FAP.},
Doi = {10.3390/children8060452},
Key = {fds358691}
}
@article{fds342824,
Author = {Puffer, ES and Friis-Healy, EA and Giusto, A and Stafford, S and Ayuku,
D},
Title = {Development and Implementation of a Family Therapy
Intervention in Kenya: a Community-Embedded Lay Provider
Model},
Journal = {Global Social Welfare},
Volume = {8},
Number = {1},
Pages = {11-28},
Year = {2021},
Month = {March},
url = {http://dx.doi.org/10.1007/s40609-019-00151-6},
Abstract = {The large burden of mental health disorders among young
people worldwide calls for scalable prevention and treatment
models that reach children and families in low-resource
settings. This paper describes the development of an
evidence-informed family therapy intervention designed for
lay counselor delivery in low-resource settings and presents
findings on the feasibility and acceptability of
implementation in Kenya. Qualitative data guided the
development of a components-based family therapy that
integrates multiple strategies from solution-focused and
systems-based therapies, as well as those from parenting
skills training and cognitive behavioral therapies. Eight
lay counselors delivered the intervention, with 10 families
completing treatment. Lay counselors demonstrated adequate
fidelity and clinical competency when treating families with
a wide range of presenting clinical problems. Unique
elements of the implementation model proved feasible and
acceptable, including recruiting “natural” lay
counselors from communities already engaged in informal
counseling for families; participants indicated trust and
respect in the counseling relationship that facilitated
their participation. Both counselors and families reported
positive perceptions of intervention content and strategies,
including those least similar to local counseling practices.
Results support the potential of this implementation
strategy that aims to add evidence-based practices to local
practices and routines rather than creating new cadres of
lay counselors or health workers. Supervision, provided by
psychology student trainees, also proved feasible and
mutually beneficial, with phone-based supervision as
acceptable as in-person meetings; this suggests the
potential feasibility of this model for use in remote
locations. Future directions include integrating these
delivery approaches into existing social structures to
develop and evaluate a comprehensive implementation model
for scale-up.},
Doi = {10.1007/s40609-019-00151-6},
Key = {fds342824}
}
@article{fds357564,
Author = {Puffer, ES and Giusto, A and Rieder, AD and Friis-Healy, E and Ayuku, D and Green, EP},
Title = {Development of the Family Togetherness Scale: A
Mixed-Methods Validation Study in Kenya.},
Journal = {Frontiers in psychology},
Volume = {12},
Pages = {662991},
Year = {2021},
Month = {January},
url = {http://dx.doi.org/10.3389/fpsyg.2021.662991},
Abstract = {Family functioning is an important target of clinical
intervention and research given its close ties with mental
health outcomes of both children and adults. However, we
lack family functioning measures validated for use in many
low- and middle-income country (LMIC) settings. In this
mixed-methods prospective diagnostic accuracy study, we
first used formative qualitative data to develop an
extensive battery of screening items to measure family
functioning in Kenya. We then recruited 30 Kenyan families
(<i>N</i> = 44 adults; 30 youth aged 8-17 years) to complete
the questionnaires and participate in clinical interviews
conducted by local interviewers. Quantitative and
qualitative analyses were then conducted to select a subset
of screening items that balanced conceptual understanding of
family distress with diagnostic efficiency and accuracy to
yield a brief but valid scale. The final index test
consisting of 30 items correctly identified distressed
families in 89% of cases according to adult-report and 76%
of cases according to child-report. The optimal cutoffs are
associated with estimates of sensitivity/specificity of
0.88/0.90 and 0.75/0.77 for adult-report and child-report
measures, respectively. The final measure-the <i>Family
Togetherness Scale (FTS)</i>-assesses global family
functioning, including items related to family organization,
emotional closeness, and communication/problem-solving. In
addition to general items, the scale also includes items
explicitly assessing family responses to stressors common in
LMIC settings. Results establish a strong rationale for
larger-scale validation studies.},
Doi = {10.3389/fpsyg.2021.662991},
Key = {fds357564}
}
@article{fds374398,
Author = {Horn, R and Wachter, K and Friis-Healy, EA and Ngugi, SW and Creighton,
J and Puffer, ES},
Title = {Mapping Complex Systems: Responses to Intimate Partner
Violence Against Women in Three Refugee Camps},
Journal = {Frontiers in Human Dynamics},
Volume = {3},
Year = {2021},
Month = {January},
url = {http://dx.doi.org/10.3389/fhumd.2021.613792},
Abstract = {Armed conflict and forced migration are associated with an
increase in intimate partner violence (IPV) against women.
Yet as risks of IPV intensify, familiar options for seeking
help dissipate as families and communities disperse and seek
refuge in a foreign country. The reconfiguration of family
and community systems, coupled with the presence of local
and international humanitarian actors, introduces
significant changes to IPV response pathways. Drawing from
intensive fieldwork, this article examines response options
available to women seeking help for IPV in refugee camps
against the backdrop of efforts to localize humanitarian
assistance. This study employed a qualitative approach to
study responses to IPV in three refugee camps: Ajuong Thok
(South Sudan), Dadaab (Kenya), and Domiz (Iraqi Kurdistan).
In each location, data collection activities were conducted
with women survivors of IPV, members of the general refugee
community, refugee leaders, and service providers. The
sample included 284 individuals. Employing visual mapping
techniques, analysis of data from these varied sources
described help seeking and response pathways in the three
camps, and the ways in which women engaged with various
systems. The analysis revealed distinct pathways for seeking
help in the camps, with several similarities across
contexts. Women in all three locations often
“persevered” in an abusive partnership for extended
periods before seeking help. When women did seek help, it
was predominantly with family members initially, and then
community-based mechanisms. Across camps, participants
typically viewed engaging formal IPV responses as a last
resort. Differences between camp settings highlighted the
importance of understanding complex informal systems, and
the availability of organizational responses, which
influenced the sequence and speed with which formal systems
were engaged. The findings indicate that key factors in
bridging formal and community-based systems in responding to
IPV in refugee camps include listening to women and
understanding their priorities, recognizing the importance
of women in camps maintaining life-sustaining connections
with their families and communities, engaging communities in
transformative change, and shifting power and resources to
local women-led organizations.},
Doi = {10.3389/fhumd.2021.613792},
Key = {fds374398}
}
@article{fds348999,
Author = {Langhaug, L and Finnegan, A and Schenk, K and Puffer, ES and Rusakaniko,
S and Green, EP},
Title = {Caregiver self-efficacy to talk about sex predicts
conversations about HIV transmission risk with perinatally
infected young people in Zimbabwe.},
Journal = {AIDS care},
Volume = {32},
Number = {12},
Pages = {1524-1528},
Year = {2020},
Month = {December},
url = {http://dx.doi.org/10.1080/09540121.2020.1724253},
Abstract = {Given advances in care and treatment for HIV, perinatally
infected young people are surviving into adolescence. These
young people are making decisions about engaging in sexual
relationships and it is critical to ensure they have the
information they need to engage responsibly in sexual
activity, particularly in an era where adherence to
treatment could make their virus undetectable. The main
objective of this analysis was to examine whether an
HIV-positive young person's knowledge about forward
transmission is associated with caregiver self-efficacy to
talk about sex and general caregiver communication. Using
data from a 12-month prospective cohort of caregivers of
HIV-positive children aged 9-15 on ART and pre-ART in rural
Zimbabwe, we found that caregiver self-efficacy to talk
about sex predicted whether conversations about HIV
transmission would occur between caregiver and the young
person. However, by the end of 12-months, nearly two-thirds
of caregivers of HIV-positive teenagers in our sample had
still not explained how their adolescents could spread the
virus to others despite these caregivers saying their
adolescent should know this information at baseline. We
discuss the implications for designing sexual and
reproductive health (SRH) programs among populations of
young people perinatally infected with HIV to ensure that
this breakthrough generation receives the SRH support they
need.},
Doi = {10.1080/09540121.2020.1724253},
Key = {fds348999}
}
@article{fds352504,
Author = {Puffer, ES and Healy, EF and Green, EP and Giusto, AM and Kaiser, BN and Patel, P and Ayuku, D},
Title = {Family Functioning and Mental Health Changes Following a
Family Therapy Intervention in Kenya: a Pilot
Trial.},
Journal = {Journal of child and family studies},
Volume = {29},
Number = {12},
Pages = {3493-3508},
Year = {2020},
Month = {December},
url = {http://dx.doi.org/10.1007/s10826-020-01816-z},
Abstract = {Family-based interventions offer a promising avenue for
addressing chronic negative family interactions that
contribute to lasting consequences, including family
violence and the onset and maintenance of mental health
disorders. The purpose of this study was to conduct a
mixed-methods, single group pre-post pilot trial of a family
therapy intervention (<i>N</i> = 10) delivered by lay
counselors in Kenya. Results show that both caregivers and
children reported reductions in family dysfunction and
improved mental health after the intervention. Point
estimates represent change of more than two standard
deviations from baseline for the majority of primary
outcomes. Treated families also reported a decrease in harsh
discipline, intimate partner violence, and alcohol-related
problems. These results were corroborated by findings from
an observational measure of family functioning and in-depth
qualitative interviews. This study presents preliminary
evidence of pre-post improvements following a family therapy
intervention consisting of streamlined, evidence-informed
family therapy strategies to target family dysfunction and
mental health.},
Doi = {10.1007/s10826-020-01816-z},
Key = {fds352504}
}
@article{fds353879,
Author = {Green, EP and Lai, Y and Pearson, N and Rajasekharan, S and Rauws, M and Joerin, A and Kwobah, E and Musyimi, C and Jones, RM and Bhat, C and Mulinge, A and Puffer, ES},
Title = {Expanding Access to Perinatal Depression Treatment in Kenya
Through Automated Psychological Support: Development and
Usability Study.},
Journal = {JMIR formative research},
Volume = {4},
Number = {10},
Pages = {e17895},
Year = {2020},
Month = {October},
url = {http://dx.doi.org/10.2196/17895},
Abstract = {<h4>Background</h4>Depression during pregnancy and in the
postpartum period is associated with poor outcomes for women
and their children. Although effective interventions exist
for common mental disorders that occur during pregnancy and
the postpartum period, most cases in low- and middle-income
countries go untreated because of a lack of trained
professionals. Task-sharing models such as the Thinking
Healthy Program have shown potential in feasibility and
efficacy trials as a strategy for expanding access to
treatment in low-resource settings; however, there are
significant barriers to scale-up. We address this gap by
adapting Thinking Healthy for automated delivery via a
mobile phone. This new intervention, Healthy Moms, uses an
existing artificial intelligence system called Tess (Zuri in
Kenya) to drive conversations with users.<h4>Objective</h4>This
prepilot study aims to gather preliminary data on the
Healthy Moms perinatal depression intervention to learn how
to build and test a more robust service.<h4>Methods</h4>We
conducted a single-case experimental design with pregnant
women and new mothers recruited from public hospitals
outside of Nairobi, Kenya. We invited these women to
complete a brief, automated screening delivered via text
messages to determine their eligibility. Enrolled
participants were randomized to a 1- or 2-week baseline
period and then invited to begin using Zuri. We prompted
participants to rate their mood via SMS text messaging every
3 days during the baseline and intervention periods, and we
used these preliminary repeated measures data to fit a
linear mixed-effects model of response to treatment. We also
reviewed system logs and conducted in-depth interviews with
participants to study engagement with the intervention,
feasibility, and acceptability.<h4>Results</h4>We invited
647 women to learn more about Zuri: 86 completed our
automated SMS screening and 41 enrolled in the study. Most
of the enrolled women submitted at least 3 mood ratings
(31/41, 76%) and sent at least 1 message to Zuri (27/41,
66%). A third of the sample engaged beyond registration
(14/41, 34%). On average, women who engaged post
registration started 3.4 (SD 3.2) Healthy Moms sessions and
completed 3.1 (SD 2.9) of the sessions they started. Most
interviewees who tried Zuri reported having a positive
attitude toward the service and expressed trust in Zuri.
They also attributed positive life changes to the
intervention. We estimated that using this alpha version of
Zuri may have led to a 7% improvement in
mood.<h4>Conclusions</h4>Zuri is feasible to deliver via SMS
and was acceptable to this sample of pregnant women and new
mothers. The results of this prepilot study will serve as a
baseline for future studies in terms of recruitment, data
collection, and outcomes.<h4>International registered report
identifier (irrid)</h4>RR2-10.2196/11800.},
Doi = {10.2196/17895},
Key = {fds353879}
}
@article{fds351009,
Author = {Giusto, A and Green, EP and Simmons, RA and Ayuku, D and Patel, P and Puffer, ES},
Title = {A multiple baseline study of a brief alcohol reduction and
family engagement intervention for fathers in
Kenya.},
Journal = {Journal of consulting and clinical psychology},
Volume = {88},
Number = {8},
Pages = {708-725},
Year = {2020},
Month = {August},
url = {http://dx.doi.org/10.1037/ccp0000559},
Abstract = {<h4>Objective</h4>To evaluate a lay provider-delivered,
brief intervention to reduce problem drinking and related
family consequences among men in Kenya. The 5-session
intervention combines behavioral activation (BA) and
motivational interviewing (MI). It integrates family-related
material explicitly and addresses central cultural factors
through gender transformative strategies.<h4>Method</h4>A
nonconcurrent multiple-baseline design was used. We
initiated treatment with 9 men ages 30 to 48 who were
fathers and screened positive for problem drinking; the
median Alcohol Use Identification Test score was 17 (harmful
range). Participants were randomized to staggered start
dates. We measured the primary outcome of weekly alcohol
consumption 4 weeks before treatment, during treatment, and
4 weeks posttreatment using the Timeline Followback measure.
Secondary outcomes were assessed using a pre-post assessment
(1-month) of men's depression symptoms, drinking- and
family-related problem behavior, involvement with child,
time with family, family functioning, relationship quality
(child and partner), and harsh treatment of child and
partner. Men, partners, and children (ages 8-17) reported on
family outcomes.<h4>Results</h4>Eight men completed
treatment. Mixed-effects hurdle model analysis showed that
alcohol use, both number of days drinking and amount
consumed, significantly decreased during and after
treatment. Odds of not drinking were 5.1 times higher
posttreatment (95% CI [3.3, 7.9]). When men did drink
posttreatment, they drank 50% less (95% CI [0.39, 0.65]).
Wilcoxon signed-ranks test demonstrated pre-post
improvements in depression symptoms and family related
outcomes.<h4>Conclusion</h4>Results provide preliminary
evidence that a BA-MI intervention developed for lay
providers may reduce alcohol use and improve family outcomes
among men in Kenya. (PsycInfo Database Record (c) 2020 APA,
all rights reserved).},
Doi = {10.1037/ccp0000559},
Key = {fds351009}
}
@article{fds331413,
Author = {Goodman, ML and Puffer, ES and Keiser, PH and Gitari,
S},
Title = {Suicide clusters among young Kenyan men.},
Journal = {Journal of health psychology},
Volume = {25},
Number = {7},
Pages = {1004-1013},
Year = {2020},
Month = {June},
url = {http://dx.doi.org/10.1177/1359105317743803},
Abstract = {Suicide is a leading cause of global mortality. Suicide
clusters have recently been identified among peer networks
in high-income countries. This study investigates dynamics
of suicide clustering within social networks of young Kenya
men (<i>n</i> = 532; 18-34 years). We found a strong,
statistically significant association between reported
number of friends who previously attempted suicide and
present suicide ideation (odds ratio = 1.9; 95%
confidence interval (1.42, 2.54); <i>p</i> < 0.001).
This association was mediated by lower collective
self-esteem (23% of total effect). Meaning in life further
mediated the association between collective self-esteem and
suicide ideation. Survivors of peer suicide should be
evaluated for suicide risk.},
Doi = {10.1177/1359105317743803},
Key = {fds331413}
}
@article{fds344650,
Author = {Watson, LK and Kaiser, BN and Giusto, AM and Ayuku, D and Puffer,
ES},
Title = {Validating mental health assessment in Kenya using an
innovative gold standard.},
Journal = {International journal of psychology : Journal international
de psychologie},
Volume = {55},
Number = {3},
Pages = {425-434},
Year = {2020},
Month = {June},
url = {http://dx.doi.org/10.1002/ijop.12604},
Abstract = {With the growing burden of mental health disorders
worldwide, alongside efforts to expand availability of
evidence-based interventions, strategies are needed to
ensure accurate identification of individuals suffering from
mental disorders. Efforts to locally validate mental health
assessments are of particular value, yet gold-standard
clinical validation is costly, time-intensive, and reliant
on available professionals. This study aimed to validate
assessment items for mental distress in Kenya, using an
innovative gold standard and a combination of culturally
adapted and locally developed items. The mixed-method study
drew on surveys and semi-structured interviews, conducted by
lay interviewers, with 48 caregivers. Interviews were used
to designate mental health "cases" or "non-cases" based on
emotional health problems, identified through a
collaborative clinical rating process with local input.
Individual mental health survey items were evaluated for
their ability to discriminate between cases and non-cases.
Discriminant survey items included 23 items adapted from
existing mental health assessment tools, as well as 6 new
items developed for the specific cultural context. When
items were combined into a scale, results showed good
psychometric properties. The use of clinically rated
semi-structured interviews provides a promising alternative
gold standard that can help address the challenges of
conducting diagnostic clinical validation in low-resource
settings.},
Doi = {10.1002/ijop.12604},
Key = {fds344650}
}
@article{fds349716,
Author = {Kuerten, BG and Brotkin, S and Bonner, MJ and Ayuku, DO and Njuguna, F and Taylor, SM and Puffer, ES},
Title = {Psychosocial Burden of Childhood Sickle Cell Disease on
Caregivers in Kenya.},
Journal = {Journal of pediatric psychology},
Volume = {45},
Number = {5},
Pages = {561-572},
Year = {2020},
Month = {June},
url = {http://dx.doi.org/10.1093/jpepsy/jsaa021},
Abstract = {<h4>Objectives</h4>To characterize the types and magnitude
of psychosocial burden present in caregivers who have a
child with sickle cell disease (SCD) in Kenya and to
identify predictors of caregiver psychosocial burden,
including disease severity and financial
hardship.<h4>Methods</h4>Primary caregivers (N = 103) of
children aged 1-10 years diagnosed with SCD completed
surveys assessing multiple domains of caregiver quality of
life (QOL), adjustment to child illness, mental health, and
financial hardship. Descriptive statistics characterize
psychosocial burden, and linear models assess
associations.<h4>Results</h4>On indicators of QOL,
caregivers report multiple difficulties across most domains,
including daily activities and physical, social, cognitive,
and emotional well-being. Daily activities emerged as most
burdensome. On indicators of parental adjustment to chronic
illness, guilt and worry emerged as the greatest concern,
followed by long-term uncertainty and unresolved sorrow and
anger; relative to these, they reported higher levels of
emotional resources. Financial hardship was high, as
caregivers reported moderate to major financial losses due
to the time spent caring for their child. General linear
model analyses revealed that level of financial hardship was
a significant predictor of all negative psychosocial
outcomes.<h4>Conclusions</h4>Results document that Kenyan
caregivers of children with SCD experience difficulties
across multiple domains of functioning and that financial
difficulties are likely associated with psychosocial burden.
Results can guide intervention development for caregivers of
children with SCD in low-resource, global
contexts.},
Doi = {10.1093/jpepsy/jsaa021},
Key = {fds349716}
}
@article{fds347034,
Author = {Patel, P and Kaiser, BN and Meade, CS and Giusto, A and Ayuku, D and Puffer, E},
Title = {Problematic alcohol use among fathers in Kenya: Poverty,
people, and practices as barriers and facilitators to help
acceptance.},
Journal = {The International journal on drug policy},
Volume = {75},
Pages = {102576},
Year = {2020},
Month = {January},
url = {http://dx.doi.org/10.1016/j.drugpo.2019.10.003},
Abstract = {<h4>Background</h4>In Kenya, the prevalence of alcohol use
disorder (AUD) is close to 6%, but a notable treatment gap
persists. AUD is especially pronounced among men, leading to
negative consequences at both individual and family levels.
This study examines the experiences of problem-drinking
fathers in Kenya regarding previous treatment-seeking
related to alcohol use. Experiences and dynamics of the
family are also explored as they pertain to
treatment-seeking experiences.<h4>Methods</h4>In Eldoret,
Kenya, semi-structured qualitative interviews were conducted
with 11 families with a male exhibiting problem drinking,
his spouse, and one child. Thematic content analysis was
used to examine themes related to barriers and facilitators
to treatment.<h4>Results</h4>Participants only reported
informal help received from family and community members;
they exhibited little awareness of available formal
treatments. Families were both deeply affected by alcohol
use and actively involved in help-seeking. Indeed, fathers'
experiences are described as help-accepting rather than
help-seeking. Three overarching themes emerged from the
results: poverty, people, and practices. Poverty could be a
motivator to accept help to support one's family
financially, but stress from lack of work also drove
drinking behaviours. People were also crucial as both
barriers and facilitators of help-accepting. Negative help
strategies or peer influence deterred fathers from accepting
help to quit. Positive motivation, social support, and
stigma against drinking were motivators. Practices that were
culturally salient, such as religiosity and gender roles,
facilitated help acceptance. Overall, most help efforts were
short-term and only lead to very short-term behaviour
change.<h4>Conclusion</h4>Families and communities are
active in help provision for problem-drinking men in Kenya,
though results confirm remaining need for effective
interventions. Future interventions could benefit from
recognizing the role of family to aid in
treatment-engagement and attending to the importance of
poverty, people, and practices in designing treatment
strategies.},
Doi = {10.1016/j.drugpo.2019.10.003},
Key = {fds347034}
}
@article{fds348728,
Author = {Wall, JT and Kaiser, BN and Friis-Healy, EA and Ayuku, D and Puffer,
ES},
Title = {What about lay counselors' experiences of task-shifting
mental health interventions? Example from a family-based
intervention in Kenya.},
Journal = {International journal of mental health systems},
Volume = {14},
Pages = {9},
Year = {2020},
Month = {January},
url = {http://dx.doi.org/10.1186/s13033-020-00343-0},
Abstract = {<h4>Background</h4>A key focus of health systems
strengthening in low- and middle-income countries is
increasing reach and access through task-shifting. As such
models become more common, it is critical to understand the
experiences of lay providers because they are on the
forefront for delivering care services. A greater
understanding would improve lay provider support and help
them provide high-quality care. This is especially the case
for those providing mental health services, as providing
psychological care may pose unique stressors. We sought to
understand experiences of lay counselors, focusing on
identity, motivation, self-efficacy, stress, and burnout.
The goal was to understand how taking on a new provider role
influences their lives beyond simply assuming a new task,
which would in turn help identify actionable steps to
improve interventions with task-shifting
components.<h4>Methods</h4>Semi-structured interviews
(n = 20) and focus group discussions (n = 3) were
conducted with three lay counselor groups with varying
levels of experience delivering a community-based family
therapy intervention in Eldoret, Kenya. Thematic analysis
was conducted, including intercoder reliability checks. A
Stress Map was created to visualize stress profiles using
free-listing and pile-sorting data collected during
interviews and focus group discussions.<h4>Results</h4>Counselors
described high intrinsic motivation to become counselors and
high self-efficacy after training. They reported positive
experiences in the counselor role, with new skills improving
their counseling and personal lives. As challenges arose,
including client engagement difficulties and balancing many
responsibilities, stress and burnout increased, dampening
motivation and self-efficacy. In response, counselors
described coping strategies, including seeking peer and
supervisor support, that restored their motivation to
persevere. At case completion, they again experienced high
self-efficacy and a desire to continue.<h4>Conclusions</h4>Findings
informed suggestions for ways to incorporate support for lay
providers into task-shifting interventions at initiation,
during training, and throughout implementation. These
include acknowledging and preparing counselors for
challenges during training, increasing explicit attention to
counselor stress in supervision, fostering peer support
among lay providers, and ensuring a fair balance between
workload and compensation. Improving and building an
evidence base around practices for supporting lay providers
will improve the effectiveness and sustainability of lay
provider-delivered interventions.},
Doi = {10.1186/s13033-020-00343-0},
Key = {fds348728}
}
@article{fds338002,
Author = {Giusto, A and Kaiser, BN and Ayuku, D and Puffer,
ES},
Title = {A Direct Observational Measure of Family Functioning for a
Low-Resource Setting: Adaptation and Feasibility in a Kenyan
Sample.},
Journal = {Behavior therapy},
Volume = {50},
Number = {2},
Pages = {459-473},
Publisher = {Elsevier BV},
Year = {2019},
Month = {March},
url = {http://dx.doi.org/10.1016/j.beth.2018.08.004},
Abstract = {Family interactions are recognized as highly influential for
youth development of psychopathology. Key challenges for
assessing family functioning include cross-cultural
variability in functioning and self-report measurement
challenges. Observational measures-adapted to cultural
context-provide an approach to addressing challenges. This
study aimed to adapt a direct observational tool for
assessing family interaction patterns in Kenya, to outline a
replicable adaptation process, and to explore tool
feasibility and acceptability. We reviewed existing tools to
assess their adaptability based on compatibility with
context-specific data. After initial modifications, the
measure was iteratively adapted through pilot testing and
collaborative discussions between U.S. and Kenyan
collaborators that drove changes and further piloting. The
measure was administered to 26 families. The Family Problem
Solving Code was chosen for adaptation. The tool's activity
structure was feasible to administer, but activity content
showed low acceptability, requiring new content. Final
activities included (a) a hands-on problem-solving task, (b)
a discussion of marital conflict with couples, and (c) a
structured discussion of family hopes. Codes were adapted to
reflect culturally congruent descriptions of behavior,
expressions, and interactions, including an emphasis on
nonverbal interactions. The scoring system was modified to
facilitate training and consistent rating among trainees
with limited experience. Observational tool findings were
consistent with those of an interview assessing family
functioning, rated by clinical and non-clinical raters.
Adaptation resulted in a culturally relevant tool assessing
family functioning that proved feasible and acceptable. The
adaptation process also proved feasible and efficient in a
low-resource setting, suggesting its utility for other
contexts.},
Doi = {10.1016/j.beth.2018.08.004},
Key = {fds338002}
}
@article{fds337064,
Author = {Green, EP and Cho, H and Gallis, J and Puffer, ES},
Title = {The impact of school support on depression among adolescent
orphans: a cluster-randomized trial in Kenya.},
Journal = {Journal of child psychology and psychiatry, and allied
disciplines},
Volume = {60},
Number = {1},
Pages = {54-62},
Year = {2019},
Month = {January},
url = {http://dx.doi.org/10.1111/jcpp.12955},
Abstract = {<h4>Background</h4>The objective of this study was to
determine if a school support intervention for adolescent
orphans in Kenya had effects on mental health, a secondary
outcome.<h4>Methods</h4>In this paper, we analyzed data from
a 4-year cluster-randomized trial of a school support
intervention (school uniforms, school fees, and nurse
visits) conducted with orphaned adolescents in Siaya County,
western Kenya, who were about to transition to secondary
school. 26 primary schools were randomized (1:1) to
intervention (410 students) or control (425 students) arms.
The study was longitudinal with annual repeated measures
collected over 4 years from 2011 to 2014. We administered
five items from the 20-item Center for Epidemiologic Studies
Depression Scale Revised, a self-reported depression
screening instrument.<h4>Results</h4>The intervention
prevented depression severity scores from increasing over
time among adolescents recruited from intervention schools.
There was no evidence of treatment heterogeneity by gender
or baseline depression status. The intervention effect on
depression was partially mediated by higher levels of
continuous school enrollment among the intervention group,
but this mediated effect was small.<h4>Conclusions</h4>School
support for orphans may help to buffer against the onset or
worsening of depression symptoms over time, promoting
resilience among an important at-risk population.},
Doi = {10.1111/jcpp.12955},
Key = {fds337064}
}
@article{fds343601,
Author = {Finnegan, A and Langhaug, L and Schenk, K and Puffer, ES and Rusakaniko,
S and Choi, Y and Mahaso, S and Green, EP},
Title = {The prevalence and process of pediatric HIV disclosure: A
population-based prospective cohort study in
Zimbabwe.},
Journal = {PloS one},
Volume = {14},
Number = {5},
Pages = {e0215659},
Year = {2019},
Month = {January},
url = {http://dx.doi.org/10.1371/journal.pone.0215659},
Abstract = {<h4>Introduction</h4>The objective of this study was to
estimate the prevalence of pediatric HIV disclosure in rural
Zimbabwe and track the process of disclosure over
time.<h4>Methods</h4>We recruited a population-based sample
of 372 caregivers of HIV-positive children ages 9 to 15 to
participate in a survey about disclosure. Using data from
this cross-sectional sample, we then identified a
prospective cohort of 123 caregivers who said their
HIV-positive child did not know his or her HIV status, and
we followed this non-disclosed cohort of caregivers through
two additional waves of data collection over the next 12
months. At each wave, we inquired about the timing and
process of disclosure and psychosocial factors related to
HIV disclosure.<h4>Results</h4>The overall prevalence of
disclosure in the cross-sectional sample was 66.9% (95% CI
62.0 to 71.5%). Only 26.9% of children knew how they were
infected and that they can transmit the virus to others
(i.e. "full disclosure"). Older children were more likely to
know their status. Among the non-disclosed caregivers at
baseline, nearly 60% of these children learned their HIV
status over the course of the 12-month study period, but
only 17.1% learned how they were infected and that they can
transmit the virus to others. Most caregivers were satisfied
with their child's disclosure experience. Caregivers who had
not disclosed their child's HIV status to the child worried
that disclosure would lead to stigma in the community,
provoke questions from their child they would not be able to
answer, or cause the child to reject the caregiver in
anger.<h4>Conclusions</h4>This study suggests that rates of
pediatric HIV disclosure may be larger than typically
reported, but also reinforces the idea that most children do
not know key details about their illness, such as how they
were infected and that they can infect others.},
Doi = {10.1371/journal.pone.0215659},
Key = {fds343601}
}
@article{fds335703,
Author = {Healy, EA and Kaiser, BN and Puffer, ES},
Title = {Family-based youth mental health interventions delivered by
nonspecialist providers in low- and middle-income countries:
A systematic review.},
Journal = {Families, systems & health : the journal of collaborative
family healthcare},
Volume = {36},
Number = {2},
Pages = {182-197},
Year = {2018},
Month = {June},
url = {http://dx.doi.org/10.1037/fsh0000334},
Abstract = {<h4>Introduction</h4>Youth in low- and middle-income
countries (LMICs) are at increased risk for poor mental
health due to economic and social disadvantage.
Interventions that strengthen families may equip children
and adolescents with the supports and resources to fulfill
their potential and buffer them from future stressors and
adversity. Due to human resource constraints,
task-sharing-delivery of interventions by nonspecialists-may
be an effective strategy to facilitate the dissemination of
mental health interventions in low resource contexts. To
this end, we conducted a systematic review of the literature
on family-based interventions delivered in LMICs by
nonspecialist providers (NSPs) targeting youth mental health
and family related outcomes.<h4>Method</h4>Cochrane and
PRISMA procedures guided this review. Searches were
conducted in PsychInfo, PubMed, and Web of Science, with
additional articles pulled from reference
lists.<h4>Results</h4>This search yielded 10 studies. Four
studies were developed specifically for the delivery context
using formative qualitative research; the remaining
interventions underwent adaptation for use in the context.
All interventions employed a period of structured training;
nine studies additionally provided ongoing supervision to
counselors. Interventions noted widespread acceptance of
program material and delivery by NSPs. They also noted the
need for ongoing supervision of NSPs to increase treatment
fidelity.<h4>Discussion</h4>Usage of NSPs is quite
consistently proving feasible, acceptable, and efficacious
and is almost certainly a valuable component within
approaches to scaling up mental health programs. A clear
next step is to establish and evaluate sustainable models of
training and supervision to further inform scalability.
(PsycINFO Database Record},
Doi = {10.1037/fsh0000334},
Key = {fds335703}
}
@article{fds332361,
Author = {Wachter, K and Horn, R and Friis, E and Falb, K and Ward, L and Apio, C and Wanjiku, S and Puffer, E},
Title = {Drivers of Intimate Partner Violence Against Women in Three
Refugee Camps.},
Journal = {Violence against women},
Volume = {24},
Number = {3},
Pages = {286-306},
Year = {2018},
Month = {March},
url = {http://dx.doi.org/10.1177/1077801216689163},
Abstract = {This qualitative study examined the "drivers" of intimate
partner violence (IPV) against women in displacement to
identify protective factors and patterns of risk.
Qualitative data were collected in three refugee camps in
South Sudan, Kenya, and Iraq ( N = 284). Findings revealed
interrelated factors that triggered and perpetuated IPV:
gendered social norms and roles, destabilization of gender
norms and roles, men's substance use, women's separation
from family, and rapid remarriages and forced marriages.
These factors paint a picture of individual, family,
community and societal processes that exacerbate women's
risk of IPV in extreme conditions created by displacement.
Implications for policy and practice are
indicated.},
Doi = {10.1177/1077801216689163},
Key = {fds332361}
}
@article{fds342062,
Author = {Murray, LK and Hall, BJ and Dorsey, S and Ugueto, AM and Puffer, ES and Sim, A and Ismael, A and Bass, J and Akiba, C and Lucid, L and Harrison, J and Erikson, A and Bolton, PA},
Title = {An evaluation of a common elements treatment approach for
youth in Somali refugee camps.},
Journal = {Global mental health (Cambridge, England)},
Volume = {5},
Pages = {e16},
Year = {2018},
Month = {January},
url = {http://dx.doi.org/10.1017/gmh.2018.7},
Abstract = {<h4>Background</h4>This paper reports on: (1) an evaluation
of a common elements treatment approach (CETA) developed for
comorbid presentations of depression, anxiety, traumatic
stress, and/or externalizing symptoms among children in
three Somali refugee camps on the Ethiopian/Somali border,
and (2) an evaluation of implementation factors from the
perspective of staff, lay providers, and families who
engaged in the intervention.<h4>Methods</h4>This project was
conducted in three refugee camps and utilized locally
validated mental health instruments for internalizing,
externalizing, and posttraumatic stress (PTS) symptoms.
Participants were recruited from either a validity study or
from referrals from social workers within International
Rescue Committee Programs. Lay providers delivered CETA to
youth (CETA-Youth) and families, and symptoms were
re-assessed post-treatment. Providers and families responded
to a semi-structured interview to assess implementation
factors.<h4>Results</h4>Children who participated in the
CETA-Youth open trial reported significant decreases in
symptoms of internalizing (<i>d</i> = 1.37),
externalizing (<i>d</i> = 0.85), and posttraumatic
stress (<i>d</i> = 1.71), and improvements in
well-being (<i>d</i> = 0.75). Caregivers also reported
significant decreases in child symptoms. Qualitative results
were positive toward the acceptability and appropriateness
of treatment, and its feasibility.<h4>Conclusions</h4>This
project is the first to examine a common elements approach
(CETA: defined as flexible delivery of elements, order, and
dosing) with children and caregivers in a low-resource
setting with delivery by lay providers. CETA-Youth may offer
an effective treatment that is easier to implement and
scale-up versus multiple focal interventions. A fullscale
randomized clinical trial is warranted.},
Doi = {10.1017/gmh.2018.7},
Key = {fds342062}
}
@article{fds342061,
Author = {Green, E and Chase, RM and Zayzay, J and Finnegan, A and Puffer,
ES},
Title = {The impact of the 2014 Ebola virus disease outbreak in
Liberia on parent preferences for harsh discipline
practices: a quasi-experimental, pre-post
design.},
Journal = {Global mental health (Cambridge, England)},
Volume = {5},
Pages = {e1},
Year = {2018},
Month = {January},
url = {http://dx.doi.org/10.1017/gmh.2017.24},
Abstract = {<h4>Background</h4>This paper uses data from a cohort of
parents and guardians of young children living in Monrovia,
Liberia collected before and after the 2014 outbreak of
Ebola virus disease (EVD) to estimate the impact of EVD
exposure on implicit preferences for harsh discipline. We
hypothesized that parents exposed to EVD-related sickness or
death would exhibit a stronger preference for harsh
discipline practices compared with non-exposed
parents.<h4>Methods</h4>The data for this analysis come from
two survey rounds conducted in Liberia as part of an
intervention trial of a behavioral parenting skills
intervention. Following a baseline assessment of 201
enrolled parents in July 2014, all program and study
activities were halted due to the outbreak of EVD. Following
the EVD crisis, we conducted a tracking survey with parents
who completed the baseline survey 12 months prior. In both
rounds, we presented parents with 12 digital comic strips of
a child misbehaving and asked them to indicate how they
would react if they were the parent in the
stories.<h4>Results</h4>Parents from households with
reported EVD sickness or death became more 'harsh' (Glass's
delta = 1.41) in their hypothetical decision-making
compared with non-exposed parents, <i>t</i> (167)=-2.3,
<i>p</i> < 0.05. Parents from households that
experienced EVD-related sickness or death not only reported
significantly more household conflict and anxiety, but also
reported that their child exhibited fewer
difficulties.<h4>Conclusions</h4>Results support the need
for family-based interventions, including strategies to help
parents learn alternatives to harsh punishment.},
Doi = {10.1017/gmh.2017.24},
Key = {fds342061}
}
@article{fds335704,
Author = {Giusto, A and Friis, E and Sim, AL and Chase, RM and Zayzay, JO and Green,
E and Puffer, E},
Title = {A Qualitative Study of Mechanisms Underlying Effects of a
Parenting Intervention in Rural Liberia},
Journal = {European Journal of Development Research},
Volume = {29},
Number = {5},
Pages = {964-982},
Publisher = {Springer Nature},
Year = {2017},
Month = {November},
url = {http://dx.doi.org/10.1057/s41287-017-0101-8},
Abstract = {Parenting interventions can reduce child maltreatment and
improve child outcomes in high-risk settings, but little is
known about mechanisms underlying effects. This study
presents qualitative findings on mechanisms of change from a
randomized trial of a parenting intervention in Liberia.
Participants (N = 30) completed semi-structured interviews,
and thematic content analysis was conducted from
transcripts. Results suggest that learning about effects of
violence on child development and discussing the value of
empathy for children strengthened caregivers' sense of
identity as nurturers and protectors. This in turn drove
efforts to decrease harsh discipline. As a result, children
expressed less fear, increasing opportunities for positive
interactions; shared enjoyment maintained reduced harsh
treatment. Caregivers also described recognizing that
physical punishment was often ineffective and using new
non-violent discipline skills alongside emotion regulation
skills to facilitate behavior change. Participants also
described reduced couples conflict and more peaceful home
environments associated with increased self-identification
as role models.},
Doi = {10.1057/s41287-017-0101-8},
Key = {fds335704}
}
@article{fds322201,
Author = {Annan, J and Sim, A and Puffer, ES and Salhi, C and Betancourt,
TS},
Title = {Improving Mental Health Outcomes of Burmese Migrant and
Displaced Children in Thailand: a Community-Based Randomized
Controlled Trial of a Parenting and Family Skills
Intervention.},
Journal = {Prevention science : the official journal of the Society for
Prevention Research},
Volume = {18},
Number = {7},
Pages = {793-803},
Year = {2017},
Month = {October},
url = {http://dx.doi.org/10.1007/s11121-016-0728-2},
Abstract = {The negative effects of displacement and poverty on child
mental health are well-known, yet research on prevention
interventions in low- and middle-income countries,
especially fragile states, remains limited. We examined the
effectiveness of a parenting skills intervention on mental
health outcomes among Burmese migrant and displaced children
living in 20 communities in Thailand. Participants were
primary caregivers and children aged 7 to 15 years
(n = 479 families). Families were randomly assigned to
receive an adapted version of the Strengthening Families
Program (n = 240) or a wait-list control condition
(n = 239). Assessments were conducted at baseline and
1-month post-intervention for both conditions and at
6 months for treatment group only. One month after the
program, children in the treatment condition showed
significant reductions in externalizing problems (caregiver
effect size (ES) -0.22, p = 0.02; child report ES -0.11,
p = 0.02) and child attention problems compared with
controls (caregiver report ES -0.23, p = 0.03). There
was no significant treatment effect on children's
internalizing problems (ES -0.06; p = 0.31). Children
reported a significant increase in prosocial protective
factors relative to controls (ES 0.20, p < 0.01).
Results suggest that an evidence-based parenting skills
intervention adapted for a displaced and migrant Burmese
population facing high levels of adversity can have positive
effects on children's externalizing symptoms and protective
psychosocial factors.<h4>Trial registration</h4>Clinicaltrials.gov:
https://clinicaltrials.gov/show/NCT01829815.},
Doi = {10.1007/s11121-016-0728-2},
Key = {fds322201}
}
@article{fds326142,
Author = {Giusto, AM and Green, EP and Puffer, ES},
Title = {Associations Between Fathers' and Sons' Sexual Risk in Rural
Kenya: The Potential for Intergenerational
Transmission.},
Journal = {The Journal of adolescent health : official publication of
the Society for Adolescent Medicine},
Volume = {61},
Number = {2},
Pages = {219-225},
Year = {2017},
Month = {August},
url = {http://dx.doi.org/10.1016/j.jadohealth.2017.02.007},
Abstract = {<h4>Purpose</h4>Despite high rates of HIV in areas of
Sub-Saharan Africa and men's role in driving the epidemic,
little is known about whether or how sexual risk-both
behaviors and beliefs-may be passed down through generations
of males. This study examined associations between sexual
risk behaviors and sex-related beliefs of adolescent males
and those of their male caregivers in Kenya, as well as the
potential moderating effects of parenting characteristics
and father-son relationship quality.<h4>Methods</h4>Cross-sectional
linear regression analysis was applied to baseline data from
a trial of a family- and church-based intervention for
families in rural Kenya that followed a stepped-wedge
cluster randomized design. Our subsample consisted of 79
male caregiver and son (aged 10-16 years)
dyads.<h4>Results</h4>Results demonstrated a direct
relationship between fathers' and sons' sex-related beliefs
that was not moderated by parenting or quality of father-son
relationship. Parenting/relationship characteristics did
moderate the relationship between fathers' and sons' sexual
behavior; if fathers did not engage in high-risk sex and
exhibited more positive parenting/higher relationship
quality, their sons were less likely to be sexually active.
Among fathers having high-risk sex, parenting was unrelated
to sons' behavior except at very high levels of positive
parenting/relationship quality; at these levels, sons were
actually more likely to have had sex.<h4>Conclusions</h4>Findings
support recommendations to include male caregivers in youth
HIV prevention efforts, potentially by targeting fathers'
parenting strategies and their individual
risk.},
Doi = {10.1016/j.jadohealth.2017.02.007},
Key = {fds326142}
}
@article{fds326143,
Author = {Puffer, ES and Annan, J and Sim, AL and Salhi, C and Betancourt,
TS},
Title = {The impact of a family skills training intervention among
Burmese migrant families in Thailand: A randomized
controlled trial.},
Journal = {PloS one},
Volume = {12},
Number = {3},
Pages = {e0172611},
Year = {2017},
Month = {January},
url = {http://dx.doi.org/10.1371/journal.pone.0172611},
Abstract = {<h4>Objective</h4>To conduct a randomized controlled trial
assessing the impact of a family-based intervention
delivered to Burmese migrant families displaced in Thailand
on parenting and family functioning.<h4>Participants and
procedures</h4>Participants included 479 Burmese migrant
families from 20 communities in Thailand. Families,
including 513 caregivers and 479 children aged 7 to 15
years, were randomized to treatment and waitlist control
groups. The treatment group received a 12-session
family-based intervention delivered to groups of families by
lay facilitators. Adapted standardized and locally derived
measures were administered before and after the intervention
to assess parent-child relationship quality, discipline
practices, and family functioning.<h4>Results</h4>Compared
with controls, intervention families demonstrated improved
quality of parent-child interactions on scales of parental
warmth and affection (Effect size (ES) = 0.25 caregivers;
0.26 children, both p < 0.05) and negative relationship
quality (ES = -0.37, p < 0.001 caregivers; -0.22 children, p
< 0.05). Both children and caregivers also reported an
effect on relationship quality based on a locally derived
measure (ES = 0.40 caregivers, p < .001; 0.43 children, p <
.05). Family functioning was improved, including family
cohesion (ES = 0.46 caregivers; 0.36 children; both p <
0.001) and decreased negative interactions (ES = -0.30
caregivers, p < 0.01; -0.24 children, p < 0.05). Family
communication also improved according to children only (ES =
0.29, p < 0.01). Caregivers, but not children, reported
decreased harsh discipline (ES = -0.39, p < 0.001), and no
effects were observed on use of positive discipline
strategies. Treatment attendance was high, with participants
attending a mean of 9.7 out of 12 sessions.<h4>Conclusion</h4>The
intervention increased protective aspects of family
well-being for migrant children and caregivers in a
middle-income country. The strongest effects were on
parent-child relationship quality and family functioning,
while results were mixed on changes in discipline practices.
Results suggest that a behavioral family-based approach
implemented by lay providers in community settings is a
promising intervention approach for strengthening families
in highly stressed contexts.<h4>Trial registration</h4>Clinicaltrials.gov:
NCT01668992.},
Doi = {10.1371/journal.pone.0172611},
Key = {fds326143}
}
@article{fds322202,
Author = {Puffer, ES and Schatz, JC and Roberts, CW},
Title = {Association between somatic growth trajectory and cognitive
functioning in young children with sickle cell
disease.},
Journal = {Journal of health psychology},
Volume = {21},
Number = {8},
Pages = {1620-1629},
Year = {2016},
Month = {August},
url = {http://dx.doi.org/10.1177/1359105314559861},
Abstract = {Children with sickle cell disease are at risk of cognitive
deficits and somatic growth delays beginning in early
childhood. We examined growth velocity from age 2 years
(height and body mass index progression over time) and
cognitive functioning in 46 children with sickle cell
disease 4 to 8 years of age. Height-for-age velocity was not
associated with cognitive outcomes. Higher body mass index
velocity was associated with higher scores on global
cognitive and visual-motor abilities but not processing
resources or academic achievement. Body mass index
progression over time may be a clinically useful indicator
of neurocognitive risk in sickle cell disease, as it may
reflect multiple sickle cell disease-related risk
factors.},
Doi = {10.1177/1359105314559861},
Key = {fds322202}
}
@article{fds322203,
Author = {Puffer, ES and Green, EP and Sikkema, KJ and Broverman, SA and Ogwang-Odhiambo, RA and Pian, J},
Title = {A church-based intervention for families to promote mental
health and prevent HIV among adolescents in rural Kenya:
Results of a randomized trial.},
Journal = {Journal of consulting and clinical psychology},
Volume = {84},
Number = {6},
Pages = {511-525},
Year = {2016},
Month = {June},
url = {http://dx.doi.org/10.1037/ccp0000076},
Abstract = {<h4>Objective</h4>To evaluate a family- and church-based
intervention for adolescents and caregivers in rural Kenya
to improve family relationships, reduce HIV risk, and
promote mental health.<h4>Method</h4>The intervention was
developed using community-based participatory methods and
focused on strengthening family communication. Modules
addressed economic, relationship, and HIV-related topics
using evidence-based behavioral strategies alongside
culturally grounded content. A stepped wedge cluster
randomized trial was conducted with 124 families (237
adolescents ages 10 to 16; 203 caregivers) from 4 churches.
Participants completed interviewer-administered surveys over
5 rounds. Primary outcomes included family communication,
HIV risk knowledge, self-efficacy, and beliefs. Secondary
outcomes included parenting, social support, mental health,
and adolescent sexual behavior. We estimated intent-to-treat
effects via ordinary least squares regression with clustered
standard errors.<h4>Results</h4>Relative to controls, the
intervention group reported better family communication
across domains at 1- and 3-months postintervention and
higher self-efficacy for risk reduction skills and
HIV-related knowledge at 1-month postintervention. Sexually
active youth in the intervention reported fewer high-risk
behaviors at 1-month postintervention, including unprotected
sex or multiple partners. Male caregivers in the
intervention reported higher parental involvement at both
time points, and youth reported more social support from
male caregivers at 3-months postintervention. No effects on
secondary outcomes of parenting, social support, and mental
health were detected.<h4>Conclusions</h4>This intervention
holds promise for strengthening positive family processes to
protect against negative future outcomes for adolescents.
Implementation with religious congregations may be a
promising strategy for improving sustainability and
scalability of interventions in low-resource settings.
(PsycINFO Database Record},
Doi = {10.1037/ccp0000076},
Key = {fds322203}
}
@article{fds322204,
Author = {Green, EP and Warren, VR and Broverman, S and Ogwang, B and Puffer,
ES},
Title = {Participatory mapping in low-resource settings: Three novel
methods used to engage Kenyan youth and other community
members in community-based HIV prevention
research.},
Journal = {Global public health},
Volume = {11},
Number = {5-6},
Pages = {583-599},
Year = {2016},
Month = {May},
url = {http://dx.doi.org/10.1080/17441692.2016.1170178},
Abstract = {Understanding the link between health and place can
strengthen the design of health interventions, particularly
in the context of HIV prevention. Individuals who might one
day participate in such interventions - including youth -
may further improve the design if engaged in a meaningful
way in the formative research process. Increasingly,
participatory mapping methods are being used to achieve both
aims. We describe the development of three innovative
mapping methods for engaging youth in formative
community-based research: 'dot map' focus groups, geocaching
games, and satellite imagery-assisted daily activity logs.
We demonstrate that these methods are feasible and
acceptable in a low-resource, rural African setting. The
discussion outlines the merits of each method and considers
possible limitations.},
Doi = {10.1080/17441692.2016.1170178},
Key = {fds322204}
}
@article{fds287928,
Author = {Horn, R and Puffer, ES and Roesch, E and Lehmann,
H},
Title = {'I don't need an eye for an eye': Women's responses to
intimate partner violence in Sierra Leone and
Liberia.},
Journal = {Global public health},
Volume = {11},
Number = {1-2},
Pages = {108-121},
Year = {2016},
Month = {January},
ISSN = {1744-1692},
url = {http://dx.doi.org/10.1080/17441692.2015.1032320},
Abstract = {This paper explores the possibilities for agency in intimate
partner violence (IPV) situations from the perspective of
women in Sierra Leone and Liberia using focus group
discussions (N groups = 14, N participants = 110) and
individual interviews (N = 20). Findings identify multiple
interrelated factors influencing the decision-making of
women experiencing IPV. At the individual level, emotional
factors and women's knowledge of their rights and options
influence their decision-making. At the relational level,
the role of neighbours, family and friends is crucial, both
for emotional support and practical assistance. At the
community level, more formal structures play a role, such as
chiefs and women's groups, though their effectiveness
varies. At the structural level are barriers to effective
responses, including a poorly functioning criminal justice
system and a social system in which children often stay with
fathers following separation or divorce. Strong cultural
beliefs operate to keep women in abusive relationships. We
identify implications for prevention and response services
and make practice recommendations. Since the desire of most
women experiencing IPV was to live in peace with their
husbands, interventions should respect women's priorities by
focusing more on prevention and interventions to end the
violence, rather than solely assisting women to leave
violent relationships.},
Doi = {10.1080/17441692.2015.1032320},
Key = {fds287928}
}
@article{fds287929,
Author = {Schatz, J and Schlenz, AM and McClellan, CB and Puffer, ES and Hardy, S and Pfeiffer, M and Roberts, CW},
Title = {Changes in coping, pain, and activity after
cognitive-behavioral training: a randomized clinical trial
for pediatric sickle cell disease using smartphones.},
Journal = {The Clinical journal of pain},
Volume = {31},
Number = {6},
Pages = {536-547},
Year = {2015},
Month = {June},
ISSN = {0749-8047},
url = {http://dx.doi.org/10.1097/ajp.0000000000000183},
Abstract = {<h4>Objectives</h4>We examined the outcomes of a
cognitive-behavioral therapy (CBT) intervention for pain in
pediatric sickle cell disease (SCD) using smartphones as a
novel delivery method.<h4>Materials and methods</h4>Forty-six
children with SCD received CBT coping skills training using
a randomized, waitlist control design. The intervention
involved a single session of CBT training and home-based
practice using smartphones for 8 weeks. Pre-post
questionnaires between the randomized groups were used to
evaluate changes in active psychological coping and negative
thinking using the Coping Strategies Questionnaire. Daily
diaries completed by the full sample during the treatment
period were used to assess whether CBT skill use was related
to reductions in next-day pain intensity and increases in
same-day functional activity.<h4>Results</h4>The pre-post
group comparison suggested that the youth increased active
psychological coping attempts with the intervention. Daily
diary data indicated that when children used CBT skills on
days with higher pain, there were reductions in next-day
pain intensity. There was no such association between skill
use and functional activity.<h4>Discussion</h4>CBT coping
skills training supported using smartphones can increase
coping and reduce pain intensity for children with SCD;
however, additions to the study protocols are recommended in
future studies. Advantages and caveats of using smartphones
are also discussed.},
Doi = {10.1097/ajp.0000000000000183},
Key = {fds287929}
}
@article{fds331414,
Author = {Puffer, ES and Green, EP and Chase, RM and Sim, AL and Zayzay, J and Friis,
E and Garcia-Rolland, E and Boone, L},
Title = {Parents make the difference: a randomized-controlled trial
of a parenting intervention in Liberia.},
Journal = {Global mental health (Cambridge, England)},
Volume = {2},
Pages = {e15},
Year = {2015},
Month = {January},
url = {http://dx.doi.org/10.1017/gmh.2015.12},
Abstract = {<h4>Background</h4>The objective of this study was to
evaluate the impact of a brief parenting intervention,
'Parents Make the Difference'(PMD), on parenting behaviors,
quality of parent-child interactions, children's cognitive,
emotional, and behavioral wellbeing, and malaria prevention
behaviors in rural, post-conflict Liberia.<h4>Methods</h4>A
sample of 270 caregivers of children ages 3-7 were
randomized into an immediate treatment group that received a
10-session parent training intervention or a wait-list
control condition (1:1 allocation). Interviewers
administered baseline and 1-month post-intervention surveys
and conducted child-caregiver observations. Intent-to-treat
estimates of the average treatment effects were calculated
using ordinary least squares regression. This study was
pre-registered at ClinicalTrials.gov (NCT01829815).<h4>Results</h4>The
program led to a 55.5% reduction in caregiver-reported use
of harsh punishment practices (<i>p</i> < 0.001). The
program also increased the use of positive behavior
management strategies and improved caregiver-child
interactions. The average caregiver in the treatment group
reported a 4.4% increase in positive interactions
(<i>p</i> < 0.05), while the average child of a caregiver
assigned to the treatment group reported a 17.5% increase
(<i>p</i> < 0.01). The program did not have a measurable
impact on child wellbeing, cognitive skills, or household
adoption of malaria prevention behaviors.<h4>Conclusions</h4>PMD
is a promising approach for preventing child abuse and
promoting positive parent-child relationships in
low-resource settings.},
Doi = {10.1017/gmh.2015.12},
Key = {fds331414}
}
@article{fds322205,
Author = {Matthews, EJ and Puffer, ES and Meade, CS and Broverman,
SA},
Title = {IMPLEMENTATION OF A SCHOOL-BASED HIV PREVENTION CURRICULUM
FOLLOWING NATIONAL DISSEMINATION IN NYANZA PROVINCE,
KENYA.},
Journal = {East African medical journal},
Volume = {91},
Number = {5},
Pages = {152-160},
Year = {2014},
Month = {May},
Abstract = {Primary School Action for Better Health (PSABH) became the
national HIV prevention curriculum of Kenya in 2005.To
examined implementation of PSABH and student risk behaviour
s.Muhuru, a rural division of Nyanza Province.One thousand
one hundred and forty six students aged 9-21 years from six
primary schools in Muhuru.Anonymous surveys were
administered to assess students'exposure to PSABH curriculum
components, sexual activity, condom use, and self-efficacy
related to engaging in lower risk behaviours.The six schools
implementing PSABH were not implementing the full
curriculum. Fifty-five percent of males and 44% of females
reported a history of sexual activity. For females, condom
self-efficacy was related to lower risk behaviour, while HIV
education during pastoral instruction was associated with
higher risk. Boys who reported higher self-efficacy and
learning about abstinence strategies engaged in lower risk
behaviour , while exposure to HIV education in assemblies
and communication with relatives about HIV was associated
with higher risk.Previous studies documented benefits of
PSABH. However, it is unclear how effective the curriculum
is after national scale-up. In this community, PSABH was
implemented at a low level, with some curriculum components
associated with higher risk behaviour, calling into question
how PSABH is being delivered. Future studies should examine
effective strategies for ongoing support, monitoring, and
evaluation. Successfully disseminating evidence-based
prevention strategies could reduce HIV incidence and the
burden on healthcare providers struggling to care for people
living with HIV/AIDS.},
Key = {fds322205}
}
@article{fds287930,
Author = {Horn, R and Puffer, ES and Roesch, E and Lehmann,
H},
Title = {Women's perceptions of effects of war on intimate partner
violence and gender roles in two post-conflict West African
Countries: consequences and unexpected opportunities.},
Journal = {Conflict and health},
Volume = {8},
Pages = {12},
Year = {2014},
Month = {January},
url = {http://dx.doi.org/10.1186/1752-1505-8-12},
Abstract = {<h4>Background</h4>The aim of this paper is to explore
women's perceptions of the causes of intimate partner
violence (IPV) in West Africa, and the ways in which they
understand these causes to interact with the experiences of
war.<h4>Methods</h4>The study was conducted in two locations
in Sierra Leone and two in Liberia, using focus group
discussions (N groups =14) and individual interviews
(N = 20).<h4>Results</h4>Women perceive the causes of
IPV to be linked with other difficulties faced by women in
these settings, including their financial dependence on men,
traditional gender expectations and social changes that took
place during and after the wars in those countries.
According to respondents, the wars increased the use of
violence by some men, as violence became for them a normal
way of responding to frustrations and challenges. However,
the war also resulted in women becoming economically active,
which was said by some to have decreased IPV, as the
pressure on men to provide for their families reduced.
Economic independence, together with services provided by
NGOs, also gave women the option of leaving a violent
relationship.<h4>Conclusions</h4>IPV was found to be a
significant problem for women in Sierra Leone and Liberia.
The interactions between war experiences and financial and
cultural issues are multi-faceted and not uniformly positive
or negative.},
Doi = {10.1186/1752-1505-8-12},
Key = {fds287930}
}
@article{fds287932,
Author = {Hall, BJ and Puffer, E and Murray, LK and Ismael, A and Bass, JK and Sim,
A and Bolton, PA},
Title = {The Importance of Establishing Reliability and Validity of
Assessment Instruments for Mental Health Problems: An
Example from Somali Children and Adolescents Living in Three
Refugee Camps in Ethiopia},
Journal = {Psychological Injury and Law},
Volume = {7},
Number = {2},
Pages = {153-164},
Publisher = {Springer Nature},
Year = {2014},
Month = {January},
ISSN = {1938-971X},
url = {http://dx.doi.org/10.1007/s12207-014-9188-9},
Abstract = {Assessing mental health problems cross-culturally for
children exposed to war and violence presents a number of
unique challenges. One of the most important issues is the
lack of validated symptom measures to assess these problems.
The present study sought to evaluate the psychometric
properties of two measures to assess mental health problems:
the Achenbach Youth Self-Report and the Child Posttraumatic
Stress Disorder Symptom Scale. We conducted a validity study
in three refugee camps in Eastern Ethiopia in the outskirts
of Jijiga, the capital of the Somali region. A total of 147
child and caregiver pairs were assessed, and scores obtained
were submitted to rigorous psychometric evaluation.
Excellent internal consistency reliability was obtained for
symptom measures for children and their caregivers.
Validation of study instruments based on local case
definitions was obtained for the caregivers but not
consistently for the children. Sensitivity and specificity
of study measures were generally low, indicating that these
scales would not perform adequately as screening
instruments. Combined test-retest and inter-rater
reliability was low for all scales. This study illustrates
the need for validation and testing of existing measures
cross-culturally. Methodological implications for future
cross-cultural research studies in low- and middle-income
countries are discussed. © 2014 Springer Science+Business
Media New York.},
Doi = {10.1007/s12207-014-9188-9},
Key = {fds287932}
}
@article{fds287935,
Author = {Puffer, ES and Pian, J and Sikkema, KJ and Ogwang-Odhiambo, RA and Broverman, SA},
Title = {Developing a family-based HIV prevention intervention in
rural Kenya: challenges in conducting community-based
participatory research.},
Journal = {Journal of empirical research on human research ethics :
JERHRE},
Volume = {8},
Number = {2},
Pages = {119-128},
Year = {2013},
Month = {April},
url = {http://www.ncbi.nlm.nih.gov/pubmed/23651936},
Abstract = {Community-Based Participatory research (CBPR) introduces new
ethical challenges for HIV prevention studies in
low-resource international settings. We describe a CBPR
study in rural Kenya to develop and pilot a family-based HIV
prevention and mental health promotion intervention.
Academic partners (APs) worked with a community advisory
committee (CAC) during formative research, intervention
development, and a pilot trial. Ethical challenges emerged
related to: negotiating power imbalances between APs and the
CAC; CAC members' shifting roles as part of the CAC and
wider community; and anticipated challenges in decision
making about sustainability. Factors contributing to ethical
dilemmas included low access to education, scarcity of
financial resources, and the shortage of HIV-related
services despite high prevalence.},
Doi = {10.1525/jer.2013.8.2.119},
Key = {fds287935}
}
@article{fds287934,
Author = {Meyer, S and Murray, LK and Puffer, ES and Larsen, J and Bolton,
P},
Title = {The nature and impact of chronic stressors on refugee
children in Ban Mai Nai Soi camp, Thailand.},
Journal = {Global public health},
Volume = {8},
Number = {9},
Pages = {1027-1047},
Year = {2013},
Month = {January},
ISSN = {1744-1692},
url = {http://www.ncbi.nlm.nih.gov/pubmed/23886374},
Abstract = {Refugee camps are replete with risk factors for mental
health problems among children, including poverty,
disruption of family structure, family violence and food
insecurity. This study, focused on refugee children from
Burma, in Ban Mai Nai Soi camp in Thailand, sought to
identify the particular risks children are exposed to in
this context, and the impacts on their mental health and
psychosocial well-being. This study employed two qualitative
methods--free list interviews and key informant
interviews--to identify the main problems impacting children
in Ban Mai Nai Soi camp and to explore the causes of these
problems and their impact on children's well-being.
Respondents in free list interviews identified a number of
problems that impact children in this context, including
fighting between adults, alcohol use by adults and children,
and child abuse and neglect. Across the issues, the causes
included economic and social conditions associated with
living in the camp and changes in family structures.
Children are chronically exposed to stressors during their
growth and development in the camp environment. Policies and
interventions in areas of protracted displacement in
camp-based settings should work to address these stressors
and their impacts at community, household and individual
levels.},
Doi = {10.1080/17441692.2013.811531},
Key = {fds287934}
}
@article{fds287940,
Author = {Puffer, ES and Skalski, LM and Meade, CS},
Title = {Changes in religious coping and relapse to drug use among
opioid-dependent patients following inpatient
detoxification.},
Journal = {Journal of religion and health},
Volume = {51},
Number = {4},
Pages = {1226-1238},
Year = {2012},
Month = {December},
url = {http://www.ncbi.nlm.nih.gov/pubmed/21125425},
Abstract = {Relapse rates remain high among people with opioid
dependence. Identifying psychosocial factors associated with
outcomes is important for informing behavioral treatments.
This study examined religious coping, opioid use, and
12-step participation among 45 participants receiving
inpatient opioid detoxification at baseline and follow-up.
At baseline, higher positive coping was related to less
frequent opioid use pre-admission (β = -.44, p < .001) and
history of 12-step participation (OR = 2.33, p < .05).
Decreases in negative coping after discharge predicted less
opioid use (β = .55, p < .001), and increases in positive
coping predicted more frequent 12-step program participation
(β = .42, p < .05). Positive religious coping may be
protective, while negative religious coping may be a barrier
to treatment.},
Doi = {10.1007/s10943-010-9418-8},
Key = {fds287940}
}
@article{fds287943,
Author = {Boateng, LB and Puffer, ES and Allen, T and Bonner, M and Thornburg,
CD},
Title = {“It is keeping him alive, and life is what it is all
about:” A Qualitative Study of Family Perspectives on
Adherence to Secondary Stroke Prevention in Children with
Sickle Cell Disease},
Journal = {Pediatric Blood and Cancer},
Volume = {in press},
Year = {2012},
Month = {December},
Abstract = {Children with sickle cell anemia and primary stroke are at
high risk of secondary stroke. Transfusions reduce but do
not eliminate this risk and results in iron overload.
Hydroxyurea in combination with phlebotomy is an
alternative. We conducted semi-structured interview based on
the Health Belief Model to examine factors influencing
adherence to secondary stroke prevention. Participants were
14 caregivers of children with history of stroke and 12 of
their children, ages 8 to 17 years. Barriers to adherence
included high frequency and length of clinic visits,
disruption of school and work, and lack of resources.
Facilitators included health benefits of therapy, social
support systems, medication reminders, and positive clinic
experiences. Caregivers and children reported a preference
for hydroxyurea over transfusions, as they perceived fewer
barriers and equivalent benefits. Healthcare providers
should work with families to preemptively identify and
address barriers to secondary stroke prevention which may
compromise care.},
Key = {fds287943}
}
@article{fds287946,
Author = {Puffer, ES and Drabkin, AS and Stashko, AL and Broverman, SA and Ogwang-Odhiambo, RA and Sikkema, KJ},
Title = {Orphan status, HIV risk behavior, and mental health among
adolescents in rural Kenya.},
Journal = {Journal of pediatric psychology},
Volume = {37},
Number = {8},
Pages = {868-878},
Year = {2012},
Month = {September},
url = {http://www.ncbi.nlm.nih.gov/pubmed/22728899},
Abstract = {<h4>Objective</h4>To examine orphan status, mental health,
social support, and HIV risk among adolescents in rural
Kenya.<h4>Methods</h4>Randomly selected adolescents aged
10-18 years completed surveys assessing sexual activity,
sex-related beliefs and self-efficacy, mental health, social
support, caregiver-child communication, time since parental
death, and economic resources. Analysis of covariance and
regression analyses compared orphans and nonorphans; orphan
status was tested as a moderator between well-being and HIV
risk.<h4>Results</h4>Orphans reported poorer mental health,
less social support, and fewer material resources. They did
not differ from nonorphans on HIV risk indicators. Longer
time since parental death was associated with poorer
outcomes. In moderator analyses, emotional problems and
poorer caregiver-youth communication were more strongly
associated with lower sex-related self-efficacy for
orphans.<h4>Conclusions</h4>Orphans are at higher risk for
psychosocial problems. These problems may affect orphans'
self-efficacy for safer sex practices more than nonorphans.
Decreased HIV risk could be one benefit of psychosocial
interventions for orphans.},
Doi = {10.1093/jpepsy/jss077},
Key = {fds287946}
}
@article{fds287942,
Author = {Meyer, S and Murray, L and Puffer, ES and Larsen, J and Bolton,
P},
Title = {Refugee children in Ban Mai Nai Soi camp, Thailand: a
qualitative study},
Journal = {Conflict and Health},
Year = {2012},
Month = {August},
Key = {fds287942}
}
@article{fds287939,
Author = {Schlenz, AM and McClellan, CB and Mark, TRM and McKelvy, A and Puffer,
ES and Roberts, CW and Sweitzer, SM and Schatz, JD},
Title = {Sensitization to Acute Procedural Pain in Pediatric Sickle
Cell Disease: Modulation by Painful Vaso-occlusive Episodes,
Age, and Endothelin-1},
Journal = {Journal of Pain},
Volume = {13},
Number = {7},
Pages = {656-665},
Year = {2012},
Month = {July},
url = {http://dx.doi.org/10.1016/j.jpain.2012.04.001},
Abstract = {The impact of pain early in life is a salient issue for
sickle cell disease (SCD), a genetic condition characterized
by painful vaso-occlusive episodes (VOEs) that can begin in
the first year of life and persist into adulthood. This
study examined the effects of age and pain history (age of
onset and frequency of recent VOEs) on acute procedural pain
in children with SCD. Endothelin-1, a vaso-active peptide
released during VOEs and acute tissue injury, and its
precursor, Big Endothelin, were explored as markers of pain
sensitization and vaso-occlusion. Sixty-one children with
SCD (ages 2 to 18) underwent venipuncture at routine health
visits. Procedural pain was assessed via child and caregiver
reports and observational distress. Pain history was
assessed using retrospective chart review. Three primary
results were found: 1) younger age was associated with
greater procedural pain across pain outcomes; 2) higher
frequency of VOEs was associated with greater procedural
pain based on observational distress (regardless of age);
and 3) age was found to moderate the relationship between
VOEs and procedural pain for child-reported pain and
observational distress for children 5 years of age and
older. Associations between the endothelin variables and
pain prior to venipuncture were also observed. PERSPECTIVE:
For children with SCD, the child's age and recent pain
history should be considered in procedural pain management.
The endothelin system may be involved in preprocedure pain,
but additional research is needed to understand the role of
endothelins in pain sensitization.},
Doi = {10.1016/j.jpain.2012.04.001},
Key = {fds287939}
}
@article{fds207457,
Author = {Puffer, E. S. and Watt, M. and Sikkema, K. J. and Ogwang-Odhiambo, R.
A. and Broverman, S. A.},
Title = {The Protective Role of Religious Coping in Adolescents'
Responses to Poverty and Sexual Decision-Making in Rural
Kenya: a brief report},
Journal = {Journal of Research on Adolescence},
Volume = {22},
Pages = {1-7},
Year = {2012},
Month = {March},
url = {http://www.ncbi.nlm.nih.gov/pubmed/22505794},
Abstract = {In this study, we explored how adolescents in rural Kenya
apply religious coping in sexual decision-making in the
context of high rates of poverty and Human Immunodeficiency
Virus (HIV). Semi-structured interviews were conducted with
34 adolescents. One-third (13) reported religious coping
related to economic stress, HIV, or sexual decision-making;
the majority (29) reported religious coping with these or
other stressors. Adolescents reported praying for God to
partner with them to engage in positive behaviors, praying
for strength to resist unwanted behaviors, and passive
strategies characterized by waiting for God to provide
resources or protection from HIV. Adolescents in Sub-Saharan
Africa may benefit from HIV prevention interventions that
integrate and build upon their use of religious
coping.},
Key = {fds207457}
}
@article{fds287947,
Author = {Puffer, ES and Watt, MH and Sikkema, KJ and Ogwang-Odhiambo, RA and Broverman, SA},
Title = {The protective role of religious coping in adolescents'
responses to poverty and sexual decision-making in rural
Kenya.},
Journal = {Journal of research on adolescence : the official journal of
the Society for Research on Adolescence},
Volume = {22},
Number = {1},
Pages = {1-7},
Year = {2012},
Month = {March},
ISSN = {1050-8392},
url = {http://www.ncbi.nlm.nih.gov/pubmed/22505794},
Abstract = {In this study, we explored how adolescents in rural Kenya
apply religious coping in sexual decision-making in the
context of high rates of poverty and Human Immunodeficiency
Virus (HIV). Semi-structured interviews were conducted with
34 adolescents. One-third (13) reported religious coping
related to economic stress, HIV, or sexual decision-making;
the majority (29) reported religious coping with these or
other stressors. Adolescents reported praying for God to
partner with them to engage in positive behaviors, praying
for strength to resist unwanted behaviors, and passive
strategies characterized by waiting for God to provide
resources or protection from HIV. Adolescents in Sub-Saharan
Africa may benefit from HIV prevention interventions that
integrate and build upon their use of religious
coping.},
Doi = {10.1111/j.1532-7795.2011.00760.x},
Key = {fds287947}
}
@article{fds287941,
Author = {Sim, A and Puffer, ES and Betancourt, T and Annan,
J},
Title = {Development in Adversity: Risk and Resilience Among
Displaced Burmese Children in Thailand},
Journal = {Social Science and Medicine},
Year = {2012},
Key = {fds287941}
}
@article{fds287945,
Author = {Puffer, E and Pian, J and Broverman, S and Ogwang Odhaimbo and R and Sikkema, K},
Title = {Developing a community-based HIV prevention intervention in
rural Kenya: Ethical challenges of community-based
participatory research},
Journal = {Journal of Empirical Research on Human Research
Ethics},
Year = {2012},
Key = {fds287945}
}
@article{fds287949,
Author = {Puffer, ES and Meade, CS and Drabkin, AS and Broverman, SA and Ogwang-Odhiambo, RA and Sikkema, KJ},
Title = {Individual- and family-level psychosocial correlates of HIV
risk behavior among youth in rural Kenya.},
Journal = {AIDS and behavior},
Volume = {15},
Number = {6},
Pages = {1264-1274},
Year = {2011},
Month = {August},
url = {http://www.ncbi.nlm.nih.gov/pubmed/20945157},
Abstract = {Associations between individual- and family-level
psychosocial factors and sexual behavior were examined among
325 adolescents ages 10-18 in rural Kenya. History of sexual
activity was reported by 51% of males and 30% of females.
Among those reporting sex within the past year, 64% of males
and 32% of females had multiple partners; 85% of males and
54% of females reported not using a condom at last sex.
Multivariate logistic regression modeling demonstrated
sexually active adolescents were significantly more likely
to be older, male, more accepting of risky behavior, and
have greater perceived HIV risk, caregiver social support,
social support related to HIV, and emotional problems.
Youths reporting high-risk behavior (unprotected sex or
multiple partners) were significantly more likely to be
younger, male, and have lower sex-related self-efficacy,
lower caregiver monitoring, and more externalizing problems.
Future studies should evaluate HIV prevention interventions
targeting improvements in mental health and family
relationships.},
Doi = {10.1007/s10461-010-9823-8},
Key = {fds287949}
}
@article{fds305726,
Author = {Miles, A and Proescholdbell, RJ and Puffer, E},
Title = {Explaining rural/non-rural disparities in physical
health-related quality of life: a study of United Methodist
clergy in North Carolina.},
Journal = {Quality of life research : an international journal of
quality of life aspects of treatment, care and
rehabilitation},
Volume = {20},
Number = {6},
Pages = {807-815},
Year = {2011},
Month = {August},
ISSN = {0962-9343},
url = {http://hdl.handle.net/10161/6213 Duke open
access},
Abstract = {<h4>Purpose</h4>Researchers have documented lower
health-related quality of life (HRQL) in rural areas. This
study seeks to identify factors that can explain this
disparity.<h4>Methods</h4>United Methodist clergy in North
Carolina (N = 1,513) completed the SF-12 measure of HRQL
and items on chronic disease diagnoses, health behaviors,
and health care access from the Behavioral Risk Factor
Surveillance Survey (BRFSS). Differences in HRQL between
rural (N = 571) and non-rural clergy (N = 942) were
examined using multiple regression analyses.<h4>Results</h4>Physical
HRQL was significantly lower for rural clergy (-2.0; 95% CI:
-2.9 to -1.1; P < 0.001). Income, body mass index, and
joint disease partially accounted for the rural/non-rural
difference, though a sizable disparity remained after
controlling for these mediators (-1.02; 95% CI: -1.89 to
-.15; P = 0.022). Mental HRQL did not differ significantly
between rural and non-rural respondents (1.0, 95% CI: -0.1
to 2.1; P = 0.067).<h4>Conclusions</h4>Rural/non-rural
disparities in physical HRQL are partially explained by
differences in income, obesity, and joint disease in rural
areas. More research into the causes and prevention of these
factors is needed. Researchers also should seek to identify
variables that can explain the difference that remains after
accounting for these variables.},
Doi = {10.1007/s11136-010-9817-z},
Key = {fds305726}
}
@article{fds287948,
Author = {Puffer, ES and Kochman, A and Hansen, NB and Sikkema,
KJ},
Title = {An evidence-based group coping intervention for women living
with HIV and history of childhood sexual
abuse.},
Journal = {International journal of group psychotherapy},
Volume = {61},
Number = {1},
Pages = {98-126},
Year = {2011},
Month = {January},
url = {http://www.ncbi.nlm.nih.gov/pubmed/21244204},
Abstract = {Women living with HIV/AIDS and a history of childhood sexual
abuse often exhibit sexual trauma symptoms and elevated
rates of HIV-risk behaviors. In this paper, we describe a
coping skills group intervention that reduced traumatic
stress and sexual-risk behavior in a recent randomized
clinical trial. We focused on clinical issues that emerged
among female participants receiving the intervention.
Clinical observations showed that recognizing connections
between trauma, psychological distress, and high risk
behaviors was a new and powerful experience for many
participants. Participants successfully applied
psychoeducational material, expressing an increased sense of
power and control over their relationships and behaviors as
they developed more adaptive cognitive and behavioral
skills. Women expressed high levels of satisfaction with the
intervention. Recommendations for clinical practice are
provided.},
Doi = {10.1521/ijgp.2011.61.1.98},
Key = {fds287948}
}
@article{fds207455,
Author = {Puffer, E. S. and Meade, C. and Drabkin, A. and Broverman, S. A. and Odhiambo, R. O. and Sikkema, K. J.},
Title = {Psychosocial correlates of HIV risk behavior among youth in
rural Kenya},
Journal = {AIDS and Behavior},
Volume = {15},
Pages = {1264-1274},
Year = {2011},
Key = {fds207455}
}
@article{fds287944,
Author = {Matthews, EJ and Puffer, ES and Meade, CS and Broverman,
SA},
Title = {. Implementation of a of a school-based HIV prevention
program in rural Kenya after national dissemination},
Journal = {East African Medical Journal},
Year = {2011},
Abstract = {Objective: Primary School Action for Better Health (PSABH)
became the national HIV prevention curriculum of Kenya in
2007. This study examined implementation of PSABH and
student risk behaviors. Setting: The study was conducted in
Muhuru, a rural division of Nyanza Province. Subjects: Six
of nine public schools in Muhuru reported implementing
PSABH. Participants were 1146 students aged 9-21 years from
these six schools. Measures: Anonymous surveys were
administered to assess students’ exposure to PSABH
curriculum components, their sexual activity, condom use,
and self-efficacy related to engaging in lower risk
behaviors. Results: All six schools with PSABH were not
implementing the full curriculum. Fifty-five percent of
males and 44% of females reported a history of sexual
activity. Boys who reported higher self-efficacy and
learning about abstinence strategies engaged in lower risk
behavior, while exposure to HIV education in assemblies and
communication with relatives about HIV increased their
likelihood to engage in riskier behavior. For females,
condom self-efficacy was related to lower risk behavior,
while HIV education during pastoral instruction was
associated with higher risk. Conclusions: Previous studies
in Kenya documented benefits of PSABH. However, it is
unclear how effective the curriculum is after national
scale-up. In this community, PSABH was implemented at a low
level, with some curriculum components associated with
higher risk behavior, calling into question how PSABH is
being delivered. Implementation barriers should be examined,
and studies should test strategies for ongoing support,
monitoring, and evaluation to increase effectiveness during
scale-up of PSABH.},
Key = {fds287944}
}
@article{fds287950,
Author = {Miles, A and Proescholdbell, RJ and Puffer, ES},
Title = {Explaining Rural and non-rural disparities in physical
health-related quality of life among clergy
members},
Journal = {Quality of Life Research},
Volume = {20},
Number = {6},
Pages = {807-815},
Year = {2011},
ISSN = {0962-9343},
url = {http://hdl.handle.net/10161/6213},
Abstract = {Purpose: Researchers have documented lower health-related
quality of life (HRQL) in rural areas. This study seeks to
identify factors that can explain this disparity. Methods:
United Methodist clergy in North Carolina (N = 1,513)
completed the SF-12 measure of HRQL and items on chronic
disease diagnoses, health behaviors, and health care access
from the Behavioral Risk Factor Surveillance Survey (BRFSS).
Differences in HRQL between rural (N = 571) and non-rural
clergy (N = 942) were examined using multiple regression
analyses. Results: Physical HRQL was significantly lower for
rural clergy (-2.0; 95% CI: -2.9 to -1.1; P < 0.001).
Income, body mass index, and joint disease partially
accounted for the rural/non-rural difference, though a
sizable disparity remained after controlling for these
mediators (-1.02; 95% CI: -1.89 to -.15; P = 0.022). Mental
HRQL did not differ significantly between rural and
non-rural respondents (1.0, 95% CI: -0.1 to 2.1; P = 0.067).
Conclusions: Rural/non-rural disparities in physical HRQL
are partially explained by differences in income, obesity,
and joint disease in rural areas. More research into the
causes and prevention of these factors is needed.
Researchers also should seek to identify variables that can
explain the difference that remains after accounting for
these variables. © 2010 Springer Science+Business Media
B.V.},
Doi = {10.1007/s11136-010-9817-z},
Key = {fds287950}
}
@article{fds342063,
Author = {Puffer, ES and Broverman, S and Odhiambo, RO and Sikkema,
KJ},
Title = {MENTAL HEALTH FACTORS ASSOCIATED WITH HIV RISK BEHAVIOR
AMONG ADOLESCENTS IN RURAL KENYA},
Journal = {ANNALS OF BEHAVIORAL MEDICINE},
Volume = {39},
Pages = {205-205},
Publisher = {SPRINGER},
Year = {2010},
Month = {April},
Key = {fds342063}
}
@article{fds305725,
Author = {McClellan, CB and Schatz, JC and Mark, TRM and McKelvy, A and Puffer, E and Roberts, CW and Sweitzer, SM},
Title = {Criterion and convergent validity for 4 measures of pain in
a pediatric sickle cell disease population.},
Journal = {The Clinical journal of pain},
Volume = {25},
Number = {2},
Pages = {146-152},
Year = {2009},
Month = {February},
ISSN = {0749-8047},
url = {http://dx.doi.org/10.1097/ajp.0b013e3181839ac4},
Abstract = {<h4>Objective</h4>To evaluate the psychometric properties of
4 measures of acute pain in youth with sickle cell disease
(SCD) during a medical procedure.<h4>Methods</h4>Heart rate,
child self-report, parent proxy-report, and observable pain
behaviors were examined in 48 youth with SCD ages 2 to 17
years. Criterion validity for acute pain was assessed by
responsiveness to a standardized painful stimulus
(venipuncture) in a prospective pre-post design. Convergent
validity was evaluated through the correlation across
measures in reactivity to the stimulus.<h4>Results</h4>Child
self-reported pain, parent proxy-report, and behavioral
distress scores increased in response to venipuncture
(concurrent and convergent validity). In contrast, heart
rate did not reliably change in response to venipuncture.
Extent of change in response to venipuncture showed moderate
intercorrelation across child and parent pain ratings, and
behavioral distress. Preprocedure pain ratings correlated
with pain experienced during the procedure. An item analysis
of observable pain behaviors suggested differences in the
presentation of pain in SCD compared with previous pediatric
research.<h4>Conclusions</h4>Criterion and convergent
validity were demonstrated for child-report, parent-report,
and observable pain behaviors. These measures seem to tap
into distinct, yet overlapping aspects of the pain
experience. Assessment of acute procedural pain responses in
SCD requires evaluation of preprocedural pain due to the
frequent presence of low-level, baseline
pain.},
Doi = {10.1097/ajp.0b013e3181839ac4},
Key = {fds305725}
}
@article{fds305724,
Author = {Schatz, J and Puffer, ES and Sanchez, C and Stancil, M and Roberts,
CW},
Title = {Language processing deficits in sickle cell disease in young
school-age children.},
Journal = {Developmental neuropsychology},
Volume = {34},
Number = {1},
Pages = {122-136},
Year = {2009},
Month = {January},
ISSN = {8756-5641},
url = {http://dx.doi.org/10.1080/87565640802499191},
Abstract = {Verbal IQ deficits are frequently reported for school-age
children with sickle cell disease (SCD), yet the profile of
language abilities in SCD is unclear. We examined semantic,
syntactic, and phonological processing in
five-to-seven-year-olds at high neurologic risk based on SCD
subtype (N = 33), at low neurologic risk with SCD (N = 21),
and without SCD (N = 54). Low-risk SCD did not show language
processing deficits. High-risk SCD showed deficits in all
three language domains. Language processing deficits in SCD
at the start of middle childhood are related to neurologic
risks and include language skills beyond
vocabulary.},
Doi = {10.1080/87565640802499191},
Key = {fds305724}
}
@article{fds287951,
Author = {Puffer, ES and Schatz, JC and Roberts, CW},
Title = {Relationships between Somatic Growth and Cognitive
Functioning in Children with Sickle Cell
Disease},
Journal = {Journal of Pediatric Psychology},
Volume = {35},
Number = {8},
Pages = {892-904},
Year = {2009},
url = {http://dx.doi.org/10.1093/jpepsy/jsp124},
Abstract = {<h4>Objective</h4>Children with sickle cell disease (SCD)
exhibit poor somatic growth due to nutritional and metabolic
effects, but potential relationships between growth and
other areas of development are unclear. We examined whether
growth is related to cognition and whether growth might be
one marker of neurocognitive risk.<h4>Methods</h4>Sixty-four
children with SCD and eighty-one demographically similar
controls, ages 4 to 8 years, completed cognitive and
anthropometric measures.<h4>Results</h4>Height-for-age
partially accounted for cognitive decrements related to SCD
on all cognitive measures. Higher body-mass-index was a
significant predictor of higher visual-motor and academic
achievement scores in children with SCD, but not in
controls.<h4>Conclusions</h4>In some children with SCD,
especially those with HbSS and Hb Sbeta(0), low
height-for-age may help to explain neurocognitive risk.
Higher body-mass-index may be related to better cognitive
outcomes in children with SCD. Nutrition deficits in SCD
could explain the association between somatic growth and
cognitive deficits.},
Doi = {10.1093/jpepsy/jsp124},
Key = {fds287951}
}
@article{fds287952,
Author = {Schatz, JC and Puffer, ES and Sanchez, C and Stancil, M and Roberts,
CW},
Title = {Language Processing Deficits in Sickle Cell Disease in Young
School-Age Children},
Journal = {Developmental Neuropsychology},
Volume = {34},
Number = {1},
Pages = {1-15},
Year = {2009},
ISSN = {8756-5641},
url = {http://dx.doi.org/10.1080/87565640802499191},
Abstract = {Verbal IQ deficits are frequently reported for school-age
children with sickle cell disease (SCD), yet the profile of
language abilities in SCD is unclear. We examined semantic,
syntactic, and phonological processing in
five-to-seven-year-olds at high neurologic risk based on SCD
subtype (N = 33), at low neurologic risk with SCD (N = 21),
and without SCD (N = 54). Low-risk SCD did not show language
processing deficits. High-risk SCD showed deficits in all
three language domains. Language processing deficits in SCD
at the start of middle childhood are related to neurologic
risks and include language skills beyond vocabulary.
Copyright © 2009 Taylor & Francis Group,
LLC.},
Doi = {10.1080/87565640802499191},
Key = {fds287952}
}
@article{fds287953,
Author = {McClellan, CB and Schatz, JC and Mark, TRM and McKelvy, A and Puffer,
ES and Roberts, C and Sweitzer, SM},
Title = {Criterion and convergent validity for 4 measures of
pediatric pain in sickle cell disease},
Journal = {Clinical Journal of Pain},
Volume = {25},
Number = {2},
Pages = {146-152},
Year = {2009},
ISSN = {0749-8047},
url = {http://dx.doi.org/10.1097/AJP.0b013e3181839ac4},
Abstract = {Objective: To evaluate the psychometric properties of 4
measures of acute pain in youth with sickle cell disease
(SCD) during a medical procedure. Methods: Heart rate, child
self-report, parent proxy-report, and observable pain
behaviors were examined in 48 youth with SCD ages 2 to 17
years. Criterion validity for acute pain was assessed by
responsiveness to a standardized painful stimulus
(venipuncture) in a prospective pre-post design. Convergent
validity was evaluated through the correlation across
measures in reactivity to the stimulus. Results: Child
self-reported pain, parent proxy-report, and behavioral
distress scores increased in response to venipuncture
(concurrent and convergent validity). In contrast, heart
rate did not reliably change in response to venipuncture.
Extent of change in response to venipuncture showed moderate
intercorrelation across child and parent pain ratings, and
behavioral distress. Preprocedure pain ratings correlated
with pain experienced during the procedure. An item analysis
of observable pain behaviors suggested differences in the
presentation of pain in SCD compared with previous pediatric
research. Conclusions: Criterion and convergent validity
were demonstrated for child-report, parent-report, and
observable pain behaviors. These measures seem to tap into
distinct, yet overlapping aspects of the pain experience.
Assessment of acute procedural pain responses in SCD
requires evaluation of preprocedural pain due to the
frequent presence of low-level, baseline pain. © 2009 by
Lippincott Williams & Wilkins.},
Doi = {10.1097/AJP.0b013e3181839ac4},
Key = {fds287953}
}
@article{fds287954,
Author = {McClellan, CB and Schatz, J and Puffer, ES and Roberts,
CW},
Title = {Use of Handheld Wireless Technology For a Home-based Sickle
Cell Pain Management Protocol},
Journal = {Journal of Pediatric Psychology},
Volume = {34},
Number = {5},
Pages = {564-573},
Year = {2009},
url = {http://dx.doi.org/10.1093/jpepsy/jsn121},
Abstract = {<h4>Purpose</h4>To evaluate use of a handheld electronic
wireless device to implement a pain management protocol for
participants with sickle cell disease (SCD).<h4>Methods</h4>Participants
were 19 patients with SCD aged 9-20 who experienced
vaso-occlusive pain. A single-session training on the use of
cognitive-behavioral coping skills was followed by
instruction on how to practice these skills and monitor
daily pain experience using the device. Daily pain
experience and practice of coping skills were collected for
the 8-week intervention period using wireless
technology.<h4>Results</h4>High rates of participation,
daily diary completion and consumer satisfaction support the
use of handheld wireless devices to implement this protocol.
A comparison of the rates of self and device-recorded skills
practice provides important information about the use of
electronic monitoring for behavioral interventions.<h4>Conclusion</h4>Wireless
data transfer technology has significant potential to become
a practical method to improve symptom monitoring and
communication between patients and providers.},
Doi = {10.1093/jpepsy/jsn121},
Key = {fds287954}
}
@article{fds287955,
Author = {Schatz, J and McClellan, CB and Puffer, ES and Johnson, K and Roberts,
CW},
Title = {Neurodevelopmental Screening in Toddlers and Early
Preschoolers with Sickle Cell Disease},
Journal = {Journal of Child Neurology},
Volume = {23},
Number = {1},
Pages = {44-50},
Year = {2008},
url = {http://dx.doi.org/10.1177/0883073807307982},
Abstract = {Sickle cell disease is associated with an elevated risk for
neurologic complications beginning in early childhood.
Detecting higher-risk cases with developmental screening
instruments may be a cost-effective method for identifying
young children in need of more frequent or intensive
assessment. We evaluated the validity of the Denver II test
as a tool to detect lower levels of developmental attainment
and their association with neurologic risk in 50 young
children with sickle cell disease. Children with suspect
Denver II outcomes showed lower scores for functional
communication skills, had lower hematocrit percentage,
higher mean velocities on transcranial Doppler ultrasound
imaging, and were more likely to have had preterm birth.
Validity of age equivalencies from specific Denver II areas
was demonstrated for Language and Fine Motor scores,
suggesting the instrument could be used to index children's
developmental levels in these domains. The Denver II may be
a useful behavioral screening tool for neurodevelopmental
risk in sickle cell disease.},
Doi = {10.1177/0883073807307982},
Key = {fds287955}
}
@article{fds287956,
Author = {Puffer, ES and Schatz, J and Roberts, CW},
Title = {The association of oral hydroxyurea therapy with improved
cognitive functioning in sickle cell disease},
Journal = {Child Neuropsychology},
Volume = {13},
Number = {2},
Pages = {142-154},
Year = {2007},
url = {http://dx.doi.org/10.1080/09297040600584626},
Abstract = {This study examined potential cognitive benefits of oral
hydroxyurea therapy for children with sickle cell disease
(SCD). Cognitive abilities of 15 children with SCD on
hydroxyurea were compared to 50 other children with SCD,
controlling for demographics and hematocrit. Children on
hydroxyurea scored significantly higher on tests of verbal
comprehension, fluid reasoning, and general cognitive
ability than children not on the drug. The data therefore
provide preliminary evidence of cognitive benefits of
hydroxyurea. Mechanisms for this effect may be improved
blood/oxygen supply to the brain or reduced fatigue and
illness.},
Doi = {10.1080/09297040600584626},
Key = {fds287956}
}
%% Articles Submitted
@article{fds221870,
Author = {Puffer, E. S. and Schatz, J. C. and Roberts, C.
W.},
Title = {Association between somatic growth trajectory and cognitive
functioning in young children with Sickle Cell
Disease},
Year = {2013},
Key = {fds221870}
}
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