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Open Access Publications from the University of California

Scholarly Works (4 results)

  • Thesis
  • Peer Reviewed
UC San Diego Electronic Theses and Dissertations (2022)

Background: Migrants from countries in the Northern Triangle made up 92% of attempted crossings on the United States Southern international border in 2021; Guatemala is the top sending country in that region. Scholarship in Guatemala has focused on escape from violence and economic opportunity as reasons for migration; however, drivers of migration are more complex, including “aspirations” of transnational families and influences of social networks. Furthermore, few studies have addressed the mental health distress caused by being “left-behind” to migration in Guatemala. Social network characteristics may moderate some mental health impacts of migration, but this has not been investigated using socio-centric network data from Central American migrant-sending communities. Methods: This dissertation includes three studies undertaken in partnership with participants using CBPR. Study 1 leverages data from focus groups and Photovoice interviews to investigate perceived changes from migration impacting community health. Qualitative results informed the research questions in studies 2 and 3. Studies 2 and 3 use data from a census of a representative community in the region. Study 2 evaluates the demographics, social network characteristics, and network dynamics influencing migration decisions. In study 3, we evaluate the relationship between migration and depressive symptoms, and the social network characteristics that may moderate that relationship. Results: Migration impacts rural communities in Guatemala in several ways, including mental health distress among those left-behind (Study 1). Twenty-two percent of the population had plans to migrate. Having a child emigrate reduced the odds of migration (OR 0.08). A spouse remaining was predictive of migration (OR 2.38) (Study 2). Having emigrant ties in the US increased the odds of depression (OR 1.11), as did a higher out-degree. Higher transitivity scores, especially for women, moderated the relationship between migrant ties and depression (Study 3). Conclusions: Migration changes social structures in rural Guatemalan communities, resulting in feelings of sadness and loss. Social network characteristics influence migration decisions among transnational families. Migration from the region is not slowing, so understanding the mental health impacts in migrant-sending communities is imperative. Social network characteristics should be explored in further research as potential assets to ease mental health burdens among those left-behind.

    Cover page: Health implications and social network dynamics of emigration and depressive symptoms among “left-behind” Indigenous Maya in the western highlands of Guatemala
    • Thesis
    • Peer Reviewed
    UC San Diego Electronic Theses and Dissertations (2024)

    Background: Social context plays a crucial role in shaping individual attitudes and behaviors. This dissertation examines how attitudes, social norms, and social networks influence reproductive autonomy and experiences of gender-based violence (GBV) among adolescent wives (AWs) in rural Niger.Methods: I conducted cross-sectional studies using data from AWs, their husbands, and mothers-in-law. I used multilevel linear regressions to examine fertility-related attitudes and social norms with AWs’ fertility desires. I used generalized estimating equation linear regressions to test the moderating effects of social networks on the relationship between very early child marriage and AWs’ contraceptive self-efficacy (CSE). Finally, I used multilevel logistic regressions to examine the association between AWs’ fertility-related attitudinal discordance from their husbands and peers with reported violence. Results: AW’s social norms (descriptive and injunctive), husbands’ injunctive norms, and community-level descriptive norms were associated with AWs’ fertility desires while individual or collective attitudes were not. (Chapter 2) Early child marriage was associated with lower CSE. AWs’ perception that social network members (alters) use contraceptives or support wives’ involvement in Family Planning (FP) decision-making weakens, and FP-related communication with alters magnifies the negative association between very early child marriage and CSE. (Chapter 3) The relationships between attitudinal discordance between AWs and their husbands/peers and reported violence varied by type of violence. Overall, AWs’ discordant attitudes favoring longer delay before first childbirth were associated with increased odds, while discordant attitudes favoring shorter delay were associated with reduced odds of experiencing violence. (Chapter 4). Conclusion: There is a complex interplay between social norms, interpersonal relationships, reproductive autonomy, and GBV. The association between social norms and fertility desires suggests the need for community-wide interventions that go beyond individual attitudes engaging men and women to foster norms where women can make decisions without social pressure. Our research also highlights the potential for social network-based interventions to mitigate the adverse effects of early child marriage on AWs’ reproductive agency. Interventions must consider how communication with alters can limit AWs' CSE in unsupportive FP contexts. Violence interventions need to be sensitive to the cultural context and address social norms tying women's values to reproduction.

      • Article
      • Peer Reviewed
      UC San Diego Previously Published Works (2023)

      Background

      The field of violence prevention research is unequivocal that interventions must target contextual factors, like social norms, to reduce gender-based violence. Limited research, however, on the social norms contributing to intimate partner violence or reproductive coercion exists. One of the driving factors is lack of measurement tools to accurately assess social norms.

      Methods

      Using an item response modelling approach, this study psychometrically assesses the reliability and validity of a social norms measure of the acceptability of intimate partner violence to exert control over wife agency, sexuality, and reproductive autonomy with data from a population-based sample of married adolescent girls (ages 13-18) and their husbands in rural Niger (n = 559 husband-wife dyads) collected in 2019.

      Results

      A two-dimensional Partial Credit Model for polytomous items was fit, showing evidence of reliability and validity. Higher scores on the "challenging husband authority" dimension were statistically associated with husband perpetration of intimate partner violence.

      Conclusions

      This brief scale is a short (5 items), practical measure with strong reliability and validity evidence. This scale can help identify populations with high-need for social norms-focused IPV prevention and to help measure the impact of such efforts.
        Cover page: Measuring social norms of intimate partner violence to exert control over wife agency, sexuality, and reproductive autonomy: an item response modelling of the IPV-ASRA scale.
        • Article
        • Peer Reviewed
        UC San Diego Previously Published Works (2023)

        Background

        Niger has the highest rate of adolescent fertility in the world, with early marriage, early childbearing and high gender inequity. This study assesses the impact of Reaching Married Adolescents (RMA), a gender-synchronized social behavioral intervention designed to improve modern contraceptive use and reduce intimate partner violence (IPV) among married adolescent couples in rural Niger.

        Methods

        We conducted a four-armed cluster-randomized trial in 48 villages across three districts in Dosso region, Niger. Married adolescent girls (ages 13-19) and their husbands were recruited within selected villages. Intervention arms included home visits by gender-matched community health workers (CHWs) (Arm 1), gender-segregated, group discussion sessions (Arm 2), and both approaches (Arm 3). We used multilevel mixed-effects Poisson regression models to assess intervention effects for our primary outcome, current modern contraceptive use, and our secondary outcome, past year IPV.

        Results

        Baseline and 24-month follow-up data were collected April-June 2016 and April-June 2018. At baseline, 1072 adolescent wives were interviewed (88% participation), with 90% retention at follow-up; 1080 husbands were interviewed (88% participation), with 72% retention at follow-up. Adolescent wives had higher likelihood of modern contraceptive use at follow-up relative to controls in Arm 1 (aIRR 3.65, 95% CI 1.41-8.78) and Arm 3 (aIRR 2.99, 95% CI 1.68-5.32); no Arm 2 effects were observed. Relative to those in the control arm, Arm 2 and Arm 3 participants were significantly less likely to report past year IPV (aIRR 0.40, 95% CI 0.18-0.88 for Arm 2; aIRR 0.46, 95% CI 0.21-1.01 for Arm 3). No Arm 1 effects were observed.

        Conclusions

        The RMA approach blending home visits by CHWs and gender-segregated group discussion sessions is the optimal format for increasing modern contraceptive use and decreasing IPV among married adolescents in Niger. Trial registration This trial is retrospectively registered with ClinicalTrials.gov, Identifier NCT03226730.
          Cover page: Effects of the reaching married adolescents program on modern contraceptive use and intimate partner violence: results of a cluster randomized controlled trial among married adolescent girls and their husbands in Dosso, Niger.
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