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Myroniuk TW, Kohler HP, Mwapasa V, Mwera J, Kohler IV. Surprising Gendered Age Differences in Rural Malawians' Early COVID-19 Pandemic Prevention Efforts. J Gerontol B Psychol Sci Soc Sci 2024; 79:gbae031. [PMID: 38457433 PMCID: PMC11000306 DOI: 10.1093/geronb/gbae031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Indexed: 03/10/2024] Open
Abstract
OBJECTIVES We assess how age, the presence of mature adults aged 45+ years, and recent deaths in rural households are associated with coronavirus disease 2019 (COVID-19) preventative actions and the likelihood of getting vaccinated against the virus in Malawi during early stages of the pandemic. METHODS We draw upon data from 2,187 rural Malawians who participated in a 2020 COVID-19 Phone Survey. We estimate the log odds of engaging in "low-cost" and "high-cost" COVID-19 preventative actions based on age, gender, household composition, and recent household deaths. Low-cost prevention efforts were washing hands with soap and water frequently, avoiding close contact with people when going out, and avoiding shaking hands. High-cost actions included staying at home and decreasing time spent close to people not living in their household. We also estimate the chances of acquiring the COVID-19 vaccine in early stages of its availability. RESULTS Mature women (45+ years) in general and younger men (<45 years)-living with at least one mature adult in the household-were less likely than others to comply with low-cost actions. Mature men were more likely than younger men (<45 years) to take on high-cost actions. To some extent, individuals who experienced a recent family death were more likely to engage in high-cost COVID-19 preventative actions as well as getting vaccinated. DISCUSSION Gendered age differences in preventing the transmission of COVID-19 offer hints of larger social norms affecting protective efforts. The analyses also inform future COVID-19 public health outreach efforts in Malawi and other rural SSA contexts.
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Affiliation(s)
- Tyler W Myroniuk
- Department of Public Health, University of Missouri, Columbia, Missouri, USA
| | - Hans-Peter Kohler
- Population Aging Research Center (PARC), University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Victor Mwapasa
- Department of Community and Environmental Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | - Iliana V Kohler
- Population Studies Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Teti M, Myroniuk TW, Kirksey G, Pratt M, Schatz E. Using peer-ethnography to explore the health and well-being of college students affected by COVID-19. Int J Qual Stud Health Well-being 2023; 18:2261841. [PMID: 37742341 PMCID: PMC10519263 DOI: 10.1080/17482631.2023.2261841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 09/19/2023] [Indexed: 09/26/2023] Open
Abstract
PURPOSE COVID-19 continues to infect and affect college-aged youth. We lack information about how students experienced the pandemic day-to-day and what they need for recovery, from their own perspectives. This study employed peer ethnography to explore student's insights for current and future prevention and care. METHODS A team of eight students were trained as peer ethnographers to observe and record conversations with their peers in 15-minute increments during the COVID-19 pandemic. Transcripts of 200 conversations were collated and analysed via theme analysis to identify patterns. RESULTS Student conversations revealed dichotomous perspectives about COVID-19. Some students prioritized safety, captured via three themes-caution, rethinking routines, and protecting others. Other students struggled to follow prevention guidelines and took risks, also captured by three themes-parties, denial, and misinformation. A third category of themes captured the results of this dichotomy-tense campus relationships and a health leadership vacuum. CONCLUSIONS Our findings identify specific locations for intervention (e.g., off campus parties) and needed community collaborations (e.g., bars and universities) for COVID-19 and future pandemics. Our findings suggest that overarching approaches, like harm reduction or affirmation (versus shame), are helpful intervention frameworks. Findings also celebrate the value of peer-ethnography, to learn about pandemics and solutions from the ground up.
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Affiliation(s)
- Michelle Teti
- Department of Public Health, University of Missouri, Columbia, MO, USA
| | - Tyler W. Myroniuk
- Department of Public Health, University of Missouri, Columbia, MO, USA
| | - Grace Kirksey
- Department of Public Health, University of Missouri, Columbia, MO, USA
| | - Mariah Pratt
- Department of Public Health, University of Missouri, Columbia, MO, USA
| | - Enid Schatz
- Department of Public Health, University of Missouri, Columbia, MO, USA
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Myroniuk TW, Lewis KR, Hermsen JM, Schatz E. Mitigating the Spread of COVID-19: Differential Perceptions of Midwestern University Students. Fam Community Health 2023; 46:203-208. [PMID: 36375447 PMCID: PMC10178915 DOI: 10.1097/fch.0000000000000354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Racially minoritized groups have disproportionately borne the impacts of the COVID-19 pandemic in America. We draw on Public Health Critical Race Praxis to investigate racial differences in college students' attitudes about mitigation efforts to limit the spread of COVID-19 and concerns about one's own and others' actions in these efforts. We used survey data from a random sample of Midwestern undergraduates (n = 620) who participated in a fall 2020 COVID-19 study; chi-square tests and logistic regression modeling were employed. Students of color were more likely than white students to report mitigation strategies as not sufficiently restrictive and that communities ought to prioritize limiting the spread of COVID-19. Students of color were also more likely to be concerned that the actions of others were spreading COVID-19. Universities need to continuously ask how their policies and practices acknowledge the broader racial context and seek the perspectives of diverse students.
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Myroniuk TW, Teti M, David I, Schatz E. How Midwestern College students protected their families in the first year of COVID-19. Front Public Health 2023; 11:1143342. [PMID: 37333538 PMCID: PMC10273838 DOI: 10.3389/fpubh.2023.1143342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 05/08/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction College students routinely visit their families due to geographic proximity and their financial dependence. Consequently, the potential of transmitting COVID-19 from campus to their families' homes is consequential. Family members are key sources of support for one another in nearly all matters but there is little research uncovering the mechanisms by which families have protected each other in the pandemic. Methods Through an exploratory qualitative study, we examined the perspectives of a diverse, randomly sampled, group of students from a Midwestern University (pseudonym), in a college town, to identify COVID-19 prevention practices with their family members. We interviewed 33 students between the end of December 2020 and mid-April 2021 and conducted a thematic analysis through an iterative process. Results Students navigated major differences in opinions and undertook significant actions in attempts to protect their family members from COVID-19 exposure. Students' actions were rooted in the greater good of public health; prosocial behavior was on display. Discussion Larger public health initiatives could target the broader population by involving students as messengers.
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David IJ, Schatz E, Angotti N, Myroniuk TW, Mojola SA. "I'm Getting Life from the Treatment": Perceptions of Life and Death Among Middle-Aged and Older Medication-Adherent Persons Living with HIV in Rural South Africa. J Aging Soc Policy 2023:1-23. [PMID: 36973857 DOI: 10.1080/08959420.2023.2195348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 08/15/2022] [Indexed: 03/29/2023]
Abstract
The widespread availability of health information and treatment for HIV in Southern Africa does not reach all populations. Few programs and materials are developed with middle-aged and older rural individuals living with HIV as the target audience, despite this being a growing population. This vacuum inevitably exacerbates the disjuncture between clinical and experiential knowledge. This study uses in-depth interviews from 2018 with middle-aged and older rural South Africans who self-report medication adherence to ART in order to explore experiences of living with HIV and beliefs about anti-retroviral treatment (ART). Participants revealed a general sense of vulnerability as a major motivation for HIV medication adherence. A majority of the participants believed that death was imminent if they defaulted on ART at any point in time. Although the availability of ART brought hope to many, HIV was still perceived as a death sentence, particularly if ART adherence was imperfect. The study findings suggest a need to examine the psychosocial component of community programs for middle-aged and older people living with HIV. For this growing population that experienced the full course of the epidemic, more research is needed on the burden of psychological and mental health issues emerging from the need for long-term HIV medication adherence.
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Affiliation(s)
- Ifeolu J David
- Department of public health, University of Missouri, Columbia, MO, USA
| | - Enid Schatz
- Department of public health, University of Missouri, Columbia, MO, USA
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nicole Angotti
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of sociology, American University, Washington DC, USA
| | - Tyler W Myroniuk
- Department of public health, University of Missouri, Columbia, MO, USA
| | - Sanyu A Mojola
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of sociology, Princeton University, Princeton, NJ, USA
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Myroniuk TW, Teti M, Schatz E, David I. Similarities in COVID-19 Mortality Between Canadian Provinces and American States Before Vaccines Were Available. Can Stud Popul 2023; 50:2. [PMID: 36974079 PMCID: PMC10034245 DOI: 10.1007/s42650-023-00073-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 03/02/2023] [Indexed: 03/25/2023]
Abstract
Canada and the USA are often compared for their markedly different approaches to health care despite cultural similarities and sharing the world’s longest international boundary. The period between the onset of the COVID-19 pandemic in January 2020 and the availability of a vaccine in December 2020 offers an ideal opportunity to compare subnational Canadian and American pandemic mortality. Preventing the spread of COVID-19 was through compliance with health orders and best practices; treatment was only available to those admitted to hospitals and whose lives were at risk. Using publicly available data from the Johns Hopkins University 2019 Novel Coronavirus Visual Dashboard, we seek to uncover if there were any similarities in Canadian provinces’ and American states’ monthly COVID-19 mortality per 100,000 people, building on a broader scientific push towards understanding the successes and failures of different health systems in the pandemic. The similar province and state cumulative COVID-19 mortality rate trajectories identified in our analyses do not amount to intuitive comparative jurisdictions which suggests the importance of identifying localized pandemic responses.
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Affiliation(s)
- Tyler W. Myroniuk
- Department of Public Health, University of Missouri, Columbia, MO USA
| | - Michelle Teti
- Department of Public Health, University of Missouri, Columbia, MO USA
| | - Enid Schatz
- Department of Public Health, University of Missouri, Columbia, MO USA
| | - Ifeolu David
- Department of Health and Rehabilitation Sciences, University of Missouri, Columbia, MO USA
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Myroniuk TW, White MJ, Madhavan S. Post-migration emotional well-being among Black South Africans. SSM Ment Health 2022; 2:100173. [PMID: 36776725 PMCID: PMC9910329 DOI: 10.1016/j.ssmmh.2022.100173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Internal migration has been an institutionalized part of life for Black South Africans from the 1800s, when men left their rural homes to work in mines, through apartheid and into the present. Like other settings in the Global South, we know surprisingly little about the emotional well-being of migrants, especially in sub-Saharan African contexts. We investigate changes in the emotional well-being of 2281 working-age Black South Africans after migration, drawing on four waves of data, from 2008 to 2015, from the nationally representative National Income Dynamics Study. Fixed-effects regressions show that migrants exhibit changes in life satisfaction as well as proclivity towards depression but that these outcomes vary by distance of move and type of move-moving within or between provinces. As South Africa's health policies expand beyond addressing infectious diseases, it is important to consider mental health particularly of those who face the necessity of migration to sustain a livelihood.
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Affiliation(s)
- Tyler W. Myroniuk
- University of Missouri, Department of Public Health, USA,Corresponding author. (T.W. Myroniuk)
| | - Michael J. White
- Brown University, Department of Sociology, Population Studies & Training Center, USA
| | - Sangeetha Madhavan
- University of Maryland, Department of African American Studies, Department of Sociology, Maryland Population Research Center, USA
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David I, Schatz E, Myroniuk TW, Teti M. " COVID Is Another Layer of Problematic Things": Change, Vulnerability, and COVID-19 among University Students. Int J Environ Res Public Health 2022; 19:15947. [PMID: 36498021 PMCID: PMC9739650 DOI: 10.3390/ijerph192315947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 11/21/2022] [Accepted: 11/23/2022] [Indexed: 06/17/2023]
Abstract
The COVID-19 pandemic not only had detrimental effects on physical health but also had adverse effects on college students' mental health. This paper begins to fill a gap in knowledge related to the contextual factors that impacted college students' mental health during COVID. Using in-depth interviews with a diverse sample of 33 college students at a Midwestern university, during Spring 2021, we highlight the pandemic's role in shaping college students' mental health and their outlook of the future. Thematic analysis revealed student reports of mental health decline during the pandemic attributed to campus closures and social distancing policies implemented by the institution to reduce the spread of COVID-19. Students shared that the pandemic created uncertainties about their future opportunities for education, career fulfillment, and employment. However, the interviews also suggested a general sense of adaptation to the pandemic's impact which was students achieved via a combination of active and passive coping strategies. Expanding institution-based mental health services to include a variety of modalities and off-line toolkits for students can help students cope with mental health challenges, whether in 'normal times' or during national crises. Future research should focus on identifying strategies for promoting mental wellness among college students and exploring post-pandemic mental health wellbeing.
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Affiliation(s)
- Ifeolu David
- Department of Health and Rehabilitation Sciences, School of Health Professions, University of Missouri, Columbia, MO 65211, USA
| | - Enid Schatz
- Department of Public Health, School of Health Professions, University of Missouri, Columbia, MO 65211, USA
| | - Tyler W. Myroniuk
- Department of Public Health, School of Health Professions, University of Missouri, Columbia, MO 65211, USA
| | - Michelle Teti
- Department of Public Health, School of Health Professions, University of Missouri, Columbia, MO 65211, USA
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Myroniuk TW, Schatz E, Teti M, Hermsen JM. Undergraduate Vaccine Hesitancy and the Influence of "Home" Locales. Int J Environ Res Public Health 2022; 19:14370. [PMID: 36361261 PMCID: PMC9653726 DOI: 10.3390/ijerph192114370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/27/2022] [Accepted: 11/01/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE In the US, the COVID-19 pandemic has exposed deeply rooted resistance to public health. This has important consequences for SARS-CoV-2 variant spread and for future uptake of influenza and other vaccines. We examine these phenomena in Missouri, where its low vaccination rates, high levels of uninsured residents, predominance of conservative values, and stark rural-urban divides are intricately connected to public health resistance. The Socio-Ecological model guides our approach. METHODS We use data from the Fall 2020 Midwestern University (MWU-a pseudonym) Study of Seropositivity and Risk for SARS-CoV-2 and COVID-19 which are harmonized with the American Community Survey, Missouri County-Level Study, and the USDA Rural-Urban Continuum Codes to estimate multi-level regression models on the relationship between undergraduate students' "home" locales and their own COVID-19 and influenza vaccine hesitancy. FINDINGS The availability of primary care physicians, the prevalence of influenza vaccinations, and location type at the county level, as well as the percentage of residents without health insurance at the zip code level differentially predict COVID-19 and influenza vaccine hesitancy. CONCLUSIONS There is a link between county-level health and geographic characteristics, and individuals'-who were influenced by those counties because that is where their parents live-hesitancy towards vaccines. Identifying feasible, precise, local solutions to reducing vaccine hesitancy could take place if community members and other stakeholders would be open to changes in local-level health policy or practice.
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Affiliation(s)
- Tyler W. Myroniuk
- Department of Public Health, University of Missouri, Columbia, MO 65211, USA
| | - Enid Schatz
- Department of Public Health, University of Missouri, Columbia, MO 65211, USA
| | - Michelle Teti
- Department of Public Health, University of Missouri, Columbia, MO 65211, USA
| | - Joan M. Hermsen
- Department of Sociology, University of Missouri, Columbia, MO 65211, USA
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Sekhon SS, Crick K, Myroniuk TW, Hamming KSC, Ghosh M, Campbell-Scherer D, Yeung RO. Adrenal Insufficiency: Investigating Prevalence and Healthcare Utilization Using Administrative Data. J Endocr Soc 2022; 6:bvab184. [PMID: 35284774 PMCID: PMC8907404 DOI: 10.1210/jendso/bvab184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Indexed: 11/19/2022] Open
Abstract
Context Adrenal insufficiency (AI) is an uncommon, life-threatening disorder requiring lifelong treatment with steroid therapy and special attention to prevent adrenal crisis. Little is known about the prevalence of AI in Canada or healthcare utilization rates by these patients. Objective We aimed to assess the prevalence and healthcare burden of AI in Alberta, Canada. Methods This study used a population-based, retrospective administrative health data approach to identify patients with a diagnosis of AI over a 5-year period and evaluated emergency and outpatient healthcare utilization rates, steroid dispense records, and visit reasons. Results The period prevalence of AI was 839 per million adults. Patients made an average of 2.3 and 17.8 visits per year in the emergency department and outpatient settings, respectively. This was 3 to 4 times as frequent as the average Albertan, and only 5% were coded as visits for AI. The majority of patients were dispensed glucocorticoid medications only. Conclusion The prevalence of AI in Alberta is higher than published data in other locations. The frequency of visits suggests a significant healthcare burden and emphasizes the need for a strong understanding of this condition across all clinical settings. Our most concerning finding is that 94.3% of visits were not labeled with AI, even though many of the top presenting complaints were consistent with adrenal crisis. Several data limitations were discovered that suggest improvements in the standardization of data submission and coding can expand the yield of future studies using this method.
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Affiliation(s)
- Sarpreet S Sekhon
- Core Internal Medicine Program, Faculty of Medicine and Dentistry, University of Alberta, AB, Canada
| | - Katelynn Crick
- Office of Lifelong Learning & the Physician Learning Program, Faculty of Medicine and Dentistry, University of Alberta, AB, Canada
| | - Tyler W Myroniuk
- Department of Public Health, School of Health Professions, University of Missouri, Columbia, MO, USA
| | - Kevin S C Hamming
- Division of Endocrinology, Department of Medicine, University of Saskatchewan, SK, Canada
| | - Mahua Ghosh
- Division of Endocrinology and Metabolism, Department of Medicine, University of Alberta, AB, Canada
| | - Denise Campbell-Scherer
- Office of Lifelong Learning & the Physician Learning Program, Faculty of Medicine and Dentistry, University of Alberta, AB, Canada.,Department of Family Medicine, University of Alberta, AB, Canada
| | - Roseanne O Yeung
- Office of Lifelong Learning & the Physician Learning Program, Faculty of Medicine and Dentistry, University of Alberta, AB, Canada.,Division of Endocrinology and Metabolism, Department of Medicine, University of Alberta, AB, Canada
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McGuckin T, Crick K, Myroniuk TW, Setchell B, Yeung RO, Campbell-Scherer D. Understanding challenges of using routinely collected health data to address clinical care gaps: a case study in Alberta, Canada. BMJ Open Qual 2022; 11:bmjoq-2021-001491. [PMID: 34996811 PMCID: PMC8744094 DOI: 10.1136/bmjoq-2021-001491] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 12/16/2021] [Indexed: 12/19/2022] Open
Abstract
High-quality data are fundamental to healthcare research, future applications of artificial intelligence and advancing healthcare delivery and outcomes through a learning health system. Although routinely collected administrative health and electronic medical record data are rich sources of information, they have significant limitations. Through four example projects from the Physician Learning Program in Edmonton, Alberta, Canada, we illustrate barriers to using routinely collected health data to conduct research and engage in clinical quality improvement. These include challenges with data availability for variables of clinical interest, data completeness within a clinical visit, missing and duplicate visits, and variability of data capture systems. We make four recommendations that highlight the need for increased clinical engagement to improve the collection and coding of routinely collected data. Advancing the quality and usability of health systems data will support the continuous quality improvement needed to achieve the quintuple aim.
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Affiliation(s)
- Taylor McGuckin
- Faculty of Medicine & Dentistry - Lifelong Learning & Physician Learning Program, University of Alberta, Edmonton, Alberta, Canada
| | - Katelynn Crick
- Faculty of Medicine & Dentistry - Lifelong Learning & Physician Learning Program, University of Alberta, Edmonton, Alberta, Canada
| | | | - Brock Setchell
- Faculty of Medicine & Dentistry - Lifelong Learning & Physician Learning Program, University of Alberta, Edmonton, Alberta, Canada
| | - Roseanne O Yeung
- Faculty of Medicine & Dentistry - Lifelong Learning & Physician Learning Program, University of Alberta, Edmonton, Alberta, Canada.,Division of Endocrinology & Metabolism, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Denise Campbell-Scherer
- Faculty of Medicine & Dentistry - Lifelong Learning & Physician Learning Program, University of Alberta, Edmonton, Alberta, Canada .,Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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Teti M, Bauerband LA, Myroniuk TW, Koegler E. Listening to Transgender Patients and Their Providers in Non-Metropolitan Spaces: Needs, Gaps, and Patient-Provider Discrepancies. Int J Environ Res Public Health 2021; 18:10843. [PMID: 34682595 PMCID: PMC8535616 DOI: 10.3390/ijerph182010843] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/09/2021] [Accepted: 10/12/2021] [Indexed: 01/26/2023]
Abstract
Trans and gender non-conforming (TGNC) patients need better care; providers need TGNC focused medical trainings. TGNC health conferences can help, yet these events occur mostly in urban centers. Meanwhile, patients in non-metropolitan areas often face significant discrimination and notably poor access to TGNC care. This study explores the ongoing needs of TGNC patients and their providers following a one-day TGNC health conference in a small town in the American Midwest. Exploratory semi-structured interviews were used to gather in-depth information from TGNC conference attendees (N = 25). Theme analysis methods were used to identify areas of need for future trainings. Providers reported that they needed more exposure to TGNC patients, judgement-free opportunities to learn the basics about TGNC care, and ongoing trainings integrated into their medical school and ongoing education credits. Patients needed better access to care, more informed providers, and safer clinics. They cited lack of specialty care (e.g., mental health, surgery) as particularly problematic in a non-metropolitan setting. TGNC patients, and their providers in non-metropolitan areas, urgently need support. Patients lack specialized care and often possess greater knowledge than their health care teams; providers, in these areas, lack opportunities to work with patients and stay up to date on treatments.
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Affiliation(s)
- Michelle Teti
- Department of Public Health, University of Missouri, Columbia, MO 65211, USA;
| | - L. A. Bauerband
- Department of Health Sciences, University of Missouri, Columbia, MO 65211, USA;
| | - Tyler W. Myroniuk
- Department of Public Health, University of Missouri, Columbia, MO 65211, USA;
| | - Erica Koegler
- School of Social Work, University of Missouri-St. Louis, St. Louis, MO 63121, USA;
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Swaleh R, McGuckin T, Myroniuk TW, Manca D, Lee K, Sharma AM, Campbell-Scherer D, Yeung RO. Using the Edmonton Obesity Staging System in the real world: a feasibility study based on cross-sectional data. CMAJ Open 2021; 9:E1141-E1148. [PMID: 34876416 PMCID: PMC8673483 DOI: 10.9778/cmajo.20200231] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The Edmonton Obesity Staging System (EOSS) combined with body mass index (BMI) enables improved functional and prognostic assessment for patients. To facilitate application of the EOSS in practice, we aimed to create tools for capturing comorbidity assessments in electronic medical records and for automating the calculation of a patient's EOSS stage. METHODS In this feasibility study, we used cross-sectional data to create a clinical dashboard to calculate and display the relation between BMI and EOSS and the prevalence of related comorbidities. We obtained data from the Northern Alberta Primary Care Research Network and the Canadian Primary Care Sentinel Surveillance Network (CPCSSN). We included patients at least 18 years of age with BMI between 30 and 60 who visited a network clinic between July 2016 and July 2019. We calculated descriptive statistics and used stepwise ordinary least squares regression to assess the contributions of age, sex and BMI to EOSS variation. RESULTS We created a clinical dashboard using the CPCSSN data presentation tool. Of the total 31 496 patients included in the study, 23 460 had a BMI of at least 30; BMI was unavailable for 8036 patients. Within each EOSS disease severity stage, there were similar proportions of patients from each BMI class (e.g., patients with EOSS stage 2 included 51.8% of those with BMI class I, 55.3% of those with BMI class II and 58.8% of those with BMI class III). INTERPRETATION Using data from primary care electronic medical records, it was feasible to create a clinical dashboard for obesity that highlighted the severity and stage of obesity. Making this information easily accessible for individual clinical care and practice-level quality improvement may advance obesity care.
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Affiliation(s)
- Rukia Swaleh
- Division of Endocrinology and Metabolism, Department of Medicine (Swaleh, Yeung), Edmonton Physician Learning Program (McGuckin, Myroniuk, Manca, Campbell-Scherer, Yeung), Department of Family Medicine (Manca, Campbell-Scherer), Division of Preventive Medicine, Department of Medicine (Lee), and Department of Medicine (Sharma), Faculty of Medicine and Dentistry; School of Public Health (Lee); School of Urban and Regional Planning (Lee); and Alberta Diabetes Institute (Sharma, Campbell-Scherer, Yeung), University of Alberta, Edmonton, Alta.; and Department of Public Health (Myroniuk), University of Missouri-Columbia, Columbia, Mo
| | - Taylor McGuckin
- Division of Endocrinology and Metabolism, Department of Medicine (Swaleh, Yeung), Edmonton Physician Learning Program (McGuckin, Myroniuk, Manca, Campbell-Scherer, Yeung), Department of Family Medicine (Manca, Campbell-Scherer), Division of Preventive Medicine, Department of Medicine (Lee), and Department of Medicine (Sharma), Faculty of Medicine and Dentistry; School of Public Health (Lee); School of Urban and Regional Planning (Lee); and Alberta Diabetes Institute (Sharma, Campbell-Scherer, Yeung), University of Alberta, Edmonton, Alta.; and Department of Public Health (Myroniuk), University of Missouri-Columbia, Columbia, Mo
| | - Tyler W Myroniuk
- Division of Endocrinology and Metabolism, Department of Medicine (Swaleh, Yeung), Edmonton Physician Learning Program (McGuckin, Myroniuk, Manca, Campbell-Scherer, Yeung), Department of Family Medicine (Manca, Campbell-Scherer), Division of Preventive Medicine, Department of Medicine (Lee), and Department of Medicine (Sharma), Faculty of Medicine and Dentistry; School of Public Health (Lee); School of Urban and Regional Planning (Lee); and Alberta Diabetes Institute (Sharma, Campbell-Scherer, Yeung), University of Alberta, Edmonton, Alta.; and Department of Public Health (Myroniuk), University of Missouri-Columbia, Columbia, Mo
| | - Donna Manca
- Division of Endocrinology and Metabolism, Department of Medicine (Swaleh, Yeung), Edmonton Physician Learning Program (McGuckin, Myroniuk, Manca, Campbell-Scherer, Yeung), Department of Family Medicine (Manca, Campbell-Scherer), Division of Preventive Medicine, Department of Medicine (Lee), and Department of Medicine (Sharma), Faculty of Medicine and Dentistry; School of Public Health (Lee); School of Urban and Regional Planning (Lee); and Alberta Diabetes Institute (Sharma, Campbell-Scherer, Yeung), University of Alberta, Edmonton, Alta.; and Department of Public Health (Myroniuk), University of Missouri-Columbia, Columbia, Mo
| | - Karen Lee
- Division of Endocrinology and Metabolism, Department of Medicine (Swaleh, Yeung), Edmonton Physician Learning Program (McGuckin, Myroniuk, Manca, Campbell-Scherer, Yeung), Department of Family Medicine (Manca, Campbell-Scherer), Division of Preventive Medicine, Department of Medicine (Lee), and Department of Medicine (Sharma), Faculty of Medicine and Dentistry; School of Public Health (Lee); School of Urban and Regional Planning (Lee); and Alberta Diabetes Institute (Sharma, Campbell-Scherer, Yeung), University of Alberta, Edmonton, Alta.; and Department of Public Health (Myroniuk), University of Missouri-Columbia, Columbia, Mo
| | - Arya M Sharma
- Division of Endocrinology and Metabolism, Department of Medicine (Swaleh, Yeung), Edmonton Physician Learning Program (McGuckin, Myroniuk, Manca, Campbell-Scherer, Yeung), Department of Family Medicine (Manca, Campbell-Scherer), Division of Preventive Medicine, Department of Medicine (Lee), and Department of Medicine (Sharma), Faculty of Medicine and Dentistry; School of Public Health (Lee); School of Urban and Regional Planning (Lee); and Alberta Diabetes Institute (Sharma, Campbell-Scherer, Yeung), University of Alberta, Edmonton, Alta.; and Department of Public Health (Myroniuk), University of Missouri-Columbia, Columbia, Mo
| | - Denise Campbell-Scherer
- Division of Endocrinology and Metabolism, Department of Medicine (Swaleh, Yeung), Edmonton Physician Learning Program (McGuckin, Myroniuk, Manca, Campbell-Scherer, Yeung), Department of Family Medicine (Manca, Campbell-Scherer), Division of Preventive Medicine, Department of Medicine (Lee), and Department of Medicine (Sharma), Faculty of Medicine and Dentistry; School of Public Health (Lee); School of Urban and Regional Planning (Lee); and Alberta Diabetes Institute (Sharma, Campbell-Scherer, Yeung), University of Alberta, Edmonton, Alta.; and Department of Public Health (Myroniuk), University of Missouri-Columbia, Columbia, Mo
| | - Roseanne O Yeung
- Division of Endocrinology and Metabolism, Department of Medicine (Swaleh, Yeung), Edmonton Physician Learning Program (McGuckin, Myroniuk, Manca, Campbell-Scherer, Yeung), Department of Family Medicine (Manca, Campbell-Scherer), Division of Preventive Medicine, Department of Medicine (Lee), and Department of Medicine (Sharma), Faculty of Medicine and Dentistry; School of Public Health (Lee); School of Urban and Regional Planning (Lee); and Alberta Diabetes Institute (Sharma, Campbell-Scherer, Yeung), University of Alberta, Edmonton, Alta.; and Department of Public Health (Myroniuk), University of Missouri-Columbia, Columbia, Mo
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14
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Schatz E, Knight L, Mukumbang FC, Teti M, Myroniuk TW. 'You Have to Withstand That Because You Have Come for What You Have Come for': Barriers and facilitators to antiretroviral treatment access among older South Africans living with HIV. Sociol Health Illn 2021; 43:624-641. [PMID: 33682928 DOI: 10.1111/1467-9566.13243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 12/09/2020] [Accepted: 12/18/2020] [Indexed: 06/12/2023]
Abstract
Nationwide rollout of antiretroviral treatment (ART) is increasing the number of older persons living with HIV (OPLWH) in South Africa. Yet, little is known about how the sociological aspects of ageing - stigma, finances and family dynamics - impact access to ART. Qualitative interviews with 23 persons aged 50-plus living near Cape Town highlight the barriers and facilitators to the acceptability, affordability and availability of ART access among OPLWH. Key age-related barriers included perceived shame of sexuality and disclosing HIV status to others, perceived disrespect by clinical staff, affording transportation to clinics and pre-existing co-morbidities. Key age-related facilitators included family moral and financial support, particularly from children and grandchildren, and access to social grants. Importantly, many barriers and facilitators had feedback loops, for example social grants reduced transportation barriers to clinics when ageing and poor health limited mobility. As the population living with HIV ages, it is critical to assess the ways ageing, as a social process, impacts ART access and to address these to improve older persons' HIV care.
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Affiliation(s)
- Enid Schatz
- Department of Public Health, School of Health Professions, University of Missouri, Columbia, MO, USA
- MRC/Wits Rural Public Health and Health Transitions Research Unit(Agincourt, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Lucia Knight
- Division of Social and Behavioural Sciences, Faculty of Health Sciences, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
- Faculty of Community and Health Sciences, School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Ferdinand C Mukumbang
- Department of Global Health, The Global Center for Integrated Health of Women, Adolescents, and Children (Global WACh, University of Washington, Seattle, WA, USA
| | - Michelle Teti
- Department of Public Health, School of Health Professions, University of Missouri, Columbia, MO, USA
| | - Tyler W Myroniuk
- Department of Public Health, School of Health Professions, University of Missouri, Columbia, MO, USA
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15
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Abstract
BACKGROUND Advancing efforts to unpack the complex relationship between marital dissolutions and health outcomes increasingly requires assessing the marital histories and health of individuals who have lived long enough to experience divorce or widowhood ‒ or even multiples of each ‒ and measurable changes in health. OBJECTIVE To explore this line of inquiry, we chose a sample from rural Malawi where a high prevalence of marital dissolutions and remarrying exists, as an ideal theoretical foil to the predominant literature found in high-income countries (HICs). We examine if changes in having experienced a marital dissolution, one's total number of dissolutions, and the percentage of one's life spent outside of marriage since first becoming married are associated with changes in mental health. METHODS Our analyses focus on 1,266 respondents aged 45 years and older who participated in the 2012 Mature Adults Cohort of the Malawi Longitudinal Study of Families and Health (MLSFH-MAC), linked back to cohort information from 2008 and 2010 available through the MLSFH. Fixed-effects regressions guide our inferences over the 2008, 2010, and 2012 waves of data. RESULTS For men, spending more life outside of marriage is associated with worse mental health, while more marital dissolutions are surprisingly associated with better mental health for women. CONCLUSIONS These results could suggest that larger portions of one's life spent unmarried are associated with a type of role strain for men or simply that men are burdened with taking up tasks that their spouses had previously done in order to survive. For women, many may have gotten out of 'bad' marriages that otherwise would have been detrimental to their mental health and/or those in good mental health are the ones able to remarry. CONTRIBUTIONS Our research from rural Malawi provides a type of litmus test for many HICs where marriage, remarriage, and dissolution rates are lower but quite consequential for mental health outcomes. Measuring time outside of marriage should be more strongly considered in such settings. These results also inform increasingly important research on the relationship between marital dissolutions and mental health in other African nations as noncommunicable diseases play a continually more important role in people's lives.
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Affiliation(s)
- Tyler W Myroniuk
- University of Missouri, Department of Public Health, 825 Lewis Hall, 65211 Columbia, MO, USA
| | - Hans-Peter Kohler
- Population Aging Research Center (PARC) and Department of Sociology, University of Pennsylvania., USA
| | - Iliana V Kohler
- Population Studies Center (PSC) and Department of Sociology, University of Pennsylvania, USA
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16
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Myroniuk TW, White MJ, Gross M, Wang R, Ginsburg C, Collinson M. Does It Take a Village? Migration among Rural South African Youth. Popul Res Policy Rev 2018; 37:1079-1108. [PMID: 31543557 PMCID: PMC6754111 DOI: 10.1007/s11113-018-9493-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 09/06/2018] [Indexed: 11/28/2022]
Abstract
In a rural African context, the saying, "it takes a village to raise a child," suggests that community characteristics are substantially important in children's lives as they transition to adulthood. Are these contextual factors also related to youth migration? Demographers are uncertain about how community characteristics improve our understanding of an individual's propensity to migrate, beyond individual and household factors. In many low and middle-income country settings, youth become migrants for the first time in their lives to provide access to resources that their families need. We employ discrete-time event history models from the 20032011 Agincourt Health and socio-Demographic Surveillance System in rural South Africa to test whether markers of development in a village are associated with the likelihood of youth and young adults migrating, distinguishing between becoming temporary and permanent migrants during this critical life cycle phase. We find that village characteristics indeed differentially predict migration, but not nearly as substantially as might be expected.
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Affiliation(s)
- Tyler W Myroniuk
- (1) George Mason University, Department of Sociology and Anthropology
| | - Michael J White
- (1) Brown University, Population Studies and Training Center, Department of Sociology
| | - Mark Gross
- (1) Cabrini University, Sociology and Criminology Department
| | - Rebecca Wang
- (1) Brown University, Population Studies and Training Center, Department of Sociology
| | - Carren Ginsburg
- (1) MRC/ Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Mark Collinson
- (1) MRC/ Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, South Africa
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17
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Myroniuk TW, Vearey J. Social Capital and Livelihoods in Johannesburg: Differential Advantages and Unexpected Outcomes among Foreign-Born Migrants, Internal Migrants, and Long-Term South African Residents. International Migration Review 2018. [DOI: 10.1111/imre.12076] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Foreign-born migrants – a group rarely compared with both internal migrants and long-term residents – are often positioned as the most disadvantaged South African urban population. We use data from a 2008 cross-sectional household survey conducted in Johannesburg to compare a contextually relevant measure of social capital and livelihood advantages between foreign-born migrants, internal migrants, and long-term South African residents. Our findings are counterintuitive and emphasize the need to explore the heterogeneity of urban migrant populations, and the mechanisms in which they better their lives, by showing that (1) foreign-born migrants have better urban livelihood outcomes, and (2) indicators of social capital are not necessarily associated with improved livelihood outcomes.
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18
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Myroniuk TW. Marital Dissolutions and the Health of Older Individuals in a Rural African Context. J Gerontol B Psychol Sci Soc Sci 2017; 72:656-664. [PMID: 27382043 PMCID: PMC5927165 DOI: 10.1093/geronb/gbw077] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 06/13/2016] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES Research from high-income countries has often found a negative relationship between marital dissolutions and health. This paper assesses that relationship among older sub-Saharan Africans, on a now-aging continent. Such individuals are likely to be at risk of a dissolution, or have already experienced one, due to high rates of marriage. METHODS Data from over 1,200 rural Malawians, age 45+, are employed from the 2008 and 2010 waves of the Malawi Longitudinal Study of Families and Health. Cross-sectional and lagged dependent variable regressions examine the relationship between marital dissolutions and 4 measures of self-reported health: retrospective health, relative health (compared with others in one's village), and age-standardized SF-12 mental and physical health scales. RESULTS Worse relative, mental, and physical health are associated with being currently divorced/widowed compared with being married. However, worse retrospective health is linked to becoming divorced/widowed between 2008 and 2010. Those divorced/widowed prior to 2008, and who remained so through 2010, are in worse relative and physical health. DISCUSSION The findings question the relative hardship of marital dissolutions for those who have managed to survive into old age, and call for the collection of more detailed longitudinal data on older Africans on this topic.
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Affiliation(s)
- Tyler W Myroniuk
- Department of Sociology and Anthropology, George Mason University, Fairfax, Virginia
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19
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Myroniuk TW. The Duration of Residence Spells among Malawians: The Role of Established Family and Friend Connections at Migrants' Destinations. J Ethn Migr Stud 2017; 44:887-907. [PMID: 31543697 PMCID: PMC6754112 DOI: 10.1080/1369183x.2017.1329649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
It is well-documented that established networks in a destination increase the chances of an individual moving to that destination, but rarely have migration scholars examined how these networks are linked to the duration of one's stay. This paper examines whether the presence of kin and/or friends known at a location prior to moving is associated with one's duration of residence. Presumably, having both kin and friends already at a destination will be associated with the longest residence spells, since migrants would likely maximize their access to diverse network resources. Using residence history data on 1069 Malawians from the Migration and Health in Malawi (MHM) Project from 2013, subtle gender differences emerge in this relationship via discrete-time event history analyses. Women who knew some friends, but no kin, prior to migrating have a significantly lower likelihood of moving away in any year compared to those who did not know anyone, or only kin. For men, knowing some friends, but no kin, does not represent a significantly lower likelihood of leaving compared to those who knew no one or only kin prior to migrating.
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Affiliation(s)
- Tyler W Myroniuk
- Department of Sociology and Anthropology George Mason University
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20
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Myroniuk TW, Prell C, Kohler HP. Why rely on friends instead of family? The role of exchanges and civic engagement in a rural sub-Saharan African context. Afr Stud 2017; 76:579-596. [PMID: 29755132 PMCID: PMC5944614 DOI: 10.1080/00020184.2017.1390911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Social science research has shown there is a nearly universal norm of seeking assistance from family members in times of need. However, when do individuals prefer to rely on friends, rather than family members, when they need support? This question has not been carefully addressed. To fill this gap in the literature we examine why rural Malawians - who typically have strong bonds with kin - might prefer to rely on friends instead of family if a crisis were to occur. Using the 2008 and 2010 waves of the Malawi Longitudinal Study of Families and Health (MLSFH), we consider how financial and non-financial exchanges with kin, and civic engagement, are associated with the composition of individuals' support networks. We find the decision to request a friend's help during a crisis is consistently associated with participation in civic-oriented activities, expanding our understanding of the determinants of different risk-pooling strategies.
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Affiliation(s)
- Tyler W Myroniuk
- George Mason University, University of Maryland, and University of Pennsylvania
| | - Christina Prell
- George Mason University, University of Maryland, and University of Pennsylvania
| | - Hans-Peter Kohler
- George Mason University, University of Maryland, and University of Pennsylvania
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21
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Myroniuk TW, Vanneman R, Desai S. Getting a Child Through Secondary School and To College in India: The Role of Household Social Capital. Sociol Dev (Oakl) 2017; 3:24-46. [PMID: 28393109 PMCID: PMC5381932 DOI: 10.1525/sod.2017.3.1.24] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In the classic formulations of social capital theory, families employ their social capital resources to enhance other capitals, in particular their human capital investments. Social capital would seem to be especially important in the case of India where, in recent years, higher education has been under considerable stress with rising educational demand, inadequate supply, and little parental experience to guide their children's transition through the education system. We use the 2005 and 2012 waves of the nationally representative India Human Development Survey (IHDS) to show how relatively high status connections advantage some families' chances of their children reaching educational milestones such as secondary school completion and college entry. The 2005 IHDS survey measure of a household's formal sector contacts in education, government, and health predicts their children's educational achievements by the second wave, seven years later, controlling for households' and children's initial backgrounds.
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Affiliation(s)
- Tyler W Myroniuk
- Population Studies & Training Center, Brown University, 68 Waterman Street, Providence, RI, USA, 02912
| | - Reeve Vanneman
- Department of Sociology, University of Maryland, 2112 Art-Sociology Building, College Park, MD, USA, 20742
| | - Sonalde Desai
- Department of Sociology, University of Maryland, 2112 Art-Sociology Building, College Park, MD, USA, 20742
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Abstract
Social capital research rarely takes a gendered approach. This article explores how black women and men from a marginalized community in Johannesburg, South Africa, rely on family, friends, and community members to survive and strategize for the future by utilizing social capital. The results from 30 semi-structured interviews and ego network mapping illustrate that gender moderates the type of social capital used and benefits associated with bonding and bridging social capital in important ways. This research builds upon knowledge of gendered advantages and disadvantages in social networks and informs researchers how women and men survive in pervasive poverty. I posit that identifying potential sources of support is an important consideration within social capital or any network research because the prospect of receiving assistance in the future undoubtedly alters the development of these individuals' livelihood strategies.
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Prell C, Sun L, Feng K, Myroniuk TW. Inequalities in Global Trade: A Cross-Country Comparison of Trade Network Position, Economic Wealth, Pollution and Mortality. PLoS One 2015; 10:e0144453. [PMID: 26642202 PMCID: PMC4671716 DOI: 10.1371/journal.pone.0144453] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 11/18/2015] [Indexed: 11/19/2022] Open
Abstract
In this paper we investigate how structural patterns of international trade give rise to emissions inequalities across countries, and how such inequality in turn impact countries' mortality rates. We employ Multi-regional Input-Output analysis to distinguish between sulfur-dioxide (SO2) emissions produced within a country's boarders (production-based emissions) and emissions triggered by consumption in other countries (consumption-based emissions). We use social network analysis to capture countries' level of integration within the global trade network. We then apply the Prais-Winsten panel estimation technique to a panel data set across 172 countries over 20 years (1990-2010) to estimate the relationships between countries' level of integration and SO2 emissions, and the impact of trade integration and SO2 emission on mortality rates. Our findings suggest a positive, (log-) linear relationship between a country's level of integration and both kinds of emissions. In addition, although more integrated countries are mainly responsible for both forms of emissions, our findings indicate that they also tend to experience lower mortality rates. Our approach offers a unique combination of social network analysis with multiregional input-output analysis, which better operationalizes intuitive concepts about global trade and trade structure.
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Affiliation(s)
- Christina Prell
- Sociology Department, University of Maryland, College Park, Maryland, United States of America
| | - Laixiang Sun
- Geographical Sciences Department, University of Maryland, College Park, Maryland, United States of America
| | - Kuishuang Feng
- Geographical Sciences Department, University of Maryland, College Park, Maryland, United States of America
| | - Tyler W. Myroniuk
- Population Studies and Training Center, Brown University, Providence, Rhode Island, United States of America
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24
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Abstract
Research on the relationship between social capital and individual health often suffers from important limitations. Most research relies on cross-sectional data, which precludes identifying whether participation predicts health and/or vice versa. Some important conceptualizations of social capital, like social participation, have seldom been examined. Little is known about participation and health in sub-Saharan Africa. Furthermore, both physical and mental health have seldom been tested together, and variation by age has rarely been examined. We use longitudinal survey data for 2,328 men and women from the Malawi Longitudinal Study of Families and Health, containing (1) several measures of social participation, (2) measures of physical and mental health, and (3) an age range of 15 to 80+ years. Our results differ by gender and age and for mental and physical health. We find that social participation is associated with better physical health but can predict worse mental health for Malawians.
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25
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Myroniuk TW. Global discourses and experiential speculation: Secondary and tertiary graduate Malawians dissect the HIV/AIDS epidemic. J Int AIDS Soc 2011; 14:47. [PMID: 21970719 PMCID: PMC3199227 DOI: 10.1186/1758-2652-14-47] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Accepted: 10/04/2011] [Indexed: 11/10/2022] Open
Abstract
Background Since the beginning of the HIV/AIDS epidemic, the perspectives of secondary and tertiary school graduates in sub-Saharan Africa regarding the effectiveness of government and international HIV/AIDS policies and programmes have not been thoroughly examined. When extensive monetary aid is directed toward "development" in a country like Malawi, it is the educated elites - secondary and tertiary graduates who are heavily involved and influential in the domestic re-distribution and implementation of millions of dollars worth of aid - on whom international expectations fall to decrease the transmission of HIV. Many Malawian jobs related to public health and HIV/AIDS are created as a direct result of this funding and are occupied by the few secondary and tertiary graduates. Thus, it is a practical venture to understand their perspectives on highly contentious and heavily funded HIV/AIDS issues that affect their nation. Methods Qualitative data was collected in this study in efforts to discover in-depth perspectives on the HIV/AIDS epidemic. Thirty-eight secondary and tertiary graduate Malawians took part in semi-structured interviews. Data was analysed using an early grounded theory approach and subsequent themes of "global discourses" and "experiential knowledge of HIV/AIDS" emerged. Results This group of Malawians frequently responded to questions regarding healthcare and access to medicine, sexual behaviours and methods of reducing the spread of HIV/AIDS by citing and explaining the widespread, international and "proper" responses. The secondary and tertiary graduate Malawians also discussed these same topics in terms of what they perceive or have experienced. Experiential responses, such as the counter-productivity of circumcision and condoms, the overestimation of HIV/AIDS prevalence, and calls for more authoritarian policing of commercial sex work, were remarkably divergent from the HIV/AIDS discourse. Conclusions The opinions of this group of secondary and tertiary graduate Malawians do not always coincide with the current literature and policies. They give deeper insight into what is perceived and what may be taking place, and hint at what the future holds for their people. The widespread and divergent perspectives must be seriously considered because these experiences describe the potential positive and negative consequences that occur on the ground throughout Malawi as a result of HIV/AIDS policies.
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Affiliation(s)
- Tyler W Myroniuk
- Department of Sociology, University of Maryland, College Park, MD, USA.
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