Browsing by Subject "Youth"
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Item Open Access Associations of Adverse Childhood Experiences With Key Health Outcomes and Viral Suppression Maintenance Among Tanzanian Youth Living With HIV(2022) Brtek, Veronica RaquelBackground: Despite improved access to HIV testing and medication, AIDS remains a leading cause of death among youth living with HIV (YLWH) in Tanzania. YLWH are prone to worse HIV outcomes than other age groups, which may be caused or mediated by mental health, social determinants of health (SDH), and adverse childhood experiences (ACEs). In this study, the investigators sought to determine if ACEs were correlated with key health variables in hopes of better understanding the factors associated with negative HIV and mental health outcomes among Tanzanian youth. Additionally, the investigators aimed to observe longitudinal trends in virologic suppression to understand the extent to which undetectable = untransmittable or “U=U” messaging applies to the more volatile youth demographic. Finally, the investigators sought to identify patterns and predictors that could aid in understanding risk of virologic failure in this population. Methods: The investigators incorporated and merged secondary data from participants who were enrolled in both of two distinct studies to create a longitudinal database spanning from 2013 to 2020. Participant ACE scores were derived from trauma exposure questionnaires and were compared with data about mental health, stigma, SDH, sexual experiences, self-reported adherence and HIV RNA (viral load). Associations of ACEs and other key variables were performed using linear regression. Results: ACEs were common among YLWH, especially loss of a parent and physical abuse. ACEs were also correlated with both mental health outcomes and virologic failure. Of the 48 participants who were virologically suppressed at the beginning of the study, one third had subsequent virologic failure, which was often associated with changes in ACEs, medication regimen, and SDH. Conclusion: Understanding common ACEs in this vulnerable population has direct relevance for the design of targeted interventions to prevent and treat repercussions of childhood trauma and improve mental health and HIV outcomes. ACEs, experiences with suicide risk, and low social support are important correlates of virologic failure and should be an alert when considering repeat HIV RNA testing and eligibility for supportive services.
Item Open Access Building a Better World: Youth, Radicalism, and the Politics of Space in New York City, 1945-1965(2012) Teal, OrionAccording to conventional wisdom, the period of intense antiradicalism that followed World War II effectively drove all radical activity underground by the early 1950s, severing the intergenerational connection between the "Old Left" of the Great Depression era and the "New Left" of the 1960s. Building a Better World revises this narrative by examining how radical activists in New York City carved out space for young people's participation in leftwing political culture between 1945 and 1965. Contrary to most studies of the postwar Red Scare that focus on the Left's decline, this study tells a story of survival. Despite concerted efforts by social critics and governmental officials to curtail radicals' political influence among the young, radicals maintained a surprisingly robust radical social world centered in summer camps, private schools, youth groups, cultural organizations, union halls, and homes throughout New York City and its environs. In these spaces, youth continued to absorb a radical worldview that celebrated the labor movement, decolonization struggles, and African Americans' quest for freedom, while forwarding a biting critique of American capitalism. This process of intergenerational transmission would not have been possible without access to social space and an ever-evolving interpretation of radical values responsive to changes in political culture and demographics. Building a Better World relies on extensive archival research, print material, visual sources, and original oral histories to document this hidden history. In so doing, the dissertation significantly revises our understanding of the American Left, the history of American childhood, spatial change in New York City, and the evolution of political, ethnic, and racial identities in modern American history.
Item Open Access Challenges and Facilitators of Transition from Adolescent to Adult HIV Care among Youth Living with HIV in Moshi, Tanzania(2018) Masese, Rita VanessaBackground: AIDS is the leading killer of adolescents in Africa, the continent most impacted by the AIDS pandemic. The East African nation of Tanzania is one of the top five countries with the highest burden of HIV in the world. Despite these challenges, scale up of anti-retroviral therapy (ART) has enabled millions of children infected with HIV to survive into adolescence and adulthood. These children attend family-centered and adolescent clinics where they not only receive HIV care, but also form close knit bonds with their healthcare providers and peers. As patients age into adulthood, they require to transition to the adult HIV clinic. Failure to transition results in an adolescent treatment bulge and strain on capacity in the family centered and adolescent clinics. This adolescent to adult transition period is a point of frequent loss to follow-up in the HIV care continuum, which may be partially due to fear and anxiety about the change. As clinics seek guidance on how best to manage the transition, few established protocols exist, and those available were primarily written for well-resourced settings. This study examined challenges and facilitators of the transition of care among youth living with HIV in Moshi, Tanzania.
Methods: Purposive sampling methods were used to recruit youth living with HIV who attended an adolescent specific clinic, Teen Club, and the adult HIV clinic at Kilimanjaro Christian Medical Centre. Two native Swahili speaking research assistants trained in qualitative research conducted in-depth interviews. Medical records were reviewed retrospectively to collect data on factors associated with HIV outcomes. Preliminary results were presented to key stakeholders. Youth and key stakeholders separately suggested solutions to identified challenges associated with transition of care. Results: 19 youth participated in the study. A slight majority were female (53%) and on first-line ART. Participants’ age of HIV diagnosis ranged from 5 to 18 years with a mean ART duration of 9.8 years. Barriers and facilitators of transition were categorized into four domains based on the Health Care Transition Research Consortium (HCTRC) framework. Individual domain: Barriers included long ART duration and financial constrains due to low socio-economic status. Facilitators to care were a positive perspective on living with HIV, high sense of maturity and responsibility, and good health maintenance. Family/Social Support Domain: Barriers were stigma and lack of social events in the adult clinic. Facilitators were family and peer support. Health care system domain: Barriers were lack of preparation for transition and concern about the quality of care in the adult clinic which entailed payment for services, few physicians, long waiting times and poor patient-provider communication. Environment domain: Barriers were lack of national guidelines for transition and inadequate investment in adolescent health and education by the government.
Conclusion: Transition is a complex, dynamic process influenced by many factors. With projections indicating that the number of youth living with HIV in Tanzania is likely to increase in the coming years, it is vital to develop a transition protocol that addresses the challenges identified and is feasible to implement in low resource settings. A strong protocol may influence the use of health system resources, facilitate continuity of care, and improve long term disease outcomes.
Item Open Access ‘Christ the Redeemer Turns His Back on Us:’ Urban Black Struggle in Rio’s Baixada Fluminense(2018) Reist, Stephanie V“Even Christ the Redeemer has turned his back to us” a young, Black female resident of the Baixada Fluminense told me. The 13 municipalities that make up this suburban periphery of Rio de Janeiro have suffered for decades from stigmatizing media narratives that cast the region as pathologically violent and culturally devoid due to its Blacker, poorer inhabitants. This has helped perpetuate government neglect, exacerbated by Rio’s hosting of the 2016 Olympic Games, through clientelist politics that thrive off the lack of jobs and basic public services in the region. My dissertation is an auto-ethnographic analysis of my three years of participatory action research with Black and brown youth in Rio de Janeiro’s stigmatized Baixada Fluminense. I argue that the music, films, social media driven journalism, and scholarly production of these youth contest the ways in which race, class, and place of origin often overlap through segregationist practices that attempt to maintain racial, socio-geographic hierarchies by relegating Black, brown, and poor bodies to the social and geographic periphery of a country than once proclaimed itself a “racial democracy.” Through transnational partnerships, these youth employ diasporic cultural forms and digital media to re-configure the Baixada and its 13 municipalities as a “Black place” that is inherently intersectional in its claims to collective access to urban and social mobility within this urban periphery.
Item Open Access Criminal Injustice: Race, Representative Bureaucracy, and New York City’s Criminal Justice System(2017) Ashe, Austin W.Recently, research concerning the United States Criminal Justice System has been dominated by discussions of mass incarceration and deadly acts of police violence. Although there is conflicting evidence regarding the impact of racial diversity in criminal justice organizations, it continues to receive consideration as a prescription for racial disparities in policing, sentencing, and incarceration. Few studies have provided a holistic analysis of multiple components of the criminal justice system in one locality. This research focuses on the role of race throughout New York City’s Criminal Justice System. Based on court observations, ethnographic data, and semi-structured interviews I focus on the experiences and perspectives of black and Latino actors involved in the criminal justice process. Findings suggest that race itself is not predictive of active representation, while the link between passive and active representation cannot be completely dismissed. I discuss the implications of these findings for future research and policy initiatives aimed at reducing racial disparities in policing and incarceration.
Item Open Access Endless Question: Youth Becomings and the Anti-Crisis of Kids in Global Japan(2014) Dixon, Dwayne EmilYoung people in Japan contend with shifting understandings of family and friends, insecure jobs, and changing frames around global and national identities. The category of youth itself is unsettled amid a long period of social and economic change and perceived widely as crisis. Within contested social categories of youth, how do young Japanese people use the city, media, and body practices to create flexible, meaningful sociality across spaces of work, education, and play? What do youthful sociality and practices reveal about globally oriented connections and how do they inform conceptions of the future, kinship, gender, and pluralized identities? In short, what is the embodied and affective experience of being young as the category itself is increasingly unstable and full of risks? These questions shape the contours of this project.
This dissertation considers youth through its becoming, that is, the lived enactment of youth as energy, emotion, and sensibility always in motion and within range of cultural, spatial, bodily, and technological forces. Three groups of young people in this layered latitudinal study demonstrate various relations to the city street, visual media, globalized identities, contingent work within affect and cultural production, and education. The three groups are distinctly different but share surprising points of connection.
I lived alongside these three groups to understand the ways young people are innovating within the shifting form of youth. I skated with male skateboarders in their teens to early 30s who created Japan's most influential skate company; I taught kids attending a specialized cram school for kikokushijo (children who have lived abroad due to a parent's job assignment); I observed and hung out with young creative workers, the photographers, web designers, and graphic artists who produce the visual and textual content and relationships composing commercial "youth culture."
My project examines how these young people redefine youth through bodily practices, identities, and economic de/attachments. The skaters' embodied actions distribute/dissipate their energies in risky ways outside formal structures of labor. The kikokushijo children, with their bi-cultural fluency produced in circuits of capitalist labor, offer a desirable image of a flexible Japanese future while their heterogeneous identities appear threatening in the present. The creative workers are precariously positioned as "affective labor" within transglobal (youth) cultural production, working to generate visual and textual content constant stressful uncertainties. All three groups share uneasy ground with capitalist practices, risky social identities, and crucially, intimate relations with city space. In attending to their practices through ethnographic participation and video, this dissertation explores questions concerning youthful relations to space produced in material contacts, remembered geographies of other places and imaginary urban sites.
The dissertation itself is electronic and non-linear; a formal enactment of the drifting contact between forms of youth. It opens up to lines of connection between questions, sites, events, and bodies and attempts an unfolding of affect, imagination, and experience to tell stories about histories of gender and labor, city life, and global dreams. It asks if the globalized forms of Japanese youth avoid the risks of the impossible secure for the open possibilities of becoming and thus refuse containment by crisis?
Item Open Access Evaluating the Impact of the North Carolina Art Therapy Institute’s Newcomer’s Program(2019) Tran, TraRefugees and asylum seeking children (Newcomers) enter the U.S.A. with little psychosocial support, despite having consistently higher rates of mental health problems. Art therapy has been seen as a potentially powerful intervention that can be implemented in high income countries with marginalized communities. Given art therapy’s un-centering of English, this mental health intervention is widely used within civil society but has not been rigorously evaluated. This study adds to the growing literature that examines the impact of art therapy interventions for Newcomer populations. We evaluated the impact of the North Carolina Art Therapy Institute’s (ATI) Newcomer’s Program, to inform further implementation of the Newcomer’s Program. In addition to the evaluation, we wanted to compare two forms of implementation, an intense weeklong “summer camp” program vs. a semester-long school-based program. This study used a mixed methods approach to assess the impact and value of the Art Therapy Institute’s (ATI) Newcomer’s Program in Durham, NC with Newcomers aged 4-14. The study, conducted in Fall 2018 in Durham, NC, compared two styles of implementation, a summer camp program (Number of youth = 31) and a school-based program (Number of youth =53). The number of hours of therapy remained consistent between programs (hours = 10.5) to allow us to compare. Qualitative data was collected after each implementation of the Newcomer’s Program with parents of refugee youth (N=2) and therapists (N=5). We found that the Newcomer’s Program had modest impact in reducing hyperactivity and inattention in both arms, and had statistically significant increase in prosocial behavior for the school-based program. Despite the modest impact observed, interviews with therapists and parents highlighted implementation challenges and non-quantifiable impact. This study has highlighted the need for further examination of the positive effects of art therapy interventions with Newcomer populations.
Item Open Access Evaluating the Long-Term Outcomes of a Mental Health Intervention in Tanzanian Youth Living with HIV(2020) Mkumba, LauraSix percent of the world’s population of youth living with HIV (YLWH) reside in Tanzania. Despite scale up of antiretroviral therapy (ART), poor ART adherence contributes to AIDS related morbidity and mortality in YLWH. Reasons for poor adherence include mental health challenges, HIV-related stigma, and lack of psychosocial support. Sauti Ya Vijana (SYV), a group-based, lay counselor delivered, 10-session mental health intervention for Tanzanian youth living with HIV was developed. The objective of this study was to describe the mental health outcomes of SYV in youth living with HIV.
This mixed-methods study enrolled 128 YLWH, aged 12-24, in Moshi, Tanzania to receive either the SYV intervention or treatment as usual. Youth in both arms completed structured questionnaires assessing their demographics, mental health and stigma symptoms, and self-reported ART adherence, at baseline, 6 months, 12 months, and 18 months study timepoints. A mixed effects linear regression model was used to analyze the change in stigma and mental health measures from baseline to the three follow-up timepoints. A subset of 10 youth who were randomized to the intervention arm completed semi-structured in-depth interviews at least one year after the intervention. Interviews were conducted in Kiswahili, and interview guide topics included participant description of history of depression symptoms, current challenges, recollection of specific SYV topics, and their experience during and after the SYV intervention. Interviews were transcribed and translated to English. Inductive thematic analysis using NVivo was used to analyze interview transcripts and identify common themes.
One hundred and five youth were randomized; 58 to the intervention arm and 47 to the treatment as usual arm. Average age of participants at baseline was 17.8 years and 49% of enrolled participants were male. Majority of the youth (86%) randomized to the intervention arm attended at least 8 out of 10 SYV sessions. The study was not powered to statistically detect treatment effect, but youth enrolled in both study groups showed improvement in their mental health and internal stigma measures at all follow-up timepoints in comparison to baseline. Ten youth, 18-25 years of age, were interviewed. Seven of the ten participants were male, and 60% were responders. All participants attended at least eight of the 10 intervention sessions and all baseline, 6 months, and 18-month follow-up appointments. Participants all reported experiencing intermittent symptoms of depression such as feelings of sadness. Current challenges included difficult interpersonal relationships and taking ART on time. The most memorable SYV lessons were coping skills such as breathing exercises. Participants described how SYV helped them have “more confidence”, accept themselves, and incorporate positive coping skills such as relaxation (deep breathing) when they felt stressed.
The findings provide evidence that providing a 10-session group based mental health intervention can have a long-term impact on the psychosocial outcomes of YLWH and can improve resilience in this population. Implementation of the SYV intervention into the routine HIV clinical care has promise to improve overall well-being of YLWH.
Item Open Access Patterns of HIV Serostatus Disclosure Among HIV-Positive Young Adults in Haiti: a Mixed Methods Investigation(2014) Philogene, JohaneBackground: By facilitating access to prevention and care services, HIV serostatus disclosure has been associated with improved physical health, psychological well-being, and improved health behaviors for people living with HIV/AIDS (PLWHA). Disclosure to sexual partners, in particular, can help prevent the forward transmission of HIV. Disclosure can increase social support but can also lead to negative social outcomes including stigma and discrimination. Thus, disclosing HIV status to friends, family, and sexual partners is a complex psychosocial challenge that PLWHA face, particularly adolescents and youth who have an increased lifespan due to current effective treatment protocols.
Objectives: This study had three objectives: 1) to determine gender-related differences in the rate and patterns of HIV serostatus disclosure to family, friends and sexual partners among HIV-positive youth in Haiti; 2) to identify gender-specific relational and psychosocial predictors of HIV disclosure to sexual partner; and 3) to qualitatively explore and describe motivations and experiences related to HIV disclosure in this population.
Methods: A cross-sectional study was conducted in a random sample of 680 sexually active HIV-positive young adults (18-29 years) from six clinics in Port-au-Prince, Haiti. Socio-demographic, health, sexual and reproductive history, sexual behavior, psychosocial and disclosure data were collected using a pre-tested interviewer-administered structured questionnaire. Rates and patterns of HIV serostatus were described, and factors associated with disclosure to all sexual partners in the past 3 months were analyzed using hierarchical logistic regression models, separately by gender. Qualitative data was collected through individual in-depth interviews with a purposefully selected sample of 12 young adult participants to explore whom they chose to disclose to, how they disclosed to these individuals, and how these individuals reacted. Content analysis allowed for the description of motivations and experiences related to HIV disclosure in this population.
Results: Slightly over half (56%) of participants had told at least one person about their HIV status. Female respondents were more likely than male respondents to have disclosed to family or friends. Male youth were more likely to disclose their status for the first time to sexual partners (35%), while female youth were more likely to choose their mother as their first confidant (51%). Overall, 33% of participants reported having disclosed their HIV status to all their sexual partners from the last 3 months, with no significant difference across genders. For both genders, older age and being unaware of partners' HIV status were significantly associated with lower odds of HIV serostatus disclosure. Additionally for young males, disclosure stigma was negatively associated with disclosure while HIV acceptance and personalized stigma were significant predictors of disclosure. Female youth who were single, had casual or multiple partners, and experienced greater personalized stigma were less likely to disclose, whereas the availability of social support was positively associated with disclosure to all sexual partners. While disclosure to sexual partners was motivated primarily by a desire to encourage partners to test for HIV and increase condom use, or by a sense of moral responsibility, important contextual differences emerged in qualitative analysis with regards to barriers to disclosure, particularly fear of stigma and fear of partner's reaction.
Conclusion: Rates of HIV serostatus disclosure to family, friends and sexual partners were low among this population of HIV-positive youth in Port-au-Prince. Context-specific gender-sensitive interventions are needed to increase social support, reduce HIV-related stigma, and assist youth living with HIV in making effective decisions on disclosure that will ultimately improve their well-being and quality of life. Further research is necessary to better understand the process and outcomes of HIV serostatus disclosure to sexual partners, as well as the relationship between HIV serostatus disclosure and sexual risk behaviors in this young HIV-positive population.
Item Open Access Playing the State: Imagining Youth in Cuban Baseball(2021) Daley, ChristopherMy research lies at the intersections of youth and their imaginaries in late socialist Cuba. Through ethnographic and historical research, I explore how Cuban teenagers and young adults make sense of their place in a changing world. My dissertation asks, what does the experience of young baseball players tells us about the way that socialism works and how it is experienced in Cuba today? I argue that baseball in Cuba reflects the distinctive trajectory of this island nation that remains one of the world’s last socialist states. I detail how the amateur athlete can be seen as an on-going experiment in the state’s attempt to create new subjectivities, which are channeled through an equally new system of ethical values based on sacrifice, care, and anti-colonial nationalism. But while players are seen to embody socialist values, I argue that baseball creates a range of meanings and possibilities for players that exceeds the State’s ability to direct or control.
Item Open Access Providing Mental Health Access to Unauthorized Children and Citizen-Children of Unauthorized Parents in Durham Area Schools(2021-05-14) Luther, NatashaWorld Relief Durham (WRD) is in the process of creating an intervention program that would support the effort to provide mental health access to unauthorized Hispanic children/youth, and citizen-children of unauthorized parents in Durham area schools. This research project contains interviews with World Relief National Offices, local experts, and Durham area schools. Language, finances, needs assessments, and fear of deportation were all barriers to mental health access that interviewees identified for unauthorized students in Durham. WRD must take the following steps to improve mental health access for unauthorized children and citizen-children of unauthorized parents in Durham: 1. Close the access gaps to mental health services by becoming a mental health provider, funding mental health service sessions, and identifying mental health service needs. 2. Build community partnerships by providing trainings for Durham school social workers and getting licensed for anti-human trafficking support. 3. Assist unauthorized parents by interviewing them, providing language assistance, removing stigma surrounding mental health, and introducing community resources. 4. Gather resources for high schoolers that can be used during and after graduation. These strategies will help build upon services that are already in place by community organizations and enhance the overall process for unauthorized children, and citizen-children of unauthorized parents to receive mental health services.Item Open Access Securing Youth: Humanitarian Futures in Post-Conflict Uganda(2021) Sebastian, Matthew RyanThe dissertation considers how young people in northern Uganda navigate post-conflict life through participant observation, interviews, and ethnographic focus groups with youth working as security guards, current and formerly incarcerated youth, and young people seeking employment in South Sudan. It offers a detailed, sustained view into the everyday practices young people undertake to envision a future after prolonged civil conflict despite intense social, political, and economic constraints. I worked extensively with individuals who occupied different positions of vulnerability and security in order to investigate how these categories overlapped and intertwined in their daily lives. By doing so, the research makes broader interventions into theories of youth and of post-conflict recovery including how individuals encounter post-war legal authority, how humanitarian interventions impact intergenerational and familial relationships, and what strategies young people employ when the resources and opportunities afforded to them through the expansive humanitarian network that once surrounded them leaves the region, or transforms into something else entirely. I argue that the constraints young people face, coupled with the state’s attempt to securitize them as a potentially destabilizing political and economic force, generate impossible predicaments which often require them to take on increasingly dangerous risks, which in turn open them up to further securitization in a cycle that leaves young people unable to build anything but fraught futures despite being the future of the nation. A central aim of my research was to destabilize the "post" in post-conflict, not only to point to the ways in which conflict has afterlives (which is well treaded territory in anthropology) but also to disrupt the clean temporality the term presumes. I argue that young people do not take the “post” as a new dawn from which to build possibility, but instead draw on their past experiences to make sense of the present despite the uncertainty of the future. Building on other recent scholarship, my research interrogates the durability of the "post" as a way of opening up pathways which young people (and others) draw on to make sense of their daily lives.
Item Open Access Socio-Economic Mobility of Youths: Factors, Obstacles, and Potential Solutions(2014-09-26) Hanna, Andrew LeonFrom early childhood to young adulthood, there are several key obstacles to the ability of a young person to improve his or her socioeconomic status. These include availability of quality early childhood education, level of peer support during adolescence, secondary school funding and quality, and skills development and job matching as a young adult. This article explores the dynamics of these critical obstacles, analyzes initiatives that are successfully helping young people overcome these obstacles around the world, and makes policy suggestions to create a society in which young people have strong opportunities to fulfill their potentials and advance socioeconomically. The article focuses on socioeconomic mobility of young people specifically in the United States, though it draws on examples of successful models from all over the globe.Item Open Access The Rationale for and Guide to Using Hip-Hop Music as A Vehicle to Spiritual Formation for Black Male Youth(2017) Mason, Rodney MasonThis thesis provides a hip-hop based curriculum that the black church can use to engage young black men in spiritual formation. Due to the negative lyrics heard in hip-hop music, many churches have rejected this style of music in their church, sometimes even demonizing those who identify with the genre. I argue that there is precedence for the church to utilize hip-hop music because the church has a history of utilizing popular culture, in particular music, to attract and engage young people in church. Moreover, individuals are formed and gain identity from more than just church music, and being aware of popular culture helps the church develop healthy relationships with young people because it tells young people that the church recognizes their music is more than just a fad, but an essential piece of their identity. My thesis expands on the historical moments where the church has used secular music to evangelize young people while offering portraits of two churches, The Tribe in New York City and Sanctuary Covenant Church in Minneapolis, that currently use a genre of popular music as a tool for helping young people gain a closer relationship with God. In addition, this thesis argues for the use of curriculum, a pedagogical approach, for engaging young black males in spiritual formation. In order to create this curriculum, I listened to a large selection of hip-hop music, past and current, and evaluated
the lyrics and themes of each song to select the songs I thought would lead to great dialogue among the participants. This thesis concludes with the creation of a Christian curriculum that uses hip-hop music as its foundation.