<b>Background:</b> Women who inject drugs face vast disparities in health outcomes relative to their counterparts in the general population, most notably in HIV. Intimate partner violence (IPV) victimisation has a detrimental individual effect on women's HIV risk behaviour. Furthermore, IPV often co-occurs with substance use and poor mental health among women in high-income countries, but little is known about the cumulative and interactive effects of these conditions on women's HIV risk behaviour in low- and middle-income countries. This thesis applied an ecological approach guided primarily by syndemics theory to understand influences on women's HIV behavioural outcomes. It examined associations and mechanisms linking IPV, substance use, and depression, with HIV sexual and injecting risk outcomes in the first quantitative study of Indonesian women who inject drugs, the Women Speak Out study. <b>Methods:</b> This study combined community-based participatory approaches and extensive formative research with quantitative survey methods. 731 women, ≥18 years of age, and injecting illicit drugs in the preceding year were recruited using respondent-driven sampling (RDS) from urban settings in Greater Jakarta and Bandung, Indonesia. Network characteristics of the sample were assessed using the RDS software package for Stata 14. Data were analysed using multivariate logistic regressions, marginal effects models, and interaction analyses on the additive and multiplicative scales. The study was conducted in collaboration with the Indonesian Drug User Network. <b>Results:</b> Paper 1: Past-year IPV victimisation doubled the odds of engaging in one or more sexual HIV risk behaviours. Several covariates were associated with higher odds of sexual risk behaviour: HIV-positive status, non-injection crystal methamphetamine (crystal meth) use, low educational attainment, younger age, and being single. Co-occurrence of psychological, physical and/or injurious, and sexual forms of IPV had cumulative effects: sexual risk behaviour was reported by 62% of women who did not experience any form of IPV, but increased to 89% among those exposed to all three forms. Paper 2: Past-year IPV elevated women's odds of receptive syringe sharing. These effects remained after controlling for socio-demographic confounders. Two covariates, injecting illicit pharmaceuticals (vs heroin only) and housing instability and/or homelessness, remained associated with receptive syringe sharing in multivariate analyses. Paper 3: More than 1 in 4 women experienced concurrent IPV, depressive symptoms, and crystal meth use. All three exposures had independent negative effects on HIV sexual risk outcomes. The co-occurrence of all three factors produced a 4-fold increase in rates of survival sex work, 5-fold increase in STI symptomatology, and a 7-fold increase in inconsistent condom use. The joint effect of depressive symptoms and crystal meth use together was greater than the product of the estimated effects of each exposure alone on STI symptomatology, indicating an interaction on the multiplicative scale. Statistically-significant positive additive interaction was detected between IPV victimisation and crystal meth on inconsistent condom use; depression and crystal meth on STI symptomatology and on survival sex work; and IPV and depression on STI symptomatology and survival sex work. <b>Conclusion:</b> This thesis provides new evidence of the individual and cumulative effects of IPV, methamphetamine use, and depression on HIV risk outcomes among Indonesian women who inject drugs. The interaction analyses are the first to empirically test the assertion that these co-occurring conditions interact synergistically to increase drug-using women's HIV risk. This thesis furthers our understanding of how syndemics function within women who inject drugs to produce health disparities, and contributes to the problem theory for HIV risk behaviour in this population. The findings of this study have great public health significance and important implications for future longitudinal research, interventions, and policy.

Masters of Public Health - see Magister Public Health / The World Health Organization (WHO) considers violence to be a global public health problem. It is estimated that 1.6 million people worldwide lost their lives to violence in 2000. This translates to a global rate of 28.8 deaths per 100 000 population. The end of Apartheid in South Africa in 1994 brought about various economic, social and political transitions within the country, resulting in rapid urbanization, increasing unemployment and deepening inequalities. Consequently, these conditions also brought about increased incidences of crime and violence. The South African Police Service (SAPS) recorded approximately 2.58 million crimes in 2000. The SAPS faced many challenges in transforming the eleven South African Police Forces to a combined South African Police Service in 1994. Literature has indicated that while serious crimes increased, the chances of an offender being caught and punished declined between 1994 and 2000. During the 2002-2003 financial year the SAPS recorded a national homicide rate of 47.4 per 100 000 population. The Western Cape and Limpopo province had the highest and lowest provincial homicide rate of 84.8 and 12.1 per 100 000 population respectively. Other studies indicated that city-specific homicide rates for Cape Town increased from 84 to 88 per 100 000 population between 1999 and 2001. A pilot study conducted in Cape Town during 2003 to determine victim-perpetrator relationships and motives for homicide that occurred in 1999 was hampered by difficulties in tracing police dockets, inconsistencies in data capturing, and the absence of perpetrator information due to some court cases not being finalized. It was therefore decided to conduct a qualitative, descriptive, comparative study between two police stations in Cape Town. Semi-structured interviews were conducted with police officers at different ranks to document the procedures and route of reported crimes and to explore the factors impacting on the criminal investigation process. The interviews were audio-recorded, transcribed and analysed using thematic content analysis. The interviews provided an insight to the contextual environment and the attitudes of police officers regarding the transformation of the SAPS, and identified the factors impacting on the criminal investigation process at the two selected police stations. Issues discussed are discipline, restructuring and motivational factors regarding the transformation process, as well as training courses, the court impact and the relationship between the detectives and prosecutors. The main constraints identified at both police stations were human resources, training courses and vehicles. Social support and community factors are also discussed. The interviews with police officers revealed that there are various issues of management at national and provincial level that need to be addressed, such as detective recruitment standards, training courses and the management of different crime types to reduce the workload of detectives. The need for closer collaboration with the courts to avoid the misplacement of dockets and to minimise delays in the finalisation of court cases was also identified. Previous studies have also identified blockages within the South African criminal justice system and it is hoped that this study could highlight those issues that still need to be addressed.

Prevention is key to keeping men who have sex with men (MSM) protected from Human Immunodeficiency Virus (HIV). Despite new and innovative HIV prevention resources such as pre-exposure prophylaxis (PrEP), factors such as education level, employment status, number of sexual partners, and access to health resources may inhibit certain populations from using PrEP. The purpose of this cross-sectional study was to examine the association between education level, employment status, number of sexual partners, and access to health resources and the use of PrEP among MSM. The fundamental cause theory was used to examine how socioeconomic barriers are associated with the use of PrEP among MSM in the United States. Secondary data from 217 surveys were collected from the Public Library of Science. Findings from multiple regression analyses indicated that employment status, access to health resources, and number of sexual partners were not associated with use of PrEP among MSM. Those who had at least some high school or a high school diploma were 3.98 times more likely to be likely to extremely likely to use PrEP, compared to those who had less than a high school education (OR = 3.98, p = .048). Those who had some college were 6.91 more likely to be likely to extremely likely to use PrEP, compared to those who had less than a high school education (OR = 6.91, p = .028). Findings may be used to assist public health professionals in identifying factors that prevent the use of PrEP. By addressing these health threats, and social barriers, specialists could have the ability to increase HIV prevention activity in populations that are more susceptible to being infected with HIV and may decrease HIV infections not only within the MSM population but also in other populations.

An Evaluation of Military Education Assistance Programs From ParticipantsF Perspectives by Ella Bolling-Harris MS, Capella University, 2008 MS, Capella University, 2004 BS, Park University, 2000 Doctoral Study Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Education Walden University August 2015 Military education programs exist to assist military members in completing their college education prior to exiting the military. At a southwestern United States Army Installation, members have expressed dissatisfaction with the education programs. The purpose of this case study was to examine the education programs from the participants' perspectives. Mezirow's transformative learning theory was used as the framework for the study. The research questions elicited program participants' perceptions of various aspects of the programs, the potential for conversion of a basic skills program to a 2-year degree program, and suggestions for leaders for implementation of programs. The sample of participants included 15 military members stationed at the Army Installation who were enrolled in college and exiting the military within 12-24 months, were serving on active duty at the Installation, had been on repeated deployments, were 18 years or older, and had been in the military 4 or more years. Data were collected through interviews and responses were coded and analyzed for common themes. Results from emergent themes were used to develop a project that included strategies for military leaders to assist military members in their degree completion. Recommendations included a timeline for leaders to implement strategies to assist military members desiring an education, converting the current Basic Skills Education Program to a 2-year general studies degree program, implementing adjustments for deployment, and creating an education buddy team for military members enrolled in college. Implications for social change include improving military education assistance programs to allow more military members to complete their education in order to assist them in entering the civilian workforce in their own communities or others after their military obligation has expired.

Bakgrund: Personer som injicerar droger har i tidigare studier visat sig ha en lägre livskvalitet än andra populationer och många lider av psykisk ohälsa. Spridning av blodsmittor som hiv och hepatiter och andra blodburna infektioner kan vara en risk vid injicering. Tillgång till sterila sprutor och kanyler genom sprututbyte är en åtgärd för att minska spridning av infektionssjukdomar. Centralt för psykiatrisk omvårdnad, i likhet med harm reduction, är att värna mänskliga rättigheter, att erbjuda vård på lika villkor och stärka förmågan till egenvård. Syfte: Syftet med denna studie var att undersöka om livskvalitet hos personer som injicerar droger förbättras över tid efter inskrivning på Stockholms sprututbyte samt om det fanns någon skillnad mellan könen. Metod: Denna studie genomfördes som en prospektiv icke-experimentell longitudinell kvantitativ studie. Urvalet bestod av besökare på Stockholms sprututbyte som valde att delta. Studiedeltagarna svarade på livskvalitetsenkäten EQ-5D vid tre mättillfällen. EQ-5D mäter graden av tillfredsställelse i fem dimensioner (indexpoäng) samt innehåller en global skattning av nuvarande hälsotillstånd (EQ VAS). Förändring över tid analyserades med hjälp av ANOVA för upprepade mätningar. Resultat: Resultatet visade på en signifikant förbättring av livskvalitet över tid avseende EQ VAS för hela gruppen. Resultatet visade vidare att kvinnor skattade sitt nuvarande hälsotillstånd EQ VAS signifikant lägre än män. Slutsats: Deltagande i sprututbyte verkar ha betydelse och inverka positivt på hälsorelaterad livskvalitet hos personer som injicerar droger men mer behöver studeras för att få en bredare kunskap om vad det är som gör att det förhåller sig så. / Background: People who inject drugs have shown in previous studies to have a lower quality of life than other populations and many suffer from mental illness. The spread of blood infections such as hiv and hepatitis and other blood borne infections can be a risk when injecting. Access to sterile syringes and needles through syringe exchange is a measure to reduce the spread of infectious diseases. Central to psychiatric care, like harm reduction, is to protect human rights, to offer care on equal terms and to strengthen the capacity for self-care. Aim: The purpose of this study was to investigate whether the quality of life of people who inject drugs improves over time after enrollment in Stockholm needle and syringe exchange program and if there were any gender differences. Method: This study was conducted as a prospective non-experimental longitudinal quantitative study. The selection consisted of visitors at the Stockholm exchange who chose to participate. The study participants answered the quality of life questionnaire EQ-5D on three occasions. EQ-5D measures the degree of satisfaction in five dimensions (index points) and contains a global estimate of the current state of health (EQ VAS). Change over time was analyzed using ANOVA for repeated measurements. Results: The results showed a significant improvement in quality of life over time with regard to EQ VAS for the entire group. The results further showed that women estimated their current state of health EQ VAS significantly lower than men. Conclusions: Participation in needle and syringe exchange programs appears to have significance and a positive impact on health-related quality of life but further studies needs to gain a broader knowledge of what it is that makes it so.

The overall aim of this thesis was to obtain an understanding of the dynamics of the HIV epidemic by estimating prevalence and exploring the relationship between HIV-related knowledge, attitudes, behavior, and HIV status in Nicaragua. Structured questionnaires were administered to adults from a health and demographic surveillance system in León, Nicaragua (Papers I–III). In-depth interviews and a survey were conducted among men who have sex with men (MSM, Paper IV). Blood sampling for HIV was carried out among 2,204 men and women (Paper I). Bivariate and multivariate analyses, including adjusted prevalence ratio (Papers I, II, IV), factor analysis, Cronbach’s alpha, and hierarchical regression analysis (Paper III) were performed. Thematic analysis was used with qualitative data (Paper IV). The prevalence of HIV in the general population was 0.35% (95% CI, 0.17–0.73). Those who have taken a HIV test were more likely to be females, younger, living in an urban setting, have a higher level of education, be married or cohabiting, and have no religious affiliation. HIV-related knowledge was lower among members of the general population than among MSM. Unprotected sex was reported more times with regular partners than with casual partners. Findings suggested that consistency of condom use and emotional attachment (steady relations) were inversely related. Stigma and discrimination were reported high in the general population; they appeared to be negatively associated with HIV-related knowledge, self-perception of HIV risk, HIV testing, and willingness to disclose HIV status in the event of being HIV-positive. Findings demonstrated an increasing tolerance towards same-sex attractions. MSM have a better understanding of HIV transmission than men and women of the general population. Although seven out of ten MSM and six out of ten women were concerned about becoming infected with HIV, inconsistent condom use was common. This study confirmed that Nicaragua has a low prevalence but high risk for HIV infection and transmission. Results underscore that social, behavioral, and cultural factors contribute to retard progress in achieving the Millennium Development Goals on reducing gender inequality and combating HIV/AIDS. Addressing these challenges depends not only on successful behavior change interventions, but requires a culturally gender-appropriate strategy.

Fatherlessness seems to have instigated a growing political and social debate in recent years (Daniels, 1998). At the core of this debate lies the questions of whether fatherlessness today is more widespread than it has been historically, and whether the necessity and efficacy of fathers is important in the changing landscape of family paradigms (Daniels, 1998). In the last thirty years, research has defined fatherlessness in terms of parental marital status, father abandonment, and father death (Daniels, 1998; Gallagher, 1998; Popenoe, 1996). Some psychoanalysts extended the definition to include the emotional absence (Blundell, 2002), or emotional unavailability of the father (Lamb & Tamis-LeMonda, 2004). Research suggests that children raised by both biological parents have greater socio-economic success (McLanahan & Teitler, 1999), seem to have an intellectual advantage (Research Center for Minority Data, 2009), and are less prone to encounter emotional problems than single-parented children (Cockett and Tripp, 1994). These factors reflect the deficit model of fatherlessness that dominated child development research prior to the 1970s (Hawkins and Dollahite, 1997). More current research focused on the benefits of father involvement and purported that fathers who are more involved in the lives of their children (Day & Lamb, 2004; Pleck & Masciadrelli, 2004), and make themselves more emotionally available tend to raise children with fewer emotional problems and better overall mental health (Lum & Phares, 2005). With society producing what some refer to as a fatherless generation (Hydrate Studios, 2006), and a number of researchers attesting that fatherlessness is a devastating modern, social trend (Blackenhorn, 1995; Popenoe, 1996), current qualitative research was warranted in order to explore factors that lead fatherless individuals to assume a fatherless identity. In this exploratory case study, semi-structured interviews were conducted to better understand fatherlessness as experienced by adult male case study participants. The study focused on the experiences of men in order to manage the scope of research, and defer to the male experiences that prompted the research. Four men self-identified as fatherless with no imposed research definition by responding to the recruitment question Are You Fatherless? Results indicated that historical ways of defining fatherless were merely factors that intensify the experience; they do not define a person as fatherless. Findings suggested that the father role, family dynamics, emotionality, socio-economic and intellectual factors, disparate ideal and perceived father images, negative emotional connections with fathers, and a sons sense of masculinity all play a part in men assuming a fatherless identity.

ABSTRACT The purpose of this qualitative case study was to gain an informed understanding of the views of elementary school staff about the characteristics of the Nutrition Positive incentive program including: program development, implementation strategies used by individual schools, and challenges and related concerns associated with program implementation. As an initial step in a process evaluation, knowledge was gained through document analysis, site observations and 14 semi-structured interviews with principals, teachers and nutrition coordinators in 4 Greater Saskatoon Catholic, and 4 Saskatoon Public, Saskatchewan schools. Findings were then compared and contrasted with three models for best practice from the scientific literature and related to school health, education, and promotion. <p>The results led to the following conclusions. Nutrition Positive serves as an entry point for health promotion in Saskatoon elementary schools. While providing principals, teachers and other school staff with the necessary supports to enable children to learn critical life and health skills, it is also practical and realistic. The program can easily be adapted to different age and developmental levels, and a variety of cultures. The Advisory Committee and the program manual provide multiple resources to facilitate implementation. Schools may adapt the program for use across curricula, within school timetables, and concurrent with other health-related programs. Nutrition Positive schools attempt to provide healthy, serve most often foods for student mealtimes, special events, fundraising activities, vending machines and classroom rewards. While the program appears to be sustainable, it needs to specify measurable objectives and requires a better design for its assessment, monitoring and evaluation components. It is recommended that schools include all stakeholders, including parents and students, when forming a school-based program committee. Committee members need to participate in developing written school policies and guidelines, as well as learning about healthy eating themselves. School activities and foods offered need to more consistently and uniformly compliment the curriculum and program goals and objectives. In order to expand, program materials need to be widely publicized, communicated in a timely manner, culturally relevant, and available in languages in addition to English.

Syftet med föreliggande studie är att kartlägga vilka behandlingsmodeller som finns för män som utövar våld mot kvinnor i nära relationer och vilka effekter de mest vanligt förekommande behandlingsinsatserna har. Vidare är syftet att undersöka behandlingsmodellernas teoretiska grundantaganden och behandlingsinnehåll. Föreliggande studie genomförs som en litteraturstudie där kunskaper om behandlingsmodeller för våldsutövande män i nära relation sammanställs. Studiens resultat visar att de behandlingsmodeller som är mest vanligt förekommande är Emerge, The Duluth Model, Change och ATV (Alternativ till våld). Utvärderingar visar att de flesta behandlingsmodeller uppvisar små men signifikanta effekter och att återfall av våldsbrott minskar på kort sikt. Studier lyfter dock upp frågan kring de svårigheter som finns i samband med att utvärdera behandlingsprogram. / The purpose of this study is to identify which treatment models that are available for men who use violence against women in intimate relationships and the effects of the most commonly used treatment interventions. The further aim is to examine the theoretical assumptions and processing content of treatment models. The present study was conducted as a literature review where knowledge about treatment models for violent men in intimate relationships are compiled. Our results demonstrate that the treatment models that are most commonly used are Emerge, The Duluth Model, Change and ATV (Alternatives to Violence). Evaluations show that most treatment models exhibit small but significant effects and recurrence of violent crime decreases in the short term. Research highlights, however problems about the difficulties associated with evaluating treatment programs.

ABSTRACT The purpose of this qualitative case study was to gain an informed understanding of the views of elementary school staff about the characteristics of the Nutrition Positive incentive program including: program development, implementation strategies used by individual schools, and challenges and related concerns associated with program implementation. As an initial step in a process evaluation, knowledge was gained through document analysis, site observations and 14 semi-structured interviews with principals, teachers and nutrition coordinators in 4 Greater Saskatoon Catholic, and 4 Saskatoon Public, Saskatchewan schools. Findings were then compared and contrasted with three models for best practice from the scientific literature and related to school health, education, and promotion. <p>The results led to the following conclusions. Nutrition Positive serves as an entry point for health promotion in Saskatoon elementary schools. While providing principals, teachers and other school staff with the necessary supports to enable children to learn critical life and health skills, it is also practical and realistic. The program can easily be adapted to different age and developmental levels, and a variety of cultures. The Advisory Committee and the program manual provide multiple resources to facilitate implementation. Schools may adapt the program for use across curricula, within school timetables, and concurrent with other health-related programs. Nutrition Positive schools attempt to provide healthy, serve most often foods for student mealtimes, special events, fundraising activities, vending machines and classroom rewards. While the program appears to be sustainable, it needs to specify measurable objectives and requires a better design for its assessment, monitoring and evaluation components. It is recommended that schools include all stakeholders, including parents and students, when forming a school-based program committee. Committee members need to participate in developing written school policies and guidelines, as well as learning about healthy eating themselves. School activities and foods offered need to more consistently and uniformly compliment the curriculum and program goals and objectives. In order to expand, program materials need to be widely publicized, communicated in a timely manner, culturally relevant, and available in languages in addition to English.