Rapidly developing communications materials during public health emergencies: the Âu CÆ¡ campaign in the USA.

During public health emergencies, health communication materials to contain the outbreak are needed promptly, which prevents the use of standard approaches for getting feedback from the intended audience. We propose a strategy for rapidly obtaining community feedback on new health communication materials during the public health emergencies. We illustrate this with COVID-19 testing campaign in a Vietnamese-American enclave in the USA. The project included community-based COVID-19 testing and communication activities to increase the awareness of the testing centers and encourage frequent testing. Our strategy involves two main components: (i) use of a research team with an existing trust relationship with the community and that includes researchers from that community and (ii) co-design of communication materials using community-based gatekeepers and a cultural broker. We developed brochures and posters to increase the awareness of the COVID-19 testing services. The cultural broker and community-based partners identified salient message concepts and worked with the researchers to define the objectives and content of the materials, which were then reviewed by the entire team. In lieu of standard pretesting, we relied on feedback on mockups of the materials and subsequent revisions from the community-based gatekeepers and cultural broker. Our strategy strikes a balance between the need to urgently disseminate new materials and the need for community input. One key takeaway is that effective planning for public health emergencies must start long before the crisis occurs.

Health Selection, Migration, and HIV Infection in Malawi.

Despite its importance in studies of migrant health, selectivity of migrants-also known as migration health selection-has seldom been examined in sub-Saharan Africa (SSA). This neglect is problematic because several features of the context in which migration occurs in SSA-very high levels of HIV, in particular-differ from contextual features in regions that have been studied more thoroughly. To address this important gap, we use longitudinal panel data from Malawi to examine whether migrants differ from nonmigrants in pre-migration health, assessed via SF-12 measures of mental and physical health. In addition to overall health selection, we focus on three more-specific factors that may affect the relationship between migration and health: (1) whether migration health selection differs by destination (rural-rural, rural-town, and rural-urban), (2) whether HIV infection moderates the relationship between migration and health, and (3) whether circular migrants differ in pre-migration health status. We find evidence of the healthy migrant phenomenon in Malawi, where physically healthier individuals are more likely to move. This relationship varies by migration destination, with healthier rural migrants moving to urban and other rural areas. We also find interactions between HIV-infected status and health: HIV-infected women moving to cities are physically healthier than their nonmigrant counterparts.

The impact of early social support on subsequent health recovery after a major disaster: A longitudinal analysis.

Social support may facilitate disaster recovery. Prior analyses are hampered by the limits of cross-sectional approaches. We use longitudinal data from the KATIVA-NOLA survey to explore whether social support soon after Hurricane Katrina facilitated recovery of health status for a representative sample of 82 Vietnamese New Orleanians. Health and social support were assessed just before Hurricane Katrina (2005), soon afterwards (2006, 2007), and at longer durations post-disaster (2010, 2018). We use random effects regression to examine how social support measured in 2006 influences mental and physical health measured in 2006, 2007, 2010, and 2018. Social support soon after Katrina was positively associated with physical health and mental health years later in 2010, even after controlling for potential confounders such as Katrina-related housing damage and pre-Katrina health and support and modeling an interaction between year and social support in 2006. Other immigrants who are highly impacted by a major disaster could benefit from programs that seek to rapidly reconstruct systems of social support.

Differences in post-disaster mental health among Vietnamese and African Americans living in adjacent urban communities flooded by Katrina.

Some communities recover more quickly after a disaster than others. Some differentials in recovery are explained by variation in the level of disaster-related community damage and differences in pre-disaster community characteristics, e.g., the quality of housing stock. But distinct communities that are similar on the above characteristics may experience different recovery trajectories, and, if so, these different trajectories must be due to more subtle differences among them. Our principal objective is to assess short-term and long-term post-disaster mental health for Vietnamese and African Americans living in two adjacent communities in eastern New Orleans that were similarly flooded by Hurricane Katrina. We employ data from two population-based cohort studies that include a sample of African American adults (the Gulf Coast Child and Family Health [GCAFH study]) and a sample of Vietnamese American adults (Katrina Impacts on Vietnamese Americans [KATIVA NOLA study]) living in adjacent neighborhoods in eastern New Orleans who were assessed near the second and thirteenth anniversaries of the disaster. Using the 12-Item Short Form Survey (SF-12) as the basis of our outcome measure, we find in multivariate analysis a significant advantage in post-disaster mental health for Vietnamese Americans over their African American counterparts at the two-year mark, but that this advantage had disappeared by the thirteenth anniversary of the Katrina disaster.

Micro- and nanomechanical analysis of articular cartilage by indentation-type atomic force microscopy: validation with a gel-microfiber composite.

As documented previously, articular cartilage exhibits a scale-dependent dynamic stiffness when probed by indentation-type atomic force microscopy (IT-AFM). In this study, a micrometer-size spherical tip revealed an unimodal stiffness distribution (which we refer to as microstiffness), whereas probing articular cartilage with a nanometer-size pyramidal tip resulted in a bimodal nanostiffness distribution. We concluded that indentation of the cartilage's soft proteoglycan (PG) gel gave rise to the lower nanostiffness peak, whereas deformation of its collagen fibrils yielded the higher nanostiffness peak. To test our hypothesis, we produced a gel-microfiber composite consisting of a chondroitin sulfate-containing agarose gel and a fibrillar poly(ethylene glycol)-terephthalate/poly(butylene)-terephthalate block copolymer. In striking analogy to articular cartilage, the microstiffness distribution of the synthetic composite was unimodal, whereas its nanostiffness exhibited a bimodal distribution. Also, similar to the case with cartilage, addition of the negatively charged chondroitin sulfate rendered the gel-microfiber composite's water content responsive to salt. When the ionic strength of the surrounding buffer solution increased from 0.15 to 2 M NaCl, the cartilage's microstiffness increased by 21%, whereas that of the synthetic biomaterial went up by 31%. When the nanostiffness was measured after the ionic strength was raised by the same amount, the cartilage's lower peak increased by 28%, whereas that of the synthetic biomaterial went up by 34%. Of interest, the higher peak values remained unchanged for both materials. Taken together, these results demonstrate that the nanoscale lower peak is a measure of the soft PG gel, and the nanoscale higher peak measures collagen fibril stiffness. In contrast, the micrometer-scale measurements fail to resolve separate stiffness values for the PG and collagen fibril moieties. Therefore, we propose to use nanostiffness as a new biomarker to analyze structure-function relationships in normal, diseased, and engineered cartilage.

Race, socioeconomic status, and return migration to New Orleans after Hurricane Katrina.

Hurricane Katrina struck New Orleans on the 29th of August 2005 and displaced virtually the entire population of the city. Soon after, observers predicted the city would become whiter and wealthier as a result of selective return migration, although challenges related to sampling and data collection in a post-disaster environment have hampered evaluation of these hypotheses. In this article, we investigate return to the city by displaced residents over a period of approximately 14 months following the storm, describing overall return rates and examining differences in return rates by race and socioeconomic status. We use unique data from a representative sample of pre-Katrina New Orleans residents collected in the Displaced New Orleans Residents Pilot Survey. We find that black residents returned to the city at a much slower pace than white residents even after controlling for socioeconomic status and demographic characteristics. However, the racial disparity disappears after controlling for housing damage. We conclude that blacks tended to live in areas that experienced greater flooding and hence suffered more severe housing damage which, in turn, led to their delayed return to the city. The full-scale survey of displaced residents being fielded in 2009-2010 will show whether the repopulation of the city was selective over a longer period.

Migration and sexual partnerships among unmarried young men in Thailand: a longitudinal approach.

OBJECTIVES: Migrants typically report more sexual behavior than non-migrants. In existing work, the potentially confounding effects of selection loom large. Our objective is to discern whether migrants actually do engage in more sexual activity than their non-migrating counterparts, once selection is accounted for. METHODS: We used three waves of data from a longitudinal panel study in Thailand. Panel members were rural unmarried men, some of whom subsequently migrated to urban areas and were re-interviewed there. Migrants were compared to their non-migrant counterparts and to a separate sample of long-term urban dwellers. RESULTS: There were no differences between eventual migrants and non-migrant counterparts in sexual partnerships before migration. Migration increased sexual partnerships with stable partners and strangers, compared with rural non-migrants. CONCLUSIONS: Unmarried men who moved to urban areas had increased sexual partnerships with stable partners and strangers. Without proper means of protection, this pattern of behavior puts these men and their sexual partners at elevated risk of unwanted pregnancy and sexually transmitted infections (STIs). Public health programs should target unmarried male migrants for pregnancy control and STI prevention.

One year later: mental illness prevalence and disparities among New Orleans residents displaced by Hurricane Katrina.

OBJECTIVES: We examined whether there were high levels of mental illness among displaced New Orleans, LA, residents in the fall of 2006, 1 year after Hurricane Katrina. METHODS: We used data from the Displaced New Orleans Residents Pilot Study, which measured the prevalence of probable mild or moderate and serious mental illness among a representative sample of people who resided in New Orleans at the time of the hurricane, including people who evacuated the city and did not return. We also analyzed disparities in mental illness by race, education, and income. RESULTS: We found high rates of mental illness in our sample and major disparities in mental illness by race, education, and income. Severe damage to or destruction of an individual's home was a major covariate of mental illness. CONCLUSIONS: The prevalence of mental illness remained high in the year following Hurricane Katrina, in contrast to the pattern found after other disasters. Economic losses and displacement may account for this finding as well as the disparity in mental illness between Blacks and Whites.

PTSD in Vietnamese Americans following Hurricane Katrina: prevalence, patterns, and predictors.

One year after Hurricane Katrina devastated New Orleans, we assessed 82 adults from a population-based sample of the Vietnamese American community who had participated in a larger study of immigration weeks before the disaster. Although 21% met criteria for partial posttraumatic stress disorder (PTSD), only 5% of the sample met all PTSD criteria. Avoidance/numbing symptoms did not form a coherent cluster and were seldom confirmed, but intrusion, arousal, and interference were common. Severity of exposure to the floodwaters, property loss, and subjective trauma were independently related to PTSD symptoms. Symptoms were highest among participants who were low in acculturation or who had high Katrina exposure in combination with prolonged stays in transition camps during emigration.

Evacuation and Return of Vietnamese New Orleanians Affected by Hurricane Katrina.

Hurricane Katrina struck near New Orleans on August 29, 2005, and resulted in the collapse of the federal protective levee system and the flooding of most of the city. New Orleans East, where the main Vietnamese enclave is located, was especially hard hit. By chance, just weeks before this disaster occurred we collected with our colleagues a wide range of demographic and health data for a population-based sample of working age Vietnamese Americans living in New Orleans. One year after the storm, we re-interviewed everyone from the original sample who had returned to the area. This re-interview sample included about two-thirds of the original sample.Those who had returned by the one year point were more likely than those yet-to-return to have been employed before the storm, to have worked in the skilled sector of the economy, to have been married, and to have been a home owner. Many problems experienced during the immediate aftermath of the storm, such as crowded and unsanitary conditions, had been resolved by the one-year anniversary. Other problems remain, such as a continuing lack of information, lack of access to medical care, and fears of violent crime.

Murder rates in New Orleans, La, 2004-2006.

Murder rates for New Orleans, La, during 2005 and 2006 were calculated with the best available population trajectories for these 2 atypical years. These calculations showed that the murder rate increased substantially during this period compared with 2004. The increase in 2005 from 2004 was 14%. The best estimate of the increase in the murder rate in 2006 compared with 2004 was 69%; the large increase in 2006 began during the second quarter of that year.

Cohort profile: internal migration in sub-Saharan Africa-The Migration and Health in Malawi (MHM) study.

PURPOSE: The Migration and Health in Malawi (MHM) study focuses on a key challenge in migration research: although it has long been established that migration and health are closely linked, identifying the effect of migration on various health outcomes is complicated by methodological challenges. The MHM study uses a longitudinal panel premigration and postmigration study design (with a non-migrant comparison group) to measure and/or control for important characteristics that affect both migration and health outcomes. PARTICIPANTS: Data are available for two waves. The MHM interviewed 398 of 715 migrants in 2007 (55.7%) and 722 of 1013 in 2013 (71.3%); as well as 604 of 751 (80.4%) for a non-migrant reference group in 2013. The total interviewed sample size for the MHM in both waves is 1809. These data include extensive information on lifetime migration, socioeconomic and demographic characteristics, sexual behaviours, marriage, household/family structure, social networks and social capital, HIV/AIDS biomarkers and other dimensions of health. FINDINGS TO DATE: Our result for the relationship between migration and health differs by health measure and analytic approach. Migrants in Malawi have a significantly higher HIV prevalence than non-migrants, which is primarily due to the selection of HIV-positive individuals into migration. We find evidence for health selection; physically healthier men and women are more likely to move, partly because migration selects younger individuals. However, we do not find differences in physical or mental health between migrants and non-migrants after moving. FUTURE PLANS: We are preparing a third round of data collection for these (and any new) migrants, which will take place in 2018. This cohort will be used to examine the effect of migration on various health measures and behaviours, including general mental and physical health, smoking and alcohol use, access to and use of health services and use of antiretroviral therapy.

Migration and HIV infection in Malawi.

OBJECTIVE: To evaluate the assumption that moving heightens HIV infection by examining the time-order between migration and HIV infection and investigate differences in HIV infection by migration destination and permanence. METHODS: We employ four waves of longitudinal data (2004-2010) for 4265 men and women from a household-based study in rural Malawi and a follow-up of migrants (2013). Using these data, we examine HIV status prior to migration. Migrants are disaggregated by destination (rural, town, and urban) and duration (return and permanent); all compared with individuals who consistently resided in the rural origin ('nonmigrants'). RESULTS: HIV-positive individuals have significantly greater odds of migration than those who are HIV negative [odds ratio 2.75; 95% confidence interval (CI) 1.89-4.01]. Being HIV positive significantly increases the relative risk (RR) that respondent will be a rural-urban migrant [RR ratio (RRR) 6.28; 95% CI 1.77-22.26), rural-town migrant (RRR 3.62; 95% CI 1.24-10.54), and a rural-rural migrant (RRR 4.09; 95% CI 1.68-9.97), instead of a nonmigrant. Being HIV positive significantly increases the RR that a respondent will move and return to the village of origin (RRR 2.58; 95% CI 1.82-3.66) and become a permanent migrant (RRR 3.21; 95% CI 1.77-5.82) instead of not migrating. CONCLUSION: HIV-positive status has a profound impact on mobility: HIV infection leads to significantly higher mobility through all forms of migration captured in our study. These findings emphasize that migration is more than just an independent risk factor for HIV infection: greater prevalence of HIV among migrants is partly due to selection of HIV-positive individuals into migration.

Community reaction to persons with HIV/AIDS and their parents: an analysis of recent evidence from Thailand.

We systematically examine community reaction to persons living with HIV/AIDS (PHAs) and their older parents in Thailand. We focus on parents as well as PHAs because parents are major providers of care for their ill adult children. Our analyses are based on several sources of recently collected survey and qualitative data from a wide range of perspectives. We find important variations in community reaction to PHAs and their families, but overall these reactions are much more positive than is widely assumed. We conclude that much existing research on community reaction to AIDS neglects both a rich body of social theory on stigma and a strong tradition of population-based empirical research in sociology. Much existing research also fails to adequately distinguish between key aspects of the social settings where most AIDS cases occur and the social settings where most of the stereotypes surrounding AIDS-related stigma have originated. A closer marriage between empirical and theoretical approaches to social stigma is required to advance our understanding of this critically important dimension of the AIDS epidemic.

Rural-to-Urban Migration and Changes in Health Among Young Adults in Thailand.

We investigate the impacts of rural-to-urban migration on the health of young adult migrants. A key methodological challenge involves the potentially confounding effects of selection on the relationship between migration and health. Our study addresses this challenge in two ways. To control for potential effects of prior health status on post-migration health outcomes, we employ a longitudinal approach. To control for static unobserved characteristics that can affect migration propensity as well as health outcomes, we use fixed-effects analyses. Data were collected in 2005 and 2007 for a cohort of young adults in rural Kanchanaburi province, western Thailand. The migrant sample includes individuals who subsequently moved to urban destinations where they were reinterviewed in 2007. Return migrants were interviewed in rural Kanchanaburi in both years but moved to an urban area and returned in the meantime. A rural comparison group comprises respondents who remained in the origin villages. An urban comparison sample includes longer-term residents of the urban destination communities. Physical and mental health measures are based on the SF-36 health survey. Findings support the "healthy migrant hypothesis." Migrants are physically healthier than their nonmigrant counterparts both before and after moving to the city. We did not find an effect of migration on physical health. Rural-to-urban migrants who stayed at destination experienced a significant improvement in mental health status. Fixed-effects analyses indicate that rural-to-urban migration positively affects mental health. Return migrants do not fare as well as migrants who stayed at destination on both physical and mental health status--evidence of selective return migration.

The relationship between mechanical properties and ballistic penetration depth in a viscoelastic gel.

The fundamental material response of a viscoelastic material when impacted by a ballistic projectile has important implication for the defense, law enforcement, and medical communities particularly for the evaluation of protective systems. In this paper, we systematically vary the modulus and toughness of a synthetic polymer gel to determine their respective influence on the velocity-dependent penetration of a spherical projectile. The polymer gels were characterized using tensile, compression, and rheological testing taking special care to address the unique challenges associated with obtaining high fidelity mechanical data on highly conformal materials. The depth of penetration data was accurately described using the elastic Froude number for viscoelastic gels ranging in Young's modulus from ~60 to 630 kPa. The minimum velocity of penetration was determined to scale with the gel toughness divided by the gel modulus, a qualitative estimate for the zone of deformation size scale upon impact. We anticipate that this work will provide insight into the critical material factors that control ballistic penetration behavior in soft materials and aid in the design and development of new ballistic testing media.

Return migration in the context of parental assistance in the AIDS epidemic: the Thai experience.

Most persons with AIDS (PWAs) eventually require demanding caregiving. This can prompt changes in living arrangements during the course of the illness. Few studies have attempted to examine the potential links between AIDS and migration from this perspective. The present study uses both direct and indirect approaches to examine the extent of return migration of adults with AIDS in Thailand and explores how this is linked to residence with and care by older aged parents. Methodological challenges and various approaches to the study of this phenomenon are discussed. Despite differences in the nature of information available from our samples and in basic sample characteristics, the findings show a consistent pattern suggestive of extensive return migration among PWAs. The fact that most return migrants die within a few months of their return indicates that they are seeking parental caregiving during the final stages of the illness. The vast majority of PWAs who returned home after becoming ill did so because of their illness, particularly due to a need for care.

HIV/AIDS-related knowledge and attitudes: a comparison of older persons and young adults in Thailand.

Levels of AIDS related knowledge are widely assumed to be high in Thailand, a country with probably the most effective response to the HIV/AIDS pandemic to date in the developing world. But efforts to verify these levels are sparse in recent years, and very little attention has ever been paid to AIDS knowledge and attitudes within the Thai older population. Because many Thai older persons (aged 50 and over) remain sexually active late in life, and because many more will be involved in interactions with and care taking of young adult persons suffering from AIDS, we explore AIDS knowledge and attitudinal data we collected during 1999 from a sample of 773 older Thais from four provinces and Bangkok. The sample provinces were chosen to include a wide range of prevalence levels and social contexts regarding the epidemic. We compare the results with data from a sample of 398 young adults using the same questionnaire, collected at the same sites, at the same time (total N = 1,171). We find an overall high level of awareness about AIDS across our age groups of interest, but also identify important deficiencies among the young adults and especially among the older Thais. Implications of the findings are discussed.

Review of Instrumented Indentation.

Instrumented indentation, also known as depth-sensing indentation or nanoindentation, is increasingly being used to probe the mechanical response of materials from metals and ceramics to polymeric and biological materials. The additional levels of control, sensitivity, and data acquisition offered by instrumented indentation systems have resulted in numerous advances in materials science, particularly regarding fundamental mechanisms of mechanical behavior at micrometer and even sub-micrometer length scales. Continued improvements of instrumented indentation testing towards absolute quantification of a wide range of material properties and behavior will require advances in instrument calibration, measurement protocols, and analysis tools and techniques. In this paper, an overview of instrumented indentation is given with regard to current instrument technology and analysis methods. Research efforts at the National Institute of Standards and Technology (NIST) aimed at improving the related measurement science are discussed.

Rural-to-urban migration and sexual debut in Thailand.

Migration from one's parents' home and sexual debut are common features of the transition to adulthood. Although many studies have described both of these features independently, few have examined the relationship between migration and sexual debut in a systematic manner. In this study, we explore this link for young adults in Thailand. With relatively high rates of internal migration, rapid modernization, a moderate HIV epidemic, and a declining average age of sexual debut, Thailand presents an instructive environment in which to examine migration and sexual debut. We use two waves of a longitudinal data set (2005 and 2007) that includes a subsample of young adults who migrated to urban areas during that period. We identify characteristics and behaviors associated with sexual debut and examine the role of migration on debut. Our approach reduces several common sources of bias that hamper existing work on both migration and sexual debut: (1) the longitudinal nature of the data enables us to examine the effects of characteristics that predate both behaviors of interest; (2) the survey on sexual behavior employed a technique that reduces response bias; and (3) we examine differences in debut by marital status. We find that migrants have a higher likelihood of sexual debut than nonmigrants.