Clea Sarnquist - Academia.edu (original) (raw)

Papers by Clea Sarnquist

Annals of global health, Aug 20, 2016

medRxiv (Cold Spring Harbor Laboratory), May 19, 2023

arXiv (Cornell University), Feb 16, 2020

We present statistical techniques for analyzing global positioning system (GPS) data in order to ... more We present statistical techniques for analyzing global positioning system (GPS) data in order to understand, communicate about, and prevent patterns of violence. In this pilot study, participants in Nairobi, Kenya were asked to rate their safety at several locations, with the goal of predicting safety and learning important patterns. These approaches are meant to help articulate differences in experiences, fostering a discussion that will help communities identify issues and policymakers develop safer communities. A generalized linear mixed model incorporating spatial information taken from existing maps of Kibera showed significant predictors (p < 0.05) of perceived lack of safety included being alone and time of day; in debrief interviews, participants described feeling unsafe in spaces with hiding places, disease carrying animals, and dangerous individuals. This pilot study demonstrates promise for detecting spatial patterns of violence, which appear to be confirmed by actual rates of measured violence at schools. Several factors relevant to community building consistently predict perceived safety and emerge in participants' qualitative descriptions, telling a cohesive story about perceived safety and empowering communication to community stakeholders.

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014), Nov 19, 2014

ABSTRACT Background: HIV-infected women may be at high risk of intimate partner violence (IPV), a... more ABSTRACT Background: HIV-infected women may be at high risk of intimate partner violence (IPV), and IPV, especially sexual violence, puts women at risk for HIV acquisition. Objectives: (1) describe the prevalence of IPV among HIV-infected women in Zimbabwe, and (2) assess associations between IPV and HIV disclosure. Methods: Survey data from 98 HIV-infected women (pregnant at baseline) were collected in 2011-12 at baseline and three months post-partum. Results: Over 75% of participants experienced at least one of the following from a partner: controlling behavior (73%), or physical (34%), sexual (15%), or emotional abuse (43%). Furthermore, 36/98 (36.7%) women reported sexual violence or moderate/severe physical violence and 14/36 (38.9%) sustained an injury as a result. Women experiencing any one kind of violence were significantly more likely to experience a second and/or third type of violence (p<0.02). Women experiencing controlling behavior (p=0.02) or emotional abuse (p=0.058) reported that their partners were less likely to disclose their HIV status. There were no significant associations between IPV and women disclosing their own HIV status. Conclusions: IPV is a significant problem in this HIV-infected population, suggesting a need for evidence-based interventions and policy changes to reduce IPV. Certain types of IPV were associated with decreased HIV disclosure. Sexual violence clearly puts women at risk of HIV; our findings suggest that emotional abuse and controlling behavior may also increase HIV risk by decreasing the likelihood of HIV disclosure before sex. These findings support the need for violence prevention in high HIV-prevalence communities.

Journal of Interpersonal Violence

Intimate partner violence (IPV) has myriad negative health and economic consequences for women an... more Intimate partner violence (IPV) has myriad negative health and economic consequences for women and families. We hypothesized that empowering women through a combination of formal business training, microfinance, and IPV support groups would decrease IPV and improve women’s economic status. The study included adult female survivors of severe IPV. Women living in Korogocho received the intervention and women in Dandora served as a standard of care (SOC) group, but received the intervention at the end of the follow-up period. Women in the intervention groups ( n = 82, SOC group, n = 81) received 8 weeks of business training, assistance creating a business plan, a small initial loan (about US$60), and weekly business and social support meetings. The two primary outcome measures included change in: (a) average daily profit margin, and (b) incidence of severe IPV. Exploratory analysis also looked at incidence of violence against children and women’s self-efficacy. Average daily profit mar...

Violence Against Women, 2019

The empirical science of measuring and preventing sexual assault is in its infancy, especially wh... more The empirical science of measuring and preventing sexual assault is in its infancy, especially when considering adolescents in developing nations. We analyze pre-intervention data collected in a two-arm cluster-randomized controlled trial of a classroom-based sexual assault prevention program deployed to Class 6 students around Nairobi, Kenya. We estimate that 7.2% of girls were raped in the prior 12 months. We identify school- and individual-level risk factors for rape. We isolate, as much as possible, variation in probability of rape attributable to a subset of these risk factors. We discuss statistical challenges and solutions in each of these domains.

Open Forum Infectious Diseases

Background Understanding how COVID-19 vaccination affects transmission of SARS-CoV-2 within house... more Background Understanding how COVID-19 vaccination affects transmission of SARS-CoV-2 within households may affect policy and healthcare decisions. We hypothesized that vaccination reduces transmission and viral load in vaccinated household members. Methods We prospectively enrolled participants during March 2020 – October 2021. Index cases (IC) were eligible if they tested positive for SARS-CoV-2 within the previous 10 days and did not have household contacts (HC) who had tested positive or had symptoms of COVID-19. Participants self-collected anterior nares swabs daily for SARS-CoV-2 RT-PCR for at least 21 days, or once every member of the household had 7 consecutive negative tests. Baseline data included demographics and self-reported vaccination status. Complete COVID-19 vaccination was defined as receiving 2 doses of Moderna/Pfizer or 1 dose of Johnson & Johnson vaccine, and incomplete vaccination as receiving 1 dose of Moderna/Pfizer vaccine. Household transmission was analyzed...

1st National Immunization Conference Online (NIC …, 2012

... 26, 2012. Poster Hall. Kris Calvin, MA , Chief Executive Officer, American Academy of Pediatr... more ... 26, 2012. Poster Hall. Kris Calvin, MA , Chief Executive Officer, American Academy of Pediatrics, California Foundation. Mark Sawyer, MD. Clea Sarnquist, DrPH, MPH. Yvonne Maldonado, MD. Wilbert Mason, MD. Dean Blumberg, MD. Jeffrey Luther, MD. Kimberly Ralston, MPH ...

Background: National estimates indicate one in three pregnant women is not HIV tested despite tes... more Background: National estimates indicate one in three pregnant women is not HIV tested despite testing mandates. Prenatal testing is highly associated with successfully preventing HIV transmission. This study looks at reasons pregnant women are not prenatally tested. Methods: 10,976 women ≥15 yrs, were sampled from the population of all 500,000+ women delivering annually in California. Subjects were identified through birth certificate data (2003-2005), as part of Maternal and Infant Health Assessment; an English/Spanish population-based mailed survey (>70% response rate). Outcomes were reasons specified in the survey for not being prenatally HIV tested; women could choose more than one reason. Results: Among women who reported not being tested (20.24%) the main reasons for lack of testing were: thought they did not have HIV (52.35%), were not offered a test (37.19%), and were previously tested (32.10%). From multivariate analysis Latina and Asian women were almost twice as likely...

Maternal and Child Health Journal, 2012

This qualitative study aimed to assess factors influencing pregnant women&amp;amp;amp;amp... more This qualitative study aimed to assess factors influencing pregnant women&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s decision to seek or avoid antenatal care (ANC) in the Andes of Peru. Open-ended, semi-structured interviews were conducted with 24 women utilizing ANC (+) and 10 women avoiding ANC (-). Interviews were translated to English from Quechua and Spanish, transcribed, and analyzed using grounded theory. Factors influencing ANC- women included: expecting criticism for having additional children; long ANC wait time and inconvenient hours of operation; and masculine gender of health workers. For ANC+ women, motivating factors included: maximizing positive health outcomes; past negative maternity experiences; pressure from family members; and avoidance of rumored fines or fees associated with ANC non-attendance and in-hospital deliveries, respectively. Both ANC+ and ANC- women were fearful and embarrassed about possible criticism for having additional children and the gender of the health workers, yet they weighed these factors differently. To better understand how rural women make decisions about ANC attendance, it is important to consider the value they place on the factors influencing their decision, and their emotional assessment of such issues.

Background: HIV is increasingly affecting both women and individuals in rural areas. Most of the ... more Background: HIV is increasingly affecting both women and individuals in rural areas. Most of the research on HIV-infected rural women has been performed in resource-scare global settings or the southeastern U.S. This study aimed to further understand the demographics and economic status of rural, HIV-infected women in California. Methods: Retrospective structured interviews with 59 HIV-infected women living in rural areas. Eleven facilities were randomly sampled to participate and all HIV-infected female patients seeking care during four months of 2007 were eligible to participate. Results: The majority of women were >40 (74%) and white (50%), followed by Latina (33%). Most were currently single (85%), and spoke primarily English (75%). 73% had an annual household income <$9,000 per year, with 32% reporting an income <$0,000 per year. However, 68% had at least a high school education, with 42% reporting at minimum some college. 33% were also the sole provider for a dependen...

Conflict and Health

Background The Democratic Republic of Congo (DRC) has a long history of conflict and ongoing loca... more Background The Democratic Republic of Congo (DRC) has a long history of conflict and ongoing local instability; the eastern provinces, including South Kivu, have been especially affected. Health systems and livelihoods have been undermined, contributing to massive inequities in access to health services and high rates of internal displacement. Asili, an innovative social enterprise program, aimed to provide essential community services and improve the health of under-five children in two South Kivu communities, Mudaka and Panzi, via provision of small-format, franchisable health clinics and clean water services. Methods We evaluated utilization and acceptance of Asili services in two study sites, Mudaka and Panzi. Data collected included questions on housing conditions, food security, and at follow up, Asili membership and use, satisfaction with services, and recommendations for improvement. Structured pre- and post-interviews with primary caregivers of families with under-five chil...

BMC Public Health, 2021

An amendment to this paper has been published and can be accessed via the original article.

Open Forum Infectious Diseases, 2017

Background As wild poliovirus is eradicated and countries switch from Oral Polio Vaccine (OPV) to... more Background As wild poliovirus is eradicated and countries switch from Oral Polio Vaccine (OPV) to Inactivated Polio Vaccine (IPV) per WHO recommendations, preventing circulation of vaccine-derived poliovirus is a top priority. However, spatial dynamics of OPV transmission are not well understood. Understanding these trends will improve resource targeting in the event of OPV reintroduction in undervaccinated communities. Mexico provides a natural environment to study OPV as it provides IPV routinely and bi-annual OPV campaigns. Methods Children in three villages near Orizaba, Mexico were randomized to three levels (10%, 30%, 70%) to receive OPV. We measured distance to nearest OPV shedding, and the amount of shedding close to unvaccinated individuals. We used maps to show the proximity and amount of shedding. Distance and density of shedding was analyzed separately using mixed effects logistic regression with random effects for household and time, adjusted for age, gender, area, and ...

The Lancet Global Health, 2018

Background Eastern DR Congo is recovering from decades of armed conflict in which violence agains... more Background Eastern DR Congo is recovering from decades of armed conflict in which violence against women (VAW) was widely used as a weapon of war. Even now, rates remain high: 34•5% and 47•5% of women in South Kivu report ever experiencing sexual or physical violence, respectively. However, there are few data on the impact of VAW on the health of women and their children. Methods In August 2016, we collected baseline data on demographic and health-related variables from mothers of children younger than 5 years in 843 households enrolled as part of a larger impact evaluation. Women's empowerment was measured using the previously validated Rosenberg's self-esteem scale (RSES), the generalised self-efficacy scale (GSES), and a gender relations scale originally developed by the Medical Research Council of South Africa. GSES and RSES scores were generated by averaging individual responses to questions; bivariate analyses of the scores with individual gender relations questions were conducted using χ² tests. Findings Of the 845 mothers interviewed, 325 (45•5%) had less than a primary education. The mean number of children younger than 18 years per household was four, with 66 (8%) of households having more than seven such children. Mean self-esteem score was 18•2 (SD 5•3) and mean self-efficacy score was 26•2 (SD 6•3), and internal reliability tests of the RSES and GSES scales yielded alphas of α=0•76 and α=0•89, respectively. Women with higher GSES or RSES scores were less likely to accept physical violence or sexual coercion than women with lower scores (p<0•05); however, perception of male authority and gender roles within the household did not vary by score. Interpretation This population of women had lower self-esteem than for a generalised population in DR Congo (21•3), probably because of the prolonged conflict in eastern DR Congo. Furthermore, mean GSES was lower than that of another post-conflict setting (Iran, 30•2), as well as several higher-income countries (29-32). Funding American Refugee Committee.

Open Forum Infectious Diseases, 2019

Background As wild poliovirus is nearing global eradication and countries switch from Oral Polio ... more Background As wild poliovirus is nearing global eradication and countries switch from Oral Polio Vaccine (OPV) to Inactivated Polio Vaccine (IPV), preventing circulating vaccine-derived poliovirus is a top priority. However, the circulation of OPV serotypes remains a concern in undervaccinated communities. We sought to examine the relationship between pediatric nutritional status and OPV shedding based on length-for-age categorizations. Mexico provides a natural environment to study these patterns as it provides routine IPV immunization and bi-annual OPV campaigns. Methods We enrolled 466 households with children eligible for OPV before the February 2015 national health week from 3 semi-rural Indigenous communities near Orizaba, Mexico. In each community, a different proportion of eligible children received OPV (10%, 30%, 70%), with a total of 155 vaccinated children. OPV shedding was measured by RT-qPCR detection of OPV in samples collected serially over 10 weeks. Anthropometric me...

Clinical Infectious Diseases, 2018

Background. Understanding the spatial dynamics of oral polio vaccine (OPV) transmission will impr... more Background. Understanding the spatial dynamics of oral polio vaccine (OPV) transmission will improve resource targeting. Mexico provides a natural laboratory, as it uses inactivated polio vaccine routinely as well as OPV biannually. Methods. Using geospatial maps, we measured the distance and density of OPV vaccinees' shedding in the areas nearest to unvaccinated households in 3 Mexican villages. Comparison of transmission to unvaccinated households utilized a mixed effects logistic regression with random effects for household and time, adjusted for age, gender, area, and running water. Results. The median distance from an unvaccinated household to its nearest OPV-shedding household was 85 meters (interquartile range, 46-145) and the median number of vaccinees shedding OPV within 200 m was 3 (2-6). Transmission to unvaccinated households occurred by day 1. There was no association (odds ratio [OR] 1.04; 95% credible interval [CrI] 0.92-1.16) between the distance from OPV shedding and the odds of transmission. The number of OPV vaccinees shedding within 200 m came close to a significant association with unvaccinated transmission (OR 0.93; CrI 0.84-1.01), but this was not the case for households 100 or 500 m apart. Results were consistent across the 3 villages. Conclusions. Geospatial analysis did not predict community transmission from vaccinated to unvaccinated households, because OPV use resulted in rapid, low transmission levels. This finding supports the global cessation of OPV.

Central European Journal of Public Health, 2011

Objective: As HIV/AIDS prevalence rises in Eastern Europe, assessment of local epidemics in the b... more Objective: As HIV/AIDS prevalence rises in Eastern Europe, assessment of local epidemics in the bordering Central European region, especially South Eastern Europe, is vital in order to meet treatment and prevention needs. Understanding current medical and social needs and barriers to care experienced by HIV-positive patients in these regions may provide insight into how to best respond to the local epidemics, increase patients' access to treatment, and reduce loss to follow-up. Design: This study assesses the patient characteristics, barriers to care, and current medical and social needs of HIV-positive patients in Albania. Semi-structured interviews were used in this cross-sectional study. Methods: We interviewed 79 of 85 patients (93% response rate) followed at the University Hospital Center of Tirana (UHCT) HIV/AIDS Ambulatory Clinic, which represented the majority of patients under HIV care in Albania during 2009. Results: The local HIV epidemic seems to be comprised mainly of heterosexual men who have spent an average of 3.6 years abroad. The vast majority of patients under care at UHCT HIV/AIDS Ambulatory Clinic had experienced barriers to care associated with social stigma (97.4%), lack of knowledge of HIV medical care (76.6%), and medical provider's lack of knowledge of HIV (70.9%). Social needs of the patients were also overwhelmingly unmet (90.0-95.7%).