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The health situation of indigenous peoples is comparable to that of the world's poorest populations, but with the additional burdens of social and cultural marginalization, geographic and cultural barriers to accessing health services, and, in some areas, appropriation of land and natural resources. Cultural transmission (the transfer of beliefs, ideas,

The health situation of indigenous peoples is comparable to that of the world's poorest populations, but with the additional burdens of social and cultural marginalization, geographic and cultural barriers to accessing health services, and, in some areas, appropriation of land and natural resources. Cultural transmission (the transfer of beliefs, ideas, and behaviors from one culture to another) from outsider health institutions should presumably aid in closing this health gap by transferring knowledge, practices, and infrastructure to prevent and treat disease. This study examines the biosocial construction of the disease ecology of tuberculosis (TB) in indigenous communities of the Paraguayan Chaco with varying degrees of cultural transmission from outside institutions (government, religious, and NGOs), to determine the influence of cultural transmission on local disease ecologies. Using a biocultural epidemiological framework for the analysis of human infectious disease ecology, this study employed an interdisciplinary, mixed methods approach to examine the interactions of host, pathogen, and the environment in the Paraguayan Chaco. Three case studies examining aspects of TB disease ecology in indigenous communities are presented: (1) The effective cultural transmission of biomedical knowledge to isolated communities, (2) Public health infrastructure, hygiene, and the prevalence of intestinal parasites: co-morbidities that promote the progression to active TB disease, and (3) Community-level risk factors for TB and indigenous TB burden. Findings from the case studies suggest that greater influence from outside institutions was not associated with greater adoption of biomedical knowledge of TB. The prevalence of helminthiasis was unexpectedly low, but infection with giardia was common, even in a community with cleaner water sources. Communities with a health post were more likely to report active adult TB, while communities with more education were less likely to report active pediatric TB, suggesting that healthcare access is the major determinant of TB detection. More research is needed on the role of non-indigenous community residents and other measures of acculturation or integration in TB outcomes, especially at the household level. Indigenous TB burden in the Chaco is disproportionately high, and better understanding of the mechanisms that produce higher incidence and prevalence of the disease is needed.
ContributorsVansteelandt, Amanda (Author) / Hurtado, Ana Magdalena (Thesis advisor) / Stone, Anne (Thesis advisor) / Hruschka, Daniel (Committee member) / Rojas de Arias, Antonieta (Committee member) / Arizona State University (Publisher)
Created2014
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Description
Energy use within urban building stocks is continuing to increase globally as populations expand and access to electricity improves. This projected increase in demand could require deployment of new generation capacity, but there is potential to offset some of this demand through modification of the buildings themselves. Building

Energy use within urban building stocks is continuing to increase globally as populations expand and access to electricity improves. This projected increase in demand could require deployment of new generation capacity, but there is potential to offset some of this demand through modification of the buildings themselves. Building stocks are quasi-permanent infrastructures which have enduring influence on urban energy consumption, and research is needed to understand: 1) how development patterns constrain energy use decisions and 2) how cities can achieve energy and environmental goals given the constraints of the stock. This requires a thorough evaluation of both the growth of the stock and as well as the spatial distribution of use throughout the city. In this dissertation, a case study in Los Angeles County, California (LAC) is used to quantify urban growth, forecast future energy use under climate change, and to make recommendations for mitigating energy consumption increases. A reproducible methodological framework is included for application to other urban areas.

In LAC, residential electricity demand could increase as much as 55-68% between 2020 and 2060, and building technology lock-in has constricted the options for mitigating energy demand, as major changes to the building stock itself are not possible, as only a small portion of the stock is turned over every year. Aggressive and timely efficiency upgrades to residential appliances and building thermal shells can significantly offset the projected increases, potentially avoiding installation of new generation capacity, but regulations on new construction will likely be ineffectual due to the long residence time of the stock (60+ years and increasing). These findings can be extrapolated to other U.S. cities where the majority of urban expansion has already occurred, such as the older cities on the eastern coast. U.S. population is projected to increase 40% by 2060, with growth occurring in the warmer southern and western regions. In these growing cities, improving new construction buildings can help offset electricity demand increases before the city reaches the lock-in phase.
ContributorsReyna, Janet Lorel (Author) / Chester, Mikhail V (Thesis advisor) / Gurney, Kevin (Committee member) / Reddy, T. Agami (Committee member) / Rey, Sergio (Committee member) / Arizona State University (Publisher)
Created2016
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Description
Suicide is one of the fastest-growing and least-understood causes of death, particularly in low and middle income countries (LMIC). In low-income settings, where the technical capacity for death surveillance is limited, suicides may constitute a significant portion of early deaths, but disappear as they are filtered through reporting systems shaped

Suicide is one of the fastest-growing and least-understood causes of death, particularly in low and middle income countries (LMIC). In low-income settings, where the technical capacity for death surveillance is limited, suicides may constitute a significant portion of early deaths, but disappear as they are filtered through reporting systems shaped by social, cultural, and political institutions. These deaths become unknown and unaddressed. This dissertation illuminates how suicide is perceived, contested, experienced, and interpreted in institutions ranging from the local (i.e., family, community) to the professional (i.e., medical, law enforcement) in Nepal, a country purported to have one of the highest suicide rates in the world. Drawing on a critical medical anthropology approach, I bridge public health and anthropological perspectives to better situate the problem of suicide within a greater social-political context. I argue that these complex, contestable deaths, become falsely homogenized, or lost. During 18 months of fieldwork in Nepal, qualitative, data tracing, and psychological autopsy methodologies were conducted. Findings are shared through three lenses: (1) health policy and world systems; (2) epidemiology and (3) socio-cultural. The first investigates how actors representing familial, legal, and medical institutions perceive, contest, and negotiate suicide documentation, ultimately failing to accurately capture a leading cause of death. Using epidemiologic perspectives, surveillance data from medical and legal agencies are analyzed and pragmatic approaches to better detect and prevent suicidal death in the Nepali context are recommended. The third lens provides perceived explanatory models for suicide. These narratives offer important insights into the material, social, and cultural factors that shape suicidal acts in Nepal. Findings are triangulated to inform policy, prevention, and intervention approaches to reduce suicidal behavior and improve health system capabilities to monitor violent deaths. These approaches go beyond typical psychological investigations of suicide by situating self-inflicted death within broader familial, social, and political contexts. Findings contribute to cultural anthropological theories related to suicide and knowledge production, while informing public health solutions. Looking from the margins towards centers of power, this dissertation explicates how varying institutional numbers can obfuscate and invalidate suffering experienced at local levels.
ContributorsHagaman, Ashley (Author) / Wutich, Amber (Thesis advisor) / Hruschka, Daniel (Committee member) / Kohrt, Brandon (Committee member) / Arizona State University (Publisher)
Created2017
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Description
Lay theories of healthy eating are a potentially important consideration for public health and nutrition efforts as perceptions and beliefs about “healthiness” are key determinants of dietary choices (Furst et al. 1996; Grunert, 2007). A rich body of social science literature has examined how people across cultures decide what counts

Lay theories of healthy eating are a potentially important consideration for public health and nutrition efforts as perceptions and beliefs about “healthiness” are key determinants of dietary choices (Furst et al. 1996; Grunert, 2007). A rich body of social science literature has examined how people across cultures decide what counts as healthy eating, yet such work has focused mainly on what people think is good and bad to consume, overlooking another important aspect- how one eats. The ways one eats can include patterns and timing of meal intake, as well as mental and emotional states during eating (henceforth, “eating styles”). This dissertation aims to 1) examine whether beliefs on eating styles constitute a separate category of healthy eating perceptions, 2) describe American and Eastern European lay models of how both food characteristics and styles of eating shape health outcomes, and 2) investigate cross-cultural variation in the endorsement of eating styles as important for health in the United States and Eastern Europe. Aims 1 and 2 use pile sorts (n=48), in-person interviews (n=49), and online surveys (n=283) to elicit subjective perspectives on how different eating considerations impact health, and aim 3 involves two sets of questionnaires collected in the U.S. (n=50; n=42) and Eastern Europe (n=42; n=35) to test the hypothesis that levels of collectivism influence variation in endorsement of eating styles for health. Results demonstrate that “eating styles” is a separate category of beliefs in people’s models of healthy eating and individuals in both cultures perceive a variety of important health outcomes from how one eats- weight management, energy levels, digestive health, and overall feeling of wellbeing. These perceptions are not uniform, as participants held contrasting models of how styles of food consumption can influence weight control, and Eastern European respondents held additional views on how aspects of food timing can affect long-term health. Finally, results show that individual level of collectivism, not differences in nationality, accounts for variation in endorsement of eating styles for health. These results suggest that the holistic pattern of attention characteristic of the collectivist social orientation extends to the domain of diet.
ContributorsVoytyuk, Mariya (Author) / Hruschka, Daniel (Thesis advisor) / Slade, Alexandra (Committee member) / Bruening, Meredith (Committee member) / Arizona State University (Publisher)
Created2017
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Description
Resource transfers can confer many adaptive benefits such as specialization, helping genetically related individuals, future compensation, and risk-pooling. Need-based transfers are a risk-pooling mechanism in which partners mitigate unpredictable losses by transferring resources based on need. Need-based transfers are likely to be most useful for resources that are necessary and

Resource transfers can confer many adaptive benefits such as specialization, helping genetically related individuals, future compensation, and risk-pooling. Need-based transfers are a risk-pooling mechanism in which partners mitigate unpredictable losses by transferring resources based on need. Need-based transfers are likely to be most useful for resources that are necessary and unpredictable because being unable to reliably obtain essential resources would be devastating. However, need-based transfers make people vulnerable to two types of exploitation: a person can be greedy by asking when not in need and a person with a surplus of resources can be stingy by not giving to someone in need. Previous research suggests that people might have cognitive mechanisms for detecting greediness and stinginess, which would serve to protect against exploitation by cheaters. This study investigated whether resources that are necessary and unpredictable are most likely to trigger greediness and stinginess detection mechanisms. Participants saw four types of rules. One rule could be violated through greedy behavior, another through stingy behavior, another by not paying a debt, and another was a descriptive rule that could be violated by not finding one type of resource near another type of resource. Then, participants saw information about events relating to one of the rules and indicated whether the rule in question could have been violated. Consistent with past research, participants were better at detecting greediness, stinginess, and debts not paid than at detecting violations of a descriptive rule. However, contrary to my predictions, the necessity and unpredictability of resources did not impact people’s ability to detect greediness and stinginess. The lack of support for my hypothesis might be because the benefits of detecting greediness and stinginess might outweigh the costs even for situations in which need-based transfer rules are unlikely to apply, because people might be able to consciously activate their greediness and stinginess mechanisms even for resources that would not naturally trigger them, or because of methodological limitations.
ContributorsMunoz Castro, Andres (Author) / Aktipis, Athena (Thesis advisor) / Hruschka, Daniel (Committee member) / Neuberg, Steven (Committee member) / Arizona State University (Publisher)
Created2019
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Description

A globally integrated carbon observation and analysis system is needed to improve the fundamental understanding of the global carbon cycle, to improve our ability to project future changes, and to verify the effectiveness of policies aiming to reduce greenhouse gas emissions and increase carbon sequestration. Building an integrated carbon observation

A globally integrated carbon observation and analysis system is needed to improve the fundamental understanding of the global carbon cycle, to improve our ability to project future changes, and to verify the effectiveness of policies aiming to reduce greenhouse gas emissions and increase carbon sequestration. Building an integrated carbon observation system requires transformational advances from the existing sparse, exploratory framework towards a dense, robust, and sustained system in all components: anthropogenic emissions, the atmosphere, the ocean, and the terrestrial biosphere. The paper is addressed to scientists, policymakers, and funding agencies who need to have a global picture of the current state of the (diverse) carbon observations.

We identify the current state of carbon observations, and the needs and notional requirements for a global integrated carbon observation system that can be built in the next decade. A key conclusion is the substantial expansion of the ground-based observation networks required to reach the high spatial resolution for CO2 and CH4 fluxes, and for carbon stocks for addressing policy-relevant objectives, and attributing flux changes to underlying processes in each region. In order to establish flux and stock diagnostics over areas such as the southern oceans, tropical forests, and the Arctic, in situ observations will have to be complemented with remote-sensing measurements. Remote sensing offers the advantage of dense spatial coverage and frequent revisit. A key challenge is to bring remote-sensing measurements to a level of long-term consistency and accuracy so that they can be efficiently combined in models to reduce uncertainties, in synergy with ground-based data.

Bringing tight observational constraints on fossil fuel and land use change emissions will be the biggest challenge for deployment of a policy-relevant integrated carbon observation system. This will require in situ and remotely sensed data at much higher resolution and density than currently achieved for natural fluxes, although over a small land area (cities, industrial sites, power plants), as well as the inclusion of fossil fuel CO2 proxy measurements such as radiocarbon in CO2 and carbon-fuel combustion tracers. Additionally, a policy-relevant carbon monitoring system should also provide mechanisms for reconciling regional top-down (atmosphere-based) and bottom-up (surface-based) flux estimates across the range of spatial and temporal scales relevant to mitigation policies. In addition, uncertainties for each observation data-stream should be assessed. The success of the system will rely on long-term commitments to monitoring, on improved international collaboration to fill gaps in the current observations, on sustained efforts to improve access to the different data streams and make databases interoperable, and on the calibration of each component of the system to agreed-upon international scales.

ContributorsCiais, P. (Author) / Dolman, A. J. (Author) / Bombelli, A. (Author) / Duren, R. (Author) / Peregon, A. (Author) / Rayner, P. J. (Author) / Miller, C. (Author) / Gobron, N. (Author) / Kinderman, G. (Author) / Marland, G. (Author) / Gruber, N. (Author) / Chevallier, F. (Author) / Andres, R. J. (Author) / Balsamo, G. (Author) / Bopp, L. (Author) / Breon, F. -M. (Author) / Broquet, G. (Author) / Dargaville, R. (Author) / Battin, T. J. (Author) / Borges, A. (Author) / Bovensmann, H. (Author) / Buchwitz, M. (Author) / Butler, J. (Author) / Canadell, J. G. (Author) / Cook, R. B. (Author) / DeFries, R. (Author) / Engelen, R. (Author) / Gurney, Kevin (Author) / Heinze, C. (Author) / Heimann, M. (Author) / Held, A. (Author) / Henry, M. (Author) / Law, B. (Author) / Luyssaert, S. (Author) / Miller, J. (Author) / Moriyama, T. (Author) / Moulin, C. (Author) / Myneni, R. (Author) / College of Liberal Arts and Sciences (Contributor)
Created2013-11-30
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Description

Errors in the specification or utilization of fossil fuel CO2 emissions within carbon budget or atmospheric CO2 inverse studies can alias the estimation of biospheric and oceanic carbon exchange. A key component in the simulation of CO2 concentrations arising from fossil fuel emissions is the spatial distribution of the emission

Errors in the specification or utilization of fossil fuel CO2 emissions within carbon budget or atmospheric CO2 inverse studies can alias the estimation of biospheric and oceanic carbon exchange. A key component in the simulation of CO2 concentrations arising from fossil fuel emissions is the spatial distribution of the emission near coastlines. Regridding of fossil fuel CO2 emissions (FFCO2) from fine to coarse grids to enable atmospheric transport simulations can give rise to mismatches between the emissions and simulated atmospheric dynamics which differ over land or water. For example, emissions originally emanating from the land are emitted from a grid cell for which the vertical mixing reflects the roughness and/or surface energy exchange of an ocean surface. We test this potential "dynamical inconsistency" by examining simulated global atmospheric CO2 concentration driven by two different approaches to regridding fossil fuel CO2 emissions. The two approaches are as follows: (1) a commonly used method that allocates emissions to grid cells with no attempt to ensure dynamical consistency with atmospheric transport and (2) an improved method that reallocates emissions to grid cells to ensure dynamically consistent results. Results show large spatial and temporal differences in the simulated CO2 concentration when comparing these two approaches. The emissions difference ranges from −30.3 TgC grid cell-1 yr-1 (−3.39 kgC m-2 yr-1) to +30.0 TgC grid cell-1 yr-1 (+2.6 kgC m-2 yr-1) along coastal margins. Maximum simulated annual mean CO2 concentration differences at the surface exceed ±6 ppm at various locations and times. Examination of the current CO2 monitoring locations during the local afternoon, consistent with inversion modeling system sampling and measurement protocols, finds maximum hourly differences at 38 stations exceed ±0.10 ppm with individual station differences exceeding −32 ppm. The differences implied by not accounting for this dynamical consistency problem are largest at monitoring sites proximal to large coastal urban areas and point sources. These results suggest that studies comparing simulated to observed atmospheric CO2 concentration, such as atmospheric CO2 inversions, must take measures to correct for this potential problem and ensure flux and dynamical consistency.

ContributorsZhang, X. (Author) / Gurney, Kevin (Author) / Rayner, P. (Author) / Liu, Y. (Author) / Asefi-Najafabady, Salvi (Author) / College of Liberal Arts and Sciences (Contributor)
Created2013-11-30
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Description

Objective: To estimate the absolute wealth of households using data from demographic and health surveys.

Methods: We developed a new metric, the absolute wealth estimate, based on the rank of each surveyed household according to its material assets and the assumed shape of the distribution of wealth among surveyed households. Using

Objective: To estimate the absolute wealth of households using data from demographic and health surveys.

Methods: We developed a new metric, the absolute wealth estimate, based on the rank of each surveyed household according to its material assets and the assumed shape of the distribution of wealth among surveyed households. Using data from 156 demographic and health surveys in 66 countries, we calculated absolute wealth estimates for households. We validated the method by comparing the proportion of households defined as poor using our estimates with published World Bank poverty headcounts. We also compared the accuracy of absolute versus relative wealth estimates for the prediction of anthropometric measures.

Findings: The median absolute wealth estimates of 1 403 186 households were 2056 international dollars per capita (interquartile range: 723-6103). The proportion of poor households based on absolute wealth estimates were strongly correlated with World Bank estimates of populations living on less than 2.00 United States dollars per capita per day (R-2=0.84). Absolute wealth estimates were better predictors of anthropometric measures than relative wealth indexes.

Conclusion: Absolute wealth estimates provide new opportunities for comparative research to assess the effects of economic resources on health and human capital, as well as the long-term health consequences of economic change and inequality.

ContributorsHruschka, Daniel (Author) / Gerkey, Drew (Author) / Hadley, Craig (Author) / College of Liberal Arts and Sciences (Contributor)
Created2015-07-01
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Background: Prior studies have shown that using uterotonics to augment or induce labor before arrival at comprehensive Emergency Obstetric and Neonatal Care (CEmONC) settings (henceforth, “outside uterotonics”) may contribute to perinatal mortality in low- and middle-income countries. We estimate its effect on perinatal mortality in rural Bangladesh.

Methods: Using hospital records (23986 singleton

Background: Prior studies have shown that using uterotonics to augment or induce labor before arrival at comprehensive Emergency Obstetric and Neonatal Care (CEmONC) settings (henceforth, “outside uterotonics”) may contribute to perinatal mortality in low- and middle-income countries. We estimate its effect on perinatal mortality in rural Bangladesh.

Methods: Using hospital records (23986 singleton term births, Jan 1, 2009-Dec 31, 2015) from rural Bangladesh, we use a logistic regression model to estimate the increased risk of perinatal death from uterotonics administered outside a CEmONC facility.

Results: Among term births (≥37 weeks gestation), the risk of perinatal death adjusted for key confounders is significantly increased among women reporting uterotonic use outside of CEmONC (OR = 3 · 0, 95 % CI = 2 · 4,3 · 7). This increased risk is particularly high for fresh stillbirths (OR = 4 · 0, 95 % CI = 3 · 0,5 · 3) and intrapartum-related causes of early neonatal deaths (birth asphyxia) (OR = 3 · 1, 95 % CI = 2 · 2,4 · 5).

Conclusions: In this sample, outside uterotonic use was associated with substantially increased risk of fresh stillbirths, deaths due to birth asphyxia, and all perinatal deaths. In settings of high uterotonic use outside of controlled settings, substantial improvement in both stillbirth and early neonatal mortality may be made by reducing such use.

ContributorsDay, Louise T. (Author) / Hruschka, Daniel (Author) / Mussell, Felicity (Author) / Jeffers, Eva (Author) / Saha, Stacy L. (Author) / Alam, Shafiul (Author) / College of Liberal Arts and Sciences (Contributor)
Created2016-10-06
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Background: Improving perinatal health is the key to achieving the Millennium Development Goal for child survival. Recently, several reviews suggest that scaling up available effective perinatal interventions in an integrated approach can substantially reduce the stillbirth and neonatal death rates worldwide. We evaluated the effect of packaged interventions given in pregnancy,

Background: Improving perinatal health is the key to achieving the Millennium Development Goal for child survival. Recently, several reviews suggest that scaling up available effective perinatal interventions in an integrated approach can substantially reduce the stillbirth and neonatal death rates worldwide. We evaluated the effect of packaged interventions given in pregnancy, delivery and post-partum periods through integration of community- and facility-based services on perinatal mortality.

Methods: This study took advantage of an ongoing health and demographic surveillance system (HDSS) and a new Maternal, Neonatal and Child Health (MNCH) Project initiated in 2007 in Matlab, Bangladesh in half (intervention area) of the HDSS area. In the other half, women received usual care through the government health system (comparison area). The MNCH Project strengthened ongoing maternal and child health services as well as added new services. The intervention followed a continuum of care model for pregnancy, intrapartum, and post-natal periods by improving established links between community- and facility-based services. With a separate pre-post samples design, we compared the perinatal mortality rates between two periods--before (2005-2006) and after (2008-2009) implementation of MNCH interventions. We also evaluated the difference-of-differences in perinatal mortality between intervention and comparison areas.

Results: Antenatal coverage, facility delivery and cesarean section rates were significantly higher in the post- intervention period in comparison with the period before intervention. In the intervention area, the odds of perinatal mortality decreased by 36% between the pre-intervention and post-intervention periods (odds ratio: 0.64; 95% confidence intervals: 0.52-0.78). The reduction in the intervention area was also significant relative to the reduction in the comparison area (OR 0.73, 95% CI: 0.56-0.95; P = 0.018).

Conclusion: The continuum of care approach provided through the integration of service delivery modes decreased the perinatal mortality rate within a short period of time. Further testing of this model is warranted within the government health system in Bangladesh and other low-income countries.

ContributorsRahman, Anisur (Author) / Moran, Allisyn (Author) / Pervin, Jesmin (Author) / Rahman, Aminur (Author) / Rahman, Monjur (Author) / Yeasmin, Sharifa (Author) / Begum, Hosneara (Author) / Rashid, Harunor (Author) / Yunus, Mohammad (Author) / Hruschka, Daniel (Author) / Arifeen, Shams E. (Author) / Streatfield, Peter K. (Author) / Sibley, Lynn (Author) / Bhuiya, Abbas (Author) / Koblinsky, Marge (Author) / College of Liberal Arts and Sciences (Contributor)
Created2011-12-10