In 2006, the Chilean government began the implementation of a “program of integrated childhood protection” called Chile Crece Contigo. This program involves the cooperation of the public health, education, and legal systems of Chile in the support of the Rights of the Child ratified by the United Nations in 1989, and guarantees accessibility to the diverse historical and cultural communities of Chile. This study seeks to evaluate the cultural pertinence of Chile Crece Contigo as implemented in the public health system of the predominantly Aymaran community of Putre and recommend policy changes and further investigation for the improvement of its implementation in all Aymaran communities of Northern Chile. These objectives were pursued through three weeks of observation of program activities as well as interviews with key implementers of Chile Crece Contigo in Putre’s Rural Family Health Center, a practitioner of traditional Aymaran medicine and mothers whose children are enrolled or were enrolled in a variety of the services offered by the program. These results highlighted successful efforts by health practitioners in Putre to provide culturally relevant care through Chile Crece Contigo, but also policy failures and ongoing uncertainty considering best practices for cultural pertinence within the program. The conclusion was reached that several funding and logistical policies of Chile Crece Contigo need to be altered to better serve this rural, Aymaran community. Also, several in-depth longitudinal studies on traditional Aymaran upbringing and the common socioeconomic conditions of the Aymaran community in Chile should be carried out in order to determine further policy changes and best practices for Chile Crece Contigo.

The purpose of this research is to exploit the neglect of specific populations and diseases in Latin America through an epidemiological literature review. As a small part of a larger publication, the foci of this research was the infectious disease, helminthiasis. Using manually indexed abstracts from the National Library of Medicine database in PubMed, 4,594 papers were synthesized and then processed for further review. Of those papers, 29 provided information about helminths in indigenous populations. These papers were reviewed and used in prevalence data extraction and variable analysis. The main conclusion was to reveal the fact that from an entire health database less than 30 papers provided information about the persistence of helminths in indigenous communities of Latin America. Not only that but the few papers that could be analyzed had consistently high prevalence ratios.

Understanding the consequences of changes in social networks is an important an-

thropological research goal. This dissertation looks at the role of data-driven social

networks on infectious disease transmission and evolution. The dissertation has two

projects. The first project is an examination of the effects of the superspreading

phenomenon, wherein a relatively few individuals are responsible for a dispropor-

tionate number of secondary cases, on the patterns of an infectious disease. The

second project examines the timing of the initial introduction of tuberculosis (TB) to

the human population. The results suggest that TB has a long evolutionary history

with hunter-gatherers. Both of these projects demonstrate the consequences of social

networks for infectious disease transmission and evolution.

The introductory chapter provides a review of social network-based studies in an-

thropology and epidemiology. Particular emphasis is paid to the concept and models

of superspreading and why to consider it, as this is central to the discussion in chapter

2. The introductory chapter also reviews relevant epidemic mathematical modeling

studies.

In chapter 2, social networks are connected with superspreading events, followed

by an investigation of how social networks can provide greater understanding of in-

fectious disease transmission through mathematical models. Using the example of

SARS, the research shows how heterogeneity in transmission rate impacts super-

spreading which, in turn, can change epidemiological inference on model parameters

for an epidemic.

Chapter 3 uses a different mathematical model to investigate the evolution of TB

in hunter-gatherers. The underlying question is the timing of the introduction of TB

to the human population. Chapter 3 finds that TB’s long latent period is consistent

with the evolutionary pressure which would be exerted by transmission on a hunter-

igatherer social network. Evidence of a long coevolution with humans indicates an

early introduction of TB to the human population.

Both of the projects in this dissertation are demonstrations of the impact of var-

ious characteristics and types of social networks on infectious disease transmission

dynamics. The projects together force epidemiologists to think about networks and

their context in nontraditional ways.

Sexual assault at colleges and universities in the United States is a significant health and human rights issue that impacts somewhere between one-in-four and one-in-five students. Despite the alarmingly high burden, overall rates of disclosing to crisis, health, and victim services, and reporting to schools and law enforcement remain low. In order to buffer students from associated short- and long-term harm, and help them reestablish safety and pursue justice, empirically-supported, innovative, and trauma-informed secondary prevention strategies are needed. To address this pressing issue, the current study used a trauma-informed, feminist community research approach to develop and design a prototype of an internet-based decision aid specifically tailored to assist students at Arizona State University who experience sexual assault with making informed choices about reporting and seeking care, advocacy, and support on and off campus. Results from preliminary alpha testing of the tool showed that: 1. It is feasible to adapt decision aids for use with the target population, and 2. While aspects of the tool can be improved during the next phases of redrafting and redesign, members of the target population find it to be acceptable, comprehensible, and usable.

This study aims to determine if there are differences in body mass index (BMI) across ethnic groups in the United States. Modern medicine is increasingly going the way of personalized medicine, and existing literature has begun to suggest that cultural differences may have an effect on physical health. Initially, this study was to explore anorexia nervosa prevalence, but the data is simply not there; this led to a shift in focus to exploring health differences in terms of BMI. The data analyzed is from the National Health and Nutritional Examination Survey (NHANES) collected by the Centers of Disease Control and Prevention (CDC) from 1999-2013. The subjects used were aged 13-25, and the ethnicities compared were African American, Caucasian American, Mexican American, Other Hispanic American, Asian American, and Other (including multiracial). Statistical tests were run through the software program SAS and included ANOVA tests, t-tests, and z-tests. It was found that there are differences across ethnicities, and that there are far more differences among females than among males. Asian American males and Mexican American males appear to be the groups that caused males to have significant differences. Asian Americans were also found to have the lowest average BMI by far. On the other hand, African Americans and Mexican Americans appeared to have the highest average BMIs. Although these findings and others detailed in the paper are intriguing, the BMI data is not strictly normal, and is still not normalized even by transforming the variable into a log of BMI. The data is still right skewed, and must be attacked in the future with different transformations and non-parametric tests to increase the accuracy and strength of these findings.

The purpose of this study is to discover the exposure and network patterns during the 2013-2015 Ebola Virus Disease epidemic. The author accomplished this by taking an opportunistic sample of news and academic articles, some of which may also capture cases untreated and therefore unrecorded by hospitals and treatment units. Most of the 315 cases came from the Washington Post, New York Times, and World Health Organization, and they consistently captured between 1-2% of WHO case numbers. The results show that of cases with known exposures, 53.6% became infected through contact with sick family members. Hospital and funeral transmission accounted for the second and third most frequent exposure scenarios at 24.6% and 12.9% respectively. The exposures over time imply that hospital and funeral transmission prevention efforts have been successful, but family transmission has remained common throughout the outbreak. Prevention initiatives should focus on families earlier in epidemics to help control EVD's spread.

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.

A variety of studies have shown that the tendency toward nicotine dependence has a genetic component. The work described in this thesis addresses three separate questions: i) are there unidentified SNPs in the nicotinic receptors or other genes that contribute to the risk for nicotine dependence; ii) is there evidence of ongoing selection at nicotinic receptor loci; and, iii) since nicotine dependence is unlikely to be the phenotype undergoing selection, is a positive effect on memory or cognition the selected phenotype. I first undertook a genome –wide association scan of imputed data using samples from the Collaborative Study of the Genetics of Nicotine Dependence (COGEND). A novel association was found between nicotine dependence and SNPs at 13q31. The genes at this newly associated locus on chromosome 13 encode a group of micro-RNAs and a member of the glypican gene family. These are among the first findings to implicate a non-candidate gene in risk for nicotine dependence. I applied several complimentary methods to sequence data from the 1000 Genomes Project to test for evidence of selection at the nicotinic receptor loci. I found strong evidence for selection for alleles in the nicotinic receptor cluster on chromosome 8 that confer risk of nicotine dependence. I then used the dataset from the Collaborative Studies on the Genetics of Alcoholism (COGA) and looked for an association between neuropsychological phenotypes and SNPs conferring risk of nicotine dependence. One SNP passed multiple test correction for association with WAIS digit symbol score. This SNP is not itself associated with nicotine dependence but is in reasonable (r 2 = 0.75) LD with SNPs that are associated with nicotine dependence. These data suggest at best, a weak correlation between nicotine dependence and any of the tested cognitive phenotypes. Given the reproducible finding of an inverse relationship between SNPs associated with risk for nicotine dependence and cocaine dependence, I hypothesize that the apparently detrimental phenotype of nicotine dependence may confer decreased risk for cocaine dependence. As cocaine use impairs the positive rewards associated with social interactions, reducing the risk of cocaine addiction may be beneficial to both the individual and the group.