A 10-year-old girl was living in a small village in southeastern Sierra Leone during the country’s decade-long civil war when the rebels arrived. “They said they were going to take the girls and boys,” she said. “I was the first person picked. They picked 20 girls and 20 boys. They took us to another town, and I was there one week. I was raped and couldn’t walk, so they left me there.”
This is just one of countless narratives of gender-based violence that adolescent girls face in humanitarian settings.
While some interventions exist, more needs to be done to ensure that global efforts to end gender-based violence include a focus on adolescent girls, finds a new study from the Brown School at Washington University in St. Louis published Nov. 20 in the journal The Lancet Child & Adolescent Health.
“Despite the fact that we know that violence against adolescent girls increases in humanitarian settings, this remains an under-researched and underfunded area of intervention,” said Lindsay Stark, associate professor and an expert on the protection and well-being of women and children in situations of extreme adversity.
“Such focused attention is essential to meeting international commitments such as the Sustainable Development Goals.”
Stark is co-author of the paper, “Gender-based violence against adolescent girls in humanitarian settings: a review of the evidence.” The study presents a novel framework for gender-based violence risks facing adolescent girls in emergencies, synthesizes the limited evidence for relevant prevention and response, and identifies barriers to effective and ethical measurement and evaluation.
“We have few evidence-based models for how to keep girls safe,” Stark said. “This reality not only has relevance for many of the global settings in which I work, but also communities closer to home who are currently being hit hard by the COVID pandemic.”
Sexual violence against girls and women is common in humanitarian settings, mainly due to their combined vulnerabilities related to age, gender and factors associated with conflict or disaster.
Among the limited studies that do exist, the majority come from sub-Saharan Africa and suggest that approximately 40% of female adolescents in emergency settings have experienced some form of intimate partner violence, Stark said.
In some humanitarian contexts, as many as 26.5% of adolescent girls have experienced nonpartner sexual violence, she said. Within the context of ongoing war, studies suggest that 29% to 44% of former female child soldiers experience rape during conflict.
Due to a lack of clear division of labor between gender-based violence and child protection sectors, adolescent girls are often neglected by both groups, and violence against this subpopulation too often goes unaddressed, the paper’s authors wrote.
The study included work in conflict-affected communities with refugees, both in camps and in urban settings; internally displaced people; and communities affected by natural disasters.
“While some early evidence highlights promising interventions for transforming girls’ attitudes around violence and gender inequity and improving mental well-being, limited evidence supports the ability of existing approaches to reduce the incidence of violence,” Stark said. “More explicit focus on adolescent girls is needed when designing and evaluating interventions to ensure global efforts to end gender-based violence are inclusive of this population.”
While many violence prevention programs focus exclusively on women or younger children, adolescent girls often fall through the cracks and lack the access and capital to advocate for their needs, she said.
“Efforts to measure experiences of gender-based violence for this often-neglected population, in particular, are critical for ensuring adolescent girls are not missed in programming,” the authors wrote in the paper. “Further, the upheaval that accompanies humanitarian crises also comes with an opening for structural and social change led by those affected; engaging and supporting adolescent girls in the process of designing, implementing and evaluating interventions and response services can help to ensure this population is not left behind in the global effort to end gender-based violence.”
Covid-19 has adversely affected millions of Americans who needed help the most even before the pandemic, an impact that has been especially noticeable in the holiday season, according to a Brown School expert who has been tracking calls to 2-1-1 helplines around the nation.
“The normal seasonal spikes in calls for help with holiday meals from low-income families are much lower this year,” said Matthew Kreuter, the Kahn Family Professor of Public Health. “Part of that is that there aren’t as many providers who are offering meals. One of the sad realities behind these numbers is that there may be a lot fewer people able to have a Thanksgiving meal.”
2-1-1 is a free and confidential service that helps people find the local resources they need 24 hours a day, seven days a week, in most communities. A team led by Kreuter, the senior scientist at the Brown School’s Health Communication Research Laboratory, and Rachel Garg, a doctoral student in Public Health Sciences, has been tracking millions of 2-1-1 calls. To do that, they are using 2-1-1 Counts, a unique, daily tracking system that analyzes calls to helplines in 35 states and is updated daily with location-specific data.
When Covid-19 was declared a pandemic in March, the team began analyzing the impact on calls and created Focus-19, a website featuring reports on its findings. The team recently completed its 100th report on trends in calls for needs like food, utility payments, and housing from around the U.S. With a grant from Washington University’s Institute for Public Health, a new site, Focus-19 St. Louis, was created to report on regional trends in line with Washington University’s emphasis on research that benefits its local community. The team has been approached by three other states to produce similar reports for them.
At the end of each month, the team looks back and examines the biggest areas of growth in calls from the prior month. In September, requests for internet service jumped dramatically as schools reopened. “There was a lot of demand, particularly among low-income families,” Kreuter said. “The places where we see the largest increases in social needs requests are the counties that have the most Covid cases, or the highest rates of Covid. There’s a pretty clear connection to how Covid is affecting the social and economic situation of families. Housing, food and utilities continue to dominate the list.”
Kreuter said there has been a four-fold increase in the use of 2-1-1 Counts dashboards around the nation since the pandemic. “That is very encouraging,” he said. “It’s very clear that people are discovering this data source.” Local policies and conditions influence or reveal the demand for certain services, he said. “So when eviction bans start and stop, it really influences people’s requests for assistance.” In North Carolina, some of the first outbreaks were at meat-processing plants and 2-1-1 calls from the counties where those plants were located saw much greater increases in requests for help. That news from Focus-19 was the subject of a newspaper report and soon thereafter a local organization reached out to provide aid to the meatpacking workers.
“Calling attention to these issues is part of our aim, so resources can be allocated more efficiently to help,” Kreuter said. But limited funding has meant that most of the team’s effort is geared to analysis, with less effort at media outreach and follow-up to magnify the impact of the data. “All of our resources are going to generating the reports,” he said. “For full impact, they need to be seen by more people in more places.”
The Focus-19 work is made possible by the 2-1-1 Counts surveillance system. “That puts us in a position to observe these Covid-related changes,” Kreuter said. “But we’re using data that these 2-1-1s work so hard to collect. They are the real heroes here.”
Dozens of Brown School students, staff and faculty volunteered at polls across the St. Louis region on November 3, helping voters to cast their ballots in what would turn out to be the largest vote total in U.S. history and the highest turnout rate since 1900. Heavy voting before Election Day meant the polls weren’t as crowded as had been feared, but volunteers played a key role in keeping lines moving and answering voter questions, a job that proved especially rewarding for many first-time poll workers.
“Oh my gosh, it was the best volunteer experience I’ve ever had,” said Sarah Mosby, MSW ’22, who served as an election monitor to help speed the lines of voters at an elementary school in St. Louis. “I met great people throughout the experience, including a man in his 80s who was voting for the first time.
“It was extraordinarily moving – our community in action,” added Mosby, who was recently admitted to the Graduate Policy Scholar program.
The Inclusive Voting: Key to Democracy Project was headed by Gena McClendon, director of the Center for Social Development’s Voter Access and Engagement Initiative, and Cynthia D. Williams, assistant dean of the Office of Community Partnerships. The St. Louis Area Voting Initiative and the St. Louis Area Election Protection Coalition partnered with CSD for election protection training and volunteer recruitment as poll workers, election monitors.
“For the most part, things went well,” said McClendon, who praised the Brown School and Dean Mary McKay for backing the effort.
McClendon said one purpose of the initiative was to engage social work and public health students with other organizations in protecting the right to vote.“We’re introducing them to the idea that they’re making history, so they will continue to do this,” she said. “They’ll use this exercise as part of their professional development and part of their profession.”
Many students, she said, are so focused on their clinical work that they don’t understand the connection between their work and voting. McClendon will make that connection clear to students next semester in a class she’ll be teaching: Voting, Racism and the Promise of Democracy.
The relevance of voting to social work was brought home years ago to Trish Kohl, an associate professor at the Brown School who volunteered as a poll monitor at a community center in Florissant. “I wasn’t personally civically engaged early in my career working for a non-profit, mental health agency. But a few years into it, I began seeing the impact of policies on families, recognizing the systemic changes that need to happen.”
“It is probably my years of work as a social worker that made it so important to me to work at the polls this year,” she said. “I believe it is critically important for social workers to engage in voting rights and ensuring people have the opportunity to vote.”
For Sicong (Summer) Sun, a PhD student from China, working as a poll monitor at a St. Louis elementary school was her first in-person experience inside the American voting process. “I was glad to see great voter turnout, especially young people and communities of color,” she said.“They showed up and made their voices heard.” She said her focus on the social determinants of health and financial capability as a research associate at CSD will be strengthened by the experience.
Like Sun, Annie LaFleur’s polling experience was a new one. LaFleur, MSW ’21, came to the Brown School from Oregon, where she had only voted by mail. Her experience at the Better Family Life Center in St. Louis was an eye-opener. “I had never been to a polling place before,” she said. “I wanted the experience to see what it would be like. I’m so glad I did it. I felt I was part of something bigger,” said LaFleur, whose concentration is mental health.
The experience gave many first-time volunteers a new appreciation for poll workers. Kevin Brown, MSW ’21, worked a 14-hour shift at an elementary school in St. Louis. “It’s exhausting and consumes the whole day,” he said. “But I would do it again. Ultimately it felt like I was serving a useful function. It was inspiring to see that many voters exercising their right to vote.”
Several students said the high-pressure, divisive nature of the 2020 elections encouraged them to volunteer, as did the pandemic.
“This year is different,” said Madelyn Brandt, MSW ’22, who worked as a monitor at a community center in Florissant. “Older poll workers were not able to be there due to the pandemic. I wanted to get involved. It was really cool volunteering with election protection. I think our presence across the nation helped people feel more comfortable. A lot of people were fearful.”
The potential danger for poll workers was brought home to Brandt in August, when she volunteered during the primary election at a polling place in her home community of St. Charles County. She became alarmed when poll workers were not required to wear masks and alerted a local TV station after receiving an e-mail from county election officials asking poll workers to “act surprised” if voters asked them to wear a mask. Outrage over the ensuing TV story, which featured Brandt, caused authorities to reverse their policy and require masking. But on Nov. 3, a poll worker who had been diagnosed with covid-19 reported to work in the county for a full-shift anyway and died later that day.
“I’m hoping that the new masking policy kept this person from spreading their Covid, or limited the spread,” Brandt said.
Brandt, who didn’t vote until 2016, said she began to get more engaged in part due to her concentration in domestic social and economic development, with a specialty in policy. She thinks greater civic engagement is a trend in the field. “A lot of social workers are becoming more active in their communities,” she said.
One reason for that activity is its relative lack of stress compared to that which many social workers face daily, said Ryan Lindsay, an associate professor of practice and assistant dean for social work at the Brown School who volunteered after running into McClendon at a Sam’s Club. “It’s a function of how exhausted and burned out social workers are in general,” he said. “They’re working trying to fix problems they cannot solve but which create significant pain for people. They don’t have a lot left to give, but this is something they can give. They just have to show up and say, ‘Tell me what to do.’”
Lindsay said his experience at a St. Louis middle school was “super rewarding,” especially a conversation with a 93-year-old survivor of the bombings of London during World War II. “I’m definitely going to sign up for this again. This gave me an opportunity to exercise my social-justice muscle,” he said. An added benefit, he said, was the opportunity to interact with people in person.
“I haven’t been in any place I’ve seen so many humans since the pandemic started,” he said. “It was invigorating.”
When Thomas and Jennifer Hillman Hall was dedicated on Oct. 2, 2015, it was hailed as a roomy addition to the Brown School, a welcoming place designed to encourage in-person collaboration and shared learning. Now, as the school prepares to celebrate the building’s 5th anniversary, the roominess of its 105,000 square feet is being appreciated more than could have been imagined.
The welcoming and in-person sharing, not so much.
“It’s ‘Come in and take advantage of in-person learning, but follow our science-based public health safety protocol,’” said Mary McKay, Neidorff Family and Centene Corporation Dean of the Brown School.
The difference, of course, is the COVID-19 pandemic, which has upended higher education around the nation and posed vexing dilemmas for university administrators who want to offer in-person learning options, while minimizing the risk of exposure for students, faculty and staff. The good news is that Hillman Hall and its wide-open spaces have provided the Brown School with the distancing resources and flexibility that have been key to its resumption of select in-person classes that began Aug. 24.
“We cannot imagine navigating the pandemic without the resource of Hillman Hall,” McKay said. “We have this beautiful building that was designed with flexibility in mind, more than our other buildings. Just having that much more space helps us distance ourselves from one another. That’s the silver lining.”
For those returning to Hillman for the first time since the coronavirus hit, the biggest change they’ll see is in the Maxine Clark and Bob Fox Forum, the building’s large and airy focal point on the first floor that features a woodwork ceiling and a glass façade. Created as a premier event space for conferences, lectures and town hall meetings, the Forum has been considered the figurative front porch of the Brown School. Now it has been transformed into a classroom, configured to maintain a safe six feet between students. Grounds for Change, the café adjacent to the Forum, is temporarily closed, with a possible reopening offering a ‘grab n’ go’ selection in the future.
“All of the features that made Hillman a collaborative and social place are detriments in this pandemic,” said Amy Eyler, associate professor and co-director of the Hillman-based Prevention Research Center who led a study of how the building as designed contributed to the well-being of those there. “I am now teaching two in-person classes and there is a whole new meaning of healthy building!”
Figuring out how to resume classes safely and fitting the logistical puzzle pieces together was the job of a large team of faculty and staff, led by committed preparedness, public health safety and administrative leadership teams. Siomari Collazo-Colon, Associate Dean of Administration notes, “We are incredibly fortunate to have some of the best public health faculty in the country. This has allowed us to put science at the forefront of every decision.”
“I was nervous at first but it’s going very well,” said team member Sunghei Han, MSW ’03, the Brown School’s manager of operations. “We’ve all been working to make this happen and we’re very confident that the protocol developed by Brown School public health experts would serve us well.”
When they sat down to plot out classroom floor plans, they quickly realized that many of the school’s classrooms were too small to accommodate six-foot distancing of students. Hence the use of the Clark-Fox Forum (and the Brown Lounge), to host classes too. Also, It was necessary to limit occupancy of the restrooms, which are now restricted to one person at a time and gender-neutral. The academic affairs team worked closely with faculty to decide which of the school’s 200 courses would be taught in person, when, and where. “It was lots of work and a tremendous collaboration,” she said. “It’s all the Brown School community doing it together. It’s been a great honor and a good experience and I’ve learned a lot.”
The building was made possible by the generous donations of Thomas and Jennifer Hillman. Jennifer Hillman was recently announced as a 2020 Woman of Achievement, and Thomas Hillman is president of the school’s National Council. Both have been in close touch with McKay about the changes in the building. “They’re glad about the flexibility and they trust us to make the right decisions,” McKay said. “They’re very practical people and we are lucky to have such Brown School champions.”
Commitment to applying best practices was shared across the school, faculty and staff as it wrestled with the challenges of resuming the in-person learning experience while keeping in mind one of the overarching goals that Hillman Hall was designed to further: the health and well-being of the people who use it.
“We’re protecting lives,” Han said.
Eleven members of the American Indian community will share stories associated with their cultural ties to Missouri as part of a project by the Brown School’s Kathryn M. Buder Center for American Indian Studies. The Digital Indigenous Storytelling Project will premiere on November 17 and highlight stories from across Missouri including Brown School’s American Indian Student Association.
Storytelling is an important tradition in Native communities across the U.S., which have been disproportionately affected by the novel coronavirus. Kellie Thompson, director of the Buder Center, said the project was a way to replace in-person events that the center had to cancel because of the pandemic, including some scheduled for November, Native American Heritage Month.
“We knew we wouldn’t be having in-person events in the fall,” she said. “This is a creative way to continue to engage our staff, students and local people to provide an event for the community.” The project is funded by the Missouri Humanities Council with federal funding from the Coronavirus Aid, Relief and Economic Security Act (CARES Act), which paid for staff to lead the project, honoraria for storytellers and technical equipment and training.
“We’ve been collecting stories from Indigenous people who have lived in Missouri or who are descended from tribes that are traditionally from the region. Their stories tie back to the land, and helps us think about how individuals stay connected to their culture,” Thompson said. “Some talk about how COVID has affected their culture. Storytelling is a way to not only share much about yourself, but often highlights lessons to be learned or knowledge that needs to be passed on to the next generation. It’s about the story, but also about the oral transmission of it.”
The stories will be posted on the Buder website on November 17; that afternoon at 4:00 p.m. the Buder Facebook page will livestream an introduction to the project. Some of the storytellers speak directly to cameras, others are the subject of interviews by Eric Pinto, the project coordinator, and two were submitted in writing and will be read by Pinto. The project hopes to continue collecting Indigenous people’s stories and will invite others to share their own.
Another response by the Buder Center to the pandemic will be a one-hour seminar that will provide culturally relevant health information for members of the Native community. The project, funded by AMB Foundation, will also disseminate health flyers and personal hygiene items such as masks and soap to help people prepare for the upcoming flu season and a second wave of COVID-19. Buder students will assist in the effort.
“The seminar will explain how to reduce the spread of the virus, what to do if you’re exposed, where to get testing, how contract tracing works and vaccine updates,” Thompson said. The seminar is open to all, but will be geared to the urban Indian community. It will be live-streamed through the Buder Center Facebook page from 12 p.m.-1 p.m. on December 2.
Sugar-sweetened beverage warning labels are effective in dissuading consumers from choosing them, with graphics having the greatest impact, finds a new study from the Brown School at Washington University in St. Louis. However, the United States has yet to pass legislation that would require such warning labels.
“The influence of sugar-sweetened beverage (SSB) warning labels tends to be in line with the efficacy of warning labels on tobacco packages,” said Ruopeng An, assistant professor and lead author of “Impact of Sugar-Sweetened Beverage Warning Labels on Consumer Behaviors: A Systematic Review and Meta-analysis,” published Oct. 12 in the American Journal of Preventative Medicine.
“In addition, SSB warning labels may alter consumers’ perceptions about the healthfulness of a beverage,” he added.
SSBs are beverages that are sweetened with various forms of added sugars, such as regular soda, fruit drinks, sports drinks, energy drinks, sweetened waters and coffee and tea beverages with added sugars. From 2011-14, on any given day, 6 in 10 youths and 5 in 10 adults in the U.S. drank SSBs and obtained over 140 calories from their consumption.
“During the past decade, various types of warning labels have been developed and tested that aimed to inform consumers about the health impact or nutritional implication of SSB consumption,” An said. “Some SSB warning labels conveyed messages in text form, some adopted symbols or graphics, and others used a combination of different means to communicate with consumers. To our knowledge, no review has been conducted to summarize the scientific evidence generated from those studies.”
In an effort to inform policymaking and promote evidence-based interventions at the population level, the new study serves as the first systematic review that aims to comprehensively identify and synthesize scientific literature that assessed the impact of SSB warning labels on consumer behaviors and intentions in the U.S. and worldwide.
A total of 23 studies met the predetermined eligibility criteria and were included in the review. Meta-analyses revealed that the use of SSB warning labels was associated with reduced odds of choosing SSBs among participants.
“Across the alternative forms of SSB warning labels, a picture or graphic warning label was associated with the most substantial decrease in the odds of choosing SSBs (66%),” An said. “Graphic warning labels may be more likely to be noticed by a consumer, which highlights the importance of salience in engaging consumers’ attention. Also, graphic warning labels might trigger a spontaneous negative response against the product that dissuades consumers.”
Failed U.S. legislative efforts
Chile passed a law in 2016 that required front-of-package warning labels for foods and drinks with added sugars, sodium, saturated fats or calories that exceeded preset limits. Some early evidence suggests that the soda purchases in Chile considerably declined following the implementation of the law. In 2019, Mexico’s Health Commission approved a proposal that introduced front-of-package food warning labels to combat obesity.
Despite the promising effect of SSB warning labels and recent legislation in other countries, An warned about the substantial political barriers in the U.S. to sign it into law by pinpointing a few failed legislative efforts.
“The Sugar-Sweetened Beverages Safety Warning Act (SB 1000) was introduced in California in early 2014,” he said. “The act prohibited the distribution and sale of certain SSBs in California that did not carry a safety warning message about the health consequences of SSB consumption. The bill was later amended to SB 203 but is no longer active.
“In the following years, similar bills were introduced in New York, Vermont, Hawaii and Washington. In 2015, San Francisco passed the nation’s first law that required the beverage industry to post health warnings on advertisements for SSBs. However, the bill was later blocked by the 9th U.S. Circuit Court. In early 2019, the Sugar-Sweetened Beverages Safety Warning Act (SB 347) was reintroduced in California and amended a few months later. To date, no law mandating SSB warning labels has been implemented in the U.S.
“SSB warning labels tend to be a low-cost, scalable and effective policy leverage to reduce calorie intake and prevent unhealthy weight gain in the population, but relevant legislation in the U.S. could be a long-lasting battle.”
Co-authors on the study are Abigail Barker, a research assistant professor at the Brown School; Timothy McBride, the Bernard Becker Professor at the Brown School; Jianxiu Liu and Ruidong Liu of Tsinghua University, China; and Roger Figueroa of Cornell University.