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PLOS Medicine Author Interview: Astha Ramaiya, DrPH, MSPH

Together with guest editors Zulfiqar BhuttaKathryn Yount, and Quique Bassat, PLOS Medicine has published research articles in a special issue devoted to the theme of global child and adolescent health and development. Below, Associate Editor Callam Davidson interviews Astha Ramaiya, DrPH, MPH, co-author of an article featured in the special issue, describing the relationship between individual agency and experiences of peer violence among adolescents in Kinshasa, Democratic Republic of Congo, and Blantyre, Malawi.

Please start off by telling us a little more about yourself – what’s your current role, where are you based, and what led you to a career in research?

I am a born, bred, and proud Tanzanian. Ever since I was a child, I have believed health is a human right. My interest in health originated from my father who worked as a doctor. As a child I would visit him and see the inequities that existed in both access to and use of healthcare. My career in research stemmed from my experiences in Tanzania and the beliefs I developed there. From the time I was in high school I either volunteered or interned at hospitals or institutions to determine the field in which I would be best placed to make a difference.

My first research project was with my father; I looked at hospital records to determine the annual cost expenditure of different diseases at the hospital. Thereafter, during university, I interned at the WHO to evaluate a HIV program implemented among adolescents engaging in transactional sex in Dar-Es-Salaam. After university, I joined Ifakara Health Institute and participated in various research projects while completing my master’s thesis comparing neonatal mortality between adolescent and adult mothers in Mtwara, Tanzania.

My interest in adolescent health grew more specialized and for my doctoral dissertation I evaluated a communication program to improve menstrual health and hygiene management in India.  Currently, I am a Research Associate for the Global Early Adolescent Study at Johns Hopkins University and explore topics including gender norms, agency, and violence.

What are your scientific interests and what inspired your study on agency and peer violence among adolescents?

During studies towards my doctorate in public health, I was able to look at how culture and context played a role in facilitating and impeding adequate menstrual health and hygiene management in Uttar Pradesh, India. Part of the project focused on how restrictions imposed during menstruation (defined as ‘limitations during menstruation, which could be imposed personally, socially and structurally’) were associated with menstrual health and hygiene management practices. We found that girls reporting restrictions had lower odds of practicing adequate behavior. These results piqued my interest in the concepts of equality and agency. My interest in violence came from the first paper that I published as part of the Global Early Adolescent Study, looking at the role of gender norms on peer-violence perpetration in Indonesia.

What was the most important take-home point from your study?

Although empowerment is a mechanism by which young people can become the agents of their own lives, it is important to understand how gendered expectations develop and relate to peer-violence in this context. In our study, we found that boys reported a higher proportion of peer-violence in comparison to girls. More specifically, boys reported experiencing a greater proportion of victimization and perpetration overlap (meaning they experienced both) in comparison to girls. In general, higher measures of agency, or the ability to act according to one’s goals, were associated with greater risk of reporting a victimization-perpetration overlap. We also found that adolescents experiencing two or more adverse childhood experiences (potentially traumatic events that occur in childhood) had a greater risk of reporting any peer-violence experience.

What are the clinical and global implications of your work?

Our study suggests that boys and girls have different peer-violence experiences, with boys showing higher perpetration and victimization overlap. To address this, it is important to include both boys and girls in empowerment programs to reduce violence and break the cycle of victimization and perpetration. The findings also suggest that in general, greater agency, is associated with a greater overlap of experiencing both victimization and perpetration, highlighting the need to integrate violence prevention strategies with empowerment programs to avoid unexpected consequences. Lastly, adolescents experiencing adverse childhood experiences reported more peer-violence experiences, reaffirming the importance of trauma-informed care to prevent teen violence.

What’s next? What are the most interesting or exciting developments in your field?

My current research is looking at sources of information about COVID-19, adverse childhood experiences during COVID-19, and education during COVID-19. I also hope to explore the agency and peer-violence project’s longitudinal data in the African and Asian regions, to study how changes in agency over time predict peer-violence in early adolescence, and to explore the impact of gender transformative interventions on both agency and intimate partner violence indicators among older adolescents.

What do you feel are the benefits of publishing with a journal that supports open science practices?

I still remember, when I was working in Tanzania, I would have to ask my friends and colleagues in high income countries to send me articles that I needed for my work but that were located behind paywalls. Open access publication leads to more discussion, more collaboration, and more publishing equity.

I believe all research that is published should be open for everyone to read, use, and adapt, to facilitate collaborative learning and create partnerships. Two of my dissertation papers were published in open access journals and that has allowed other scholars to read, cite, and reach out to me if they have any questions or comments. Since most of my research is in global health, I also believe our colleagues and partners outside of universities should have the same access to the article as do those within academia.

What do you like to do when you’re not working on your research?

I am a researcher with a lot of diverse interests! When I am not working, I like to travel and experience different cultures, people, and food. I feel most alive when I am outdoors and can appreciate how wondrous and magnificent the natural world is in comparison to humans. This is one of the reasons why I enjoy hiking in the mountains, swimming, kayaking, and white-water rafting.  When I am not able to travel, I love reading books about different lands written by authors from around the world, writing personal thoughts, dancing with my son, and reminiscing about old stories with my family.

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