The ethical challenges in the 2009 study of Osrin et al. are consent from cluster guardians, consent by individuals, benefits to control areas and requests by participants. The ethical issues that revolved around cluster guardianship noted in this study are the participants’ perceived adequate information about the trial according to the guidelines of the Declaration of Helsinki. In a complex society or in a society where participation is decided by the concept of a utilitarian judgment there will always be a burning concern for the guaranteed unalloyed voluntary nature of involvement. While cluster randomized controlled trials have been around for a long time, there is a growing concern to evaluate the delivery of health services, public education, and policy on social care (Edwards et al., 1999). Utilitarianism and Kantian ethics are the two most important moral traditions that the ethical aspects of medical practice and medical research are most often discussed. Concerned with increasing social utility (value), utilitarianism, in the long run, the social utility will not be served by demanding that individuals be self-sacrificing for the common good. The collective decision of a local guardian or representative may be contested given that communities are usually amalgams of smaller communities. There is the question whether the decision is in the best interest of the participants or the expected interest is based on the hidden personal agenda of the cluster guardian. It is a matter of distributive justice whereby utility and disutility, benefits and costs, are distributed as fairly and evenly as possible across society (Edwards et al. 1999). On the other hand, Kantian tradition refers to our moral duty to respect a person’s autonomy, significant in individual-cluster trials that differ with the paramount importance of the utilitarian welfare of the cluster in cluster-cluster trials.
Positioning ourselves as researchers within the ethical folds, and not cross the thin red line of a moral dilemma; we should remember that ethics establish the fundamental principles of “right and wrong.” While laws may set the legal parameters that govern data use, ethics are critical to the appropriate management and use of research data. The burning questions are: Do we have the prior knowledge on the unethical collection of the data? Did we learn about the breach after we are done analyzing the data? I believe, it is our responsibility to assess the quality and the manner data was collected. Even if the intent of the research is for the better good, we should not be blinded by the urgency of the endeavor and justify the beneficial outcomes at the expense of the suffering of the participants. Using a secondary data obtained unethically for the better good that could impact a community, presents a blur between right and wrong. Would the use of unethically collected secondary data a personal choice? Assuming that the institutional review board (IRB) approved the use of such data, would it give us the option to use the data for the common goods? A point to ponder, given that the Nuremberg Code was not established until after World War II, the collection of NAZI experiments could not be considered “illegal’ (Vollmann, 1996). Given this scenario, would current researchers be free to use the data from these experiments for ethical and beneficial results? Would it justify the use of Dr. Sigmund Racher’s data on hypothermia and altitude experiments at Dachau to inform on ethically sound studies on hypothermia prevention and treatment? The study of Dr. Robert Pozos of the University of Minnesota was denied publication in the New England Journal of Medicine (NEJM) after using Dr. Racher’s data on rewarming techniques to fill in critical gaps in his research (Cohen, 1990). Having this said, personally, regardless how comprehensive the secondary data, if unethically aggregated, I would refrain from using such data even if the data could have a positive outcome. Within the argument of guilty by association, I believe that using unethically collected research data; we are as guilty as the person/individuals who collected the data. The best recourse is to look for a more superior data that follows the prescribed ethical guidelines. On the other hand, if the data could lead to discovery to save lives of the many, for example, a vaccine to prevent the spread of an infectious disease, or prevent a bioterrorism event, then it is justifiable to use such data considering the benefits outweigh the harms of the methods.
Cohen, B. (1989). The ethics of using medical data from Nazi experiments. Journal of Halacha and Contemporary Society, 103-126.
Edwards, S. J., Braunholtz, D. A., Lilford, R. J., & Stevens, A. J. (1999). Ethical issues in the design and conduct of cluster randomised controlled trials. British Medical Journal, 318(7195), 1407.
Ford, N., Mills, E. J., Zachariah, R., & Upshur, R. (2009). Ethics of conducting research in conflict settings. Confl Health, 3(7).
Osrin, D., Azad, K., Fernandez, A., Manandhar, D. S., Mwansambo, C. W., Tripathy, P., & Costello, A. M. (2009). Ethical challenges in cluster randomized controlled trials: experiences from public health interventions in Africa and Asia. Bulletin of the World Health Organization, 87(10), 772-779.84-887.
Steinberg, J. (2015). The Ethical Use of Unethical Human Research. New York University, nd Web, 30.
Vollmann, J., & Winau, R. (1996). Informed consent in human experimentation before the Nuremberg code. BMJ: British Medical Journal,313(7070), 1445.
Over the past 15 years, the incidence of violent extremism has increased worldwide. Adapa et al. (2016) noted a sharp increase in the number of attacks and deaths since 2012 based on data from the National Consortium for the Study of Terrorism and Responses to Terrorism (NCSTRT), while the Global Terrorism Index (2014), showed that there was an increase of 41% in the number of violent attacks between 2012 and 2013, and an increase in deaths by 61% reaching around 18,000. Moreover, terrorist/violent attacks rose 81% globally in 2014, causing 3.2-4.4% increase in fatalities with more than 5,000 attacks against private citizens and property (NCSTRT, 2015). Violence related statistics had already increased if the 2015 Paris and San Bernardino California attacks are included; and the recent attacks in Turkey, Orlando, Dallas and Nice, France are quantified.
Jerkins (2010) examined the extent to which radicalization has occurred within the United States (U.S.). For example, between December 2009 and September 2011, there were 46 cases involving domestic radicalization and recruitment into jihadist terrorist groups, and 125 out of 46 cases were identified. There are 3 million Muslims in the U.S., and the incidence of radicalization among this population is 1 in 30,000 (Jerkins, 2010). The NCSTRT (2015) stated that from 2001 to 2014, the number of deaths related to terrorist attacks was 3,066, while 2,961 occurred in the U.S. were 2,902 took place during the September 11, 2001, attacks. The Institute for Economics and Peace (2014) showed that 82% of deaths (killed) globally occurred in five countries: Iraq, Afghanistan, Pakistan, Nigeria, and Syria. Moreover, as compared to homicide, there were 437,000 homicides which are 40 times greater than compared to deaths related terrorism (Institute for Economics and Peace, 2014). Radicalization rates were found higher in regions of South Asia and Sub-Saharan Africa (2006-2012). Furthermore, the typical profile of a radicalized individual was younger than average, less educated than average, unemployed and struggling to meet ends, less religious than average, and willing to sacrifice his/her for (Kiendrebeogo & Ianchovichina, 2015). Despite radicalization prevention, it has been estimated that 20,000 individuals from around the world, including 500 from the United Kingdom, and 3,000 from Europe could be considered under the spectrum of violent radicalization (Bhui, 2015). Channel (anti-radicalization scheme) a study conducted by the United Kingdom (U.K.) police, found that 44% of 500 are vulnerable as it relates to mental health or psychological difficulties, while 15% found to have possible vulnerabilities, but requires further assessment (Dodd, 2016). A survey conducted by the Department for Communities and Local Government, U.K. (2010) focused on attitudes towards extremism in England and Wales, 85% of participants stated that it was ‘always wrong’ to use violent extremism to protest against things that are unfair or unjust; 95% indicated that it was ‘always wrong’ to use violent extremism in the name of religion to achieve a goal; 92% stated that it was ‘always wrong’ for political campaigners to distribute leaflets that encourage violence towards other ethnic groups, and 81% indicated that it was ‘always wrong’ for animal protesters to use violence to protect animals.
Prevailing Theories and Conceptual Frameworks
Empathy gap and social movement theory. A Facebook live feed of Philando Castile dying next to his fiancé with a 4-year old girl in the back seat could have convinced Micah Johnson to drop his bigger plan, and commit a tragic event that killed five Dallas police officers on the street, one through a second-floor window. What is the role that empathy plays in establishing individual or group identity? Failures of empathy are especially likely if the sufferer is socially distant, for example, the perceived social injustice among black Americans for being unfairly treated by the police authority. Emile Bruneau, a cognitive neuroscientist at the Massachusetts Institute of Technology, has spent the past eight years studying intractable conflicts around the world. Bruneau’s theory on “empathy gap” states that while empathy signals might be great at improving prosocial behavior among individuals, boosting a person’s empathy could also increase hostility toward the enemy (Interlandi, 2016). Therefore, it is paramount to explore the significance of “empathy gap” parallel to social movement theory’s potential social, cultural, and political consequences that empower social mobilization.
Criminal justice system approach. Bhui et al. (2012a) suggested a criminal justice model to understand violent radicalization. This theory is focused on comprehending the motivation and pathway that leads to radicalization and eventual terrorism, and it assumes that it is capable of handling crimes regardless of their origins and context, and terrorism can be prevented through intelligence and specifically geared justice system versus theories and practice. Bhui et al. (2012a) go on to argue that an epidemiological approach, along with psychology, sociology and other behavioral sciences.
Situational action theory (SAT). Based on a theory of offending, aimed at providing fundamental insights into the causal processes leading to acts of crime, or more generally, moral rule breaking (Wikstrom et al., 2012). This theory serves to understand the violent extremism and consequently conceptualize acts of violent extremism as the result of the interaction between an individual and the environment (Schils & Pauwels, 2014). There are some assumptions related to this theory including; 1) the individual propensity to violent extremism and exposure to violent extremist settings can be seen as direct causes of political violence, and 2) the impact of exposure to violent extremist settings is contingent on the level of individual violent extremist propensity (Schils & Pauwels, 2014). Bouhana and Wikstrom (2008) mentioned that the likelihood that a person will commit political violence depends on his/her propensity towards violent extremism and its interplay with exposure to violent extremist settings.
Psychoanalytic theories. Psychoanalytic theorists applied their knowledge to the reasons behind sociopolitical conflicts, the origins of violent terrorist activity, and the psychodynamics of organizations (Reid & Yakeley, 2014). This theory suggested that terrorism is meaningful communication expressed as violence (Reid & Yakeley, 2014). Psychic determinism, the notion that unconscious forces control the conscious thoughts, actions, behaviors, and symptoms describe how violence may represent communication from conscious and unconscious fantasies, wishes, memories, and defenses (Reid & Yakeley, 2014). Furthermore, terrorism is influenced from past trauma and manifests itself into the present as violence (Reid & Yakeley, 2014). The psychoanalytic theory suggests that individual behaviors determined by the culture and large group identity (Reid & Yakeley, 2014). Large group dynamics influences individuals where rational thoughts give way to terrorist views (Reid & Yakeley, 2014).
Construal level theory (CLT). Initially proposed by Trope and Liberman (2010) and stated that as psychological distance increases, thoughts become more abstract and distal, while as psychological distance decreases thoughts become more concrete or immediate. CLT under the lens of a public health professional, policy maker local and state leader, an ethnic enclave could be like a forest, to see the trees in a forest you need to move closer. Adapa et al. (2016) related to this angle as someone in a high-level construal will use an abstract thought process, perceiving the big picture (the forest), whereas someone in a low-level construal will use a real process of reflection recognizing its details (the individual trees).
Evaluation of Methods within the Literature
Szlachter et al. (2012) explored how psychosocial adversity, economic, psychological, social, political and religious factors aligned in the process of violent radicalization among Islamic believers living in Poland. A survey method was used to collect economic, psychological, social, political, and religious factors among 536 individuals. The researchers used mixed data collection strategies including individual and small group survey at particular settings to ensure the anonymity. The scales of socio-political attitudes and beliefs included in the survey method demonstrated reliable score, where Cronbach’s alpha values ranging from 0.60 to 0.91 (Szlachter et al., 2012). However, they used a convenience sample which might result in biases findings, where the sample might not be representative of the study population.
Bhui et al. (2014) explored depression, psychosocial adversity, and limited social assets and its perceived effects to violent radicalization vulnerability. A cross-sectional design and an interview survey method were used to identify risk and protective factors (e.g., depression, psychosocial adversity, limited social assets, and demographics and psychological characteristics) associated to violent radicalization. The interviewers were trained to handle sensitive and personal experience, data aggregation using a computer-assisted format, among 608 individuals of Pakistani or Bangladeshi origins, aged 18 to 45, of Muslim heritage and living in East London and Bradford. The interview survey includes questions about social, lifestyle, health outcomes, safety issued for Muslim, and demographic characteristics. These methods measured radicalization by 16 items including a comprehensive literature review and focus groups assuring the face and content validity. However, this approach excluded factors that might be associated to violence radicalization; as well the respondents’ perceived anonymity could be influenced, which may affect the validity of the study. Also, the cross-sectional design the causality cannot be directly inferred.
Adapa et al. (2016) hypothesized that high-level construal could increase an individual’s likelihood to engage in ideologically based violence, and low-level construal decreases an individual’s likelihood to engage in ideologically based violence. Vignettes were developed and refined in the pilot study and were used in the second stage. Construal level manipulation (high construal, low construal, or no construal) was performed in the second stage. Multi-part statistics analysis was conducted in the final stage to analyze the impact of construal level manipulations on likelihood to engage in ideologically based violence. A total of 1,112 individuals completed the pre-screening process, and 139 qualified participants completed the entire study. Adapa et al. (2016) found that many of the statistical results did not support the hypothesis of the study which could be explained by the vulnerability in the study paradigm, and the construal level does not affect or has a non-significant effect on willingness to participate in ideologically based violence. While the study design aimed to establish a robust data aggregation model, the logistical limitations, vignette ideology issues, and novel features of this study that could have adversely impacted the results. Researchers asserted that future research could use vignettes time distance manipulations to induce construal shifts, rather than using low-level and high-level manipulations. The understanding of decision-making patterns and ideologically based violence is dependent upon a fundamental knowledge of the way abstract and concrete mindsets alter thought processes.
Malthaner and Waldmann (2014) conducted a systematic review of social movement studies that involved protests, studies that examined terrorist groups and their social environment, and works about to the influence of the social environment. Researchers introduced the radical concept milieu to focus attention on interactions and patterns between terrorist groups and their social environment (Malthaner & Waldmann, 2014). Through this method, researchers identified the relationship between these groups and individuals and the impact of their social environment, providing critical data on how individuals influence political violence from relationships and the dynamics of interactions. However, these methods lack to examine how the immediate social environment further influences the terrorist. Reid and Yakeley (2014) conducted a literature review of theoretical databases over the past 15 years from a psychoanalytic perspective, and introduced the stratum of lone-wolf violent radicalization with the argument of conscious and unconscious reasons to exert violence towards others. The lone wolf terrorist includes suicide bombers in the Middle Eastern conflict, or mass shooters in the U.S. Lone wolf terrorists rationalize their violence as moral outrage based on personal grievances which outweigh any moral reasoning (Reid & Yakeley, 2014). These mental disturbances are thought to begin in adolescence but may be earlier because of genetic influences and environmental adversity (Reid & Yakeley, 2014). This method was focused on the psychodynamics of the lone wolf to determine what motivates them to act violently towards others. Conversely, through this approach, it is difficult to attribute the disturbed state of mind of lone wolf terrorists to the high-risk developmental probability. Researchers review of empirical research of the psychoanalytic thoughts of lone wolf terrorists and future research should include large groups and case study analysis.
Adapa, A., Caporale, C., Griffin, N., Hrab, M., Jeong, C., Kim, M., … & Vanarsdall, R. (2016). The Effect of Psychological Distance on Willingness to Engage in Ideologically Based Violence (Doctoral dissertation). Retrieved from http://drum.lib.umd.edu/bitstream/handle/1903/18086/Judgment_PDF.pdf?sequence=1
Bouhana, N. &Wikstrom, P.O. (2008). Theorizing Terrorism: Terrorism as Moral Action. UCL Jill Dando Institute of Security and Crime Science: London, UK.
Bhui, K. (2015). Radicalisation: A mental health issue, not a religious one. New Scientist. Retrieved from https://www.newscientist.com/article/mg22630160-200-radicalisation-a-mental-health-issue-not-a-religious-one/
Bhui, K., Everitt, B., & Jones, E. (2014). Might Depression, Psychosocial Adversity, and Limited Social Assets Explain Vulnerability to and Resistance against Violent Radicalization? Plos One, 9(9), e105918.
Bhui, K. S., Hicks, M. H., Lashley, M., & Jones, E. (2012a). A public health approach to understanding and preventing violent radicalization. BMC medicine, 10(1), 16.
Bhui, K., Dinos, S., & Jones, E. (2012b). Psychological process and pathways to radicalization. Journal of Bioterrorism & Biodefense, 2014.
Cudeck, R. (2000). Exploratory factor analysis. Handbook of applied multivariate statistics and mathematical modeling, 265-296.
Department for communities and local government, United Kingdom. (2010). Citizenship Survey: April – December 2009, England and Wales: Attitudes towards Violent Extremism (experimental statistics). Retrieved from http://webarchive.nationalarchives.gov.uk/20120919132719/http://www.communities.gov.uk/publications/corporate/statistics/citizenshipsurvey2009extremism
Dodd, V. (2016). Police study links radicalisation to mental health problems. The Guardian. Retrieved from https://www.theguardian.com/uk-news/2016/may/20/police-study-radicalisation-mental-health-problems
Global Terrorism Index. (2014). Measuring and understanding the impact of terrorism. Institute for Economics and Peace. Retrieved from http://www.visionofhumanity.org/sites/ default/files/Global%2 0Terrorism, 20
Interlandi, J. (2016). The Brain’s Empathy Gap. Retrieved from http://www.nytimes.com/2015/03/22/magazine/the-brains-empathy-gap.html?_r=0
Jenkins, B. M. (2010). Would-be warriors: Incidents of jihadist terrorist radicalization in the United States since September 11, 2001. Rand Corporation.
Kiendrebeogo, Y & Ianchovichina, E. (2016). Who Supports Violent Extremism in Developing Countries?. Middle East and North Africa Region: World Bank Group.
Malthaner, S., & Waldmann, P. (2014). The radical milieu: Conceptualizing the supportive social environment of terrorist groups. Studies in Conflict & Terrorism, 37(12), 979-998.
National Consortium for the Study of Terrorism and Responses to Terrorism (NCSTRT). (2015). Annex of statistical information: Country reports on terrorism in 2014. Retrieved from http://www.state.gov/documents/organization/239628.pdf
Reid Meloy, J., & Yakeley, J. (2014). The violent true believer as a “lone wolf”–psychoanalytic perspectives on terrorism. Behavioral sciences & the law, 32(3), 347-365.
Schils, N., & Pauwels, L. (2014). Explaining Violent Extremism for Subgroups by Gender and Immigrant Background, Using SAT as a Framework. Journal of Strategic Security, 3(7), Article 3.
Szlachter, D., Kaczorowski, W., Muszynski, Z., Potejko, P., Chomentowski, P., & Borzol, T. (2012). The radicalization of religious minority groups and the terrorist threat – report from research on religious extremism among Islam believers living in Poland. Internal Security, 4(2), 79-100.
Trope, Y., & Liberman, N. (2010). Construal-level theory of psychological distance. Psychological review, 117(2), 440.
Wikstrom, P.O., Oberwittler, D., Treiber, K., & Hardie B. (2012). Breaking Rules: The Social and Situational Dynamics of Young People’s Urban Crime. Oxford: Oxford University Press.
The protozoan parasite Trypanosoma cruzi was first described by Carlos Chagas after isolation of the organism from the blood of a Brazilian patient in 1909 (Garcia et al., 2015). An estimated 7.5 t…
The protozoan parasite Trypanosoma cruzi was first described by Carlos Chagas after isolation of the organism from the blood of a Brazilian patient in 1909 (Garcia et al., 2015). An estimated 7.5 to 10 million persons are infected with Chagas disease worldwide (Hotez et al., 2008; Hotez et al., 2014). In the United States, the disease is anecdotally referred to as a “silent killer” with a 30% chance of those infected to develop a potentially fatal cardiac disease. According to Cantey et al. (2012), Chagas disease is emerging as a significant public health concern in the United States. Given the proximity of Texas to Latin America, cases imported from highly endemic areas in Latin America would likely occur in Texas. Recent communication from the Centers for Disease Control and Prevention that the bite of blood-sucking triatomine bugs in the subfamily Triatominae also termed “kissing bugs” that transfers the parasites to humans have now been found in 28 states, including California and Pennsylvania. Garcia et al. (2015) argued that despite the numerous publications related to Chagas disease in the southern US and northern regions of Mexico, very little is known about the disease burden from imported and locally acquired T. cruzi infection.There is concern that Chagas disease might be undiagnosed in the US as a result of documented low physician awareness (Stimpert & Montgomery, 2010). While the zoonotic nature of Chagas’ life cycle implies unfeasible eradication; entomological surveillance is and will remain crucial to containing Chagas disease transmission (Tarleton et al., 2007).
While it is considered safe to breastfeed even if the mother has Chagas disease (Centers for disease control and prevention, 2013); people can also become infected through blood transfusion, congenital transmission (from a pregnant woman to her baby), organ transplantation, accidental laboratory exposure and consumption of uncooked food contaminated with feces from infected bugs. If the mother has cracked nipples or blood in the breast milk, it is warranted to pump and discard the milk until the bleeding resolves and the nipples heal (Centers for disease control and prevention, 2013). The enduring challenge of household reinfestation by locally native vectors as stated by Abad-Franch et al. (2011), horizontal strategies works better when the community takes on a protagonist role. Encouraging vector notification by residents and other simple forms of participation can substantially enhance the effectiveness of surveillance (Abad-Franch et al., 2011). Therefore, control programs in concert with community-based approaches as a strategic asset from inception that requires a timely, professional response to every notification, benefiting from a strengthened focus on community empowerment. According to Schofield (1978), when bug population density is low, vector detection failures are unavoidable. Decision-making will be dependent upon the accurate estimation of infestation rates (World Health Organization, 2002), and imperfect detection can seriously misguide Chagas disease control management program. Continued attentiveness from governmental and health organizations are warranted, as this disease continue to be a globalized public health issue. Improved diagnostic tools, expanded surveillance and increased research funding will be required in maintaining existing effective public health strategies and in preventing the spread of the disease to new areas and populations (Bonney, 2014). To improve outbreak control, and improve Chagas disease response, it is essential to discuss the gaps in the scientific knowledge of the disease. Moreover, crucial in improving the morbidity in the state of Texas and neighboring states is the recommendation of the needed steps to enhance the understanding of T. cruzi.
Abad-Franch, F., Vega, M. C., Rolón, M. S., Santos, W. S., & de Arias, A. R. (2011). Community participation in Chagas disease vector surveillance: systematic review. PLoS Negl Trop Dis, 5(6), e1207.
Bonney, K. M. (2014). Chagas disease in the 21st century: a public health success or an emerging threat?. Parasite, 21, 11.
Cantey, P. T., Stramer, S. L., Townsend, R. L., Kamel, H., Ofafa, K., Todd, C. W., … & Hall, C. (2012). The United States Trypanosoma cruzi Infection Study: evidence for vector‐borne transmission of the parasite that causes Chagas disease among United States blood donors. Transfusion, 52(9), 1922-1930.
Centers for disease control and prevention. (2013). Parasites-American Trypanosomiasis (also known as Chagas Disease). Retrieved 21 July, 2016, from http://www.cdc.gov/parasites/chagas/gen_info/detailed.html
Garcia, M. N., Woc-Colburn, L., Aguilar, D., Hotez, P. J., & Murray, K. O. (2015). Historical perspectives on the epidemiology of human chagas disease in Texas and recommendations for enhanced understanding of clinical chagas disease in the Southern United States. PLOS Negl Trop Dis, 9(11), e0003981.
Hotez, P. J., Bottazzi, M. E., Franco-Paredes, C., Ault, S. K., & Periago, M. R. (2008). The neglected tropical diseases of Latin America and the Caribbean: a review of disease burden and distribution and a roadmap for control and elimination. PLoS Negl Trop Dis, 2(9), e300.
Hotez, P. J., Alvarado, M., Basáñez, M. G., Bolliger, I., Bourne, R., Boussinesq, M., … & Carabin, H. (2014). The global burden of disease study 2010: interpretation and implications for the neglected tropical diseases. PLoS Negl Trop Dis, 8(7), e2865.
Schofield, C. J. (1978). A comparison of sampling techniques for domestic populations of Triatominae. Transactions of the Royal Society of Tropical Medicine and Hygiene, 72(5), 449-455.
Stimpert, K. K., & Montgomery, S. P. (2010). Physician awareness of Chagas disease, USA. Emerging infectious diseases, 16(5), 871.
Tarleton, R. L., Reithinger, R., Urbina, J. A., Kitron, U., & Gürtler, R. E. (2007). The challenges of Chagas disease—Grim outlook or glimmer of hope?. PLoS Med, 4(12), e332.
World Health Organization. (2002). Control of Chagas disease: second report of the WHO expert committee.
In most countries, public health approaches to address violent radicalization are already applied in street violence and bioterrorism; but leaders and stakeholders need to embrace the significance of public health interventions and research on violent radicalization (Bhui et al., 2012). While past studies (Bakker, 2006; Loza, 2007) found that overwhelming majority of people who become radicalized to violence in the West are young and male, generally aged between mid-teens and mid-20s; scarcity of research findings on the extent and nature of women’s roles in group and community radicalization (Carter, 2013). The recent acts of terrorism around the world, especially the event in San Bernardino California, it is important to note the urgent need to look at the significance of a public health approach to understanding violent radicalization. Recognizing this sense of urgency introduce the possible role of collective responsibility of leaders in epidemiology, sociology, psychology and other behavioral sciences in developing novel epidemiologic measures towards prevention strategies (Bhui, Hicks, Lashley, & Jones, 2012). While most nation’s counterterrorism approaches are grounded in inter-governmental intelligence data exchange and criminal justice systems, embracing the perceived belief that existing legal system can deal with violent radicalization effectively; it is paramount to argue that new players be included in the collection of relevant data needed in the development of public health approach to address violence such as the World Health Organization’s Violence Prevention Alliance, and the Centers for Disease Control and Prevention (CDC). The goal of CDC’s “Public Health Approach to Violence Prevention” is to decrease risk factors and increase protective factors. The logical argument for this proposed study is the need for public health research, and establish a new approach to guard against violent radicalization.
Given the current integrated surveillance system that monitors death and injuries as a direct effect of terrorism events, it is critical to recognize the risk and protective factors for violent radicalization. Bhui et al. (2102) noted “the perceived discrimination in the population as a whole or amongst distinct segments of the population; trust in authorities and their counterterrorism approaches; perceived or real economic inequalities patterned by ethnicity or religious groups; and international conflict in which the authorities appear to be biased or unfair towards a specific migrant, religious or ethnic group.” For future research, it is paramount to identify the possible independent variables that are associated with the increased probability of radicalization in certain communities such as marginalized communities, diaspora communities, and ideology. The perceived feeling of inclusion or integration in a larger, popular community was theorized to amplify the extent of susceptibility to radicalization. Baumeister and Leary (1995) asserted on the importance of adapting psychological theories on stable interpersonal relationships. It is critical to examine the perceived instability in diaspora communities that could increase the risk of marginalization. Indicators related specifically to diaspora communities are language, the size of the community, the arrival age of immigrant(s) to the community, the age structure of the population, and the spatial concentration of the community. Marret et al. (2013) asserted the importance of understanding the core of radicalization process that demands the necessity to question and debate the concept of violent radicalization at the theoretical level and the empirical level. The motivation for an individual or group to commit extremist violence or terrorism is not grounded in a single ideology, but selectively demonstrate their commitment from different clusters of belief systems. Behavioral indicators as stated by Fishman (2010) could be generated from social media, chat rooms, and involvement in public ideologically motivated legal activities might provide insights into community-based ideological sentiments.
Bakker, E. (2006). Jihadi terrorists in Europe, their characteristics and the circumstances in which they joined the jihad: an exploratory study.
Baumeister, R. F., & Leary, M. R. (1995). The need to belong: desire for interpersonal attachments as a fundamental human motivation. Psychological bulletin, 117(3), 497.
Bhui, K. S., Hicks, M. H., Lashley, M., & Jones, E. (2012). A public health approach to understanding and preventing violent radicalization. BMC medicine, 10(1), 16.
Carter, B. (2013). Women and violent extremism. GSDRC Helpdesk Research Report.
Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. (2008). The public health approach to violence prevention. Atlanta, GA: CDC.
Fishman, Shira. (2010). “Community-Level Indicators of Radicalization: A Data and Methods Task Force.” Report to Human Factors / Behavioral Sciences Division, Science and Technology Directorate, U.S. Department of Homeland Security. Retrieved from http://www.start.umd.edu/pubs/START_HFD_CommRadReport.pdf
King, G., & Zeng, L. (2001). Logistic regression in rare events data. Political analysis, 9(2), 137-163.
Labilles, U. (2016). The significance of Public Health Approach on Violent Radicalization (Unpublished, Advanced Epidemiology Methods, PUBH-8520-1, 2016 Winter Qtr. Wk9Proj) Walden University, Minneapolis.
Loza, W. (2007). The psychology of extremism and terrorism: A Middle-Eastern perspective. Aggression and Violent Behavior, 12(2), 141-155.
Marret, J. L., Feddes, A. R., Mann, L., Doosje, B., & Griffioen-Young, H. (2013). An Overview of the SAFIRE Project: A Scientific Approach to Finding Indicators and Responses to Radicalization. Journal Exit-Deutschland. Zeitschrift für Deradikalisierung und demokratische Kultur, 2, 123-148.
I am currently working on two essays that I needed to submit with my fellowship application, but the event in Paris made me stop for a few minutes and reflect on the scorching reminder that terrorism has no religion, a brand of madness, not faith. Such event amplified the urgency to stress the significance of New Public Health that carries a high potential for healthy less aggressive societies. The main principles of living together in healthy communities were summarized by Laaser et al. (2002) as four ethical concepts of the New Public Health essential to violence reduction – equity, participation, subsidiarity, and sustainability. The coupling of current economic, demographic, and social issues will play a role in guiding future policy revisions. While my fellowship of interest is in epidemiology and infectious diseases, increased understanding of the interrelated dimensions of deracination or forced migration using the modern concept of public health is warranted. It is critical to understand the determinants of violence: the type of stigmatization; the process of urbanization; religious, ethnic, and racial prejudices; women’s status; the level of education; employment status; socialization of the family; availability of firearms; alcohol and drug consumption; and poverty.
Laaser, U., Donev, D., Bjegovic, V., & Sarolli, Y. (2002). Public health and peace. Croatian medical journal, 43(2), 107-113.
Dallas is the seventh largest city in the United States with a population exceeding 1.1 million citizens in the year 2000. Dallas is the fourth largest park system in the United States. The second wave of the environmental justice movement is a concept concerned with urban design, public health, and availability of outdoor physical activities. The upgrade to the 21,526 acres of parkland will amplify the quality of and access to outdoor recreation. The Dallas Park and Recreation Department’s “Renaissance Plan” is a response to the increased demand of the citizens for new and expanded park facilities, recreation programs, open space areas, and unique recreational amenities. Physical activity is one of the health indicators for Healthy People 2010, and responding to these demands is a step forward of meeting its goals. Dallas’ wide spectrum of park facilities will provide physical activities that will have positive health outcome to Dallas residents including the low-income population of the Dallas County and contiguous counties. Recognition of environmental exposure affecting economically and politically disadvantaged members of the community gave birth to the first wave of environmental justice movement. In addition to health problems related to environmental exposures, environmental justice (EJ) also cover disparities in physical activity, dietary habits, and obesity among different populations. Disparities on the access of public facilities and resources for physical activity (PA) is an EJ issue that has a negative impact on health among low-income and racial/ethnic minorities (Labilles, 2013). The 2007 cross-sectional study of Taylor et al. suggest an association between disproportionate low access to parks and recreation services (PRS) and other activity-friendly environments in low-income and racial/ethnic minority communities. The prevalence of lower levels of PA and higher rates of obesity was observed in the minority population, which is a direct outcome of the prevalence of lower levels of PA. These differences violate the fair treatment principle necessary for environmental justice.
The treatment of health conditions associated with physical inactivity such as obesity poses an economic cost of at least $117 billion each year. Physical inactivity contributes to many physical and mental health problems. The reported 200,000-deaths per year in the US is attributed to physical inactivity, and data from surveillance system indicate that people from some racial/ethnic minority groups experience disproportionately higher rates of chronic diseases associated with physical inactivity. Taylor, Poston, Jones & Kraft (2006) findings, provided preliminary evidence for the hypothesis that socioeconomic status disparities in overweight and obesity are related to differences in environmental characteristics. However, most of the studies had encountered epidemiologic “black box” problem, making it impossible to determine which characteristics of the environment (e.g., density of food service outlets or physical activity resources) may be most important (Labilles, 2013). Ellaway et al. found that body-mass index (BMI), waist circumference, and prevalence of obesity, and greater obesity risk is associated with low area or neighborhood socio-economic status.
Behavioral Risk Factor Surveillance System (BRFSS). Atlanta: Centers for Disease Control and Prevention; 2000.Centers for Disease Control and Prevention; 2000.
Ellaway A, Anderson A, Macintyre S. Does area of residence affect body size and shape? Int J Obes Relat Metab Disord. 1997; 21:304-308.
Labilles, U. (2013). Environment Matters: The Disproportionate Burden of Environmental Challenges. PUBH 8115-1 Environmental Health Spring Qtr. Minneapolis: Walden University.
Taylor, W., Floyd, M., Whitt-Glover, M. & Brooks, J. (2007). Environmental Justice: A Framework for Collaboration between the Public Health and Parks and Recreation Fields to Study Disparities in Physical Activity. Journal of Physical Activity & Health, 4, supp 1, s50-s63.
US Dept of Health and Human Services. Physical activity and health: A report of the Surgeon General. Atlanta: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion; 1996.
US Dept of Health and Human Services. Healthy People 2010: With understanding and improving health and objectives for improving health (2nd ed). Washington: US Govt Printing Office; 2000.
Wolf AM, Manson JE, Colditz GA. The economic impact of overweight, obesity, and weight loss. In: Eckel R, ed. Obesity Mechanisms and Clinical Management. Philadelphia: Lippincott, Williams, & Wilkins; 2002.
For 26 days in 2011, every place in Texas showed higher concentrations of lung-damaging ozone than allowed by federal air-quality standards, especially in Dallas. The federal standard set in 2008 is 75 parts per billion. The spike in ozone which is particularly a summer phenomenon is exacerbated by trucks carrying drilling materials that emit nitrogen oxides, and natural gas escaping from pipelines or storage tanks that emit volatile organic compounds, or VOCs. Known ozone “precursors” such as nitrogen oxides and VOCs can react with each other to form ozone when aided by sunlight. The most difficult environmental issue North Central Texas face today is air quality. Dallas Forth Worth (DFW) region meets the standard for five of six criteria air pollutants defined by the EPA. The six pollutants are carbon monoxide, lead, nitrogen dioxides, ozone, particulate matter, and sulfur dioxide. The only air pollutant for which DFW do not meet the National Ambient Air Quality Standard is the ozone. In hot summers, combination of nitrogen dioxides and VOCs and concentrations of traffic and industry, Dallas is an ideal incubator for the creation of ground-level ozone.
Under the Clean Air Act, ozone pollution has long been regulated because of its tremendous hazards to the public. Under the Clean Air Act, ozone poses tremendous hazards to the public health and the environment. High ozone levels lead to respiratory distress and disorders; decreased lung function; increases in the emergency room visits and sick days. To address the serious problem of ozone, the Clean Air Act provides a multi-step process for ensuring that all areas of the country achieve acceptable ozone levels. EPA establish nationwide air quality standards for ozone (called National Ambient Air Quality Standards), which are required to be strong enough to protect public health with an adequate margin of safety. The next step, EPA designate areas of the country that meet the standards, and those who do not. The last step, requiring states to submit plans for achieving and maintaining compliance with EPA’s ozone standards — with especially strict requirements for areas that currently do not meet the standards. The U.S. Environmental Protection Agency (EPA) updated its ozone air quality standards in March 2008. The EPA towards the end of 2012 promised the DFW residents for stronger protections against the harmful public health and environmental impacts of ground-level ozone. The agency announced on January 7, 2012 about its determination that Wise County, Texas contributes to high ozone levels in nearby Dallas-Fort Worth. This action required polluters in Wise County to do their fair share to reduce ozone levels in Dallas-Fort Worth. Wise County was included in the DFW ozone designation due in large part to the emissions of nitrogen oxides, and volatile organic compounds from a recent boom in oil and gas production in the area. According to the Technical Support Document (TSD), the final area designations in the Dallas-Fort Worth (DFW) area for the 2008 ozone national ambient air quality standards are based on several factors and indicators. The population density and degree of urbanization were analyzed. TSD stated: EPA evaluated the population and vehicle use characteristics and trends of the area as indicators of the probable location and magnitude of non-point source emissions. These include ozone precursor emissions from on-road and off-road vehicles and engines, consumer products, residential fuel combustion, and consumer services. Areas of dense population or commercial development are an indicator of area source and mobile source NO2 and VOC emissions that may contribute to ozone formation that contributes to nonattainment in the area. Rapid growth in population or vehicle miles traveled (VMT) in a county on the urban perimeter signifies increasing integration with the core urban area and indicates that it may be appropriate to include such perimeter area(s) as part of the nonattainment area.
It is very important to recognize the effect of ozone to a population, especially adults and children who are already had chronic respiratory diseases such as asthma. Exposure may compromise the ability of the body to fight respiratory infections. Bell et al. (2004) a multisite time-series study of 95 large US urban communities throughout a 14-year period found that widespread pollutant such as ozone adversely affects public health.
Area Designations for the 2008 Ozone National Ambient Air … (n.d.). Retrieved from http://www.epa.gov/airquality/ozonepollution/designations/2008standards/documents/R6_DFW_TSD_Final.pdf
Bell, M., McDermott, A., Zeger, S., Samet, J. & Dominici, F. (2004). Ozone and Short-term Mortality in 95 US Urban Communities, 1987-2000. JAMA;292(19):2372-2378. doi:10.1001/jama.292.19.2372.
Dallas Fort-Worth Breathes Easier Following EPA’s Decision … (n.d.). Retrieved from http://blogs.edf.org/energyexchange/2013/01/16/dallas-fort-worth-breathes-easier-following-epas-decision-on-wise-county-ozone-petitions/
Green Dallas…building a greener city! (n.d.). Retrieved from http://www.greendallas.net/air_quality.html
Labilles, U. (2013). Obstacles of Disease Surveillance Interoperability: A Challenge to Public Health. (Unpublished, PUBH-8115-1/HUMN-8115-1-Soc Behave Cultural Fact in Public Health. 2013 Spring Qtr. WK7Disc) Walden University, Minneapolis.
The obstacles that impact interoperability of the disease surveillance systems starts with the issue of balance between the public interest in the collection of information and the privacy rights. In theory, properly utilized, surveillance is a fundamental government activity, indispensable in nature (Gostin & Gostin, 2000). The legal complications brought about by the Fourth Amendment prohibition against unreasonable searches and seizures, triggered the social impetus behind HIPAA and the HHS Report. The Fourth Amendment is a constitutional protection against wrongful enforcement of the law on access to private medical records. These offers insight into the growth and development of non-Fourth Amendment protections for medical records privacy, and examines later actions that appear to restrict or undercut these potential medical record protections. The shared goals of both public health surveillance and the protection of health information privacy will encourage individuals to fully utilize health services and cooperate with health agencies. The key to protecting the well-being of the community is the optimum balance between public health activities and privacy protection. This balance is challenged by the enactment and enforcement of current legislation such as the Health Insurance Portability and Accountability Act’s Privacy (HIPAA). The way public health exception of HIPAA Rule was drafted resulted to confusion and put this balance in jeopardy, as well as recognized reluctance to provide information to state and local public health agencies. Wilson (2009) stated that the exception ambiguously defines the role of public health authorities in maintaining the privacy of personally identifiable health information. Incertitude about privacy can be equipoised by initiatives by state and federal policy makers such as the report “Confidentiality of Individually-Identifiable Health Information” issued by the Department of Health and Human Services (HHS). This report reflected a legitimate interpretation and representation of the best aspects of constitutional and judicial protections of medical records privacy using current innovative technology in health information and communication.
State, local, and tribal public health authorities shares the privacy challenges that are inherent in data sharing. Wilson (2009) stated that, in the process of promulgating the Privacy Rule, HHS recognized the need to inscribe an exception for public health purposes in order to allow authorities at all levels of government to continue to collect, analyze, and use health information that would otherwise be unavailable without prior patient consent. State courts and policy makers have produced some protection for individuals’ medical histories which are characterized more by their diversity and conflicting standards than by the quality of protection. Unfortunately, state laws offer little additional support for medical records protection from law enforcement intrusion, thereby it is paramount for continued collaboration between public health professionals, health leaders and policy makers to focus on needed amendments to protect the interest of both the public, patients and researchers which will then bridge the divide on the interpretation of the law. It is critical to acknowledge that challenge of law- and policy-makers in finding common ground between individual privacy expectations and the communal health authorities’ needs for identifiable health data. The dissemination and use of identifiable health data for public health purposes are typically supported by the public, but it relies on how the government and other entities maintain appropriate privacy and security protections in acquiring the data. It is warranted for the continued improvement on the level of protection afforded to the public and patients by state laws governing medical records privacy. Moral justifications should be considered in establishing firm, consistent set of rules governing law enforcement’s use and exchange of private medical records and data needed in clinical research. The obstacles that forestall data-sharing practices should be assessed and remedied within each jurisdiction. Legal interpretations should be openly discussed to properly develop and implement model policy to strengthen disease surveillance, and increase the efficiency of data-sharing practices between researchers and public health authorities at all levels.
Aarestrup, F. M., Brown, E. W., Detter, C., Gerner-Smidt, P., Gilmour, M. W., Harmsen, D., … & Schlundt, J. (2012). Integrating genome-based informatics to modernize global disease monitoring, information sharing, and response. Emerging infectious diseases, 18(11), e1.
Act, A. (1996). Health insurance portability and accountability act of 1996.Public Law, 104, 191.
Bernstein, A. B., & Sweeney, M. H. (2012). Public health surveillance data: legal, policy, ethical, regulatory, and practical issues. MMWR Surveill Summ, 30-4.
Carroll, L. N., Au, A. P., Detwiler, L. T., Fu, T. C., Painter, I. S., & Abernethy, N. F. (2014). Visualization and analytics tools for infectious disease epidemiology: A systematic review. Journal of biomedical informatics.
Chan, M., Kazatchkine, M., Lob-Levyt, J., Obaid, T., Schweizer, J., Sidibe, M., … & Yamada, T. (2010). Meeting the demand for results and accountability: a call for action on health data from eight global health agencies. PLoS Med, 7(1), e1000223.
Chowdhary, S., & Srivastava, A. (2013). Cloud Computing: A Key to Effective & Efficient Disease Surveillance System. In Int. Conf. on Advances in Signal Processing and Communication. ACEEE (Lucknow).
El Emam, K., Hu, J., Mercer, J., Peyton, L., Kantarcioglu, M., Malin, B., … & Earle, C. (2011). A secure protocol for protecting the identity of providers when disclosing data for disease surveillance. Journal of the American Medical Informatics Association, 18(3), 212-217.
Gostin, L. O., & Gostin, L. O. (2000). Public health law: power, duty, restraint (Vol. 3). Univ of California Press.
Gostin, L. O., Hodge, J. G., & Marks, L. (2002). The Nationalization of Health Information Privacy Protections. Tort & Insurance Law Journal, 1113-1138.
Hodge Jr, J. G., Torrey Kaufman, J. D., & Jaques, C. (2012). Legal Issues Concerning Identifiable Health Data Sharing Between State/Local Public Health Authorities and Tribal Epidemiology Centers in Selected US Jurisdictions.
Kulynych, J., & Korn, D. (2003). The New HIPAA (Health Insurance Portability and Accountability Act of 1996) Medical Privacy Rule Help or Hindrance for Clinical Research? Circulation, 108(8), 912-914.
Labilles, U. (2014). Obstacles of Disease Surveillance Interoperability: A Challenge to Public Health. (Unpublished, PUBH-8270-2. Health Informatics and Surveillance. 2014 Spring Qtr. WK11Disc) Walden University, Minneapolis.
Lenert, L., & Sundwall, D. N. (2012). Public health surveillance and meaningful use regulations: a crisis of opportunity. American journal of public health, 102(3), e1-e7.
Office for Civil Rights, H. H. S. (2002). Standards for privacy of individually identifiable health information. Final rule. Federal Register, 67(157), 53181.
Van Der Goes Jr, P. H. (1999). Opportunity Lost: Why and How to Improve the HHS-Proposed Legislation Governing Law Enforcement Access to Medical Records. University of Pennsylvania law review, 1009-1067.
Wilson, A. (2009). MISSING THE MARK: THE PUBLIC HEALTH EXCEPTION TO THE HIPAA PRIVACY RULE AND ITS IMPACT ON SURVEILLANCE ACTIVITY. HOUS. J. HEALTH L & POL’Y, 131(156), 131.