Eve S Puffer
Biographic Data
| ID | 94483 |
|---|---|
| NAME | Eve S Puffer |
| GIVEN NAMES | Eve S |
| FAMILY NAME | Puffer |
| SIGNATURE | PUFFER E S |
| AFFILIATIONS | Duke University |
| ORCID | 0000-0003-2281-821X |
| VERIFIED | Yes |
| TOTAL WORKS | 44 |
| TOTAL CITATIONS | 39 |
| AUTHOR COUNT | 44 |
| EDITOR COUNT | 0 |
| FIRST PUBLICATION YEAR | 2010 |
| LATEST PUBLICATION YEAR | 2026 |
| H-INDEX | 3 |
‘Sawa Aqwa’ (Stronger Together)
BACKGROUND: There are no evaluated family-based mental health and psychosocial support (MHPSS) interventions for adolescents in Southwest Asia (known as the Middle East), and few whole-family interventions in low- and middle-income countries, despite consistent evidence for the impact of family support on mental health and well-being. This study aims to evaluate the effectiveness of a brief family systemic mental health intervention, deliverable …
I just want to be normal”
Background : Adolescents and young adults with sickle cell disease (SCD) in Kenya experience psychosocial challenges shaped by developmental transitions and social and health system contexts. Limited research has examined differences across adolescence and young adulthood in low-resource settings. Methods : We conducted a qualitative study using focus group discussions and thematic analysis to explore psychosocial experiences across three stages:…
The PREvention Program for Adolescent Relationship and Emotional Development (PREPARED)
The bi-directional link between mental health problems and intimate partner violence (IPV) is well established, yet there is a lack of prevention approaches directly targeting both during adolescence. This study conducted a mixed-methods pilot evaluation of the Prevention Program for Adolescent Relationship and Emotional Development (PREPARED), a weekly, six-session, non-specialist delivered, prevention program to promote mental health and preven…
Parenting on the border
There is currently a lack of evidence-based interventions with a dual focus on improving parenting and caregiver mental health in conflict and humanitarian settings. To address this gap, we co-designed a trauma-informed, edutainment-enhanced intervention to improve both parenting and mental health outcomes among migrant and displaced caregivers on the Thailand-Myanmar border. This paper outlines the study protocol for a pragmatic, community-based…
The Intersection of Mental Health and Intimate Partner Violence Among Adolescents in Kenya
This study examines intersections between adolescent mental health and intimate partner violence (IPV) in rural southwestern Kenya through focus groups with adolescents (9-17) and caregivers of adolescents. Blended community participatory and thematic analysis identified drivers of mental health problems and IPV. Financial pressures and familial conflict influence adolescent well-being. Partner financial expectations perceived or actual unfaithfu…
A comparison of assessment tools for childcare centers in high vs. low resource settings
Studies suggest issues may arise when using childcare setting assessment tools designed for high-resource settings in low-resource settings to assess and improve the quality of care, including placing disproportionate weight on features of the childcare environment that may not be available or culturally appropriate within the low-resource context. This study compares a novel assessment tool developed in and for low-income and low-resource settin…
Correlates of Intimate Partner Violence Victimization and Perpetration in Adolescents and Young Adults in Sub-Saharan Africa
Intimate partner violence (IPV) is a global public health crisis with long-term adverse consequences for both victims and perpetrators. Patterns of violence often begin during adolescence, yet most interventions target adult relationships. A systematic review was conducted to identify correlates of IPV victimization and perpetration among adolescents and young adults in sub-Saharan Africa (SSA). Eligible studies included participants 10 to 24 yea…
Nurturing families
Armed conflict and forced displacement can significantly strain nurturing family environments, which are essential for child well-being. Yet, limited evidence exists on the effectiveness of family-systemic interventions in these contexts. We conducted a two-arm, single-masked, feasibility Randomised Controlled Trial (fRCT) of a whole-family intervention with Syrian, Iraqi and Jordanian families in Jordan. We aimed to determine the feasibility of …
Congregation leader and member discussions in a church-based family strengthening, mental health promotion, and HIV prevention trial
Collaboration with African religious congregations can promote psychosocial well-being with greater accessibility. Effective collaboration requires studying congregations as unique intervention contexts. This study explored how an intervention in western Kenya fit within and altered congregational discussion patterns. We conducted a cluster-randomized trial of a church-based intervention to improve family relationships, mental health and sexual h…
Social Vulnerability, Covid-19, Racial Violence, and Depressive Symptoms
Comparing fears about paediatric HIV disclosure to the lived experiences of parents and guardians
OBJECTIVE: We aimed to: (1) follow parents and guardians through the process of paediatric HIV disclosure to understand how often pre-disclosure worries are realised; and (2) estimate the effects of disclosure on child, caregiver, and family well-being. DESIGN: We conducted a 12-month prospective cohort study in Zimbabwe with 123 primary caregivers of children ages 9 to 15 years who were HIV positive but did not know their serostatus at baseline.…
Adapting a substance use screening and brief intervention for peer-delivery and for youth in Kenya
Background: Substance use is a major problem among youth in sub-Saharan Africa, yet interventions that address this problem are scarce within the region. Screening and brief intervention is a cost-effective, efficacious, and easy to scale public health approach to addressing substance use problems. We conducted a pilot study to evaluate the feasibility of implementing a peer delivered screening and brief intervention program for youth in Kenya. T…
Resettlement, mental health, and coping
Study findings highlight both the resilience of refugee parents and the psychological toll of navigating their families through a new and challenging environment. Policies and programs to provide comprehensive social and economic supports to refugees beyond the first one to two years after arrival are necessary to mitigate the mental health impacts of displacement over time and strengthen individual and family resilience. Such programs should inc…
Feasibility and acceptability of a peer provider delivered substance use screening and brief intervention program for youth in Kenya
Background Youth in sub-Saharan Africa are at high risk of substance use yet lack access to substance use interventions. The goal of this project was to evaluate the feasibility and acceptability of a peer-delivered, single-session substance use screening and brief intervention program for youth in Kenya. Methods This was a convergent parallel mixed methods study utilizing both quantitative and qualitative approaches. Two trained peer providers a…
Early childhood parenting programs and community peacebuilding behaviors
Caregiver preferences for physically harsh discipline of children in rural Uganda
The high prevalence of physically harsh discipline preferences warrant interventions aimed at reframing caregivers' approaches to discipline
A Community-Embedded Implementation Model for Mental-Health Interventions
The mental-health-care treatment gap remains very large in low-resource communities, both within high-income countries and globally in low- and middle-income countries. Existing approaches for disseminating psychological interventions within health systems are not working well enough, and hard-to-reach, high-risk populations are often going unreached. Alternative implementation models are needed to expand access and to address the burden of menta…
Pathways from parent mental health to child outcomes in Liberia
Children in humanitarian settings face complex adversities that impact development. The interplay of caregiver mental health, couples' relationship quality, and parenting practices can both protect against adversity and contribute to it. The purpose of the study was to examine whether caregiver depressive symptoms are associated with increased couples' distress, in turn predicting fewer positive parent-child interactions and then worse child emot…
Bringing Parent–Child Interaction Therapy to South Africa
There is a large assessment and treatment gap in child and adolescent mental health services, prominently so in low- and middle-income countries, where 90% of the world's children live. There is an urgent need to find evidence-based interventions that can be implemented successfully in these low-resource contexts. This pre-pilot study aimed to explore the barriers and facilitators to implementation as well as overall feasibility of Parent-Child I…
Dietary Diversity and Dietary Patterns in School-Aged Children in Western Kenya
Inadequate diet among children has both immediate and long-term negative health impacts, but little is known about dietary diversity and dietary patterns of school-aged children in rural Kenya. We assessed dietary diversity and identified dietary patterns in school-aged children in Western Kenya using a latent class approach. We collected dietary intake using a 24 h dietary recall among students in elementary schools in two rural villages (hereaf…
“When my children see their father is sober, they are happy”
Background: Men's alcohol misuse does not occur in a vacuum but has a cascade of consequences for families and children, with ties to violence, poor parenting, and poor partner and child mental health. Despite the intersection of individual and interpersonal problems associated with men's alcohol use, studies exploring the impact of men's completion of alcohol misuse treatment on family and family member outcomes are scarce. Here we begin to expl…
Flexible protocols and paused audio recorders
Lay-counselors have become a key human resource in the field of global mental health, aiming to address the estimated one-million-person shortage of mental healthcare providers. However, the role of lay-counselors is ambiguous and in tension: their role is quasi-professional, with specific training and skills that set them apart within communities, yet their role is also defined in contrast to professional mental healthcare providers. We explore …
Children’s Beliefs about Pain
Functional abdominal pain (FAP) is one of the most common childhood medical complaints, associated with significant distress and impairment. Little is known about how children understand their pain. Do they attribute it to personal weakness? Do they perceive pain as having global impact, affecting a variety of activities? How do they cope with pain? We explored the pain beliefs of 5- to 9-year-old children with FAP using a novel Teddy Bear Interv…
Is social-ecological risk associated with individual HIV risk beliefs and behaviours
The places where adolescents live, learn, and play are thought to influence behaviours and health, but we have limited tools for measuring environmental risk on a hyperlocal (e.g. neighbourhood) level. Working with 218 adolescents and their parents/guardians in rural western Kenya, we combined participatory mapping activities with satellite imagery to identify adolescent activity spaces and create a novel measure of social-ecological risks. We th…
Building community-based helping practices by training peer-father counselors
Drivers of Intimate Partner Violence Against Women in Three Refugee Camps
This qualitative study examined the "drivers" of intimate partner violence (IPV) against women in displacement to identify protective factors and patterns of risk. Qualitative data were collected in three refugee camps in South Sudan, Kenya, and Iraq ( N = 284). Findings revealed interrelated factors that triggered and perpetuated IPV: gendered social norms and roles, destabilization of gender norms and roles, men's substance use, women's separat…
Women's perceptions of effects of war on intimate partner violence and gender roles in two post-conflict West African Countries
The aim of this paper is to explore women's perceptions of the causes of intimate partner violence (IPV) in West Africa, and the ways in which they understand these causes to interact with the experiences of war.The study was conducted in two locations in Sierra Leone and two in Liberia, using focus group discussions (N groups =14) and individual interviews (N = 20).Women perceive the causes of IPV to be linked with other difficulties faced by wo…
The Protective Role of Religious Coping in Adolescents’ Responses to Poverty and Sexual Decision‐Making in Rural Kenya
In this study, we explored how adolescents in rural Kenya apply religious coping in sexual decision-making in the context of high rates of poverty and Human Immunodeficiency Virus (HIV). Semi-structured interviews were conducted with 34 adolescents. One-third (13) reported religious coping related to economic stress, HIV, or sexual decision-making; the majority (29) reported religious coping with these or other stressors. Adolescents reported pra…
Caregiver preferences for physically harsh discipline of children in rural Uganda
The high prevalence of physically harsh discipline preferences warrant interventions aimed at reframing caregivers' approaches to discipline
Mapping Complex Systems
Armed conflict and forced migration are associated with an increase in intimate partner violence (IPV) against women. Yet as risks of IPV intensify, familiar options for seeking help dissipate as families and communities disperse and seek refuge in a foreign country. The reconfiguration of family and community systems, coupled with the presence of local and international humanitarian actors, introduces significant changes to IPV response pathways…
Suicide clusters among young Kenyan men
Suicide is a leading cause of global mortality. Suicide clusters have recently been identified among peer networks in high-income countries. This study investigates dynamics of suicide clustering within social networks of young Kenya men ( n = 532; 18-34 years). We found a strong, statistically significant association between reported number of friends who previously attempted suicide and present suicide ideation (odds ratio = 1.9; 95% confidence…
A Qualitative Study of Mechanisms Underlying Effects of a Parenting Intervention in Rural Liberia
Developing a Family-Based Hiv Prevention Intervention in Rural Kenya
Community-Based Participatory research (CBPR) introduces new ethical challenges for HIV prevention studies in low-resource international settings. We describe a CBPR study in rural Kenya to develop and pilot a family-based HIV prevention and mental health promotion intervention. Academic partners (APs) worked with a community advisory committee (CAC) during formative research, intervention development, and a pilot trial. Ethical challenges emerge…
Individual- and Family-Level Psychosocial Correlates of HIV Risk Behavior Among Youth in Rural Kenya
Explaining rural/non-rural disparities in physical health-related quality of life
The Protective Role of Religious Coping in Adolescents’ Responses to Poverty and Sexual Decision‐Making in Rural Kenya
In this study, we explored how adolescents in rural Kenya apply religious coping in sexual decision-making in the context of high rates of poverty and Human Immunodeficiency Virus (HIV). Semi-structured interviews were conducted with 34 adolescents. One-third (13) reported religious coping related to economic stress, HIV, or sexual decision-making; the majority (29) reported religious coping with these or other stressors. Adolescents reported pra…
Changes in Religious Coping and Relapse to Drug Use Among Opioid-Dependent Patients Following Inpatient Detoxification
The nature and impact of chronic stressors on refugee children in Ban Mai Nai Soi camp, Thailand
Refugee camps are replete with risk factors for mental health problems among children, including poverty, disruption of family structure, family violence and food insecurity. This study, focused on refugee children from Burma, in Ban Mai Nai Soi camp in Thailand, sought to identify the particular risks children are exposed to in this context, and the impacts on their mental health and psychosocial well-being. This study employed two qualitative m…
Developing a Family-Based Hiv Prevention Intervention in Rural Kenya
Community-Based Participatory research (CBPR) introduces new ethical challenges for HIV prevention studies in low-resource international settings. We describe a CBPR study in rural Kenya to develop and pilot a family-based HIV prevention and mental health promotion intervention. Academic partners (APs) worked with a community advisory committee (CAC) during formative research, intervention development, and a pilot trial. Ethical challenges emerge…
Women's perceptions of effects of war on intimate partner violence and gender roles in two post-conflict West African Countries
The aim of this paper is to explore women's perceptions of the causes of intimate partner violence (IPV) in West Africa, and the ways in which they understand these causes to interact with the experiences of war.The study was conducted in two locations in Sierra Leone and two in Liberia, using focus group discussions (N groups =14) and individual interviews (N = 20).Women perceive the causes of IPV to be linked with other difficulties faced by wo…
Parents make the difference
PMD is a promising approach for preventing child abuse and promoting positive parent-child relationships in low-resource settings
I don’t need an eye for an eye’
This paper explores the possibilities for agency in intimate partner violence (IPV) situations from the perspective of women in Sierra Leone and Liberia using focus group discussions (N groups = 14, N participants = 110) and individual interviews (N = 20). Findings identify multiple interrelated factors influencing the decision-making of women experiencing IPV. At the individual level, emotional factors and women's knowledge of their rights and o…
Participatory mapping in low-resource settings
Understanding the link between health and place can strengthen the design of health interventions, particularly in the context of HIV prevention. Individuals who might one day participate in such interventions - including youth - may further improve the design if engaged in a meaningful way in the formative research process. Increasingly, participatory mapping methods are being used to achieve both aims. We describe the development of three innov…
Association between somatic growth trajectory and cognitive functioning in young children with sickle cell disease
Children with sickle cell disease are at risk of cognitive deficits and somatic growth delays beginning in early childhood. We examined growth velocity from age 2 years (height and body mass index progression over time) and cognitive functioning in 46 children with sickle cell disease 4 to 8 years of age. Height-for-age velocity was not associated with cognitive outcomes. Higher body mass index velocity was associated with higher scores on global…
Drivers of Intimate Partner Violence Against Women in Three Refugee Camps
This qualitative study examined the "drivers" of intimate partner violence (IPV) against women in displacement to identify protective factors and patterns of risk. Qualitative data were collected in three refugee camps in South Sudan, Kenya, and Iraq ( N = 284). Findings revealed interrelated factors that triggered and perpetuated IPV: gendered social norms and roles, destabilization of gender norms and roles, men's substance use, women's separat…
A Qualitative Study of Mechanisms Underlying Effects of a Parenting Intervention in Rural Liberia
An evaluation of a common elements treatment approach for youth in Somali refugee camps
This project is the first to examine a common elements approach (CETA: defined as flexible delivery of elements, order, and dosing) with children and caregivers in a low-resource setting with delivery by lay providers. CETA-Youth may offer an effective treatment that is easier to implement and scale-up versus multiple focal interventions. A fullscale randomized clinical trial is warranted
The impact of the 2014 Ebola virus disease outbreak in Liberia on parent preferences for harsh discipline practices
Results support the need for family-based interventions, including strategies to help parents learn alternatives to harsh punishment
Caregiver self-efficacy to talk about sex predicts conversations about HIV transmission risk with perinatally infected young people in Zimbabwe
Given advances in care and treatment for HIV, perinatally infected young people are surviving into adolescence. These young people are making decisions about engaging in sexual relationships and it is critical to ensure they have the information they need to engage responsibly in sexual activity, particularly in an era where adherence to treatment could make their virus undetectable. The main objective of this analysis was to examine whether an H…
Problematic alcohol use among fathers in Kenya
Suicide clusters among young Kenyan men
Suicide is a leading cause of global mortality. Suicide clusters have recently been identified among peer networks in high-income countries. This study investigates dynamics of suicide clustering within social networks of young Kenya men ( n = 532; 18-34 years). We found a strong, statistically significant association between reported number of friends who previously attempted suicide and present suicide ideation (odds ratio = 1.9; 95% confidence…
“When my children see their father is sober, they are happy”
Background: Men's alcohol misuse does not occur in a vacuum but has a cascade of consequences for families and children, with ties to violence, poor parenting, and poor partner and child mental health. Despite the intersection of individual and interpersonal problems associated with men's alcohol use, studies exploring the impact of men's completion of alcohol misuse treatment on family and family member outcomes are scarce. Here we begin to expl…
Flexible protocols and paused audio recorders
Lay-counselors have become a key human resource in the field of global mental health, aiming to address the estimated one-million-person shortage of mental healthcare providers. However, the role of lay-counselors is ambiguous and in tension: their role is quasi-professional, with specific training and skills that set them apart within communities, yet their role is also defined in contrast to professional mental healthcare providers. We explore …
Children’s Beliefs about Pain
Functional abdominal pain (FAP) is one of the most common childhood medical complaints, associated with significant distress and impairment. Little is known about how children understand their pain. Do they attribute it to personal weakness? Do they perceive pain as having global impact, affecting a variety of activities? How do they cope with pain? We explored the pain beliefs of 5- to 9-year-old children with FAP using a novel Teddy Bear Interv…
Is social-ecological risk associated with individual HIV risk beliefs and behaviours
The places where adolescents live, learn, and play are thought to influence behaviours and health, but we have limited tools for measuring environmental risk on a hyperlocal (e.g. neighbourhood) level. Working with 218 adolescents and their parents/guardians in rural western Kenya, we combined participatory mapping activities with satellite imagery to identify adolescent activity spaces and create a novel measure of social-ecological risks. We th…
Building community-based helping practices by training peer-father counselors
Mapping Complex Systems
Armed conflict and forced migration are associated with an increase in intimate partner violence (IPV) against women. Yet as risks of IPV intensify, familiar options for seeking help dissipate as families and communities disperse and seek refuge in a foreign country. The reconfiguration of family and community systems, coupled with the presence of local and international humanitarian actors, introduces significant changes to IPV response pathways…
A Community-Embedded Implementation Model for Mental-Health Interventions
The mental-health-care treatment gap remains very large in low-resource communities, both within high-income countries and globally in low- and middle-income countries. Existing approaches for disseminating psychological interventions within health systems are not working well enough, and hard-to-reach, high-risk populations are often going unreached. Alternative implementation models are needed to expand access and to address the burden of menta…
Medicine (34 works) · Psychology (31 works) · Psychiatry (22 works) · Psychological intervention (18 works) · Clinical Psychology (14 works) · Political science (14 works) · Environmental health (13 works) · Mental health (13 works) · Adolescent Sexual and Reproductive Health (12 works) · Clinical Psychology (12 works)