Throughout the developing world, girls face hardships surrounding menstruation, often resulting in poor emotional wellbeing and missing school. Providing ways to keep girls in school will increase their educational and earning potentials, which will ultimately trickle down to improving the economic standing of nations in the next generation. Informed by the Transactional Model of Stress and Coping, this work evaluates the roles that cultural and school environments play in appraisals of menstruation as a major life stressor for adolescent females and the impacts of emotional stress on missing school. Using primary survey data from schools in Nepal, robust results are found to support the theoretical framework based on conditional mixed-process (CMP) estimation with fixed effects, utilizing multiple index building techniques. Strong cultural norms during menstruation appear to increase the probability of girls self-reporting emotional stress, while the presence of hygiene supporting infrastructure at schools reduces this outcome. Furthermore, there is strong support for the finding that the presence of emotional stress during menstruation increases the likelihood of not only missing school but also for an extended period of time. Our findings motivate increasing government policies to provide stronger hygiene infrastructure in schools to improve successful coping skills and attendance rates.

Adolescents are slowly being recognized as a generation, worldwide, that may require different policy approaches to improve staggering statistics on their failing well-being, including mental health. By providing the support to allow the next generation to achieve better mental health outcomes, they are going to be more economically successful and the future economic growth of nations can be better assured. Adoption of mobile-based health interventions (e.g., mHealth) has garnered a lot of attention toward this end. While mHealth interventions are growing in popularity, many researchers/policy-makers appear to have neglected assessing potential (indirect) costs/negative consequences from their use. Evidence from the developed world shows strong associations between extensive cell phone use and negative mental health outcomes, but similar research is minimal in developing world contexts. Additionally, the bulk of work on the outcomes of mobile phone use is studied using a unidirectional approach with blinders to front-end motivations. Using primary data from a large-scale, school-based survey of older adolescents in southwestern Nepal (N= 539), this work investigates such a tension between mobile/smartphone usage as a true mobile health (mHealth) opportunity in Nepal or as a potential problem, introducing additional deleterious well-being effects from over-use. Founded in Basic Psychological Needs Theory (BPNT), robust results of analyses using full structural modeling approaches (and traditional regression-based sensitivity analyses) indicate support for the BPNT framework in explaining statistically significant positive associations between bullying and anxiety, as well as, negative associations between bullying and grit, including evidence to support the mediating role of problematic mobile phone use in these relationships. More than 56% of the sample showed indicators of mild to moderate anxiety and over 10% claim experiences of bullying, coupled with over 75% of the sample scoring above the midline of a problematic mobile phone use scale, all of which motivates the relevance of our findings. Potential policy implications of these findings, and mention of other intriguing avenues for future work are further discussed.

Background To combat the lack of proper facilities and menstrual health knowledge in developing countries, many WASH (Water, Hygiene, and Sanitation) initiatives are including menstrual hygiene management (MHM) components. However, evidence shows that prior efforts have not been ultimately successful in inducing relevant behavior changes, due in part to cultural constraints and unidimensional interventions. As such, MHM research may need to include consideration of new theories/approaches. Evidence is growing of the role that physical presence/proximity and ability to touch objects has on incentives for consumers to purchase goods, captured through willingness to pay (WTP) figures. Such findings can be partially explained by Pavlovian processes. Objective This study sought to provide field-work validation of such findings of the role of Pavlovian processes and endowment effect on WTP figures for a female hygiene kit, reflecting motivation to adopt better hygiene behaviors. Methods This study used primary survey data collected from females in two upper-level schools in southwestern Nepal (n = 169). When presented in conjunction with a hygiene education session, one group of females was allowed physical interaction with a female hygiene kit, while another was not, before being surveyed on their WTP for the kit. Both non-parametric and parametric statistical analyses were performed to assess the impact of this ability to touch the kits on WTP figures. Results Results show a statistically significant difference between the WTP figures of those females allowed interaction with the kits prior to being surveyed and those who did not. This confirms the positive impact of physical presence/touch on motivations to use/acquire hygiene-related tools. Conclusions Such findings reveal how, through application of the theory of Pavlovian processes, future (menstrual) health education efforts could harness the human instinct to consume, remember, and use those objects presented in physical form, and include personal contact and demonstrations of better health practices in future MHM and WASH education initiatives. Such an approach may allow protocols and interventions to have more success, and dissemination of healthier behaviors and knowledge to be more prominent.