title: Civic engagement among orphans and non-orphans in five low- and middle-income countries.
abstract: Communities and nations seeking to foster social responsibility in their youth are interested in understanding factors that predict and promote youth involvement in public activities. Orphans and separated children (OSC) are a vulnerable population whose numbers are increasing, particularly in resource-poor settings. Understanding whether and how OSC are engaged in civic activities is important for community and world leaders who need to provide care for OSC and ensure their involvement in sustainable development.
  
  
  
  The Positive Outcomes for Orphans study (POFO) is a multi-country, longitudinal cohort study of OSC randomly sampled from institution-based care and from family-based care, and of non-OSC sampled from the same study regions. Participants represent six sites in five low-and middle-income countries. We examined civic engagement activities and government trust among subjects > =16 years old at 90-month follow-up (approximately 7.5 years after baseline). We calculated prevalences and estimated the association between key demographic variables and prevalence of regular volunteer work using multivariable Poisson regression, with sampling weights to accounting for the complex sampling design.
  
  
  
  Among the 1,281 POFO participants > =16 who were assessed at 90-month follow-up, 45 % participated in regular community service or volunteer work; two-thirds of those volunteers did so on a strictly voluntary basis. While government trust was fairly high, at approximately 70 % for each level of government, participation in voting was only 15 % among those who were > =18 years old. We did not observe significant associations between demographic characteristics and regular volunteer work, with the exception of large variation by study site.
  
  
  
  As the world's leaders grapple with the many competing demands of global health, economic security, and governmental stability, the participation of today's youth in community and governance is essential for sustainability. This study provides a first step in understanding the degree to which OSC from different care settings across multiple low- and middle-income countries are engaged in their communities.
authors.affiliation: Department of Epidemiology, Gillings School of Global Public Health, CB #7435, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599-7435, USA. clgray@email.unc.edu.
authors.forename: Christine L
authors.initials: CL
authors.lastname: Gray
authors.affiliation: Department of Epidemiology, Gillings School of Global Public Health, CB #7435, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599-7435, USA.|Center for Health Policy, Duke Global Health Institute, Box 90519, Duke University, Durham, NC, 27708, USA.
authors.forename: Brian W
authors.initials: BW
authors.lastname: Pence
authors.affiliation: Department of Epidemiology, Gillings School of Global Public Health, CB #7435, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599-7435, USA.|Center for Health Policy, Duke Global Health Institute, Box 90519, Duke University, Durham, NC, 27708, USA.|School of Community Health, College of Urban and Public Affairs, Portland State University, PO Box 751, Portland, OR, 97207, USA.
authors.forename: Lynne C
authors.initials: LC
authors.lastname: Messer
authors.affiliation: Center for Health Policy, Duke Global Health Institute, Box 90519, Duke University, Durham, NC, 27708, USA.
authors.forename: Jan
authors.initials: J
authors.lastname: Ostermann
authors.affiliation: Center for Health Policy, Duke Global Health Institute, Box 90519, Duke University, Durham, NC, 27708, USA.
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Whetten
authors.affiliation: Center for Health Policy, Duke Global Health Institute, Box 90519, Duke University, Durham, NC, 27708, USA.|Department of Medicine, DUMC #3152, Division of Infectious Diseases and International Health, Duke University, Durham, NC, 27710, USA.
authors.forename: Nathan M
authors.initials: NM
authors.lastname: Thielman
authors.affiliation: Center for Health Policy, Duke Global Health Institute, Box 90519, Duke University, Durham, NC, 27708, USA.|Center for Child and Family Health, Duke University, 411 West Chapel Hill Street, Suite 908, Durham, NC, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: O'Donnell
authors.affiliation: Center for Health Policy, Duke Global Health Institute, Box 90519, Duke University, Durham, NC, 27708, USA.|Terry Sanford Institute of Public Policy, Box 90239, Duke University, Box 90239, Durham, NC, 27708-0239, USA.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Whetten
mesh_terms: D000293:Adolescent; D054540:Child, Orphaned / Q000193:education / Q000523:psychology* / Q000706:statistics & numerical data; D003906:Developing Countries; D005260:Female; D006801:Humans; D008297:Male; D015995:Prevalence; D012941:Social Responsibility; D014838:Volunteers / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Civic engagement; Low- and middle-income countries; Orphans; Volunteer; Vote